Rates Effective as of: 1/1/2023,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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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," $2,600.00 ", See APR-DRG Rate ," $2,472.00 ", See MS-DRG Rate ," $1,716.00 "," $1,705.08 ", 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 "," $1,705.08 "," $3,664.00 "," $1,820.00 "
,4501010001,Hospital Chargemaster,W2 MedSurg Private,Inpatient,Per Diem,111," $1,535.00 ", See APR-DRG Rate ," $2,472.00 ", See MS-DRG Rate ," $1,013.10 "," $1,006.65 ", 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 "," $1,006.65 "," $3,664.00 "," $1,074.50 "
,4501410001,Hospital Chargemaster,W1 MedSurg Private,Inpatient,Per Diem,111," $1,535.00 ", See APR-DRG Rate ," $2,472.00 ", See MS-DRG Rate ," $1,013.10 "," $1,006.65 ", 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 "," $1,006.65 "," $3,664.00 "," $1,074.50 "
,4550010003,Hospital Chargemaster,Obstetrics Private,Inpatient,Per Diem,112," $1,535.00 ", See APR-DRG Rate ," $2,472.00 ", See MS-DRG Rate ," $1,013.10 "," $1,006.65 ", 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 "," $1,006.65 "," $7,093.00 "," $1,074.50 "
,4501010002,Hospital Chargemaster,PEDI MedSurg Private,Inpatient,Per Diem,113," $1,535.00 ", See APR-DRG Rate ," $2,472.00 ", See MS-DRG Rate ," $1,013.10 "," $1,006.65 ", 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 "," $1,006.65 "," $7,093.00 "," $1,074.50 "
,4501010003,Hospital Chargemaster,W2 MedSurg Semi Private,Inpatient,Per Diem,121," $1,535.00 ", See APR-DRG Rate ," $2,472.00 ", See MS-DRG Rate ," $1,013.10 "," $1,006.65 ", 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 "," $1,006.65 "," $3,664.00 "," $1,074.50 "
,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," $1,535.00 ", See APR-DRG Rate ," $2,472.00 ", See MS-DRG Rate ," $1,013.10 "," $1,006.65 ", 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 "," $1,006.65 "," $3,664.00 "," $1,074.50 "
,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
,4550010004,Hospital Chargemaster,Obstetrics Semi Private,Inpatient,Per Diem,122," $1,200.00 ", See APR-DRG Rate ," $2,472.00 ", See MS-DRG Rate , $792.00 , $786.96 , 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 ", $786.96 ," $7,514.75 ", $840.00
,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," $1,535.00 ", See APR-DRG Rate ," $2,472.00 ", See MS-DRG Rate ," $1,013.10 "," $1,006.65 ", 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 "," $1,006.65 "," $3,664.00 "," $1,074.50 "
,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
,4530010001,Hospital Chargemaster,Semi Private - PSYCH,Inpatient,Per Diem,124," $1,535.00 ", See APR-DRG Rate ," $1,236.00 ", See MS-DRG Rate ," $1,013.10 "," $1,006.65 ", 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 "," $1,006.65 "," $3,664.00 "," $1,074.50 "
,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," $1,200.00 ", See APR-DRG Rate ," $1,236.00 ", See MS-DRG Rate , $792.00 , $786.96 , 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 ," $2,705.70 "," $2,705.70 "," $2,705.70 "," $2,705.70 ", See MS-DRG Rates ," $2,554.29 "," $3,664.00 ", $786.96 ," $3,664.00 ", $840.00
,4534010002,Hospital Chargemaster,GPU Semi Private SNF S9485,Inpatient,Per Diem,124," $1,200.00 ", See APR-DRG Rate ," $1,236.00 ", See MS-DRG Rate , $792.00 , $786.96 , 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 ," $2,705.70 "," $2,705.70 "," $2,705.70 "," $2,705.70 ", See MS-DRG Rates ," $2,554.29 "," $3,664.00 ", $786.96 ," $3,664.00 ", $840.00
,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," $1,535.00 ", See APR-DRG Rate ," $2,472.00 ", See MS-DRG Rate ," $1,013.10 "," $1,006.65 ", 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 "," $1,006.65 "," $3,664.00 "," $1,074.50 "
,4540010002,Hospital Chargemaster,Semi Private - ICU,Inpatient,Per Diem,129," $1,535.00 ", See APR-DRG Rate ," $2,472.00 ", See MS-DRG Rate ," $1,013.10 "," $1,006.65 ", 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 "," $1,006.65 "," $3,664.00 "," $1,074.50 "
,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
,4553110001,Hospital Chargemaster,Semi Private - NUR,Inpatient,Per Diem,171, $900.00 , See APR-DRG Rate ," $2,090.90 ", 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 , $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 ", $590.22 ," $3,664.00 ", $630.00
,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," $1,535.00 ", See APR-DRG Rate ," $3,117.81 ", See MS-DRG Rate ," $1,013.10 "," $1,006.65 ", 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 "," $1,006.65 "," $4,793.00 "," $1,074.50 "
,4501410004,Hospital Chargemaster,W1 Telemetry Semi Private,Inpatient,Per Diem,214," $1,535.00 ", See APR-DRG Rate ," $3,117.81 ", See MS-DRG Rate ," $1,013.10 "," $1,006.65 ", 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 "," $1,006.65 "," $4,793.00 "," $1,074.50 "
,4540010006,Hospital Chargemaster,Telemetry - ICU,Inpatient,Per Diem,214," $1,535.00 ", See APR-DRG Rate ," $3,117.81 ", See MS-DRG Rate ," $1,013.10 "," $1,006.65 ", 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 "," $1,006.65 "," $4,793.00 "," $1,074.50 "
,5710010001,Hospital Chargemaster,0.9 % Sod Chl 1000 mL IV Sol,Outpatient,Outpatient Default Percent / Case Rate,250, $21.35 , $11.74 , $17.08 , See APC Packaged Rates , $14.95 , $8.33 , $20.60 , $20.69 , $11.00 , See APC Packaged Rates , See APC Packaged Rates , $14.33 , $14.33 , See APC Packaged Rates , See APC Packaged Rates , $19.86 , $19.86 , $19.86 , $19.86 , See APC Packaged Rates , $7.47 , $12.81 , $7.47 , $20.69 , $14.95
,5710010002,Hospital Chargemaster,0.9 % Sod Chl 100 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
,5710010003,Hospital Chargemaster,0.9 % Sod Chl 150 mL IV Sol,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
,5710010004,Hospital Chargemaster,0.9 % Sod Chl 250 mL IV Sol,Outpatient,Outpatient Default Percent / Case Rate,250, $6.32 , $3.48 , $5.06 , See APC Packaged Rates , $4.42 , $2.46 , $6.10 , $6.12 , $3.25 , See APC Packaged Rates , See APC Packaged Rates , $4.24 , $4.24 , See APC Packaged Rates , See APC Packaged Rates , $5.88 , $5.88 , $5.88 , $5.88 , See APC Packaged Rates , $2.21 , $3.79 , $2.21 , $6.12 , $4.42
,5710010005,Hospital Chargemaster,0.9 % Sod Chl 250 mL IV Sol,Outpatient,Outpatient Default Percent / Case Rate,250, $13.33 , $7.33 , $10.66 , See APC Packaged Rates , $9.33 , $5.20 , $12.86 , $12.92 , $6.87 , See APC Packaged Rates , See APC Packaged Rates , $8.94 , $8.94 , See APC Packaged Rates , See APC Packaged Rates , $12.40 , $12.40 , $12.40 , $12.40 , See APC Packaged Rates , $4.67 , $8.00 , $4.67 , $12.92 , $9.33
,5710010006,Hospital Chargemaster,0.9 % Sod Chl 500 mL IV Sol,Outpatient,Outpatient Default Percent / Case Rate,250, $11.70 , $6.44 , $9.36 , See APC Packaged Rates , $8.19 , $4.56 , $11.29 , $11.34 , $6.03 , See APC Packaged Rates , See APC Packaged Rates , $7.85 , $7.85 , See APC Packaged Rates , See APC Packaged Rates , $10.88 , $10.88 , $10.88 , $10.88 , See APC Packaged Rates , $4.10 , $7.02 , $4.10 , $11.34 , $8.19
,5710010007,Hospital Chargemaster,0.9 % Sod Chl 500 mL IV Sol,Outpatient,Outpatient Default Percent / Case Rate,250, $10.70 , $5.89 , $8.56 , See APC Packaged Rates , $7.49 , $4.17 , $10.32 , $10.37 , $5.51 , See APC Packaged Rates , See APC Packaged Rates , $7.18 , $7.18 , See APC Packaged Rates , See APC Packaged Rates , $9.95 , $9.95 , $9.95 , $9.95 , See APC Packaged Rates , $3.75 , $6.42 , $3.75 , $10.37 , $7.49
,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, $6.92 , $3.81 , $5.54 , See APC Packaged Rates , $4.84 , $2.70 , $6.68 , $6.71 , $3.56 , See APC Packaged Rates , See APC Packaged Rates , $4.64 , $4.64 , See APC Packaged Rates , See APC Packaged Rates , $6.44 , $6.44 , $6.44 , $6.44 , See APC Packaged Rates , $2.42 , $4.15 , $2.42 , $6.71 , $4.84
,5710010011,Hospital Chargemaster,0.9 % Sod Chl 250 mL IV Pggybk,Outpatient,Outpatient Default Percent / Case Rate,250, $9.34 , $5.14 , $7.47 , See APC Packaged Rates , $6.54 , $3.64 , $9.01 , $9.05 , $4.81 , See APC Packaged Rates , See APC Packaged Rates , $6.27 , $6.27 , See APC Packaged Rates , See APC Packaged Rates , $8.69 , $8.69 , $8.69 , $8.69 , See APC Packaged Rates , $3.27 , $5.60 , $3.27 , $9.05 , $6.54
,5710010014,Hospital Chargemaster,0.9 % Sod Chl 10 mL Syringe,Outpatient,Outpatient Default Percent / Case Rate,250, $1.57 , $0.86 , $1.26 , See APC Packaged Rates , $1.10 , $0.61 , $1.51 , $1.52 , $0.81 , See APC Packaged Rates , See APC Packaged Rates , $1.05 , $1.05 , See APC Packaged Rates , See APC Packaged Rates , $1.46 , $1.46 , $1.46 , $1.46 , See APC Packaged Rates , $0.55 , $0.94 , $0.55 , $1.52 , $1.10
,5710010015,Hospital Chargemaster,0.9 % Sod Chl 10 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $2.34 , $1.29 , $1.87 , See APC Packaged Rates , $1.64 , $0.91 , $2.26 , $2.27 , $1.21 , See APC Packaged Rates , See APC Packaged Rates , $1.57 , $1.57 , See APC Packaged Rates , See APC Packaged Rates , $2.18 , $2.18 , $2.18 , $2.18 , See APC Packaged Rates , $0.82 , $1.40 , $0.82 , $2.27 , $1.64
,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, $92.00 , $50.60 , $73.60 , See APC Packaged Rates , $64.40 , $35.88 , $88.77 , $89.16 , $47.38 , See APC Packaged Rates , See APC Packaged Rates , $61.73 , $61.73 , See APC Packaged Rates , See APC Packaged Rates , $85.56 , $85.56 , $85.56 , $85.56 , See APC Packaged Rates , $32.20 , $55.20 , $32.20 , $89.16 , $64.40
,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, $5.42 , $2.98 , $4.34 , See APC Packaged Rates , $3.79 , $2.11 , $5.23 , $5.25 , $2.79 , See APC Packaged Rates , See APC Packaged Rates , $3.64 , $3.64 , See APC Packaged Rates , See APC Packaged Rates , $5.04 , $5.04 , $5.04 , $5.04 , See APC Packaged Rates , $1.90 , $3.25 , $1.90 , $5.25 , $3.79
,5710010323,Hospital Chargemaster,Bupivacaine 0.5 % 50 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $13.05 , $7.18 , $10.44 , See APC Packaged Rates , $9.14 , $5.09 , $12.59 , $12.65 , $6.72 , See APC Packaged Rates , See APC Packaged Rates , $8.76 , $8.76 , See APC Packaged Rates , See APC Packaged Rates , $12.14 , $12.14 , $12.14 , $12.14 , See APC Packaged Rates , $4.57 , $7.83 , $4.57 , $12.65 , $9.14
,5710010325,Hospital Chargemaster,BupivPF 0.25 % w/Epine 50mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $37.59 , $20.67 , $30.07 , See APC Packaged Rates , $26.31 , $14.66 , $36.27 , $36.43 , $19.36 , See APC Packaged Rates , See APC Packaged Rates , $25.22 , $25.22 , See APC Packaged Rates , See APC Packaged Rates , $34.96 , $34.96 , $34.96 , $34.96 , See APC Packaged Rates , $13.16 , $22.55 , $13.16 , $36.43 , $26.31
,5710010328,Hospital Chargemaster,BupivPF 0.25 % w/Epine 10mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $14.82 , $8.15 , $11.86 , See APC Packaged Rates , $10.37 , $5.78 , $14.30 , $14.36 , $7.63 , See APC Packaged Rates , See APC Packaged Rates , $9.94 , $9.94 , See APC Packaged Rates , See APC Packaged Rates , $13.78 , $13.78 , $13.78 , $13.78 , See APC Packaged Rates , $5.19 , $8.89 , $5.19 , $14.36 , $10.37
,5710010330,Hospital Chargemaster,BupivPF 0.25 % w/Epine 30mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $8.02 , $4.41 , $6.42 , See APC Packaged Rates , $5.61 , $3.13 , $7.74 , $7.77 , $4.13 , See APC Packaged Rates , See APC Packaged Rates , $5.38 , $5.38 , See APC Packaged Rates , See APC Packaged Rates , $7.46 , $7.46 , $7.46 , $7.46 , See APC Packaged Rates , $2.81 , $4.81 , $2.81 , $7.77 , $5.61
,5710010331,Hospital Chargemaster,BupivPF 0.5 % w/Epine 10 mL Vl,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
,5710010332,Hospital Chargemaster,BupivPF 0.5 % w/Epine 30 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $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
,5710010334,Hospital Chargemaster,Bupivacaine MPF 0.25 % 10mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $14.54 , $8.00 , $11.63 , See APC Packaged Rates , $10.18 , $5.67 , $14.03 , $14.09 , $7.49 , See APC Packaged Rates , See APC Packaged Rates , $9.76 , $9.76 , See APC Packaged Rates , See APC Packaged Rates , $13.52 , $13.52 , $13.52 , $13.52 , See APC Packaged Rates , $5.09 , $8.72 , $5.09 , $14.09 , $10.18
,5710010335,Hospital Chargemaster,Bupivacaine MPF 0.25 % 30mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $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
,5710010336,Hospital Chargemaster,Bupivacaine MPF 0.5 % 10 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $11.65 , $6.41 , $9.32 , See APC Packaged Rates , $8.16 , $4.54 , $11.24 , $11.29 , $6.00 , See APC Packaged Rates , See APC Packaged Rates , $7.82 , $7.82 , See APC Packaged Rates , See APC Packaged Rates , $10.83 , $10.83 , $10.83 , $10.83 , See APC Packaged Rates , $4.08 , $6.99 , $4.08 , $11.29 , $8.16
,5710010337,Hospital Chargemaster,Bupivacaine MPF 0.5 % 30 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $4.67 , $2.57 , $3.74 , See APC Packaged Rates , $3.27 , $1.82 , $4.51 , $4.53 , $2.41 , See APC Packaged Rates , See APC Packaged Rates , $3.13 , $3.13 , See APC Packaged Rates , See APC Packaged Rates , $4.34 , $4.34 , $4.34 , $4.34 , See APC Packaged Rates , $1.63 , $2.80 , $1.63 , $4.53 , $3.27
,5710010382,Hospital Chargemaster,Calcium Chl 1 gm/10mL Syr,Outpatient,Outpatient Default Percent / Case Rate,250, $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
,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, $40.32 , $22.18 , $32.26 , See APC Packaged Rates , $28.22 , $15.72 , $38.90 , $39.07 , $20.77 , See APC Packaged Rates , See APC Packaged Rates , $27.05 , $27.05 , See APC Packaged Rates , See APC Packaged Rates , $37.50 , $37.50 , $37.50 , $37.50 , See APC Packaged Rates , $14.11 , $24.19 , $14.11 , $39.07 , $28.22
,5710010550,Hospital Chargemaster,Clindamycin 600 mg/4 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $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
,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, $37.84 , $20.81 , $30.27 , See APC Packaged Rates , $26.49 , $14.76 , $36.51 , $36.67 , $19.49 , See APC Packaged Rates , See APC Packaged Rates , $25.39 , $25.39 , See APC Packaged Rates , See APC Packaged Rates , $35.19 , $35.19 , $35.19 , $35.19 , See APC Packaged Rates , $13.24 , $22.70 , $13.24 , $36.67 , $26.49
,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, $17.82 , $9.80 , $14.26 , See APC Packaged Rates , $12.47 , $6.95 , $17.19 , $17.27 , $9.18 , See APC Packaged Rates , See APC Packaged Rates , $11.96 , $11.96 , See APC Packaged Rates , See APC Packaged Rates , $16.57 , $16.57 , $16.57 , $16.57 , See APC Packaged Rates , $6.24 , $10.69 , $6.24 , $17.27 , $12.47
,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, $215.48 , $118.51 , $172.38 , See APC Packaged Rates , $150.84 , $84.04 , $207.92 , $208.82 , $110.98 , See APC Packaged Rates , See APC Packaged Rates , $144.59 , $144.59 , See APC Packaged Rates , See APC Packaged Rates , $200.40 , $200.40 , $200.40 , $200.40 , See APC Packaged Rates , $75.42 , $129.29 , $75.42 , $208.82 , $150.84
,5710010685,Hospital Chargemaster,Dextrose 10 %-Water 1000 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $24.46 , $13.45 , $19.57 , See APC Packaged Rates , $17.12 , $9.54 , $23.60 , $23.70 , $12.60 , See APC Packaged Rates , See APC Packaged Rates , $16.41 , $16.41 , See APC Packaged Rates , See APC Packaged Rates , $22.75 , $22.75 , $22.75 , $22.75 , See APC Packaged Rates , $8.56 , $14.68 , $8.56 , $23.70 , $17.12
,5710010686,Hospital Chargemaster,Dextrose 10 %-Water 250 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $6.18 , $3.40 , $4.94 , See APC Packaged Rates , $4.33 , $2.41 , $5.96 , $5.99 , $3.18 , 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 , $3.71 , $2.16 , $5.99 , $4.33
,5710010687,Hospital Chargemaster,Dextrose 10 %-Water 500 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $14.22 , $7.82 , $11.38 , See APC Packaged Rates , $9.95 , $5.55 , $13.72 , $13.78 , $7.32 , See APC Packaged Rates , See APC Packaged Rates , $9.54 , $9.54 , See APC Packaged Rates , See APC Packaged Rates , $13.22 , $13.22 , $13.22 , $13.22 , See APC Packaged Rates , $4.98 , $8.53 , $4.98 , $13.78 , $9.95
,5710010693,Hospital Chargemaster,Dex 5 %-0.9 % NaCl 1000 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $23.44 , $12.89 , $18.75 , See APC Packaged Rates , $16.41 , $9.14 , $22.62 , $22.72 , $12.07 , See APC Packaged Rates , See APC Packaged Rates , $15.73 , $15.73 , See APC Packaged Rates , See APC Packaged Rates , $21.80 , $21.80 , $21.80 , $21.80 , See APC Packaged Rates , $8.20 , $14.06 , $8.20 , $22.72 , $16.41
,5710010695,Hospital Chargemaster,Dextrose 5 % in Water 1000 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $24.27 , $13.35 , $19.42 , See APC Packaged Rates , $16.99 , $9.47 , $23.42 , $23.52 , $12.50 , See APC Packaged Rates , See APC Packaged Rates , $16.29 , $16.29 , See APC Packaged Rates , See APC Packaged Rates , $22.57 , $22.57 , $22.57 , $22.57 , See APC Packaged Rates , $8.49 , $14.56 , $8.49 , $23.52 , $16.99
,5710010696,Hospital Chargemaster,Dextrose 5 % in Water 100 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $13.97 , $7.68 , $11.18 , See APC Packaged Rates , $9.78 , $5.45 , $13.48 , $13.54 , $7.19 , See APC Packaged Rates , See APC Packaged Rates , $9.37 , $9.37 , See APC Packaged Rates , See APC Packaged Rates , $12.99 , $12.99 , $12.99 , $12.99 , See APC Packaged Rates , $4.89 , $8.38 , $4.89 , $13.54 , $9.78
,5710010700,Hospital Chargemaster,Dextrose 5 % in Water 250 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $9.30 , $5.12 , $7.44 , See APC Packaged Rates , $6.51 , $3.63 , $8.97 , $9.01 , $4.79 , See APC Packaged Rates , See APC Packaged Rates , $6.24 , $6.24 , See APC Packaged Rates , See APC Packaged Rates , $8.65 , $8.65 , $8.65 , $8.65 , See APC Packaged Rates , $3.26 , $5.58 , $3.26 , $9.01 , $6.51
,5710010702,Hospital Chargemaster,Dextrose 5 % in Water 500 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $11.95 , $6.57 , $9.56 , See APC Packaged Rates , $8.37 , $4.66 , $11.53 , $11.58 , $6.15 , See APC Packaged Rates , See APC Packaged Rates , $8.02 , $8.02 , See APC Packaged Rates , See APC Packaged Rates , $11.11 , $11.11 , $11.11 , $11.11 , See APC Packaged Rates , $4.18 , $7.17 , $4.18 , $11.58 , $8.37
,5710010703,Hospital Chargemaster,Dextrose 5 % in Water 500 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $11.94 , $6.57 , $9.55 , See APC Packaged Rates , $8.36 , $4.66 , $11.52 , $11.57 , $6.15 , See APC Packaged Rates , See APC Packaged Rates , $8.01 , $8.01 , See APC Packaged Rates , See APC Packaged Rates , $11.10 , $11.10 , $11.10 , $11.10 , See APC Packaged Rates , $4.18 , $7.16 , $4.18 , $11.57 , $8.36
,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, $21.90 , $12.05 , $17.52 , See APC Packaged Rates , $15.33 , $8.54 , $21.13 , $21.22 , $11.28 , See APC Packaged Rates , See APC Packaged Rates , $14.69 , $14.69 , See APC Packaged Rates , See APC Packaged Rates , $20.37 , $20.37 , $20.37 , $20.37 , See APC Packaged Rates , $7.67 , $13.14 , $7.67 , $21.22 , $15.33
,5710010713,Hospital Chargemaster,Dex 5%-Lactated Ring 1000 mL,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
,5710010714,Hospital Chargemaster,Dex 5%-Lactated Ring 500 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $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
,5710010716,Hospital Chargemaster,Dextrose 25 gm/50 mL Syringe,Outpatient,Outpatient Default Percent / Case Rate,250, $24.92 , $13.71 , $19.94 , See APC Packaged Rates , $17.44 , $9.72 , $24.05 , $24.15 , $12.83 , See APC Packaged Rates , See APC Packaged Rates , $16.72 , $16.72 , See APC Packaged Rates , See APC Packaged Rates , $23.18 , $23.18 , $23.18 , $23.18 , See APC Packaged Rates , $8.72 , $14.95 , $8.72 , $24.15 , $17.44
,5710010749,Hospital Chargemaster,dilTIAZem 25 mg/5 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $8.95 , $4.92 , $7.16 , See APC Packaged Rates , $6.27 , $3.49 , $8.64 , $8.67 , $4.61 , See APC Packaged Rates , See APC Packaged Rates , $6.01 , $6.01 , See APC Packaged Rates , See APC Packaged Rates , $8.32 , $8.32 , $8.32 , $8.32 , See APC Packaged Rates , $3.13 , $5.37 , $3.13 , $8.67 , $6.27
,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, $33.80 , $18.59 , $27.04 , See APC Packaged Rates , $23.66 , $13.18 , $32.61 , $32.76 , $17.41 , See APC Packaged Rates , See APC Packaged Rates , $22.68 , $22.68 , See APC Packaged Rates , See APC Packaged Rates , $31.43 , $31.43 , $31.43 , $31.43 , See APC Packaged Rates , $11.83 , $20.28 , $11.83 , $32.76 , $23.66
,5710010826,Hospital Chargemaster,Doxycycline Hyclate 100 mg Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $67.14 , $36.93 , $53.71 , See APC Packaged Rates , $47.00 , $26.18 , $64.78 , $65.07 , $34.58 , See APC Packaged Rates , See APC Packaged Rates , $45.05 , $45.05 , See APC Packaged Rates , See APC Packaged Rates , $62.44 , $62.44 , $62.44 , $62.44 , See APC Packaged Rates , $23.50 , $40.28 , $23.50 , $65.07 , $47.00
,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, $36.67 , $20.17 , $29.34 , See APC Packaged Rates , $25.67 , $14.30 , $35.38 , $35.54 , $18.89 , See APC Packaged Rates , See APC Packaged Rates , $24.61 , $24.61 , See APC Packaged Rates , See APC Packaged Rates , $34.10 , $34.10 , $34.10 , $34.10 , See APC Packaged Rates , $12.83 , $22.00 , $12.83 , $35.54 , $25.67
,5710010928,Hospital Chargemaster,Etomidate 20 mg/10 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $14.34 , $7.89 , $11.47 , See APC Packaged Rates , $10.04 , $5.59 , $13.84 , $13.90 , $7.39 , See APC Packaged Rates , See APC Packaged Rates , $9.62 , $9.62 , See APC Packaged Rates , See APC Packaged Rates , $13.34 , $13.34 , $13.34 , $13.34 , See APC Packaged Rates , $5.02 , $8.60 , $5.02 , $13.90 , $10.04
,5710010937,Hospital Chargemaster,Famotidine/NaCl 20mg/50mL Bag,Outpatient,Outpatient Default Percent / Case Rate,250, $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
,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, $12.55 , $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
,5710011129,Hospital Chargemaster,Haloperidol 5 mg/1 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $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
,5710011134,Hospital Chargemaster,Heparin 5000 Unit/1 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $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
,5710011135,Hospital Chargemaster,"Hepar/D5W 25,000 Unit/250 mL",Outpatient,Outpatient Default Percent / Case Rate,250, $35.85 , $19.72 , $28.68 , See APC Packaged Rates , $25.10 , $13.98 , $34.59 , $34.74 , $18.46 , See APC Packaged Rates , See APC Packaged Rates , $24.06 , $24.06 , See APC Packaged Rates , See APC Packaged Rates , $33.34 , $33.34 , $33.34 , $33.34 , See APC Packaged Rates , $12.55 , $21.51 , $12.55 , $34.74 , $25.10
,5710011166,Hospital Chargemaster,hydrALAZINE 20 mg/1 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $36.01 , $19.81 , $28.81 , See APC Packaged Rates , $25.21 , $14.04 , $34.75 , $34.90 , $18.55 , See APC Packaged Rates , See APC Packaged Rates , $24.16 , $24.16 , See APC Packaged Rates , See APC Packaged Rates , $33.49 , $33.49 , $33.49 , $33.49 , See APC Packaged Rates , $12.60 , $21.61 , $12.60 , $34.90 , $25.21
,5710011183,Hospital Chargemaster,Hydrocort Sod Succ/PF 100mg Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $45.63 , $25.10 , $36.50 , See APC Packaged Rates , $31.94 , $17.80 , $44.03 , $44.22 , $23.50 , See APC Packaged Rates , See APC Packaged Rates , $30.62 , $30.62 , See APC Packaged Rates , See APC Packaged Rates , $42.44 , $42.44 , $42.44 , $42.44 , See APC Packaged Rates , $15.97 , $27.38 , $15.97 , $44.22 , $31.94
,5710011318,Hospital Chargemaster,Ketamine HCl 500 mg/5 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $21.14 , $11.63 , $16.91 , See APC Packaged Rates , $14.80 , $8.24 , $20.40 , $20.49 , $10.89 , See APC Packaged Rates , See APC Packaged Rates , $14.18 , $14.18 , See APC Packaged Rates , See APC Packaged Rates , $19.66 , $19.66 , $19.66 , $19.66 , See APC Packaged Rates , $7.40 , $12.68 , $7.40 , $20.49 , $14.80
,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, $19.10 , $10.51 , $15.28 , See APC Packaged Rates , $13.37 , $7.45 , $18.43 , $18.51 , $9.84 , See APC Packaged Rates , See APC Packaged Rates , $12.82 , $12.82 , See APC Packaged Rates , See APC Packaged Rates , $17.76 , $17.76 , $17.76 , $17.76 , See APC Packaged Rates , $6.69 , $11.46 , $6.69 , $18.51 , $13.37
,5710011335,Hospital Chargemaster,Labetalol 100 mg/20 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $9.16 , $5.04 , $7.33 , See APC Packaged Rates , $6.41 , $3.57 , $8.84 , $8.88 , $4.72 , See APC Packaged Rates , See APC Packaged Rates , $6.15 , $6.15 , See APC Packaged Rates , See APC Packaged Rates , $8.52 , $8.52 , $8.52 , $8.52 , See APC Packaged Rates , $3.21 , $5.50 , $3.21 , $8.88 , $6.41
,5710011406,Hospital Chargemaster,Lidocaine 1 % 2 mL Vial,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
,5710011408,Hospital Chargemaster,Lidocaine 1 % 20 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $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
,5710011411,Hospital Chargemaster,Lidocaine 2 % 20 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $5.39 , $2.96 , $4.31 , See APC Packaged Rates , $3.77 , $2.10 , $5.20 , $5.22 , $2.78 , See APC Packaged Rates , See APC Packaged Rates , $3.62 , $3.62 , See APC Packaged Rates , See APC Packaged Rates , $5.01 , $5.01 , $5.01 , $5.01 , See APC Packaged Rates , $1.89 , $3.23 , $1.89 , $5.22 , $3.77
,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, $8.06 , $4.43 , $6.45 , See APC Packaged Rates , $5.64 , $3.14 , $7.78 , $7.81 , $4.15 , See APC Packaged Rates , See APC Packaged Rates , $5.41 , $5.41 , See APC Packaged Rates , See APC Packaged Rates , $7.50 , $7.50 , $7.50 , $7.50 , See APC Packaged Rates , $2.82 , $4.84 , $2.82 , $7.81 , $5.64
,5710011426,Hospital Chargemaster,Lidoc 1%/Epi 1:100k 20 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $5.50 , $3.03 , $4.40 , See APC Packaged Rates , $3.85 , $2.15 , $5.31 , $5.33 , $2.83 , See APC Packaged Rates , See APC Packaged Rates , $3.69 , $3.69 , See APC Packaged Rates , See APC Packaged Rates , $5.12 , $5.12 , $5.12 , $5.12 , See APC Packaged Rates , $1.93 , $3.30 , $1.93 , $5.33 , $3.85
,5710011427,Hospital Chargemaster,Lidoc 1%/Epi 1:100k 30 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $13.09 , $7.20 , $10.47 , See APC Packaged Rates , $9.16 , $5.11 , $12.63 , $12.69 , $6.74 , See APC Packaged Rates , See APC Packaged Rates , $8.78 , $8.78 , See APC Packaged Rates , See APC Packaged Rates , $12.17 , $12.17 , $12.17 , $12.17 , See APC Packaged Rates , $4.58 , $7.85 , $4.58 , $12.69 , $9.16
,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
,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, $7.60 , $4.18 , $6.08 , See APC Packaged Rates , $5.32 , $2.96 , $7.33 , $7.37 , $3.91 , See APC Packaged Rates , See APC Packaged Rates , $5.10 , $5.10 , See APC Packaged Rates , See APC Packaged Rates , $7.07 , $7.07 , $7.07 , $7.07 , See APC Packaged Rates , $2.66 , $4.56 , $2.66 , $7.37 , $5.32
,5710011441,Hospital Chargemaster,Lidocaine 1 % MPF 5 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $9.78 , $5.38 , $7.82 , See APC Packaged Rates , $6.85 , $3.81 , $9.44 , $9.48 , $5.04 , See APC Packaged Rates , See APC Packaged Rates , $6.56 , $6.56 , See APC Packaged Rates , See APC Packaged Rates , $9.10 , $9.10 , $9.10 , $9.10 , See APC Packaged Rates , $3.42 , $5.87 , $3.42 , $9.48 , $6.85
,5710011443,Hospital Chargemaster,Lidocaine 2 % MPF 10 mL Amp,Outpatient,Outpatient Default Percent / Case Rate,250, $9.87 , $5.43 , $7.90 , See APC Packaged Rates , $6.91 , $3.85 , $9.52 , $9.57 , $5.08 , See APC Packaged Rates , See APC Packaged Rates , $6.62 , $6.62 , See APC Packaged Rates , See APC Packaged Rates , $9.18 , $9.18 , $9.18 , $9.18 , See APC Packaged Rates , $3.45 , $5.92 , $3.45 , $9.57 , $6.91
,5710011447,Hospital Chargemaster,Lidocaine/PF 100 mg/5 mL Syr,Outpatient,Outpatient Default Percent / Case Rate,250, $9.83 , $5.41 , $7.86 , See APC Packaged Rates , $6.88 , $3.83 , $9.48 , $9.53 , $5.06 , See APC Packaged Rates , See APC Packaged Rates , $6.60 , $6.60 , See APC Packaged Rates , See APC Packaged Rates , $9.14 , $9.14 , $9.14 , $9.14 , See APC Packaged Rates , $3.44 , $5.90 , $3.44 , $9.53 , $6.88
,5710011542,Hospital Chargemaster,Meperidine/PF 25 mg/1 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $15.25 , $8.39 , $12.20 , See APC Packaged Rates , $10.68 , $5.95 , $14.71 , $14.78 , $7.85 , See APC Packaged Rates , See APC Packaged Rates , $10.23 , $10.23 , See APC Packaged Rates , See APC Packaged Rates , $14.18 , $14.18 , $14.18 , $14.18 , See APC Packaged Rates , $5.34 , $9.15 , $5.34 , $14.78 , $10.68
,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, $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
,5710011621,Hospital Chargemaster,metroNIDAZOLE/NS 500 mg/100mL,Outpatient,Outpatient Default Percent / Case Rate,250, $5.84 , $3.21 , $4.67 , See APC Packaged Rates , $4.09 , $2.28 , $5.64 , $5.66 , $3.01 , See APC Packaged Rates , See APC Packaged Rates , $3.92 , $3.92 , See APC Packaged Rates , See APC Packaged Rates , $5.43 , $5.43 , $5.43 , $5.43 , See APC Packaged Rates , $2.04 , $3.50 , $2.04 , $5.66 , $4.09
,5710011700,Hospital Chargemaster,"MVI, Adult 10 mL Vial",Outpatient,Outpatient Default Percent / Case Rate,250, $28.63 , $15.75 , $22.90 , See APC Packaged Rates , $20.04 , $11.17 , $27.63 , $27.75 , $14.75 , See APC Packaged Rates , See APC Packaged Rates , $19.21 , $19.21 , See APC Packaged Rates , See APC Packaged Rates , $26.63 , $26.63 , $26.63 , $26.63 , See APC Packaged Rates , $10.02 , $17.18 , $10.02 , $27.75 , $20.04
,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, $65.08 , $35.79 , $52.06 , See APC Packaged Rates , $45.56 , $25.38 , $62.80 , $63.07 , $33.52 , See APC Packaged Rates , See APC Packaged Rates , $43.67 , $43.67 , See APC Packaged Rates , See APC Packaged Rates , $60.52 , $60.52 , $60.52 , $60.52 , See APC Packaged Rates , $22.78 , $39.05 , $22.78 , $63.07 , $45.56
,5710011799,Hospital Chargemaster,Norepinephrine 4 mg/4 mL Ampul,Outpatient,Outpatient Default Percent / Case Rate,250, $21.22 , $11.67 , $16.98 , See APC Packaged Rates , $14.85 , $8.28 , $20.48 , $20.56 , $10.93 , See APC Packaged Rates , See APC Packaged Rates , $14.24 , $14.24 , See APC Packaged Rates , See APC Packaged Rates , $19.73 , $19.73 , $19.73 , $19.73 , See APC Packaged Rates , $7.43 , $12.73 , $7.43 , $20.56 , $14.85
,5710011824,Hospital Chargemaster,OLANZapine 10 mg Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $96.08 , $52.84 , $76.86 , See APC Packaged Rates , $67.26 , $37.47 , $92.71 , $93.11 , $49.48 , See APC Packaged Rates , See APC Packaged Rates , $64.47 , $64.47 , See APC Packaged Rates , See APC Packaged Rates , $89.35 , $89.35 , $89.35 , $89.35 , See APC Packaged Rates , $33.63 , $57.65 , $33.63 , $93.11 , $67.26
,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, $12.91 , $7.10 , $10.33 , See APC Packaged Rates , $9.04 , $5.03 , $12.46 , $12.51 , $6.65 , See APC Packaged Rates , See APC Packaged Rates , $8.66 , $8.66 , See APC Packaged Rates , See APC Packaged Rates , $12.01 , $12.01 , $12.01 , $12.01 , See APC Packaged Rates , $4.52 , $7.75 , $4.52 , $12.51 , $9.04
,5710011927,Hospital Chargemaster,Penicill G Pot 5 MU Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $32.44 , $17.84 , $25.95 , See APC Packaged Rates , $22.71 , $12.65 , $31.30 , $31.44 , $16.71 , See APC Packaged Rates , See APC Packaged Rates , $21.77 , $21.77 , See APC Packaged Rates , See APC Packaged Rates , $30.17 , $30.17 , $30.17 , $30.17 , See APC Packaged Rates , $11.35 , $19.46 , $11.35 , $31.44 , $22.71
,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, $1.00 , $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
,5710012012,Hospital Chargemaster,Potassium Chl 40 mEq/20 mL Vl,Outpatient,Outpatient Default Percent / Case Rate,250, $11.67 , $6.42 , $9.34 , See APC Packaged Rates , $8.17 , $4.55 , $11.26 , $11.31 , $6.01 , See APC Packaged Rates , See APC Packaged Rates , $7.83 , $7.83 , See APC Packaged Rates , See APC Packaged Rates , $10.85 , $10.85 , $10.85 , $10.85 , See APC Packaged Rates , $4.08 , $7.00 , $4.08 , $11.31 , $8.17
,5710012016,Hospital Chargemaster,KCl 20 mEq/0.9 % NaCl 1000 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $21.96 , $12.08 , $17.57 , See APC Packaged Rates , $15.37 , $8.56 , $21.19 , $21.28 , $11.31 , See APC Packaged Rates , See APC Packaged Rates , $14.74 , $14.74 , See APC Packaged Rates , See APC Packaged Rates , $20.42 , $20.42 , $20.42 , $20.42 , See APC Packaged Rates , $7.69 , $13.18 , $7.69 , $21.28 , $15.37
,5710012017,Hospital Chargemaster,KCl 40 mEq/0.9 % NaCl 1000 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $24.83 , $13.66 , $19.86 , See APC Packaged Rates , $17.38 , $9.68 , $23.96 , $24.06 , $12.79 , See APC Packaged Rates , See APC Packaged Rates , $16.66 , $16.66 , See APC Packaged Rates , See APC Packaged Rates , $23.09 , $23.09 , $23.09 , $23.09 , See APC Packaged Rates , $8.69 , $14.90 , $8.69 , $24.06 , $17.38
,5710012018,Hospital Chargemaster,KCl 20 mEq/5 % Dextr 1000 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $22.76 , $12.52 , $18.21 , See APC Packaged Rates , $15.93 , $8.88 , $21.96 , $22.06 , $11.72 , See APC Packaged Rates , See APC Packaged Rates , $15.27 , $15.27 , See APC Packaged Rates , See APC Packaged Rates , $21.17 , $21.17 , $21.17 , $21.17 , See APC Packaged Rates , $7.97 , $13.66 , $7.97 , $22.06 , $15.93
,5710012022,Hospital Chargemaster,Potassium Chl 10 mEq/100mL Bag,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
,5710012023,Hospital Chargemaster,Potassium Chl 20 mEq/100mL Bag,Outpatient,Outpatient Default Percent / Case Rate,250, $9.56 , $5.26 , $7.65 , See APC Packaged Rates , $6.69 , $3.73 , $9.22 , $9.26 , $4.92 , See APC Packaged Rates , See APC Packaged Rates , $6.41 , $6.41 , See APC Packaged Rates , See APC Packaged Rates , $8.89 , $8.89 , $8.89 , $8.89 , See APC Packaged Rates , $3.35 , $5.74 , $3.35 , $9.26 , $6.69
,5710012025,Hospital Chargemaster,KCl 20 mEq/0.45% NaCl 1000 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $24.11 , $13.26 , $19.29 , See APC Packaged Rates , $16.88 , $9.40 , $23.26 , $23.37 , $12.42 , See APC Packaged Rates , See APC Packaged Rates , $16.18 , $16.18 , See APC Packaged Rates , See APC Packaged Rates , $22.42 , $22.42 , $22.42 , $22.42 , See APC Packaged Rates , $8.44 , $14.47 , $8.44 , $23.37 , $16.88
,5710012028,Hospital Chargemaster,KCl 20 mEq/D5-1/2NS 1000 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $21.22 , $11.67 , $16.98 , See APC Packaged Rates , $14.85 , $8.28 , $20.48 , $20.56 , $10.93 , See APC Packaged Rates , See APC Packaged Rates , $14.24 , $14.24 , See APC Packaged Rates , See APC Packaged Rates , $19.73 , $19.73 , $19.73 , $19.73 , See APC Packaged Rates , $7.43 , $12.73 , $7.43 , $20.56 , $14.85
,5710012030,Hospital Chargemaster,KCl 40 mEq/D5-1/2NS 1000 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $25.48 , $14.01 , $20.38 , See APC Packaged Rates , $17.84 , $9.94 , $24.59 , $24.69 , $13.12 , See APC Packaged Rates , See APC Packaged Rates , $17.10 , $17.10 , See APC Packaged Rates , See APC Packaged Rates , $23.70 , $23.70 , $23.70 , $23.70 , See APC Packaged Rates , $8.92 , $15.29 , $8.92 , $24.69 , $17.84
,5710012031,Hospital Chargemaster,KCl 20 mEq/D5-NS 1000 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $23.17 , $12.74 , $18.54 , See APC Packaged Rates , $16.22 , $9.04 , $22.36 , $22.45 , $11.93 , See APC Packaged Rates , See APC Packaged Rates , $15.55 , $15.55 , See APC Packaged Rates , See APC Packaged Rates , $21.55 , $21.55 , $21.55 , $21.55 , See APC Packaged Rates , $8.11 , $13.90 , $8.11 , $22.45 , $16.22
,5710012032,Hospital Chargemaster,KCl 40 mEq/D5-NS 1000 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $23.87 , $13.13 , $19.10 , See APC Packaged Rates , $16.71 , $9.31 , $23.03 , $23.13 , $12.29 , 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 , $14.32 , $8.35 , $23.13 , $16.71
,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, $41.50 , $22.83 , $33.20 , See APC Packaged Rates , $29.05 , $16.19 , $40.04 , $40.22 , $21.37 , See APC Packaged Rates , See APC Packaged Rates , $27.85 , $27.85 , See APC Packaged Rates , See APC Packaged Rates , $38.60 , $38.60 , $38.60 , $38.60 , See APC Packaged Rates , $14.53 , $24.90 , $14.53 , $40.22 , $29.05
,5710012095,Hospital Chargemaster,Propofol 500 mg/50 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $47.81 , $26.30 , $38.25 , See APC Packaged Rates , $33.47 , $18.65 , $46.13 , $46.33 , $24.62 , See APC Packaged Rates , See APC Packaged Rates , $32.08 , $32.08 , See APC Packaged Rates , See APC Packaged Rates , $44.46 , $44.46 , $44.46 , $44.46 , See APC Packaged Rates , $16.73 , $28.69 , $16.73 , $46.33 , $33.47
,5710012096,Hospital Chargemaster,Propofol 200 mg/20 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $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
,5710012097,Hospital Chargemaster,Propofol 1000 mg/100 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $76.50 , $42.08 , $61.20 , See APC Packaged Rates , $53.55 , $29.84 , $73.81 , $74.14 , $39.40 , See APC Packaged Rates , See APC Packaged Rates , $51.33 , $51.33 , See APC Packaged Rates , See APC Packaged Rates , $71.15 , $71.15 , $71.15 , $71.15 , See APC Packaged Rates , $26.78 , $45.90 , $26.78 , $74.14 , $53.55
,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, $21.87 , $12.03 , $17.50 , See APC Packaged Rates , $15.31 , $8.53 , $21.10 , $21.19 , $11.26 , See APC Packaged Rates , See APC Packaged Rates , $14.67 , $14.67 , See APC Packaged Rates , See APC Packaged Rates , $20.34 , $20.34 , $20.34 , $20.34 , See APC Packaged Rates , $7.65 , $13.12 , $7.65 , $21.19 , $15.31
,5710012170,Hospital Chargemaster,Lactated Ringers 500 mL,Outpatient,Outpatient Default Percent / Case Rate,250, $11.43 , $6.29 , $9.14 , See APC Packaged Rates , $8.00 , $4.46 , $11.03 , $11.08 , $5.89 , See APC Packaged Rates , See APC Packaged Rates , $7.67 , $7.67 , See APC Packaged Rates , See APC Packaged Rates , $10.63 , $10.63 , $10.63 , $10.63 , See APC Packaged Rates , $4.00 , $6.86 , $4.00 , $11.08 , $8.00
,5710012195,Hospital Chargemaster,Rocuronium 50 mg/5 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $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
,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, $38.82 , $21.35 , $31.06 , See APC Packaged Rates , $27.17 , $15.14 , $37.46 , $37.62 , $19.99 , See APC Packaged Rates , See APC Packaged Rates , $26.05 , $26.05 , See APC Packaged Rates , See APC Packaged Rates , $36.10 , $36.10 , $36.10 , $36.10 , See APC Packaged Rates , $13.59 , $23.29 , $13.59 , $37.62 , $27.17
,5710012253,Hospital Chargemaster,Sodium Acet 40 mEq/20 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $8.16 , $4.49 , $6.53 , See APC Packaged Rates , $5.71 , $3.18 , $7.87 , $7.91 , $4.20 , See APC Packaged Rates , See APC Packaged Rates , $5.48 , $5.48 , See APC Packaged Rates , See APC Packaged Rates , $7.59 , $7.59 , $7.59 , $7.59 , See APC Packaged Rates , $2.86 , $4.90 , $2.86 , $7.91 , $5.71
,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, $19.74 , $10.86 , $15.79 , See APC Packaged Rates , $13.82 , $7.70 , $19.05 , $19.13 , $10.17 , See APC Packaged Rates , See APC Packaged Rates , $13.25 , $13.25 , See APC Packaged Rates , See APC Packaged Rates , $18.36 , $18.36 , $18.36 , $18.36 , See APC Packaged Rates , $6.91 , $11.84 , $6.91 , $19.13 , $13.82
,5710012258,Hospital Chargemaster,Sod Bicarb 8.4% 50 mL Syringe,Outpatient,Outpatient Default Percent / Case Rate,250, $36.86 , $20.27 , $29.49 , See APC Packaged Rates , $25.80 , $14.38 , $35.57 , $35.72 , $18.98 , See APC Packaged Rates , See APC Packaged Rates , $24.73 , $24.73 , See APC Packaged Rates , See APC Packaged Rates , $34.28 , $34.28 , $34.28 , $34.28 , See APC Packaged Rates , $12.90 , $22.12 , $12.90 , $35.72 , $25.80
,5710012259,Hospital Chargemaster,Sod Bicarb 8.4% 50 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $24.84 , $13.66 , $19.87 , See APC Packaged Rates , $17.39 , $9.69 , $23.97 , $24.07 , $12.79 , See APC Packaged Rates , See APC Packaged Rates , $16.67 , $16.67 , See APC Packaged Rates , See APC Packaged Rates , $23.10 , $23.10 , $23.10 , $23.10 , See APC Packaged Rates , $8.69 , $14.90 , $8.69 , $24.07 , $17.39
,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, $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
,5710012303,Hospital Chargemaster,Sugammadex 200 mg/2 mL Vial,Outpatient,Outpatient Default Percent / Case Rate,250, $294.32 , $161.88 , $235.46 , See APC Packaged Rates , $206.02 , $114.78 , $283.99 , $285.23 , $151.58 , See APC Packaged Rates , See APC Packaged Rates , $197.49 , $197.49 , See APC Packaged Rates , See APC Packaged Rates , $273.72 , $273.72 , $273.72 , $273.72 , See APC Packaged Rates , $103.01 , $176.59 , $103.01 , $285.23 , $206.02
,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, $64.26 , $35.34 , $51.41 , See APC Packaged Rates , $44.98 , $25.06 , $62.00 , $62.27 , $33.10 , See APC Packaged Rates , See APC Packaged Rates , $43.12 , $43.12 , See APC Packaged Rates , See APC Packaged Rates , $59.76 , $59.76 , $59.76 , $59.76 , See APC Packaged Rates , $22.49 , $38.56 , $22.49 , $62.27 , $44.98
,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, $15.30 , $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
,5710012529,Hospital Chargemaster,"Water for Inj, Ster 10 mL",Outpatient,Outpatient Default Percent / Case Rate,250, $2.34 , $1.29 , $1.87 , See APC Packaged Rates , $1.64 , $0.91 , $2.26 , $2.27 , $1.21 , See APC Packaged Rates , See APC Packaged Rates , $1.57 , $1.57 , See APC Packaged Rates , See APC Packaged Rates , $2.18 , $2.18 , $2.18 , $2.18 , See APC Packaged Rates , $0.82 , $1.40 , $0.82 , $2.27 , $1.64
,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
,5710012804,Hospital Chargemaster,Ketamine/H20 50mg/mL Syringe,Outpatient,Outpatient Default Percent / Case Rate,250, $12.53 , $6.89 , $10.02 , See APC Packaged Rates , $8.77 , $4.89 , $12.09 , $12.14 , $6.45 , See APC Packaged Rates , See APC Packaged Rates , $8.41 , $8.41 , See APC Packaged Rates , See APC Packaged Rates , $11.65 , $11.65 , $11.65 , $11.65 , See APC Packaged Rates , $4.39 , $7.52 , $4.39 , $12.14 , $8.77
,5710012842,Hospital Chargemaster,Bupivacaine HCl 0.125%/NaCl PF,Outpatient,Outpatient Default Percent / Case Rate,250, $174.42 , $95.93 , $139.54 , See APC Packaged Rates , $122.09 , $68.02 , $168.30 , $169.03 , $89.83 , See APC Packaged Rates , See APC Packaged Rates , $117.04 , $117.04 , See APC Packaged Rates , See APC Packaged Rates , $162.21 , $162.21 , $162.21 , $162.21 , See APC Packaged Rates , $61.05 , $104.65 , $61.05 , $169.03 , $122.09
,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
,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, $5.56 , $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
,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, $1.70 , $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
,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
,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, $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
,5710010081,Hospital Chargemaster,Albuterol 8 gm Inhaler,Outpatient,Outpatient Default Percent / Case Rate,259, $67.50 , $37.13 , $54.00 , See APC Packaged Rates , $47.25 , $26.33 , $65.13 , $65.41 , $34.76 , See APC Packaged Rates , See APC Packaged Rates , $45.29 , $45.29 , See APC Packaged Rates , See APC Packaged Rates , $62.78 , $62.78 , $62.78 , $62.78 , See APC Packaged Rates , $23.63 , $40.50 , $23.63 , $65.41 , $47.25
,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, $2.04 , $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
,5710010090,Hospital Chargemaster,Alendronate 70 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $52.25 , $28.74 , $41.80 , See APC Packaged Rates , $36.58 , $20.38 , $50.42 , $50.64 , $26.91 , See APC Packaged Rates , See APC Packaged Rates , $35.06 , $35.06 , See APC Packaged Rates , See APC Packaged Rates , $48.59 , $48.59 , $48.59 , $48.59 , See APC Packaged Rates , $18.29 , $31.35 , $18.29 , $50.64 , $36.58
,5710010091,Hospital Chargemaster,Allopurinol 100 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
,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, $1.63 , $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
,5710010094,Hospital Chargemaster,ALPRAZolam 0.5 mg Tablet,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
,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, $1.56 , $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
,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, $2.70 , $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
,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, $10.62 , $5.84 , $8.50 , See APC Packaged Rates , $7.43 , $4.14 , $10.25 , $10.29 , $5.47 , See APC Packaged Rates , See APC Packaged Rates , $7.13 , $7.13 , See APC Packaged Rates , See APC Packaged Rates , $9.88 , $9.88 , $9.88 , $9.88 , See APC Packaged Rates , $3.72 , $6.37 , $3.72 , $10.29 , $7.43
,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, $12.50 , $6.88 , $10.00 , See APC Packaged Rates , $8.75 , $4.88 , $12.06 , $12.11 , $6.44 , See APC Packaged Rates , See APC Packaged Rates , $8.39 , $8.39 , See APC Packaged Rates , See APC Packaged Rates , $11.63 , $11.63 , $11.63 , $11.63 , See APC Packaged Rates , $4.38 , $7.50 , $4.38 , $12.11 , $8.75
,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, $22.05 , $12.13 , $17.64 , See APC Packaged Rates , $15.44 , $8.60 , $21.28 , $21.37 , $11.36 , See APC Packaged Rates , See APC Packaged Rates , $14.80 , $14.80 , See APC Packaged Rates , See APC Packaged Rates , $20.51 , $20.51 , $20.51 , $20.51 , See APC Packaged Rates , $7.72 , $13.23 , $7.72 , $21.37 , $15.44
,5710010172,Hospital Chargemaster,Apixaban 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $21.97 , $12.08 , $17.58 , See APC Packaged Rates , $15.38 , $8.57 , $21.20 , $21.29 , $11.31 , See APC Packaged Rates , See APC Packaged Rates , $14.74 , $14.74 , See APC Packaged Rates , See APC Packaged Rates , $20.43 , $20.43 , $20.43 , $20.43 , See APC Packaged Rates , $7.69 , $13.18 , $7.69 , $21.29 , $15.38
,5710010177,Hospital Chargemaster,Arformoterol 15 mcg/2 mL Neb,Outpatient,Outpatient Default Percent / Case Rate,259, $47.83 , $26.31 , $38.26 , See APC Packaged Rates , $33.48 , $18.65 , $46.15 , $46.35 , $24.63 , See APC Packaged Rates , See APC Packaged Rates , $32.09 , $32.09 , See APC Packaged Rates , See APC Packaged Rates , $44.48 , $44.48 , $44.48 , $44.48 , See APC Packaged Rates , $16.74 , $28.70 , $16.74 , $46.35 , $33.48
,5710010181,Hospital Chargemaster,ARIPiprazole 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $81.88 , $45.03 , $65.50 , See APC Packaged Rates , $57.32 , $31.93 , $79.01 , $79.35 , $42.17 , See APC Packaged Rates , See APC Packaged Rates , $54.94 , $54.94 , See APC Packaged Rates , See APC Packaged Rates , $76.15 , $76.15 , $76.15 , $76.15 , See APC Packaged Rates , $28.66 , $49.13 , $28.66 , $79.35 , $57.32
,5710010182,Hospital Chargemaster,ARIPiprazole 15 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $4.41 , $2.43 , $3.53 , See APC Packaged Rates , $3.09 , $1.72 , $4.26 , $4.27 , $2.27 , See APC Packaged Rates , See APC Packaged Rates , $2.96 , $2.96 , See APC Packaged Rates , See APC Packaged Rates , $4.10 , $4.10 , $4.10 , $4.10 , See APC Packaged Rates , $1.54 , $2.65 , $1.54 , $4.27 , $3.09
,5710010184,Hospital Chargemaster,ARIPiprazole 2 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $52.47 , $28.86 , $41.98 , See APC Packaged Rates , $36.73 , $20.46 , $50.63 , $50.85 , $27.02 , See APC Packaged Rates , See APC Packaged Rates , $35.21 , $35.21 , See APC Packaged Rates , See APC Packaged Rates , $48.80 , $48.80 , $48.80 , $48.80 , See APC Packaged Rates , $18.36 , $31.48 , $18.36 , $50.85 , $36.73
,5710010186,Hospital Chargemaster,ARIPiprazole 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $51.32 , $28.23 , $41.06 , See APC Packaged Rates , $35.92 , $20.01 , $49.52 , $49.73 , $26.43 , See APC Packaged Rates , See APC Packaged Rates , $34.44 , $34.44 , See APC Packaged Rates , See APC Packaged Rates , $47.73 , $47.73 , $47.73 , $47.73 , See APC Packaged Rates , $17.96 , $30.79 , $17.96 , $49.73 , $35.92
,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, $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
,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, $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
,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, $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
,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, $2.12 , $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
,5710010214,Hospital Chargemaster,Atorvastatin 10 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
,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, $129.20 , $71.06 , $103.36 , See APC Packaged Rates , $90.44 , $50.39 , $124.67 , $125.21 , $66.54 , See APC Packaged Rates , See APC Packaged Rates , $86.69 , $86.69 , See APC Packaged Rates , See APC Packaged Rates , $120.16 , $120.16 , $120.16 , $120.16 , See APC Packaged Rates , $45.22 , $77.52 , $45.22 , $125.21 , $90.44
,5710010235,Hospital Chargemaster,Azithromycin 250 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $19.84 , $10.91 , $15.87 , See APC Packaged Rates , $13.89 , $7.74 , $19.14 , $19.23 , $10.22 , See APC Packaged Rates , See APC Packaged Rates , $13.31 , $13.31 , See APC Packaged Rates , See APC Packaged Rates , $18.45 , $18.45 , $18.45 , $18.45 , See APC Packaged Rates , $6.94 , $11.90 , $6.94 , $19.23 , $13.89
,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
,5710010250,Hospital Chargemaster,Baclofen 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $6.30 , $3.47 , $5.04 , See APC Packaged Rates , $4.41 , $2.46 , $6.08 , $6.11 , $3.24 , See APC Packaged Rates , See APC Packaged Rates , $4.23 , $4.23 , See APC Packaged Rates , See APC Packaged Rates , $5.86 , $5.86 , $5.86 , $5.86 , See APC Packaged Rates , $2.21 , $3.78 , $2.21 , $6.11 , $4.41
,5710010252,Hospital Chargemaster,Baclofen 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $3.16 , $1.74 , $2.53 , See APC Packaged Rates , $2.21 , $1.23 , $3.05 , $3.06 , $1.63 , See APC Packaged Rates , See APC Packaged Rates , $2.12 , $2.12 , See APC Packaged Rates , See APC Packaged Rates , $2.94 , $2.94 , $2.94 , $2.94 , See APC Packaged Rates , $1.11 , $1.90 , $1.11 , $3.06 , $2.21
,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, $11.26 , $6.19 , $9.01 , See APC Packaged Rates , $7.88 , $4.39 , $10.86 , $10.91 , $5.80 , See APC Packaged Rates , See APC Packaged Rates , $7.56 , $7.56 , See APC Packaged Rates , See APC Packaged Rates , $10.47 , $10.47 , $10.47 , $10.47 , See APC Packaged Rates , $3.94 , $6.76 , $3.94 , $10.91 , $7.88
,5710010259,Hospital Chargemaster,Beclomethasone Dip 40 mcg Inh,Outpatient,Outpatient Default Percent / Case Rate,259, $611.13 , $336.12 , $488.90 , See APC Packaged Rates , $427.79 , $238.34 , $589.68 , $592.25 , $314.74 , See APC Packaged Rates , See APC Packaged Rates , $410.07 , $410.07 , See APC Packaged Rates , See APC Packaged Rates , $568.35 , $568.35 , $568.35 , $568.35 , See APC Packaged Rates , $213.90 , $366.68 , $213.90 , $592.25 , $427.79
,5710010260,Hospital Chargemaster,Beclomethasone Dip 80 mcg Inh,Outpatient,Outpatient Default Percent / Case Rate,259, $818.27 , $450.05 , $654.62 , See APC Packaged Rates , $572.79 , $319.13 , $789.55 , $792.99 , $421.43 , See APC Packaged Rates , See APC Packaged Rates , $549.06 , $549.06 , See APC Packaged Rates , See APC Packaged Rates , $760.99 , $760.99 , $760.99 , $760.99 , See APC Packaged Rates , $286.39 , $490.96 , $286.39 , $792.99 , $572.79
,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, $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
,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, $11.45 , $6.30 , $9.16 , See APC Packaged Rates , $8.02 , $4.47 , $11.05 , $11.10 , $5.90 , See APC Packaged Rates , See APC Packaged Rates , $7.68 , $7.68 , See APC Packaged Rates , See APC Packaged Rates , $10.65 , $10.65 , $10.65 , $10.65 , See APC Packaged Rates , $4.01 , $6.87 , $4.01 , $11.10 , $8.02
,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, $228.89 , $125.89 , $183.11 , See APC Packaged Rates , $160.22 , $89.27 , $220.86 , $221.82 , $117.88 , See APC Packaged Rates , See APC Packaged Rates , $153.59 , $153.59 , See APC Packaged Rates , See APC Packaged Rates , $212.87 , $212.87 , $212.87 , $212.87 , See APC Packaged Rates , $80.11 , $137.33 , $80.11 , $221.82 , $160.22
,5710010292,Hospital Chargemaster,Bisacodyl 10 mg Supp,Outpatient,Outpatient Default Percent / Case Rate,259, $3.83 , $2.11 , $3.06 , See APC Packaged Rates , $2.68 , $1.49 , $3.70 , $3.71 , $1.97 , See APC Packaged Rates , See APC Packaged Rates , $2.57 , $2.57 , See APC Packaged Rates , See APC Packaged Rates , $3.56 , $3.56 , $3.56 , $3.56 , See APC Packaged Rates , $1.34 , $2.30 , $1.34 , $3.71 , $2.68
,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, $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
,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, $87.52 , $48.14 , $70.02 , See APC Packaged Rates , $61.26 , $34.13 , $84.45 , $84.82 , $45.07 , See APC Packaged Rates , See APC Packaged Rates , $58.73 , $58.73 , See APC Packaged Rates , See APC Packaged Rates , $81.39 , $81.39 , $81.39 , $81.39 , See APC Packaged Rates , $30.63 , $52.51 , $30.63 , $84.82 , $61.26
,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, $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
,5710010315,Hospital Chargemaster,Budesonide/Formote 80/4.5 Inh,Outpatient,Outpatient Default Percent / Case Rate,259, $82.54 , $45.40 , $66.03 , See APC Packaged Rates , $57.78 , $32.19 , $79.64 , $79.99 , $42.51 , See APC Packaged Rates , See APC Packaged Rates , $55.38 , $55.38 , See APC Packaged Rates , See APC Packaged Rates , $76.76 , $76.76 , $76.76 , $76.76 , See APC Packaged Rates , $28.89 , $49.52 , $28.89 , $79.99 , $57.78
,5710010316,Hospital Chargemaster,Budesonide/Formote 160/4.5 Inh,Outpatient,Outpatient Default Percent / Case Rate,259, $108.78 , $59.83 , $87.02 , See APC Packaged Rates , $76.15 , $42.42 , $104.96 , $105.42 , $56.02 , See APC Packaged Rates , See APC Packaged Rates , $72.99 , $72.99 , See APC Packaged Rates , See APC Packaged Rates , $101.17 , $101.17 , $101.17 , $101.17 , See APC Packaged Rates , $38.07 , $65.27 , $38.07 , $105.42 , $76.15
,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
,5710010352,Hospital Chargemaster,buPROPion 100 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
,5710010353,Hospital Chargemaster,buPROPion 75 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $3.95 , $2.17 , $3.16 , See APC Packaged Rates , $2.77 , $1.54 , $3.81 , $3.83 , $2.03 , See APC Packaged Rates , See APC Packaged Rates , $2.65 , $2.65 , See APC Packaged Rates , See APC Packaged Rates , $3.67 , $3.67 , $3.67 , $3.67 , See APC Packaged Rates , $1.38 , $2.37 , $1.38 , $3.83 , $2.77
,5710010354,Hospital Chargemaster,buPROPion SR 100 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $4.31 , $2.37 , $3.45 , See APC Packaged Rates , $3.02 , $1.68 , $4.16 , $4.18 , $2.22 , See APC Packaged Rates , See APC Packaged Rates , $2.89 , $2.89 , See APC Packaged Rates , See APC Packaged Rates , $4.01 , $4.01 , $4.01 , $4.01 , See APC Packaged Rates , $1.51 , $2.59 , $1.51 , $4.18 , $3.02
,5710010355,Hospital Chargemaster,buPROPion SR 150 mg Tab,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
,5710010356,Hospital Chargemaster,buPROPion XL 150 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $12.16 , $6.69 , $9.73 , See APC Packaged Rates , $8.51 , $4.74 , $11.73 , $11.78 , $6.26 , See APC Packaged Rates , See APC Packaged Rates , $8.16 , $8.16 , See APC Packaged Rates , See APC Packaged Rates , $11.31 , $11.31 , $11.31 , $11.31 , See APC Packaged Rates , $4.26 , $7.30 , $4.26 , $11.78 , $8.51
,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, $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
,5710010360,Hospital Chargemaster,busPIRone 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.96 , $1.08 , $1.57 , See APC Packaged Rates , $1.37 , $0.76 , $1.89 , $1.90 , $1.01 , See APC Packaged Rates , See APC Packaged Rates , $1.32 , $1.32 , See APC Packaged Rates , See APC Packaged Rates , $1.82 , $1.82 , $1.82 , $1.82 , See APC Packaged Rates , $0.69 , $1.18 , $0.69 , $1.90 , $1.37
,5710010362,Hospital Chargemaster,Butal/Apap/Caff 50/325/40 Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $4.31 , $2.37 , $3.45 , See APC Packaged Rates , $3.02 , $1.68 , $4.16 , $4.18 , $2.22 , See APC Packaged Rates , See APC Packaged Rates , $2.89 , $2.89 , See APC Packaged Rates , See APC Packaged Rates , $4.01 , $4.01 , $4.01 , $4.01 , See APC Packaged Rates , $1.51 , $2.59 , $1.51 , $4.18 , $3.02
,5710010371,Hospital Chargemaster,Calamine/Zinc Ox 177 mL Lotion,Outpatient,Outpatient Default Percent / Case Rate,259, $10.66 , $5.86 , $8.53 , See APC Packaged Rates , $7.46 , $4.16 , $10.29 , $10.33 , $5.49 , See APC Packaged Rates , See APC Packaged Rates , $7.15 , $7.15 , See APC Packaged Rates , See APC Packaged Rates , $9.91 , $9.91 , $9.91 , $9.91 , See APC Packaged Rates , $3.73 , $6.40 , $3.73 , $10.33 , $7.46
,5710010373,Hospital Chargemaster,Calcitonin Nasal 3.7 mL Spray,Outpatient,Outpatient Default Percent / Case Rate,259, $302.28 , $166.25 , $241.82 , See APC Packaged Rates , $211.60 , $117.89 , $291.67 , $292.94 , $155.68 , See APC Packaged Rates , See APC Packaged Rates , $202.83 , $202.83 , See APC Packaged Rates , See APC Packaged Rates , $281.12 , $281.12 , $281.12 , $281.12 , See APC Packaged Rates , $105.80 , $181.37 , $105.80 , $292.94 , $211.60
,5710010376,Hospital Chargemaster,Calcitriol 0.25 mcg 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
,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, $0.99 , $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
,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, $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
,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
,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, $5.43 , $2.99 , $4.34 , See APC Packaged Rates , $3.80 , $2.12 , $5.24 , $5.26 , $2.80 , See APC Packaged Rates , See APC Packaged Rates , $3.64 , $3.64 , See APC Packaged Rates , See APC Packaged Rates , $5.05 , $5.05 , $5.05 , $5.05 , See APC Packaged Rates , $1.90 , $3.26 , $1.90 , $5.26 , $3.80
,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, $17.19 , $9.45 , $13.75 , See APC Packaged Rates , $12.03 , $6.70 , $16.59 , $16.66 , $8.85 , See APC Packaged Rates , See APC Packaged Rates , $11.53 , $11.53 , See APC Packaged Rates , See APC Packaged Rates , $15.99 , $15.99 , $15.99 , $15.99 , See APC Packaged Rates , $6.02 , $10.31 , $6.02 , $16.66 , $12.03
,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, $19.33 , $10.63 , $15.46 , See APC Packaged Rates , $13.53 , $7.54 , $18.65 , $18.73 , $9.96 , See APC Packaged Rates , See APC Packaged Rates , $12.97 , $12.97 , See APC Packaged Rates , See APC Packaged Rates , $17.98 , $17.98 , $17.98 , $17.98 , See APC Packaged Rates , $6.77 , $11.60 , $6.77 , $18.73 , $13.53
,5710010477,Hospital Chargemaster,cephALEXin 250 mg Capsule,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
,5710010478,Hospital Chargemaster,cephALEXin 500 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $3.52 , $1.94 , $2.82 , See APC Packaged Rates , $2.46 , $1.37 , $3.40 , $3.41 , $1.81 , See APC Packaged Rates , See APC Packaged Rates , $2.36 , $2.36 , See APC Packaged Rates , See APC Packaged Rates , $3.27 , $3.27 , $3.27 , $3.27 , See APC Packaged Rates , $1.23 , $2.11 , $1.23 , $3.41 , $2.46
,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, $6.98 , $3.84 , $5.58 , See APC Packaged Rates , $4.89 , $2.72 , $6.74 , $6.76 , $3.59 , See APC Packaged Rates , See APC Packaged Rates , $4.68 , $4.68 , See APC Packaged Rates , See APC Packaged Rates , $6.49 , $6.49 , $6.49 , $6.49 , See APC Packaged Rates , $2.44 , $4.19 , $2.44 , $6.76 , $4.89
,5710010482,Hospital Chargemaster,Cetirizine 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $6.33 , $3.48 , $5.06 , See APC Packaged Rates , $4.43 , $2.47 , $6.11 , $6.13 , $3.26 , See APC Packaged Rates , See APC Packaged Rates , $4.25 , $4.25 , See APC Packaged Rates , See APC Packaged Rates , $5.89 , $5.89 , $5.89 , $5.89 , See APC Packaged Rates , $2.22 , $3.80 , $2.22 , $6.13 , $4.43
,5710010486,Hospital Chargemaster,Charcoal/Sorb 50 gm/240mL Susp,Outpatient,Outpatient Default Percent / Case Rate,259, $103.25 , $56.79 , $82.60 , See APC Packaged Rates , $72.28 , $40.27 , $99.63 , $100.06 , $53.18 , See APC Packaged Rates , See APC Packaged Rates , $69.28 , $69.28 , See APC Packaged Rates , See APC Packaged Rates , $96.02 , $96.02 , $96.02 , $96.02 , See APC Packaged Rates , $36.14 , $61.95 , $36.14 , $100.06 , $72.28
,5710010491,Hospital Chargemaster,chlordiazePOXIDE 25 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
,5710010492,Hospital Chargemaster,chlordiazePOXIDE 5 mg Capsule,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
,5710010503,Hospital Chargemaster,chlorproMAZINE 100 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $37.97 , $20.88 , $30.38 , See APC Packaged Rates , $26.58 , $14.81 , $36.64 , $36.80 , $19.56 , See APC Packaged Rates , See APC Packaged Rates , $25.48 , $25.48 , See APC Packaged Rates , See APC Packaged Rates , $35.31 , $35.31 , $35.31 , $35.31 , See APC Packaged Rates , $13.29 , $22.78 , $13.29 , $36.80 , $26.58
,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, $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
,5710010510,Hospital Chargemaster,Cholecal (Vit D3) 400 Unit 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
,5710010511,Hospital Chargemaster,Cholestyramine 4 gm Powder,Outpatient,Outpatient Default Percent / Case Rate,259, $8.59 , $4.72 , $6.87 , See APC Packaged Rates , $6.01 , $3.35 , $8.29 , $8.32 , $4.42 , See APC Packaged Rates , See APC Packaged Rates , $5.76 , $5.76 , See APC Packaged Rates , See APC Packaged Rates , $7.99 , $7.99 , $7.99 , $7.99 , See APC Packaged Rates , $3.01 , $5.15 , $3.01 , $8.32 , $6.01
,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
,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, $81.06 , $44.58 , $64.85 , See APC Packaged Rates , $56.74 , $31.61 , $78.21 , $78.56 , $41.75 , See APC Packaged Rates , See APC Packaged Rates , $54.39 , $54.39 , See APC Packaged Rates , See APC Packaged Rates , $75.39 , $75.39 , $75.39 , $75.39 , See APC Packaged Rates , $28.37 , $48.64 , $28.37 , $78.56 , $56.74
,5710010534,Hospital Chargemaster,Citalopram 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $6.25 , $3.44 , $5.00 , See APC Packaged Rates , $4.38 , $2.44 , $6.03 , $6.06 , $3.22 , See APC Packaged Rates , See APC Packaged Rates , $4.19 , $4.19 , See APC Packaged Rates , See APC Packaged Rates , $5.81 , $5.81 , $5.81 , $5.81 , See APC Packaged Rates , $2.19 , $3.75 , $2.19 , $6.06 , $4.38
,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, $2.19 , $1.20 , $1.75 , See APC Packaged Rates , $1.53 , $0.85 , $2.11 , $2.12 , $1.13 , See APC Packaged Rates , See APC Packaged Rates , $1.47 , $1.47 , See APC Packaged Rates , See APC Packaged Rates , $2.04 , $2.04 , $2.04 , $2.04 , See APC Packaged Rates , $0.77 , $1.31 , $0.77 , $2.12 , $1.53
,5710010560,Hospital Chargemaster,cloNIDine 0.1 mg/24 hr Patch,Outpatient,Outpatient Default Percent / Case Rate,259, $84.46 , $46.45 , $67.57 , See APC Packaged Rates , $59.12 , $32.94 , $81.50 , $81.85 , $43.50 , See APC Packaged Rates , See APC Packaged Rates , $56.67 , $56.67 , See APC Packaged Rates , See APC Packaged Rates , $78.55 , $78.55 , $78.55 , $78.55 , See APC Packaged Rates , $29.56 , $50.68 , $29.56 , $81.85 , $59.12
,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, $8.75 , $4.81 , $7.00 , See APC Packaged Rates , $6.13 , $3.41 , $8.44 , $8.48 , $4.51 , See APC Packaged Rates , See APC Packaged Rates , $5.87 , $5.87 , See APC Packaged Rates , See APC Packaged Rates , $8.14 , $8.14 , $8.14 , $8.14 , See APC Packaged Rates , $3.06 , $5.25 , $3.06 , $8.48 , $6.13
,5710010575,Hospital Chargemaster,cloZAPine 25 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $3.37 , $1.85 , $2.70 , See APC Packaged Rates , $2.36 , $1.31 , $3.25 , $3.27 , $1.74 , See APC Packaged Rates , See APC Packaged Rates , $2.26 , $2.26 , See APC Packaged Rates , See APC Packaged Rates , $3.13 , $3.13 , $3.13 , $3.13 , See APC Packaged Rates , $1.18 , $2.02 , $1.18 , $3.27 , $2.36
,5710010582,Hospital Chargemaster,Cod Liver/Zinc Ox 60gm Paste,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
,5710010584,Hospital Chargemaster,guaiFEN/Cod 200/20/10mL Liq,Outpatient,Outpatient Default Percent / Case Rate,259, $1.91 , $1.05 , $1.53 , See APC Packaged Rates , $1.34 , $0.74 , $1.84 , $1.85 , $0.98 , See APC Packaged Rates , See APC Packaged Rates , $1.28 , $1.28 , See APC Packaged Rates , See APC Packaged Rates , $1.78 , $1.78 , $1.78 , $1.78 , See APC Packaged Rates , $0.67 , $1.15 , $0.67 , $1.85 , $1.34
,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, $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
,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, $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
,5710010606,Hospital Chargemaster,Cyclobenzaprine 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $4.41 , $2.43 , $3.53 , See APC Packaged Rates , $3.09 , $1.72 , $4.26 , $4.27 , $2.27 , See APC Packaged Rates , See APC Packaged Rates , $2.96 , $2.96 , See APC Packaged Rates , See APC Packaged Rates , $4.10 , $4.10 , $4.10 , $4.10 , See APC Packaged Rates , $1.54 , $2.65 , $1.54 , $4.27 , $3.09
,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, $27.25 , $14.99 , $21.80 , See APC Packaged Rates , $19.08 , $10.63 , $26.29 , $26.41 , $14.03 , See APC Packaged Rates , See APC Packaged Rates , $18.28 , $18.28 , See APC Packaged Rates , See APC Packaged Rates , $25.34 , $25.34 , $25.34 , $25.34 , See APC Packaged Rates , $9.54 , $16.35 , $9.54 , $26.41 , $19.08
,5710010624,Hospital Chargemaster,Dabigatran 75 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $20.28 , $11.15 , $16.22 , See APC Packaged Rates , $14.20 , $7.91 , $19.57 , $19.65 , $10.44 , See APC Packaged Rates , See APC Packaged Rates , $13.61 , $13.61 , See APC Packaged Rates , See APC Packaged Rates , $18.86 , $18.86 , $18.86 , $18.86 , See APC Packaged Rates , $7.10 , $12.17 , $7.10 , $19.65 , $14.20
,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, $19.27 , $10.60 , $15.42 , See APC Packaged Rates , $13.49 , $7.52 , $18.59 , $18.67 , $9.92 , See APC Packaged Rates , See APC Packaged Rates , $12.93 , $12.93 , See APC Packaged Rates , See APC Packaged Rates , $17.92 , $17.92 , $17.92 , $17.92 , See APC Packaged Rates , $6.74 , $11.56 , $6.74 , $18.67 , $13.49
,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, $134.18 , $73.80 , $107.34 , See APC Packaged Rates , $93.93 , $52.33 , $129.47 , $130.03 , $69.11 , See APC Packaged Rates , See APC Packaged Rates , $90.03 , $90.03 , See APC Packaged Rates , See APC Packaged Rates , $124.79 , $124.79 , $124.79 , $124.79 , See APC Packaged Rates , $46.96 , $80.51 , $46.96 , $130.03 , $93.93
,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, $3.44 , $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
,5710010746,Hospital Chargemaster,dilTIAZem 30 mg Tablet,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
,5710010752,Hospital Chargemaster,dilTIAZem CD 180 mg Cap ER 24H,Outpatient,Outpatient Default Percent / Case Rate,259, $89.69 , $49.33 , $71.75 , See APC Packaged Rates , $62.78 , $34.98 , $86.54 , $86.92 , $46.19 , See APC Packaged Rates , See APC Packaged Rates , $60.18 , $60.18 , See APC Packaged Rates , See APC Packaged Rates , $83.41 , $83.41 , $83.41 , $83.41 , See APC Packaged Rates , $31.39 , $53.81 , $31.39 , $86.92 , $62.78
,5710010753,Hospital Chargemaster,dilTIAZem CD 300 mg Cap ER 24H,Outpatient,Outpatient Default Percent / Case Rate,259, $6.86 , $3.77 , $5.49 , See APC Packaged Rates , $4.80 , $2.68 , $6.62 , $6.65 , $3.53 , See APC Packaged Rates , See APC Packaged Rates , $4.60 , $4.60 , See APC Packaged Rates , See APC Packaged Rates , $6.38 , $6.38 , $6.38 , $6.38 , See APC Packaged Rates , $2.40 , $4.12 , $2.40 , $6.65 , $4.80
,5710010754,Hospital Chargemaster,dilTIAZem CD 120 mg Cap ER DEG,Outpatient,Outpatient Default Percent / Case Rate,259, $70.44 , $38.74 , $56.35 , See APC Packaged Rates , $49.31 , $27.47 , $67.97 , $68.26 , $36.28 , See APC Packaged Rates , See APC Packaged Rates , $47.27 , $47.27 , See APC Packaged Rates , See APC Packaged Rates , $65.51 , $65.51 , $65.51 , $65.51 , See APC Packaged Rates , $24.65 , $42.26 , $24.65 , $68.26 , $49.31
,5710010755,Hospital Chargemaster,dilTIAZem CD 240 mg Cap ER DEG,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
,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, $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
,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, $6.25 , $3.44 , $5.00 , See APC Packaged Rates , $4.38 , $2.44 , $6.03 , $6.06 , $3.22 , See APC Packaged Rates , See APC Packaged Rates , $4.19 , $4.19 , See APC Packaged Rates , See APC Packaged Rates , $5.81 , $5.81 , $5.81 , $5.81 , See APC Packaged Rates , $2.19 , $3.75 , $2.19 , $6.06 , $4.38
,5710010787,Hospital Chargemaster,Divalproex Sod ER 500 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $10.38 , $5.71 , $8.30 , See APC Packaged Rates , $7.27 , $4.05 , $10.02 , $10.06 , $5.35 , See APC Packaged Rates , See APC Packaged Rates , $6.96 , $6.96 , See APC Packaged Rates , See APC Packaged Rates , $9.65 , $9.65 , $9.65 , $9.65 , See APC Packaged Rates , $3.63 , $6.23 , $3.63 , $10.06 , $7.27
,5710010788,Hospital Chargemaster,Divalproex Sod DR 125mg Sprink,Outpatient,Outpatient Default Percent / Case Rate,259, $3.61 , $1.99 , $2.89 , See APC Packaged Rates , $2.53 , $1.41 , $3.48 , $3.50 , $1.86 , See APC Packaged Rates , See APC Packaged Rates , $2.42 , $2.42 , See APC Packaged Rates , See APC Packaged Rates , $3.36 , $3.36 , $3.36 , $3.36 , See APC Packaged Rates , $1.26 , $2.17 , $1.26 , $3.50 , $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, $1.79 , $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
,5710010802,Hospital Chargemaster,Dofetilide 250 mcg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $27.38 , $15.06 , $21.90 , See APC Packaged Rates , $19.17 , $10.68 , $26.42 , $26.53 , $14.10 , See APC Packaged Rates , See APC Packaged Rates , $18.37 , $18.37 , See APC Packaged Rates , See APC Packaged Rates , $25.46 , $25.46 , $25.46 , $25.46 , See APC Packaged Rates , $9.58 , $16.43 , $9.58 , $26.53 , $19.17
,5710010804,Hospital Chargemaster,Dolutegravir 50 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $168.82 , $92.85 , $135.06 , See APC Packaged Rates , $118.17 , $65.84 , $162.89 , $163.60 , $86.95 , See APC Packaged Rates , See APC Packaged Rates , $113.28 , $113.28 , See APC Packaged Rates , See APC Packaged Rates , $157.00 , $157.00 , $157.00 , $157.00 , See APC Packaged Rates , $59.09 , $101.29 , $59.09 , $163.60 , $118.17
,5710010805,Hospital Chargemaster,Donepezil 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $22.08 , $12.14 , $17.66 , See APC Packaged Rates , $15.46 , $8.61 , $21.30 , $21.40 , $11.37 , See APC Packaged Rates , See APC Packaged Rates , $14.82 , $14.82 , See APC Packaged Rates , See APC Packaged Rates , $20.53 , $20.53 , $20.53 , $20.53 , See APC Packaged Rates , $7.73 , $13.25 , $7.73 , $21.40 , $15.46
,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, $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
,5710010816,Hospital Chargemaster,Doxazosin 2 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $9.59 , $5.27 , $7.67 , See APC Packaged Rates , $6.71 , $3.74 , $9.25 , $9.29 , $4.94 , See APC Packaged Rates , See APC Packaged Rates , $6.43 , $6.43 , See APC Packaged Rates , See APC Packaged Rates , $8.92 , $8.92 , $8.92 , $8.92 , See APC Packaged Rates , $3.36 , $5.75 , $3.36 , $9.29 , $6.71
,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, $2.14 , $1.18 , $1.71 , See APC Packaged Rates , $1.50 , $0.83 , $2.06 , $2.07 , $1.10 , See APC Packaged Rates , See APC Packaged Rates , $1.44 , $1.44 , See APC Packaged Rates , See APC Packaged Rates , $1.99 , $1.99 , $1.99 , $1.99 , See APC Packaged Rates , $0.75 , $1.28 , $0.75 , $2.07 , $1.50
,5710010823,Hospital Chargemaster,Doxycycline Hyclate 100 mg Cap,Outpatient,Outpatient Default Percent / Case Rate,259, $3.06 , $1.68 , $2.45 , See APC Packaged Rates , $2.14 , $1.19 , $2.95 , $2.97 , $1.58 , 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 , $1.84 , $1.07 , $2.97 , $2.14
,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, $20.02 , $11.01 , $16.02 , See APC Packaged Rates , $14.01 , $7.81 , $19.32 , $19.40 , $10.31 , See APC Packaged Rates , See APC Packaged Rates , $13.43 , $13.43 , See APC Packaged Rates , See APC Packaged Rates , $18.62 , $18.62 , $18.62 , $18.62 , See APC Packaged Rates , $7.01 , $12.01 , $7.01 , $19.40 , $14.01
,5710010835,Hospital Chargemaster,DULoxetine 60 mg Capsule.DR,Outpatient,Outpatient Default Percent / Case Rate,259, $19.89 , $10.94 , $15.91 , See APC Packaged Rates , $13.92 , $7.76 , $19.19 , $19.28 , $10.24 , See APC Packaged Rates , See APC Packaged Rates , $13.35 , $13.35 , See APC Packaged Rates , See APC Packaged Rates , $18.50 , $18.50 , $18.50 , $18.50 , See APC Packaged Rates , $6.96 , $11.93 , $6.96 , $19.28 , $13.92
,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
,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, $5.02 , $2.76 , $4.02 , See APC Packaged Rates , $3.51 , $1.96 , $4.84 , $4.86 , $2.59 , See APC Packaged Rates , See APC Packaged Rates , $3.37 , $3.37 , See APC Packaged Rates , See APC Packaged Rates , $4.67 , $4.67 , $4.67 , $4.67 , See APC Packaged Rates , $1.76 , $3.01 , $1.76 , $4.86 , $3.51
,5710010896,Hospital Chargemaster,Erythromycin Base 250 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $21.39 , $11.76 , $17.11 , See APC Packaged Rates , $14.97 , $8.34 , $20.64 , $20.73 , $11.02 , See APC Packaged Rates , See APC Packaged Rates , $14.35 , $14.35 , See APC Packaged Rates , See APC Packaged Rates , $19.89 , $19.89 , $19.89 , $19.89 , See APC Packaged Rates , $7.49 , $12.83 , $7.49 , $20.73 , $14.97
,5710010897,Hospital Chargemaster,Erythromycin 0.5% 1 gm Oint,Outpatient,Outpatient Default Percent / Case Rate,259, $31.65 , $17.41 , $25.32 , See APC Packaged Rates , $22.16 , $12.34 , $30.54 , $30.67 , $16.30 , See APC Packaged Rates , See APC Packaged Rates , $21.24 , $21.24 , See APC Packaged Rates , See APC Packaged Rates , $29.43 , $29.43 , $29.43 , $29.43 , See APC Packaged Rates , $11.08 , $18.99 , $11.08 , $30.67 , $22.16
,5710010902,Hospital Chargemaster,Escitalopram 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $10.97 , $6.03 , $8.78 , See APC Packaged Rates , $7.68 , $4.28 , $10.58 , $10.63 , $5.65 , See APC Packaged Rates , See APC Packaged Rates , $7.36 , $7.36 , See APC Packaged Rates , See APC Packaged Rates , $10.20 , $10.20 , $10.20 , $10.20 , See APC Packaged Rates , $3.84 , $6.58 , $3.84 , $10.63 , $7.68
,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, $35.00 , $19.25 , $28.00 , See APC Packaged Rates , $24.50 , $13.65 , $33.77 , $33.92 , $18.03 , 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 , $21.00 , $12.25 , $33.92 , $24.50
,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, $28.76 , $15.82 , $23.01 , See APC Packaged Rates , $20.13 , $11.22 , $27.75 , $27.87 , $14.81 , See APC Packaged Rates , See APC Packaged Rates , $19.30 , $19.30 , See APC Packaged Rates , See APC Packaged Rates , $26.75 , $26.75 , $26.75 , $26.75 , See APC Packaged Rates , $10.07 , $17.26 , $10.07 , $27.87 , $20.13
,5710010936,Hospital Chargemaster,Famotidine 20 mg Tablet,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
,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, $67.22 , $36.97 , $53.78 , See APC Packaged Rates , $47.05 , $26.22 , $64.86 , $65.14 , $34.62 , See APC Packaged Rates , See APC Packaged Rates , $45.10 , $45.10 , See APC Packaged Rates , See APC Packaged Rates , $62.51 , $62.51 , $62.51 , $62.51 , See APC Packaged Rates , $23.53 , $40.33 , $23.53 , $65.14 , $47.05
,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, $200.71 , $110.39 , $160.57 , See APC Packaged Rates , $140.50 , $78.28 , $193.67 , $194.51 , $103.37 , See APC Packaged Rates , See APC Packaged Rates , $134.68 , $134.68 , See APC Packaged Rates , See APC Packaged Rates , $186.66 , $186.66 , $186.66 , $186.66 , See APC Packaged Rates , $70.25 , $120.43 , $70.25 , $194.51 , $140.50
,5710010966,Hospital Chargemaster,Ferrous Sulf 300 mg/5mL Liquid,Outpatient,Outpatient Default Percent / Case Rate,259, $10.38 , $5.71 , $8.30 , See APC Packaged Rates , $7.27 , $4.05 , $10.02 , $10.06 , $5.35 , See APC Packaged Rates , See APC Packaged Rates , $6.96 , $6.96 , See APC Packaged Rates , See APC Packaged Rates , $9.65 , $9.65 , $9.65 , $9.65 , See APC Packaged Rates , $3.63 , $6.23 , $3.63 , $10.06 , $7.27
,5710010967,Hospital Chargemaster,Ferrous Sulf 324 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
,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, $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
,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, $14.26 , $7.84 , $11.41 , See APC Packaged Rates , $9.98 , $5.56 , $13.76 , $13.82 , $7.34 , See APC Packaged Rates , See APC Packaged Rates , $9.57 , $9.57 , See APC Packaged Rates , See APC Packaged Rates , $13.26 , $13.26 , $13.26 , $13.26 , See APC Packaged Rates , $4.99 , $8.56 , $4.99 , $13.82 , $9.98
,5710010988,Hospital Chargemaster,Fludrocortisone 0.1 mg Tablet,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
,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, $13.53 , $7.44 , $10.82 , See APC Packaged Rates , $9.47 , $5.28 , $13.06 , $13.11 , $6.97 , See APC Packaged Rates , See APC Packaged Rates , $9.08 , $9.08 , See APC Packaged Rates , See APC Packaged Rates , $12.58 , $12.58 , $12.58 , $12.58 , See APC Packaged Rates , $4.74 , $8.12 , $4.74 , $13.11 , $9.47
,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, $1.30 , $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
,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, $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
,5710011051,Hospital Chargemaster,Gabapentin 400 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
,5710011052,Hospital Chargemaster,Gabapentin 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
,5710011070,Hospital Chargemaster,Galantamine 4 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $10.76 , $5.92 , $8.61 , See APC Packaged Rates , $7.53 , $4.20 , $10.38 , $10.43 , $5.54 , See APC Packaged Rates , See APC Packaged Rates , $7.22 , $7.22 , See APC Packaged Rates , See APC Packaged Rates , $10.01 , $10.01 , $10.01 , $10.01 , See APC Packaged Rates , $3.77 , $6.46 , $3.77 , $10.43 , $7.53
,5710011071,Hospital Chargemaster,Galantamine ER 8 mg Cap,Outpatient,Outpatient Default Percent / Case Rate,259, $11.68 , $6.42 , $9.34 , See APC Packaged Rates , $8.18 , $4.56 , $11.27 , $11.32 , $6.02 , See APC Packaged Rates , See APC Packaged Rates , $7.84 , $7.84 , See APC Packaged Rates , See APC Packaged Rates , $10.86 , $10.86 , $10.86 , $10.86 , See APC Packaged Rates , $4.09 , $7.01 , $4.09 , $11.32 , $8.18
,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
,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, $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, $1.63 , $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
,5710011114,Hospital Chargemaster,guaiFEN LA 600 mg Tab.ER.12H,Outpatient,Outpatient Default Percent / Case Rate,259, $1.64 , $0.90 , $1.31 , See APC Packaged Rates , $1.15 , $0.64 , $1.58 , $1.59 , $0.84 , See APC Packaged Rates , See APC Packaged Rates , $1.10 , $1.10 , See APC Packaged Rates , See APC Packaged Rates , $1.53 , $1.53 , $1.53 , $1.53 , See APC Packaged Rates , $0.57 , $0.98 , $0.57 , $1.59 , $1.15
,5710011116,Hospital Chargemaster,guaiFEN DM 200/20/10 mL Syrup,Outpatient,Outpatient Default Percent / Case Rate,259, $7.06 , $3.88 , $5.65 , See APC Packaged Rates , $4.94 , $2.75 , $6.81 , $6.84 , $3.64 , See APC Packaged Rates , See APC Packaged Rates , $4.74 , $4.74 , See APC Packaged Rates , See APC Packaged Rates , $6.57 , $6.57 , $6.57 , $6.57 , See APC Packaged Rates , $2.47 , $4.24 , $2.47 , $6.84 , $4.94
,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, $1.71 , $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
,5710011125,Hospital Chargemaster,Haloperidol 5 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
,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, $1.00 , $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
,5710011167,Hospital Chargemaster,hydroCHLOROthiazide 12.5mg Cap,Outpatient,Outpatient Default Percent / Case Rate,259, $1.07 , $0.59 , $0.86 , See APC Packaged Rates , $0.75 , $0.42 , $1.03 , $1.04 , $0.55 , See APC Packaged Rates , See APC Packaged Rates , $0.72 , $0.72 , See APC Packaged Rates , See APC Packaged Rates , $1.00 , $1.00 , $1.00 , $1.00 , See APC Packaged Rates , $0.37 , $0.64 , $0.37 , $1.04 , $0.75
,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, $1.07 , $0.59 , $0.86 , See APC Packaged Rates , $0.75 , $0.42 , $1.03 , $1.04 , $0.55 , See APC Packaged Rates , See APC Packaged Rates , $0.72 , $0.72 , See APC Packaged Rates , See APC Packaged Rates , $1.00 , $1.00 , $1.00 , $1.00 , See APC Packaged Rates , $0.37 , $0.64 , $0.37 , $1.04 , $0.75
,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, $4.32 , $2.38 , $3.46 , See APC Packaged Rates , $3.02 , $1.68 , $4.17 , $4.19 , $2.22 , See APC Packaged Rates , See APC Packaged Rates , $2.90 , $2.90 , See APC Packaged Rates , See APC Packaged Rates , $4.02 , $4.02 , $4.02 , $4.02 , See APC Packaged Rates , $1.51 , $2.59 , $1.51 , $4.19 , $3.02
,5710011178,Hospital Chargemaster,Hydrocortisone 1 % 30 gm Cr,Outpatient,Outpatient Default Percent / Case Rate,259, $6.97 , $3.83 , $5.58 , See APC Packaged Rates , $4.88 , $2.72 , $6.73 , $6.75 , $3.59 , See APC Packaged Rates , See APC Packaged Rates , $4.68 , $4.68 , See APC Packaged Rates , See APC Packaged Rates , $6.48 , $6.48 , $6.48 , $6.48 , See APC Packaged Rates , $2.44 , $4.18 , $2.44 , $6.75 , $4.88
,5710011179,Hospital Chargemaster,Hydrocortisone 1 % 30 gm Oin,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
,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, $1.00 , $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
,5710011199,Hospital Chargemaster,Hydroxychloroquine 200 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $11.12 , $6.12 , $8.90 , See APC Packaged Rates , $7.78 , $4.34 , $10.73 , $10.78 , $5.73 , See APC Packaged Rates , See APC Packaged Rates , $7.46 , $7.46 , See APC Packaged Rates , See APC Packaged Rates , $10.34 , $10.34 , $10.34 , $10.34 , See APC Packaged Rates , $3.89 , $6.67 , $3.89 , $10.78 , $7.78
,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, $1.38 , $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
,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
,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, $3.16 , $1.74 , $2.53 , See APC Packaged Rates , $2.21 , $1.23 , $3.05 , $3.06 , $1.63 , See APC Packaged Rates , See APC Packaged Rates , $2.12 , $2.12 , See APC Packaged Rates , See APC Packaged Rates , $2.94 , $2.94 , $2.94 , $2.94 , See APC Packaged Rates , $1.11 , $1.90 , $1.11 , $3.06 , $2.21
,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
,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, $783.49 , $430.92 , $626.79 , See APC Packaged Rates , $548.44 , $305.56 , $755.99 , $759.28 , $403.51 , See APC Packaged Rates , See APC Packaged Rates , $525.72 , $525.72 , See APC Packaged Rates , See APC Packaged Rates , $728.65 , $728.65 , $728.65 , $728.65 , See APC Packaged Rates , $274.22 , $470.09 , $274.22 , $759.28 , $548.44
,5710011264,Hospital Chargemaster,Insulin Detemir 1 Unit,Outpatient,Outpatient Default Percent / Case Rate,259, $5.74 , $3.16 , $4.59 , See APC Packaged Rates , $4.02 , $2.24 , $5.54 , $5.56 , $2.96 , See APC Packaged Rates , See APC Packaged Rates , $3.85 , $3.85 , See APC Packaged Rates , See APC Packaged Rates , $5.34 , $5.34 , $5.34 , $5.34 , See APC Packaged Rates , $2.01 , $3.44 , $2.01 , $5.56 , $4.02
,5710011266,Hospital Chargemaster,Insulin Lispro 3 mL Vial,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
,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, $206.50 , $113.58 , $165.20 , See APC Packaged Rates , $144.55 , $80.54 , $199.25 , $200.12 , $106.35 , See APC Packaged Rates , See APC Packaged Rates , $138.56 , $138.56 , See APC Packaged Rates , See APC Packaged Rates , $192.05 , $192.05 , $192.05 , $192.05 , See APC Packaged Rates , $72.28 , $123.90 , $72.28 , $200.12 , $144.55
,5710011271,Hospital Chargemaster,Insulin Regular 3 mL Vial,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
,5710011289,Hospital Chargemaster,Ipratropium 0.5 mg/2.5 mL Neb,Outpatient,Outpatient Default Percent / Case Rate,259, $3.37 , $1.85 , $2.70 , See APC Packaged Rates , $2.36 , $1.31 , $3.25 , $3.27 , $1.74 , See APC Packaged Rates , See APC Packaged Rates , $2.26 , $2.26 , See APC Packaged Rates , See APC Packaged Rates , $3.13 , $3.13 , $3.13 , $3.13 , See APC Packaged Rates , $1.18 , $2.02 , $1.18 , $3.27 , $2.36
,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, $5.61 , $3.09 , $4.49 , See APC Packaged Rates , $3.93 , $2.19 , $5.41 , $5.44 , $2.89 , See APC Packaged Rates , See APC Packaged Rates , $3.76 , $3.76 , See APC Packaged Rates , See APC Packaged Rates , $5.22 , $5.22 , $5.22 , $5.22 , See APC Packaged Rates , $1.96 , $3.37 , $1.96 , $5.44 , $3.93
,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, $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
,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, $11.86 , $6.52 , $9.49 , See APC Packaged Rates , $8.30 , $4.63 , $11.44 , $11.49 , $6.11 , See APC Packaged Rates , See APC Packaged Rates , $7.96 , $7.96 , See APC Packaged Rates , See APC Packaged Rates , $11.03 , $11.03 , $11.03 , $11.03 , See APC Packaged Rates , $4.15 , $7.12 , $4.15 , $11.49 , $8.30
,5710011323,Hospital Chargemaster,Ketoconazole 2 % 120mL SHAmpOO,Outpatient,Outpatient Default Percent / Case Rate,259, $9.07 , $4.99 , $7.26 , See APC Packaged Rates , $6.35 , $3.54 , $8.75 , $8.79 , $4.67 , See APC Packaged Rates , See APC Packaged Rates , $6.09 , $6.09 , See APC Packaged Rates , See APC Packaged Rates , $8.44 , $8.44 , $8.44 , $8.44 , See APC Packaged Rates , $3.17 , $5.44 , $3.17 , $8.79 , $6.35
,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, $140.48 , $77.26 , $112.38 , See APC Packaged Rates , $98.34 , $54.79 , $135.55 , $136.14 , $72.35 , See APC Packaged Rates , See APC Packaged Rates , $94.26 , $94.26 , See APC Packaged Rates , See APC Packaged Rates , $130.65 , $130.65 , $130.65 , $130.65 , See APC Packaged Rates , $49.17 , $84.29 , $49.17 , $136.14 , $98.34
,5710011333,Hospital Chargemaster,Labetalol 100 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.22 , $0.67 , $0.98 , See APC Packaged Rates , $0.85 , $0.48 , $1.18 , $1.18 , $0.63 , See APC Packaged Rates , See APC Packaged Rates , $0.82 , $0.82 , See APC Packaged Rates , See APC Packaged Rates , $1.13 , $1.13 , $1.13 , $1.13 , See APC Packaged Rates , $0.43 , $0.73 , $0.43 , $1.18 , $0.85
,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, $26.34 , $14.49 , $21.07 , See APC Packaged Rates , $18.44 , $10.27 , $25.42 , $25.53 , $13.57 , See APC Packaged Rates , See APC Packaged Rates , $17.67 , $17.67 , See APC Packaged Rates , See APC Packaged Rates , $24.50 , $24.50 , $24.50 , $24.50 , See APC Packaged Rates , $9.22 , $15.80 , $9.22 , $25.53 , $18.44
,5710011339,Hospital Chargemaster,Lactase 3000 Unit 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
,5710011341,Hospital Chargemaster,Lactobacillus Rham Cap.SPRINK,Outpatient,Outpatient Default Percent / Case Rate,259, $2.66 , $1.46 , $2.13 , See APC Packaged Rates , $1.86 , $1.04 , $2.57 , $2.58 , $1.37 , See APC Packaged Rates , See APC Packaged Rates , $1.78 , $1.78 , See APC Packaged Rates , See APC Packaged Rates , $2.47 , $2.47 , $2.47 , $2.47 , See APC Packaged Rates , $0.93 , $1.60 , $0.93 , $2.58 , $1.86
,5710011343,Hospital Chargemaster,Lactulose 20 gm/30 mL Solution,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
,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, $0.99 , $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
,5710011353,Hospital Chargemaster,Lansoprazole 15 mg Tab.RAP.DR,Outpatient,Outpatient Default Percent / Case Rate,259, $35.29 , $19.41 , $28.23 , See APC Packaged Rates , $24.70 , $13.76 , $34.05 , $34.20 , $18.18 , See APC Packaged Rates , See APC Packaged Rates , $23.68 , $23.68 , See APC Packaged Rates , See APC Packaged Rates , $32.82 , $32.82 , $32.82 , $32.82 , See APC Packaged Rates , $12.35 , $21.17 , $12.35 , $34.20 , $24.70
,5710011354,Hospital Chargemaster,Latanoprost 0.005 % 2.5mL Drop,Outpatient,Outpatient Default Percent / Case Rate,259, $96.90 , $53.30 , $77.52 , See APC Packaged Rates , $67.83 , $37.79 , $93.50 , $93.91 , $49.91 , See APC Packaged Rates , See APC Packaged Rates , $65.02 , $65.02 , See APC Packaged Rates , See APC Packaged Rates , $90.12 , $90.12 , $90.12 , $90.12 , See APC Packaged Rates , $33.92 , $58.14 , $33.92 , $93.91 , $67.83
,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, $1.53 , $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
,5710011379,Hospital Chargemaster,levETIRAcetam 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
,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, $3.59 , $1.97 , $2.87 , See APC Packaged Rates , $2.51 , $1.40 , $3.46 , $3.48 , $1.85 , See APC Packaged Rates , See APC Packaged Rates , $2.41 , $2.41 , See APC Packaged Rates , See APC Packaged Rates , $3.34 , $3.34 , $3.34 , $3.34 , See APC Packaged Rates , $1.26 , $2.15 , $1.26 , $3.48 , $2.51
,5710011394,Hospital Chargemaster,Levothyroxine 112 mcg 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
,5710011395,Hospital Chargemaster,Levothyroxine 125 mcg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.84 , $1.01 , $1.47 , See APC Packaged Rates , $1.29 , $0.72 , $1.78 , $1.78 , $0.95 , See APC Packaged Rates , See APC Packaged Rates , $1.23 , $1.23 , See APC Packaged Rates , See APC Packaged Rates , $1.71 , $1.71 , $1.71 , $1.71 , See APC Packaged Rates , $0.64 , $1.10 , $0.64 , $1.78 , $1.29
,5710011397,Hospital Chargemaster,Levothyroxine 150 mcg Tablet,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
,5710011400,Hospital Chargemaster,Levothyroxine 25 mcg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.22 , $0.67 , $0.98 , See APC Packaged Rates , $0.85 , $0.48 , $1.18 , $1.18 , $0.63 , See APC Packaged Rates , See APC Packaged Rates , $0.82 , $0.82 , See APC Packaged Rates , See APC Packaged Rates , $1.13 , $1.13 , $1.13 , $1.13 , See APC Packaged Rates , $0.43 , $0.73 , $0.43 , $1.18 , $0.85
,5710011401,Hospital Chargemaster,Levothyroxine 50 mcg 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
,5710011402,Hospital Chargemaster,Levothyroxine 75 mcg Tablet,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
,5710011403,Hospital Chargemaster,Levothyroxine 88 mcg 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
,5710011405,Hospital Chargemaster,Lidocaine 5 % ADH..PATCH,Outpatient,Outpatient Default Percent / Case Rate,259, $59.85 , $32.92 , $47.88 , See APC Packaged Rates , $41.90 , $23.34 , $57.75 , $58.00 , $30.82 , See APC Packaged Rates , See APC Packaged Rates , $40.16 , $40.16 , See APC Packaged Rates , See APC Packaged Rates , $55.66 , $55.66 , $55.66 , $55.66 , See APC Packaged Rates , $20.95 , $35.91 , $20.95 , $58.00 , $41.90
,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, $16.35 , $8.99 , $13.08 , See APC Packaged Rates , $11.45 , $6.38 , $15.78 , $15.84 , $8.42 , See APC Packaged Rates , See APC Packaged Rates , $10.97 , $10.97 , See APC Packaged Rates , See APC Packaged Rates , $15.21 , $15.21 , $15.21 , $15.21 , See APC Packaged Rates , $5.72 , $9.81 , $5.72 , $15.84 , $11.45
,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, $2.75 , $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
,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, $4.82 , $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
,5710011456,Hospital Chargemaster,Lip/Prot/Amy 10.4-39.2K Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $8.97 , $4.93 , $7.18 , See APC Packaged Rates , $6.28 , $3.50 , $8.66 , $8.69 , $4.62 , See APC Packaged Rates , See APC Packaged Rates , $6.02 , $6.02 , See APC Packaged Rates , See APC Packaged Rates , $8.34 , $8.34 , $8.34 , $8.34 , See APC Packaged Rates , $3.14 , $5.38 , $3.14 , $8.69 , $6.28
,5710011457,Hospital Chargemaster,Lip/Prot/Amyl 24/76/120K Cap,Outpatient,Outpatient Default Percent / Case Rate,259, $18.39 , $10.11 , $14.71 , See APC Packaged Rates , $12.87 , $7.17 , $17.74 , $17.82 , $9.47 , See APC Packaged Rates , See APC Packaged Rates , $12.34 , $12.34 , See APC Packaged Rates , See APC Packaged Rates , $17.10 , $17.10 , $17.10 , $17.10 , See APC Packaged Rates , $6.44 , $11.03 , $6.44 , $17.82 , $12.87
,5710011458,Hospital Chargemaster,Lip/Prot/Amyl 5/17/24K Cap,Outpatient,Outpatient Default Percent / Case Rate,259, $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
,5710011459,Hospital Chargemaster,Lisinopril 10 mg Tablet,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
,5710011460,Hospital Chargemaster,Lisinopril 5 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
,5710011461,Hospital Chargemaster,Lisinopril 2.5 mg Tablet,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
,5710011463,Hospital Chargemaster,Lisinopril 20 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $3.37 , $1.85 , $2.70 , See APC Packaged Rates , $2.36 , $1.31 , $3.25 , $3.27 , $1.74 , See APC Packaged Rates , See APC Packaged Rates , $2.26 , $2.26 , See APC Packaged Rates , See APC Packaged Rates , $3.13 , $3.13 , $3.13 , $3.13 , See APC Packaged Rates , $1.18 , $2.02 , $1.18 , $3.27 , $2.36
,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, $2.22 , $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
,5710011476,Hospital Chargemaster,Loratadine 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
,5710011478,Hospital Chargemaster,LORazepam 0.5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $1.22 , $0.67 , $0.98 , See APC Packaged Rates , $0.85 , $0.48 , $1.18 , $1.18 , $0.63 , See APC Packaged Rates , See APC Packaged Rates , $0.82 , $0.82 , See APC Packaged Rates , See APC Packaged Rates , $1.13 , $1.13 , $1.13 , $1.13 , See APC Packaged Rates , $0.43 , $0.73 , $0.43 , $1.18 , $0.85
,5710011479,Hospital Chargemaster,LORazepam 1 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
,5710011480,Hospital Chargemaster,LORazepam 2 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $3.11 , $1.71 , $2.49 , See APC Packaged Rates , $2.18 , $1.21 , $3.00 , $3.01 , $1.60 , See APC Packaged Rates , See APC Packaged Rates , $2.09 , $2.09 , See APC Packaged Rates , See APC Packaged Rates , $2.89 , $2.89 , $2.89 , $2.89 , See APC Packaged Rates , $1.09 , $1.87 , $1.09 , $3.01 , $2.18
,5710011484,Hospital Chargemaster,Losartan 25 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $4.28 , $2.35 , $3.42 , See APC Packaged Rates , $3.00 , $1.67 , $4.13 , $4.15 , $2.20 , See APC Packaged Rates , See APC Packaged Rates , $2.87 , $2.87 , See APC Packaged Rates , See APC Packaged Rates , $3.98 , $3.98 , $3.98 , $3.98 , See APC Packaged Rates , $1.50 , $2.57 , $1.50 , $4.15 , $3.00
,5710011485,Hospital Chargemaster,Losartan 50 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $5.74 , $3.16 , $4.59 , See APC Packaged Rates , $4.02 , $2.24 , $5.54 , $5.56 , $2.96 , See APC Packaged Rates , See APC Packaged Rates , $3.85 , $3.85 , See APC Packaged Rates , See APC Packaged Rates , $5.34 , $5.34 , $5.34 , $5.34 , See APC Packaged Rates , $2.01 , $3.44 , $2.01 , $5.56 , $4.02
,5710011491,Hospital Chargemaster,Lurasidone HCl 20 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $116.20 , $63.91 , $92.96 , See APC Packaged Rates , $81.34 , $45.32 , $112.12 , $112.61 , $59.85 , See APC Packaged Rates , See APC Packaged Rates , $77.97 , $77.97 , See APC Packaged Rates , See APC Packaged Rates , $108.07 , $108.07 , $108.07 , $108.07 , See APC Packaged Rates , $40.67 , $69.72 , $40.67 , $112.61 , $81.34
,5710011492,Hospital Chargemaster,Lurasidone HCl 40 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $116.34 , $63.99 , $93.07 , See APC Packaged Rates , $81.44 , $45.37 , $112.26 , $112.75 , $59.92 , See APC Packaged Rates , See APC Packaged Rates , $78.06 , $78.06 , See APC Packaged Rates , See APC Packaged Rates , $108.20 , $108.20 , $108.20 , $108.20 , See APC Packaged Rates , $40.72 , $69.80 , $40.72 , $112.75 , $81.44
,5710011495,Hospital Chargemaster,mg Hyd/Alum Hyd/Sim 30mL Susp,Outpatient,Outpatient Default Percent / Case Rate,259, $9.66 , $5.31 , $7.73 , See APC Packaged Rates , $6.76 , $3.77 , $9.32 , $9.36 , $4.98 , See APC Packaged Rates , See APC Packaged Rates , $6.48 , $6.48 , See APC Packaged Rates , See APC Packaged Rates , $8.98 , $8.98 , $8.98 , $8.98 , See APC Packaged Rates , $3.38 , $5.80 , $3.38 , $9.36 , $6.76
,5710011497,Hospital Chargemaster,Magnesium Cit 300 mL Solution,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
,5710011498,Hospital Chargemaster,Magnesium Hydroxide 30 mL,Outpatient,Outpatient Default Percent / Case Rate,259, $5.97 , $3.28 , $4.78 , See APC Packaged Rates , $4.18 , $2.33 , $5.76 , $5.79 , $3.07 , 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 , $3.58 , $2.09 , $5.79 , $4.18
,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, $1.79 , $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
,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, $0.99 , $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
,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, $24.68 , $13.57 , $19.74 , See APC Packaged Rates , $17.28 , $9.63 , $23.81 , $23.92 , $12.71 , See APC Packaged Rates , See APC Packaged Rates , $16.56 , $16.56 , See APC Packaged Rates , See APC Packaged Rates , $22.95 , $22.95 , $22.95 , $22.95 , See APC Packaged Rates , $8.64 , $14.81 , $8.64 , $23.92 , $17.28
,5710011532,Hospital Chargemaster,Memantine HCl 10 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $18.90 , $10.40 , $15.12 , See APC Packaged Rates , $13.23 , $7.37 , $18.24 , $18.32 , $9.73 , See APC Packaged Rates , See APC Packaged Rates , $12.68 , $12.68 , See APC Packaged Rates , See APC Packaged Rates , $17.58 , $17.58 , $17.58 , $17.58 , See APC Packaged Rates , $6.62 , $11.34 , $6.62 , $18.32 , $13.23
,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, $18.13 , $9.97 , $14.50 , See APC Packaged Rates , $12.69 , $7.07 , $17.49 , $17.57 , $9.34 , See APC Packaged Rates , See APC Packaged Rates , $12.17 , $12.17 , See APC Packaged Rates , See APC Packaged Rates , $16.86 , $16.86 , $16.86 , $16.86 , See APC Packaged Rates , $6.35 , $10.88 , $6.35 , $17.57 , $12.69
,5710011553,Hospital Chargemaster,Mesalamine 400 mg Capsule DR,Outpatient,Outpatient Default Percent / Case Rate,259, $9.82 , $5.40 , $7.86 , See APC Packaged Rates , $6.87 , $3.83 , $9.48 , $9.52 , $5.06 , See APC Packaged Rates , See APC Packaged Rates , $6.59 , $6.59 , See APC Packaged Rates , See APC Packaged Rates , $9.13 , $9.13 , $9.13 , $9.13 , See APC Packaged Rates , $3.44 , $5.89 , $3.44 , $9.52 , $6.87
,5710011554,Hospital Chargemaster,Mesalamine 250 mg Capsule ER,Outpatient,Outpatient Default Percent / Case Rate,259, $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
,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, $1.96 , $1.08 , $1.57 , See APC Packaged Rates , $1.37 , $0.76 , $1.89 , $1.90 , $1.01 , See APC Packaged Rates , See APC Packaged Rates , $1.32 , $1.32 , See APC Packaged Rates , See APC Packaged Rates , $1.82 , $1.82 , $1.82 , $1.82 , See APC Packaged Rates , $0.69 , $1.18 , $0.69 , $1.90 , $1.37
,5710011566,Hospital Chargemaster,Methacholine 100 mg Vial.Neb,Outpatient,Outpatient Default Percent / Case Rate,259, $198.90 , $109.40 , $159.12 , See APC Packaged Rates , $139.23 , $77.57 , $191.92 , $192.75 , $102.44 , See APC Packaged Rates , See APC Packaged Rates , $133.46 , $133.46 , See APC Packaged Rates , See APC Packaged Rates , $184.98 , $184.98 , $184.98 , $184.98 , See APC Packaged Rates , $69.62 , $119.34 , $69.62 , $192.75 , $139.23
,5710011568,Hospital Chargemaster,methADONE 10 mg Tablet,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
,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, $8.62 , $4.74 , $6.90 , See APC Packaged Rates , $6.03 , $3.36 , $8.32 , $8.35 , $4.44 , See APC Packaged Rates , See APC Packaged Rates , $5.78 , $5.78 , See APC Packaged Rates , See APC Packaged Rates , $8.02 , $8.02 , $8.02 , $8.02 , See APC Packaged Rates , $3.02 , $5.17 , $3.02 , $8.35 , $6.03
,5710011576,Hospital Chargemaster,methIMAzole 5 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
,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
,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, $3.11 , $1.71 , $2.49 , See APC Packaged Rates , $2.18 , $1.21 , $3.00 , $3.01 , $1.60 , See APC Packaged Rates , See APC Packaged Rates , $2.09 , $2.09 , See APC Packaged Rates , See APC Packaged Rates , $2.89 , $2.89 , $2.89 , $2.89 , See APC Packaged Rates , $1.09 , $1.87 , $1.09 , $3.01 , $2.18
,5710011609,Hospital Chargemaster,Metoprolol Succ ER 25 mg 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
,5710011610,Hospital Chargemaster,Metoprolol Succ ER 50 mg Tab,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
,5710011612,Hospital Chargemaster,Zolpidem 5 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
,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, $1.45 , $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
,5710011616,Hospital Chargemaster,metroNIDAZOLE 250 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
,5710011641,Hospital Chargemaster,Midodrine HCl 2.5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $3.06 , $1.68 , $2.45 , See APC Packaged Rates , $2.14 , $1.19 , $2.95 , $2.97 , $1.58 , 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 , $1.84 , $1.07 , $2.97 , $2.14
,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
,5710011646,Hospital Chargemaster,Mineral Oil 30 mL OIL,Outpatient,Outpatient Default Percent / Case Rate,259, $2.13 , $1.17 , $1.70 , See APC Packaged Rates , $1.49 , $0.83 , $2.06 , $2.06 , $1.10 , See APC Packaged Rates , See APC Packaged Rates , $1.43 , $1.43 , See APC Packaged Rates , See APC Packaged Rates , $1.98 , $1.98 , $1.98 , $1.98 , See APC Packaged Rates , $0.75 , $1.28 , $0.75 , $2.06 , $1.49
,5710011649,Hospital Chargemaster,Artificial Tears Oph 3.5gm Oin,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
,5710011650,Hospital Chargemaster,Moisturizing Cream 4 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
,5710011658,Hospital Chargemaster,Mirtazapine 15 mg Tablet,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
,5710011660,Hospital Chargemaster,Mirtazapine 7.5 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
,5710011661,Hospital Chargemaster,miSOPROStol 100 mcg Tablet,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
,5710011662,Hospital Chargemaster,miSOPROStol 200 mcg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $3.06 , $1.68 , $2.45 , See APC Packaged Rates , $2.14 , $1.19 , $2.95 , $2.97 , $1.58 , 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 , $1.84 , $1.07 , $2.97 , $2.14
,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
,5710011687,Hospital Chargemaster,Morphine ER 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
,5710011688,Hospital Chargemaster,Morphine ER 30 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
,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, $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
,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, $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
,5710011705,Hospital Chargemaster,Multivitamin 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
,5710011706,Hospital Chargemaster,Multivit/Minerals 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
,5710011707,Hospital Chargemaster,Mupirocin 2 % 22 gm Oint,Outpatient,Outpatient Default Percent / Case Rate,259, $4.84 , $2.66 , $3.87 , See APC Packaged Rates , $3.39 , $1.89 , $4.67 , $4.69 , $2.49 , See APC Packaged Rates , See APC Packaged Rates , $3.25 , $3.25 , See APC Packaged Rates , See APC Packaged Rates , $4.50 , $4.50 , $4.50 , $4.50 , See APC Packaged Rates , $1.69 , $2.90 , $1.69 , $4.69 , $3.39
,5710011709,Hospital Chargemaster,Mycophenolate Mofet 250 mg Cap,Outpatient,Outpatient Default Percent / Case Rate,259, $9.99 , $5.49 , $7.99 , See APC Packaged Rates , $6.99 , $3.90 , $9.64 , $9.68 , $5.15 , See APC Packaged Rates , See APC Packaged Rates , $6.70 , $6.70 , See APC Packaged Rates , See APC Packaged Rates , $9.29 , $9.29 , $9.29 , $9.29 , See APC Packaged Rates , $3.50 , $5.99 , $3.50 , $9.68 , $6.99
,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, $10.99 , $6.04 , $8.79 , See APC Packaged Rates , $7.69 , $4.29 , $10.60 , $10.65 , $5.66 , See APC Packaged Rates , See APC Packaged Rates , $7.37 , $7.37 , See APC Packaged Rates , See APC Packaged Rates , $10.22 , $10.22 , $10.22 , $10.22 , See APC Packaged Rates , $3.85 , $6.59 , $3.85 , $10.65 , $7.69
,5710011729,Hospital Chargemaster,NaPROXEN 250 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
,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, $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
,5710011757,Hospital Chargemaster,Niacin ER 500 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $13.31 , $7.32 , $10.65 , See APC Packaged Rates , $9.32 , $5.19 , $12.84 , $12.90 , $6.85 , See APC Packaged Rates , See APC Packaged Rates , $8.93 , $8.93 , See APC Packaged Rates , See APC Packaged Rates , $12.38 , $12.38 , $12.38 , $12.38 , See APC Packaged Rates , $4.66 , $7.99 , $4.66 , $12.90 , $9.32
,5710011764,Hospital Chargemaster,Nicotine 7 mg PATCH.TD24,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
,5710011765,Hospital Chargemaster,Nicotine 14 mg PATCH.TD24,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
,5710011766,Hospital Chargemaster,Nicotine 21 mg PATCH.TD24,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
,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, $3.40 , $1.87 , $2.72 , See APC Packaged Rates , $2.38 , $1.33 , $3.28 , $3.29 , $1.75 , See APC Packaged Rates , See APC Packaged Rates , $2.28 , $2.28 , See APC Packaged Rates , See APC Packaged Rates , $3.16 , $3.16 , $3.16 , $3.16 , See APC Packaged Rates , $1.19 , $2.04 , $1.19 , $3.29 , $2.38
,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, $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
,5710011787,Hospital Chargemaster,Nitroglycerin 0.4 mg Tab SL,Outpatient,Outpatient Default Percent / Case Rate,259, $3.58 , $1.97 , $2.86 , See APC Packaged Rates , $2.51 , $1.40 , $3.45 , $3.47 , $1.84 , See APC Packaged Rates , See APC Packaged Rates , $2.40 , $2.40 , See APC Packaged Rates , See APC Packaged Rates , $3.33 , $3.33 , $3.33 , $3.33 , See APC Packaged Rates , $1.25 , $2.15 , $1.25 , $3.47 , $2.51
,5710011803,Hospital Chargemaster,Nortriptyline 10 mg Capsule,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
,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, $4.21 , $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
,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, $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
,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, $36.39 , $20.01 , $29.11 , See APC Packaged Rates , $25.47 , $14.19 , $35.11 , $35.27 , $18.74 , See APC Packaged Rates , See APC Packaged Rates , $24.42 , $24.42 , See APC Packaged Rates , See APC Packaged Rates , $33.84 , $33.84 , $33.84 , $33.84 , See APC Packaged Rates , $12.74 , $21.83 , $12.74 , $35.27 , $25.47
,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, $0.97 , $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
,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
,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, $6.86 , $3.77 , $5.49 , See APC Packaged Rates , $4.80 , $2.68 , $6.62 , $6.65 , $3.53 , See APC Packaged Rates , See APC Packaged Rates , $4.60 , $4.60 , See APC Packaged Rates , See APC Packaged Rates , $6.38 , $6.38 , $6.38 , $6.38 , See APC Packaged Rates , $2.40 , $4.12 , $2.40 , $6.65 , $4.80
,5710011865,Hospital Chargemaster,Oxybutynin 5 mg Tablet,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
,5710011866,Hospital Chargemaster,Oxybutynin ER 5 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $8.36 , $4.60 , $6.69 , See APC Packaged Rates , $5.85 , $3.26 , $8.07 , $8.10 , $4.31 , See APC Packaged Rates , See APC Packaged Rates , $5.61 , $5.61 , See APC Packaged Rates , See APC Packaged Rates , $7.77 , $7.77 , $7.77 , $7.77 , See APC Packaged Rates , $2.93 , $5.02 , $2.93 , $8.10 , $5.85
,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, $11.93 , $6.56 , $9.54 , See APC Packaged Rates , $8.35 , $4.65 , $11.51 , $11.56 , $6.14 , See APC Packaged Rates , See APC Packaged Rates , $8.01 , $8.01 , See APC Packaged Rates , See APC Packaged Rates , $11.09 , $11.09 , $11.09 , $11.09 , See APC Packaged Rates , $4.18 , $7.16 , $4.18 , $11.56 , $8.35
,5710011871,Hospital Chargemaster,oxyCODONE ER 20 mg Tab.ER.12H,Outpatient,Outpatient Default Percent / Case Rate,259, $22.42 , $12.33 , $17.94 , See APC Packaged Rates , $15.69 , $8.74 , $21.63 , $21.73 , $11.55 , See APC Packaged Rates , See APC Packaged Rates , $15.04 , $15.04 , See APC Packaged Rates , See APC Packaged Rates , $20.85 , $20.85 , $20.85 , $20.85 , See APC Packaged Rates , $7.85 , $13.45 , $7.85 , $21.73 , $15.69
,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, $1.38 , $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
,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, $9.65 , $5.31 , $7.72 , See APC Packaged Rates , $6.76 , $3.76 , $9.31 , $9.35 , $4.97 , See APC Packaged Rates , See APC Packaged Rates , $6.48 , $6.48 , See APC Packaged Rates , See APC Packaged Rates , $8.97 , $8.97 , $8.97 , $8.97 , See APC Packaged Rates , $3.38 , $5.79 , $3.38 , $9.35 , $6.76
,5710011902,Hospital Chargemaster,Pantoprazole 40 mg Tablet DR,Outpatient,Outpatient Default Percent / Case Rate,259, $10.25 , $5.64 , $8.20 , See APC Packaged Rates , $7.18 , $4.00 , $9.89 , $9.93 , $5.28 , See APC Packaged Rates , See APC Packaged Rates , $6.88 , $6.88 , See APC Packaged Rates , See APC Packaged Rates , $9.53 , $9.53 , $9.53 , $9.53 , See APC Packaged Rates , $3.59 , $6.15 , $3.59 , $9.93 , $7.18
,5710011906,Hospital Chargemaster,PARoxetine 10 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
,5710011907,Hospital Chargemaster,PARoxetine 20 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
,5710011911,Hospital Chargemaster,PEG 3350 4000 mL Sol.RECON,Outpatient,Outpatient Default Percent / Case Rate,259, $119.37 , $65.65 , $95.50 , See APC Packaged Rates , $83.56 , $46.55 , $115.18 , $115.68 , $61.48 , See APC Packaged Rates , See APC Packaged Rates , $80.10 , $80.10 , See APC Packaged Rates , See APC Packaged Rates , $111.01 , $111.01 , $111.01 , $111.01 , See APC Packaged Rates , $41.78 , $71.62 , $41.78 , $115.68 , $83.56
,5710011932,Hospital Chargemaster,Penicill VK 250 mg Tablet,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
,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
,5710011941,Hospital Chargemaster,Perphenazine 2 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $4.57 , $2.51 , $3.66 , See APC Packaged Rates , $3.20 , $1.78 , $4.41 , $4.43 , $2.35 , See APC Packaged Rates , See APC Packaged Rates , $3.07 , $3.07 , See APC Packaged Rates , See APC Packaged Rates , $4.25 , $4.25 , $4.25 , $4.25 , See APC Packaged Rates , $1.60 , $2.74 , $1.60 , $4.43 , $3.20
,5710011942,Hospital Chargemaster,Perphenazine 4 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $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
,5710011947,Hospital Chargemaster,Phenazopyridine 100 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $6.13 , $3.37 , $4.90 , See APC Packaged Rates , $4.29 , $2.39 , $5.91 , $5.94 , $3.16 , See APC Packaged Rates , See APC Packaged Rates , $4.11 , $4.11 , See APC Packaged Rates , See APC Packaged Rates , $5.70 , $5.70 , $5.70 , $5.70 , See APC Packaged Rates , $2.15 , $3.68 , $2.15 , $5.94 , $4.29
,5710011951,Hospital Chargemaster,PHENob/Hyos/Atrop/Scop 5 mL,Outpatient,Outpatient Default Percent / Case Rate,259, $45.33 , $24.93 , $36.26 , See APC Packaged Rates , $31.73 , $17.68 , $43.74 , $43.93 , $23.35 , See APC Packaged Rates , See APC Packaged Rates , $30.42 , $30.42 , See APC Packaged Rates , See APC Packaged Rates , $42.16 , $42.16 , $42.16 , $42.16 , See APC Packaged Rates , $15.87 , $27.20 , $15.87 , $43.93 , $31.73
,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, $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
,5710011960,Hospital Chargemaster,Throat Spray 6 OZ,Outpatient,Outpatient Default Percent / Case Rate,259, $0.75 , $0.41 , $0.60 , See APC Packaged Rates , $0.53 , $0.29 , $0.72 , $0.73 , $0.39 , See APC Packaged Rates , See APC Packaged Rates , $0.50 , $0.50 , See APC Packaged Rates , See APC Packaged Rates , $0.70 , $0.70 , $0.70 , $0.70 , See APC Packaged Rates , $0.26 , $0.45 , $0.26 , $0.73 , $0.53
,5710011963,Hospital Chargemaster,Hemorrhoidal 60 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
,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
,5710011975,Hospital Chargemaster,Phenytoin 50 mg Tab Chew,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
,5710011978,Hospital Chargemaster,Phenytoin Sod Ext 100 mg Cap,Outpatient,Outpatient Default Percent / Case Rate,259, $4.02 , $2.21 , $3.22 , See APC Packaged Rates , $2.81 , $1.57 , $3.88 , $3.90 , $2.07 , See APC Packaged Rates , See APC Packaged Rates , $2.70 , $2.70 , See APC Packaged Rates , See APC Packaged Rates , $3.74 , $3.74 , $3.74 , $3.74 , See APC Packaged Rates , $1.41 , $2.41 , $1.41 , $3.90 , $2.81
,5710011979,Hospital Chargemaster,Phenytoin 30 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $3.14 , $1.73 , $2.51 , See APC Packaged Rates , $2.20 , $1.22 , $3.03 , $3.04 , $1.62 , See APC Packaged Rates , See APC Packaged Rates , $2.11 , $2.11 , See APC Packaged Rates , See APC Packaged Rates , $2.92 , $2.92 , $2.92 , $2.92 , See APC Packaged Rates , $1.10 , $1.88 , $1.10 , $3.04 , $2.20
,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, $4.80 , $2.64 , $3.84 , See APC Packaged Rates , $3.36 , $1.87 , $4.63 , $4.65 , $2.47 , 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 , $2.88 , $1.68 , $4.65 , $3.36
,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, $1.25 , $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
,5710012011,Hospital Chargemaster,Potassium Chl 20 mEq Packet,Outpatient,Outpatient Default Percent / Case Rate,259, $27.39 , $15.06 , $21.91 , See APC Packaged Rates , $19.17 , $10.68 , $26.43 , $26.54 , $14.11 , See APC Packaged Rates , See APC Packaged Rates , $18.38 , $18.38 , See APC Packaged Rates , See APC Packaged Rates , $25.47 , $25.47 , $25.47 , $25.47 , See APC Packaged Rates , $9.59 , $16.43 , $9.59 , $26.54 , $19.17
,5710012046,Hospital Chargemaster,Pramipexole 0.125 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
,5710012047,Hospital Chargemaster,Pramipexole 0.25 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $18.79 , $10.33 , $15.03 , See APC Packaged Rates , $13.15 , $7.33 , $18.13 , $18.21 , $9.68 , See APC Packaged Rates , See APC Packaged Rates , $12.61 , $12.61 , See APC Packaged Rates , See APC Packaged Rates , $17.47 , $17.47 , $17.47 , $17.47 , See APC Packaged Rates , $6.58 , $11.27 , $6.58 , $18.21 , $13.15
,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, $41.97 , $23.08 , $33.58 , See APC Packaged Rates , $29.38 , $16.37 , $40.50 , $40.67 , $21.62 , See APC Packaged Rates , See APC Packaged Rates , $28.16 , $28.16 , See APC Packaged Rates , See APC Packaged Rates , $39.03 , $39.03 , $39.03 , $39.03 , See APC Packaged Rates , $14.69 , $25.18 , $14.69 , $40.67 , $29.38
,5710012053,Hospital Chargemaster,Pravastatin 20 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $8.33 , $4.58 , $6.66 , See APC Packaged Rates , $5.83 , $3.25 , $8.04 , $8.07 , $4.29 , See APC Packaged Rates , See APC Packaged Rates , $5.59 , $5.59 , See APC Packaged Rates , See APC Packaged Rates , $7.75 , $7.75 , $7.75 , $7.75 , See APC Packaged Rates , $2.92 , $5.00 , $2.92 , $8.07 , $5.83
,5710012057,Hospital Chargemaster,Prazosin HCl 1 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $4.62 , $2.54 , $3.70 , See APC Packaged Rates , $3.23 , $1.80 , $4.46 , $4.48 , $2.38 , See APC Packaged Rates , See APC Packaged Rates , $3.10 , $3.10 , See APC Packaged Rates , See APC Packaged Rates , $4.30 , $4.30 , $4.30 , $4.30 , See APC Packaged Rates , $1.62 , $2.77 , $1.62 , $4.48 , $3.23
,5710012058,Hospital Chargemaster,Prazosin HCl 5 mg Capsule,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
,5710012059,Hospital Chargemaster,prednisoLONE Acet 1% 5mL Ophth,Outpatient,Outpatient Default Percent / Case Rate,259, $27.16 , $14.94 , $21.73 , See APC Packaged Rates , $19.01 , $10.59 , $26.21 , $26.32 , $13.99 , See APC Packaged Rates , See APC Packaged Rates , $18.22 , $18.22 , See APC Packaged Rates , See APC Packaged Rates , $25.26 , $25.26 , $25.26 , $25.26 , See APC Packaged Rates , $9.51 , $16.30 , $9.51 , $26.32 , $19.01
,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, $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
,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, $22.58 , $12.42 , $18.06 , See APC Packaged Rates , $15.81 , $8.81 , $21.79 , $21.88 , $11.63 , See APC Packaged Rates , See APC Packaged Rates , $15.15 , $15.15 , See APC Packaged Rates , See APC Packaged Rates , $21.00 , $21.00 , $21.00 , $21.00 , See APC Packaged Rates , $7.90 , $13.55 , $7.90 , $21.88 , $15.81
,5710012072,Hospital Chargemaster,Pregabalin 75 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $24.67 , $13.57 , $19.74 , See APC Packaged Rates , $17.27 , $9.62 , $23.80 , $23.91 , $12.71 , 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 , $14.80 , $8.63 , $23.91 , $17.27
,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, $150.53 , $82.79 , $120.42 , See APC Packaged Rates , $105.37 , $58.71 , $145.25 , $145.88 , $77.53 , See APC Packaged Rates , See APC Packaged Rates , $101.01 , $101.01 , See APC Packaged Rates , See APC Packaged Rates , $139.99 , $139.99 , $139.99 , $139.99 , See APC Packaged Rates , $52.69 , $90.32 , $52.69 , $145.88 , $105.37
,5710012076,Hospital Chargemaster,Primidone 50 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
,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, $2.91 , $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
,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, $5.25 , $2.89 , $4.20 , See APC Packaged Rates , $3.68 , $2.05 , $5.07 , $5.09 , $2.70 , 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 , $3.15 , $1.84 , $5.09 , $3.68
,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, $0.98 , $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
,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, $17.47 , $9.61 , $13.98 , See APC Packaged Rates , $12.23 , $6.81 , $16.86 , $16.93 , $9.00 , See APC Packaged Rates , See APC Packaged Rates , $11.72 , $11.72 , See APC Packaged Rates , See APC Packaged Rates , $16.25 , $16.25 , $16.25 , $16.25 , See APC Packaged Rates , $6.11 , $10.48 , $6.11 , $16.93 , $12.23
,5710012120,Hospital Chargemaster,QUEtiapine 200 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $31.16 , $17.14 , $24.93 , See APC Packaged Rates , $21.81 , $12.15 , $30.07 , $30.20 , $16.05 , See APC Packaged Rates , See APC Packaged Rates , $20.91 , $20.91 , See APC Packaged Rates , See APC Packaged Rates , $28.98 , $28.98 , $28.98 , $28.98 , See APC Packaged Rates , $10.91 , $18.70 , $10.91 , $30.20 , $21.81
,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, $20.94 , $11.52 , $16.75 , See APC Packaged Rates , $14.66 , $8.17 , $20.21 , $20.29 , $10.78 , See APC Packaged Rates , See APC Packaged Rates , $14.05 , $14.05 , See APC Packaged Rates , See APC Packaged Rates , $19.47 , $19.47 , $19.47 , $19.47 , See APC Packaged Rates , $7.33 , $12.56 , $7.33 , $20.29 , $14.66
,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, $3.19 , $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
,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, $77.01 , $42.36 , $61.61 , See APC Packaged Rates , $53.91 , $30.03 , $74.31 , $74.63 , $39.66 , See APC Packaged Rates , See APC Packaged Rates , $51.67 , $51.67 , See APC Packaged Rates , See APC Packaged Rates , $71.62 , $71.62 , $71.62 , $71.62 , See APC Packaged Rates , $26.95 , $46.21 , $26.95 , $74.63 , $53.91
,5710012150,Hospital Chargemaster,Ranolazine 500 mg Tab.ER.12H,Outpatient,Outpatient Default Percent / Case Rate,259, $17.47 , $9.61 , $13.98 , See APC Packaged Rates , $12.23 , $6.81 , $16.86 , $16.93 , $9.00 , See APC Packaged Rates , See APC Packaged Rates , $11.72 , $11.72 , See APC Packaged Rates , See APC Packaged Rates , $16.25 , $16.25 , $16.25 , $16.25 , See APC Packaged Rates , $6.11 , $10.48 , $6.11 , $16.93 , $12.23
,5710012165,Hospital Chargemaster,rifAXIMin 550 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $121.05 , $66.58 , $96.84 , See APC Packaged Rates , $84.74 , $47.21 , $116.80 , $117.31 , $62.34 , See APC Packaged Rates , See APC Packaged Rates , $81.22 , $81.22 , See APC Packaged Rates , See APC Packaged Rates , $112.58 , $112.58 , $112.58 , $112.58 , See APC Packaged Rates , $42.37 , $72.63 , $42.37 , $117.31 , $84.74
,5710012173,Hospital Chargemaster,risperiDONE 0.25 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $9.92 , $5.46 , $7.94 , See APC Packaged Rates , $6.94 , $3.87 , $9.57 , $9.61 , $5.11 , See APC Packaged Rates , See APC Packaged Rates , $6.66 , $6.66 , See APC Packaged Rates , See APC Packaged Rates , $9.23 , $9.23 , $9.23 , $9.23 , See APC Packaged Rates , $3.47 , $5.95 , $3.47 , $9.61 , $6.94
,5710012174,Hospital Chargemaster,risperiDONE 0.5 mg Tablet,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
,5710012175,Hospital Chargemaster,risperiDONE 1 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
,5710012176,Hospital Chargemaster,risperiDONE 2 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $19.35 , $10.64 , $15.48 , See APC Packaged Rates , $13.55 , $7.55 , $18.67 , $18.75 , $9.97 , See APC Packaged Rates , See APC Packaged Rates , $12.98 , $12.98 , See APC Packaged Rates , See APC Packaged Rates , $18.00 , $18.00 , $18.00 , $18.00 , See APC Packaged Rates , $6.77 , $11.61 , $6.77 , $18.75 , $13.55
,5710012177,Hospital Chargemaster,risperiDONE 3 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $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
,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, $43.32 , $23.83 , $34.66 , See APC Packaged Rates , $30.32 , $16.89 , $41.80 , $41.98 , $22.31 , See APC Packaged Rates , See APC Packaged Rates , $29.07 , $29.07 , See APC Packaged Rates , See APC Packaged Rates , $40.29 , $40.29 , $40.29 , $40.29 , See APC Packaged Rates , $15.16 , $25.99 , $15.16 , $41.98 , $30.32
,5710012191,Hospital Chargemaster,Rivaroxaban 15 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $43.22 , $23.77 , $34.58 , See APC Packaged Rates , $30.25 , $16.86 , $41.70 , $41.88 , $22.26 , See APC Packaged Rates , See APC Packaged Rates , $29.00 , $29.00 , See APC Packaged Rates , See APC Packaged Rates , $40.19 , $40.19 , $40.19 , $40.19 , See APC Packaged Rates , $15.13 , $25.93 , $15.13 , $41.88 , $30.25
,5710012193,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
,5710012200,Hospital Chargemaster,rOPINIRole HCl 0.25 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
,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, $2.37 , $1.30 , $1.90 , See APC Packaged Rates , $1.66 , $0.92 , $2.29 , $2.30 , $1.22 , See APC Packaged Rates , See APC Packaged Rates , $1.59 , $1.59 , See APC Packaged Rates , See APC Packaged Rates , $2.20 , $2.20 , $2.20 , $2.20 , See APC Packaged Rates , $0.83 , $1.42 , $0.83 , $2.30 , $1.66
,5710012209,Hospital Chargemaster,Sacubitril/Valsartan 24/26 Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $26.13 , $14.37 , $20.90 , See APC Packaged Rates , $18.29 , $10.19 , $25.21 , $25.32 , $13.46 , See APC Packaged Rates , See APC Packaged Rates , $17.53 , $17.53 , See APC Packaged Rates , See APC Packaged Rates , $24.30 , $24.30 , $24.30 , $24.30 , See APC Packaged Rates , $9.15 , $15.68 , $9.15 , $25.32 , $18.29
,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
,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, $7.27 , $4.00 , $5.82 , See APC Packaged Rates , $5.09 , $2.84 , $7.01 , $7.05 , $3.74 , See APC Packaged Rates , See APC Packaged Rates , $4.88 , $4.88 , See APC Packaged Rates , See APC Packaged Rates , $6.76 , $6.76 , $6.76 , $6.76 , See APC Packaged Rates , $2.54 , $4.36 , $2.54 , $7.05 , $5.09
,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, $7.06 , $3.88 , $5.65 , See APC Packaged Rates , $4.94 , $2.75 , $6.81 , $6.84 , $3.64 , See APC Packaged Rates , See APC Packaged Rates , $4.74 , $4.74 , See APC Packaged Rates , See APC Packaged Rates , $6.57 , $6.57 , $6.57 , $6.57 , See APC Packaged Rates , $2.47 , $4.24 , $2.47 , $6.84 , $4.94
,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, $12.21 , $6.72 , $9.77 , See APC Packaged Rates , $8.55 , $4.76 , $11.78 , $11.83 , $6.29 , See APC Packaged Rates , See APC Packaged Rates , $8.19 , $8.19 , See APC Packaged Rates , See APC Packaged Rates , $11.36 , $11.36 , $11.36 , $11.36 , See APC Packaged Rates , $4.27 , $7.33 , $4.27 , $11.83 , $8.55
,5710012243,Hospital Chargemaster,Simvastatin 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
,5710012248,Hospital Chargemaster,SITagliptin 25 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $43.54 , $23.95 , $34.83 , See APC Packaged Rates , $30.48 , $16.98 , $42.01 , $42.19 , $22.42 , See APC Packaged Rates , See APC Packaged Rates , $29.22 , $29.22 , See APC Packaged Rates , See APC Packaged Rates , $40.49 , $40.49 , $40.49 , $40.49 , See APC Packaged Rates , $15.24 , $26.12 , $15.24 , $42.19 , $30.48
,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, $4.19 , $2.30 , $3.35 , See APC Packaged Rates , $2.93 , $1.63 , $4.04 , $4.06 , $2.16 , See APC Packaged Rates , See APC Packaged Rates , $2.81 , $2.81 , See APC Packaged Rates , See APC Packaged Rates , $3.90 , $3.90 , $3.90 , $3.90 , See APC Packaged Rates , $1.47 , $2.51 , $1.47 , $4.06 , $2.93
,5710012288,Hospital Chargemaster,"Sod,Potass Phosph Powd Pack",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
,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, $6.53 , $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
,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
,5710012314,Hospital Chargemaster,SUMAtriptan 25 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $69.89 , $38.44 , $55.91 , See APC Packaged Rates , $48.92 , $27.26 , $67.44 , $67.73 , $35.99 , See APC Packaged Rates , See APC Packaged Rates , $46.90 , $46.90 , See APC Packaged Rates , See APC Packaged Rates , $65.00 , $65.00 , $65.00 , $65.00 , See APC Packaged Rates , $24.46 , $41.93 , $24.46 , $67.73 , $48.92
,5710012318,Hospital Chargemaster,Tacrolimus 0.5 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $8.13 , $4.47 , $6.50 , See APC Packaged Rates , $5.69 , $3.17 , $7.84 , $7.88 , $4.19 , See APC Packaged Rates , See APC Packaged Rates , $5.46 , $5.46 , See APC Packaged Rates , See APC Packaged Rates , $7.56 , $7.56 , $7.56 , $7.56 , See APC Packaged Rates , $2.85 , $4.88 , $2.85 , $7.88 , $5.69
,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, $10.74 , $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
,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, $7.10 , $3.91 , $5.68 , See APC Packaged Rates , $4.97 , $2.77 , $6.85 , $6.88 , $3.66 , See APC Packaged Rates , See APC Packaged Rates , $4.76 , $4.76 , See APC Packaged Rates , See APC Packaged Rates , $6.60 , $6.60 , $6.60 , $6.60 , See APC Packaged Rates , $2.49 , $4.26 , $2.49 , $6.88 , $4.97
,5710012356,Hospital Chargemaster,Thiamine HCl 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
,5710012371,Hospital Chargemaster,Ticagrelor 90 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $17.87 , $9.83 , $14.30 , See APC Packaged Rates , $12.51 , $6.97 , $17.24 , $17.32 , $9.20 , See APC Packaged Rates , See APC Packaged Rates , $11.99 , $11.99 , See APC Packaged Rates , See APC Packaged Rates , $16.62 , $16.62 , $16.62 , $16.62 , See APC Packaged Rates , $6.25 , $10.72 , $6.25 , $17.32 , $12.51
,5710012374,Hospital Chargemaster,Timolol 0.25 % 5 mL Drops,Outpatient,Outpatient Default Percent / Case Rate,259, $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
,5710012375,Hospital Chargemaster,Timolol 0.5 % 5 mL Drops,Outpatient,Outpatient Default Percent / Case Rate,259, $8.67 , $4.77 , $6.94 , See APC Packaged Rates , $6.07 , $3.38 , $8.37 , $8.40 , $4.47 , See APC Packaged Rates , See APC Packaged Rates , $5.82 , $5.82 , See APC Packaged Rates , See APC Packaged Rates , $8.06 , $8.06 , $8.06 , $8.06 , See APC Packaged Rates , $3.03 , $5.20 , $3.03 , $8.40 , $6.07
,5710012378,Hospital Chargemaster,Tiotropium 18 mcg Cap.W.DEV,Outpatient,Outpatient Default Percent / Case Rate,259, $49.45 , $27.20 , $39.56 , See APC Packaged Rates , $34.62 , $19.29 , $47.71 , $47.92 , $25.47 , See APC Packaged Rates , See APC Packaged Rates , $33.18 , $33.18 , See APC Packaged Rates , See APC Packaged Rates , $45.99 , $45.99 , $45.99 , $45.99 , See APC Packaged Rates , $17.31 , $29.67 , $17.31 , $47.92 , $34.62
,5710012380,Hospital Chargemaster,TiZANidine HCl 2 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $5.43 , $2.99 , $4.34 , See APC Packaged Rates , $3.80 , $2.12 , $5.24 , $5.26 , $2.80 , See APC Packaged Rates , See APC Packaged Rates , $3.64 , $3.64 , See APC Packaged Rates , See APC Packaged Rates , $5.05 , $5.05 , $5.05 , $5.05 , See APC Packaged Rates , $1.90 , $3.26 , $1.90 , $5.26 , $3.80
,5710012392,Hospital Chargemaster,Tolterodine Tartrate 2 mg Tab,Outpatient,Outpatient Default Percent / Case Rate,259, $8.67 , $4.77 , $6.94 , See APC Packaged Rates , $6.07 , $3.38 , $8.37 , $8.40 , $4.47 , See APC Packaged Rates , See APC Packaged Rates , $5.82 , $5.82 , See APC Packaged Rates , See APC Packaged Rates , $8.06 , $8.06 , $8.06 , $8.06 , See APC Packaged Rates , $3.03 , $5.20 , $3.03 , $8.40 , $6.07
,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, $5.36 , $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
,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, $2.04 , $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
,5710012409,Hospital Chargemaster,traZODone HCl 100 mg Tablet,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
,5710012410,Hospital Chargemaster,traZODone HCl 150 mg Tablet,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
,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
,5710012451,Hospital Chargemaster,Ursodiol 300 mg Capsule,Outpatient,Outpatient Default Percent / Case Rate,259, $35.55 , $19.55 , $28.44 , See APC Packaged Rates , $24.89 , $13.86 , $34.30 , $34.45 , $18.31 , See APC Packaged Rates , See APC Packaged Rates , $23.85 , $23.85 , See APC Packaged Rates , See APC Packaged Rates , $33.06 , $33.06 , $33.06 , $33.06 , See APC Packaged Rates , $12.44 , $21.33 , $12.44 , $34.45 , $24.89
,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, $1.91 , $1.05 , $1.53 , See APC Packaged Rates , $1.34 , $0.74 , $1.84 , $1.85 , $0.98 , See APC Packaged Rates , See APC Packaged Rates , $1.28 , $1.28 , See APC Packaged Rates , See APC Packaged Rates , $1.78 , $1.78 , $1.78 , $1.78 , See APC Packaged Rates , $0.67 , $1.15 , $0.67 , $1.85 , $1.34
,5710012464,Hospital Chargemaster,Valsartan 160 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $13.29 , $7.31 , $10.63 , See APC Packaged Rates , $9.30 , $5.18 , $12.82 , $12.88 , $6.84 , See APC Packaged Rates , See APC Packaged Rates , $8.92 , $8.92 , See APC Packaged Rates , See APC Packaged Rates , $12.36 , $12.36 , $12.36 , $12.36 , See APC Packaged Rates , $4.65 , $7.97 , $4.65 , $12.88 , $9.30
,5710012466,Hospital Chargemaster,Valsartan 40 mg Tablet,Outpatient,Outpatient Default Percent / Case Rate,259, $9.82 , $5.40 , $7.86 , See APC Packaged Rates , $6.87 , $3.83 , $9.48 , $9.52 , $5.06 , See APC Packaged Rates , See APC Packaged Rates , $6.59 , $6.59 , See APC Packaged Rates , See APC Packaged Rates , $9.13 , $9.13 , $9.13 , $9.13 , See APC Packaged Rates , $3.44 , $5.89 , $3.44 , $9.52 , $6.87
,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, $10.73 , $5.90 , $8.58 , See APC Packaged Rates , $7.51 , $4.18 , $10.35 , $10.40 , $5.53 , See APC Packaged Rates , See APC Packaged Rates , $7.20 , $7.20 , See APC Packaged Rates , See APC Packaged Rates , $9.98 , $9.98 , $9.98 , $9.98 , See APC Packaged Rates , $3.76 , $6.44 , $3.76 , $10.40 , $7.51
,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, $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
,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, $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
,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, $1.63 , $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
,5710012521,Hospital Chargemaster,Warfarin 3 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
,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, $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
,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, $21.60 , $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
,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, $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
,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
,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, $83.65 , $46.01 , $66.92 , See APC Packaged Rates , $58.56 , $32.62 , $80.71 , $81.07 , $43.08 , See APC Packaged Rates , See APC Packaged Rates , $56.13 , $56.13 , See APC Packaged Rates , See APC Packaged Rates , $77.79 , $77.79 , $77.79 , $77.79 , See APC Packaged Rates , $29.28 , $50.19 , $29.28 , $81.07 , $58.56
,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
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 "
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, $10.73 , $5.90 , $8.84 , See APC Packaged Rates , $7.51 , $4.18 , $10.35 , $10.40 , $5.53 , See APC Packaged Rates , See APC Packaged Rates , $7.20 , $7.20 , See APC Packaged Rates , See APC Packaged Rates , $10.73 , $- , $- , $- , See APC Packaged Rates , $3.76 , $- , $- , $10.73 , $7.51
V5257,5430120002,Hospital Chargemaster,Hearing Aid DIG Monaural BTE,Outpatient,Outpatient Default Percent / Case Rate,271," $1,295.87 ", $712.73 ," $1,067.80 ", See APC Packaged Rates , $907.11 , $505.39 ," $1,250.38 "," $1,255.83 ", $667.40 , See APC Packaged Rates , See APC Packaged Rates , $869.53 , $869.53 , See APC Packaged Rates , See APC Packaged Rates ," $1,205.16 "," $1,205.16 "," $1,205.16 "," $1,205.16 ", See APC Packaged Rates , $453.55 , $- , $- ," $1,255.83 ", $907.11
V5259,5430120003,Hospital Chargemaster,Hearing Aid DIG Binaural ITC,Outpatient,Outpatient Default Percent / Case Rate,271," $2,057.60 "," $1,131.68 "," $1,695.46 ", See APC Packaged Rates ," $1,440.32 ", $802.46 ," $1,985.38 "," $1,994.02 "," $1,059.71 ", See APC Packaged Rates , See APC Packaged Rates ," $1,380.65 "," $1,380.65 ", See APC Packaged Rates , See APC Packaged Rates ," $1,913.57 "," $1,913.57 "," $1,913.57 "," $1,913.57 ", See APC Packaged Rates , $720.16 , $- , $- ," $1,994.02 "," $1,440.32 "
V5260,5430120004,Hospital Chargemaster,Hearing Aid DIG Binaural ITE,Outpatient,Outpatient Default Percent / Case Rate,271," $1,125.00 ", $618.75 , $927.00 , See APC Packaged Rates , $787.50 , $438.75 ," $1,085.51 "," $1,090.24 ", $579.40 , See APC Packaged Rates , See APC Packaged Rates , $754.88 , $754.88 , See APC Packaged Rates , See APC Packaged Rates ," $1,125.00 ", $- , $- , $- , See APC Packaged Rates , $393.75 , $- , $- ," $1,125.00 ", $787.50
V5261,5430120005,Hospital Chargemaster,Hearing Aid DIG Binaural BTE,Outpatient,Outpatient Default Percent / Case Rate,271," $1,955.87 "," $1,075.73 "," $1,611.64 ", See APC Packaged Rates ," $1,369.11 ", $762.79 ," $1,887.22 "," $1,895.43 "," $1,007.31 ", See APC Packaged Rates , See APC Packaged Rates ," $1,312.39 "," $1,312.39 ", See APC Packaged Rates , See APC Packaged Rates ," $1,486.81 ", $- , $- , $- , See APC Packaged Rates , $684.55 , $- , $- ," $1,895.43 "," $1,369.11 "
,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
,61500056,Hospital Chargemaster,Laser Fiber Greenlight Moxy,Outpatient,Outpatient Default Percent / Case Rate,272," $2,756.25 "," $1,515.94 "," $2,205.00 ", See APC Packaged Rates ," $1,929.38 "," $1,074.94 "," $2,659.51 "," $2,671.08 "," $1,419.52 ", See APC Packaged Rates , See APC Packaged Rates ," $1,849.44 "," $1,849.44 ", See APC Packaged Rates , See APC Packaged Rates ," $2,563.31 "," $2,563.31 "," $2,563.31 "," $2,563.31 ", See APC Packaged Rates , $964.69 ," $1,653.75 ", $964.69 ," $2,671.08 "," $1,929.38 "
,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
,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
,61500211,Hospital Chargemaster,Balloon XForce 6mmx4cmx6F,Outpatient,Outpatient Default Percent / Case Rate,272, $601.93 , $331.06 , $481.54 , See APC Packaged Rates , $421.35 , $234.75 , $580.80 , $583.33 , $310.01 , See APC Packaged Rates , See APC Packaged Rates , $403.90 , $403.90 , See APC Packaged Rates , See APC Packaged Rates , $559.79 , $559.79 , $559.79 , $559.79 , See APC Packaged Rates , $210.68 , $361.16 , $210.68 , $583.33 , $421.35
,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," $1,378.16 ", $757.99 ," $1,102.53 ", See APC Packaged Rates , $964.71 , $537.48 ," $1,329.79 "," $1,335.57 ", $709.78 , See APC Packaged Rates , See APC Packaged Rates , $924.75 , $924.75 , See APC Packaged Rates , See APC Packaged Rates ," $1,281.69 "," $1,281.69 "," $1,281.69 "," $1,281.69 ", See APC Packaged Rates , $482.36 , $826.90 , $482.36 ," $1,335.57 ", $964.71
,61500245,Hospital Chargemaster,Sonicbeat Lap 35cm,Outpatient,Outpatient Default Percent / Case Rate,272, $856.01 , $470.81 , $684.81 , See APC Packaged Rates , $599.21 , $333.84 , $825.96 , $829.56 , $440.86 , See APC Packaged Rates , See APC Packaged Rates , $574.38 , $574.38 , See APC Packaged Rates , See APC Packaged Rates , $796.09 , $796.09 , $796.09 , $796.09 , See APC Packaged Rates , $299.60 , $513.61 , $299.60 , $829.56 , $599.21
,61500246,Hospital Chargemaster,Thuderbeat Open Extended,Outpatient,Outpatient Default Percent / Case Rate,272," $1,489.94 ", $819.47 ," $1,191.95 ", See APC Packaged Rates ," $1,042.96 ", $581.08 ," $1,437.64 "," $1,443.90 ", $767.35 , See APC Packaged Rates , See APC Packaged Rates , $999.75 , $999.75 , See APC Packaged Rates , See APC Packaged Rates ," $1,385.64 "," $1,385.64 "," $1,385.64 "," $1,385.64 ", See APC Packaged Rates , $521.48 , $893.96 , $521.48 ," $1,443.90 "," $1,042.96 "
,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
,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
,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," $1,474.20 ", $810.81 ," $1,179.36 ", See APC Packaged Rates ," $1,031.94 ", $574.94 ," $1,422.46 "," $1,428.65 ", $759.24 , See APC Packaged Rates , See APC Packaged Rates , $989.19 , $989.19 , See APC Packaged Rates , See APC Packaged Rates ," $1,371.01 "," $1,371.01 "," $1,371.01 "," $1,371.01 ", See APC Packaged Rates , $515.97 , $884.52 , $515.97 ," $1,428.65 "," $1,031.94 "
,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, $175.43 , $96.49 , $140.34 , See APC Packaged Rates , $122.80 , $68.42 , $169.27 , $170.01 , $90.35 , See APC Packaged Rates , See APC Packaged Rates , $117.71 , $117.71 , See APC Packaged Rates , See APC Packaged Rates , $163.15 , $163.15 , $163.15 , $163.15 , See APC Packaged Rates , $61.40 , $105.26 , $61.40 , $170.01 , $122.80
,61503485,Hospital Chargemaster,Retractor Retentus Pennus,Outpatient,Outpatient Default Percent / Case Rate,272, $198.98 , $109.44 , $159.18 , See APC Packaged Rates , $139.29 , $77.60 , $192.00 , $192.83 , $102.48 , See APC Packaged Rates , See APC Packaged Rates , $133.52 , $133.52 , See APC Packaged Rates , See APC Packaged Rates , $185.05 , $185.05 , $185.05 , $185.05 , See APC Packaged Rates , $69.64 , $119.39 , $69.64 , $192.83 , $139.29
,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, $223.97 , $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
,61508309,Hospital Chargemaster,Staple Disposeable,Outpatient,Outpatient Default Percent / Case Rate,272, $272.43 , $149.84 , $217.94 , See APC Packaged Rates , $190.70 , $106.25 , $262.87 , $264.01 , $140.31 , See APC Packaged Rates , See APC Packaged Rates , $182.80 , $182.80 , See APC Packaged Rates , See APC Packaged Rates , $253.36 , $253.36 , $253.36 , $253.36 , See APC Packaged Rates , $95.35 , $163.46 , $95.35 , $264.01 , $190.70
,61508378,Hospital Chargemaster,"Surgicel 4"" X 8""",Outpatient,Outpatient Default Percent / Case Rate,272, $400.94 , $220.52 , $320.75 , See APC Packaged Rates , $280.66 , $156.37 , $386.87 , $388.55 , $206.49 , See APC Packaged Rates , See APC Packaged Rates , $269.03 , $269.03 , See APC Packaged Rates , See APC Packaged Rates , $372.87 , $372.87 , $372.87 , $372.87 , See APC Packaged Rates , $140.33 , $240.56 , $140.33 , $388.55 , $280.66
,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, $147.39 , $81.06 , $117.91 , See APC Packaged Rates , $103.17 , $57.48 , $142.22 , $142.84 , $75.91 , See APC Packaged Rates , See APC Packaged Rates , $98.90 , $98.90 , See APC Packaged Rates , See APC Packaged Rates , $137.07 , $137.07 , $137.07 , $137.07 , See APC Packaged Rates , $51.59 , $88.43 , $51.59 , $142.84 , $103.17
,61508689,Hospital Chargemaster,Multifire TA 55 Stap,Outpatient,Outpatient Default Percent / Case Rate,272, $271.15 , $149.13 , $216.92 , See APC Packaged Rates , $189.81 , $105.75 , $261.63 , $262.77 , $139.65 , See APC Packaged Rates , See APC Packaged Rates , $181.94 , $181.94 , See APC Packaged Rates , See APC Packaged Rates , $252.17 , $252.17 , $252.17 , $252.17 , See APC Packaged Rates , $94.90 , $162.69 , $94.90 , $262.77 , $189.81
,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, $251.08 , $138.09 , $200.86 , See APC Packaged Rates , $175.76 , $97.92 , $242.27 , $243.32 , $129.31 , See APC Packaged Rates , See APC Packaged Rates , $168.47 , $168.47 , See APC Packaged Rates , See APC Packaged Rates , $233.50 , $233.50 , $233.50 , $233.50 , See APC Packaged Rates , $87.88 , $150.65 , $87.88 , $243.32 , $175.76
,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
,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
,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
,61509942,Hospital Chargemaster,"Cath, Cholangiogsam 18x4.5",Outpatient,Outpatient Default Percent / Case Rate,272, $175.18 , $96.35 , $140.14 , See APC Packaged Rates , $122.63 , $68.32 , $169.03 , $169.77 , $90.22 , See APC Packaged Rates , See APC Packaged Rates , $117.55 , $117.55 , See APC Packaged Rates , See APC Packaged Rates , $162.92 , $162.92 , $162.92 , $162.92 , See APC Packaged Rates , $61.31 , $105.11 , $61.31 , $169.77 , $122.63
,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
,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 "
C1713,61510866,Hospital Chargemaster,Button Nasal Septal,Outpatient,Outpatient Default Percent / Case Rate,272, $809.55 , $445.25 , $667.07 , See APC Packaged Rates , $566.69 , $315.72 , $781.13 , $784.53 , $416.93 , See APC Packaged Rates , See APC Packaged Rates , $543.21 , $543.21 , See APC Packaged Rates , See APC Packaged Rates , $752.88 , $752.88 , $752.88 , $752.88 , See APC Packaged Rates , $283.34 , $- , $- , $784.53 , $566.69
,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
,61511148,Hospital Chargemaster,Stapler Contour Curved Green,Outpatient,Outpatient Default Percent / Case Rate,272," $1,610.34 ", $885.69 ," $1,288.27 ", See APC Packaged Rates ," $1,127.24 ", $628.03 ," $1,553.82 "," $1,560.58 ", $829.36 , See APC Packaged Rates , See APC Packaged Rates ," $1,080.54 "," $1,080.54 ", See APC Packaged Rates , See APC Packaged Rates ," $1,497.62 "," $1,497.62 "," $1,497.62 "," $1,497.62 ", See APC Packaged Rates , $563.62 , $966.20 , $563.62 ," $1,560.58 "," $1,127.24 "
,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, $249.09 , $137.00 , $199.27 , See APC Packaged Rates , $174.36 , $97.15 , $240.35 , $241.39 , $128.29 , See APC Packaged Rates , See APC Packaged Rates , $167.14 , $167.14 , See APC Packaged Rates , See APC Packaged Rates , $231.65 , $231.65 , $231.65 , $231.65 , See APC Packaged Rates , $87.18 , $149.45 , $87.18 , $241.39 , $174.36
,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," $2,283.75 "," $1,256.06 "," $1,827.00 ", See APC Packaged Rates ," $1,598.63 ", $890.66 ," $2,203.59 "," $2,213.18 "," $1,176.18 ", See APC Packaged Rates , See APC Packaged Rates ," $1,532.40 "," $1,532.40 ", See APC Packaged Rates , See APC Packaged Rates ," $2,123.89 "," $2,123.89 "," $2,123.89 "," $2,123.89 ", See APC Packaged Rates , $799.31 ," $1,370.25 ", $799.31 ," $2,213.18 "," $1,598.63 "
,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, $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
,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," $1,684.65 ", $926.56 ," $1,347.72 ", See APC Packaged Rates ," $1,179.26 ", $657.01 ," $1,625.52 "," $1,632.59 ", $867.63 , See APC Packaged Rates , See APC Packaged Rates ," $1,130.40 "," $1,130.40 ", See APC Packaged Rates , See APC Packaged Rates ," $1,566.72 "," $1,566.72 "," $1,566.72 "," $1,566.72 ", See APC Packaged Rates , $589.63 ," $1,010.79 ", $589.63 ," $1,632.59 "," $1,179.26 "
,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, $557.72 , $306.75 , $446.18 , See APC Packaged Rates , $390.40 , $217.51 , $538.14 , $540.49 , $287.24 , See APC Packaged Rates , See APC Packaged Rates , $374.23 , $374.23 , See APC Packaged Rates , See APC Packaged Rates , $518.68 , $518.68 , $518.68 , $518.68 , See APC Packaged Rates , $195.20 , $334.63 , $195.20 , $540.49 , $390.40
,61512164,Hospital Chargemaster,Ligamax Clip Applier,Outpatient,Outpatient Default Percent / Case Rate,272, $439.69 , $241.83 , $351.75 , See APC Packaged Rates , $307.78 , $171.48 , $424.26 , $426.10 , $226.45 , See APC Packaged Rates , See APC Packaged Rates , $295.03 , $295.03 , See APC Packaged Rates , See APC Packaged Rates , $408.91 , $408.91 , $408.91 , $408.91 , See APC Packaged Rates , $153.89 , $263.81 , $153.89 , $426.10 , $307.78
,61512319,Hospital Chargemaster,Cutter Linear Reload Green75M,Outpatient,Outpatient Default Percent / Case Rate,272, $306.29 , $168.46 , $245.03 , See APC Packaged Rates , $214.40 , $119.45 , $295.54 , $296.83 , $157.75 , See APC Packaged Rates , See APC Packaged Rates , $205.52 , $205.52 , See APC Packaged Rates , See APC Packaged Rates , $284.85 , $284.85 , $284.85 , $284.85 , See APC Packaged Rates , $107.20 , $183.77 , $107.20 , $296.83 , $214.40
,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, $843.57 , $463.96 , $674.86 , See APC Packaged Rates , $590.50 , $328.99 , $813.96 , $817.50 , $434.46 , See APC Packaged Rates , See APC Packaged Rates , $566.04 , $566.04 , See APC Packaged Rates , See APC Packaged Rates , $784.52 , $784.52 , $784.52 , $784.52 , See APC Packaged Rates , $295.25 , $506.14 , $295.25 , $817.50 , $590.50
,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," $1,086.91 ", $597.80 , $869.53 , See APC Packaged Rates , $760.84 , $423.89 ," $1,048.76 "," $1,053.32 ", $559.78 , See APC Packaged Rates , See APC Packaged Rates , $729.32 , $729.32 , See APC Packaged Rates , See APC Packaged Rates ," $1,010.83 "," $1,010.83 "," $1,010.83 "," $1,010.83 ", See APC Packaged Rates , $380.42 , $652.15 , $380.42 ," $1,053.32 ", $760.84
,61512728,Hospital Chargemaster,Lead Introducer 7Fr Medtronic,Outpatient,Outpatient Default Percent / Case Rate,272, $183.96 , $101.18 , $147.17 , See APC Packaged Rates , $128.77 , $71.74 , $177.50 , $178.28 , $94.74 , See APC Packaged Rates , See APC Packaged Rates , $123.44 , $123.44 , See APC Packaged Rates , See APC Packaged Rates , $171.08 , $171.08 , $171.08 , $171.08 , See APC Packaged Rates , $64.39 , $110.38 , $64.39 , $178.28 , $128.77
,61512729,Hospital Chargemaster,Lead Introducer 9Fr Medtronic,Outpatient,Outpatient Default Percent / Case Rate,272, $183.96 , $101.18 , $147.17 , See APC Packaged Rates , $128.77 , $71.74 , $177.50 , $178.28 , $94.74 , See APC Packaged Rates , See APC Packaged Rates , $123.44 , $123.44 , See APC Packaged Rates , See APC Packaged Rates , $171.08 , $171.08 , $171.08 , $171.08 , See APC Packaged Rates , $64.39 , $110.38 , $64.39 , $178.28 , $128.77
,61513264,Hospital Chargemaster,Blade Truclear Incisor+ 2.9,Outpatient,Outpatient Default Percent / Case Rate,272," $1,813.28 ", $997.30 ," $1,450.62 ", See APC Packaged Rates ," $1,269.30 ", $707.18 ," $1,749.63 "," $1,757.25 ", $933.88 , See APC Packaged Rates , See APC Packaged Rates ," $1,216.71 "," $1,216.71 ", See APC Packaged Rates , See APC Packaged Rates ," $1,686.35 "," $1,686.35 "," $1,686.35 "," $1,686.35 ", See APC Packaged Rates , $634.65 ," $1,087.97 ", $634.65 ," $1,757.25 "," $1,269.30 "
,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," $1,190.70 ", $654.89 , $952.56 , See APC Packaged Rates , $833.49 , $464.37 ," $1,148.91 "," $1,153.91 ", $613.23 , See APC Packaged Rates , See APC Packaged Rates , $798.96 , $798.96 , See APC Packaged Rates , See APC Packaged Rates ," $1,107.35 "," $1,107.35 "," $1,107.35 "," $1,107.35 ", See APC Packaged Rates , $416.75 , $714.42 , $416.75 ," $1,153.91 ", $833.49
,61513461,Hospital Chargemaster,Tubing In-Flow Truclear,Outpatient,Outpatient Default Percent / Case Rate,272, $443.78 , $244.08 , $355.02 , See APC Packaged Rates , $310.65 , $173.07 , $428.20 , $430.07 , $228.56 , See APC Packaged Rates , See APC Packaged Rates , $297.78 , $297.78 , See APC Packaged Rates , See APC Packaged Rates , $412.72 , $412.72 , $412.72 , $412.72 , See APC Packaged Rates , $155.32 , $266.27 , $155.32 , $430.07 , $310.65
,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, $286.78 , $157.73 , $229.42 , See APC Packaged Rates , $200.75 , $111.84 , $276.71 , $277.92 , $147.70 , See APC Packaged Rates , See APC Packaged Rates , $192.43 , $192.43 , See APC Packaged Rates , See APC Packaged Rates , $266.71 , $266.71 , $266.71 , $266.71 , See APC Packaged Rates , $100.37 , $172.07 , $100.37 , $277.92 , $200.75
,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 "
,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," $2,078.51 "," $1,143.18 "," $1,712.69 ", See APC Packaged Rates ," $1,454.96 ", $810.62 ," $2,005.55 "," $2,014.28 "," $1,070.47 ", See APC Packaged Rates , See APC Packaged Rates ," $1,394.68 "," $1,394.68 ", See APC Packaged Rates , See APC Packaged Rates ," $1,933.01 "," $1,933.01 "," $1,933.01 "," $1,933.01 ", See APC Packaged Rates , $727.48 , $- , $- ," $2,014.28 "," $1,454.96 "
A4649,61513774,Hospital Chargemaster,Lumbarcool Kit 100M,Outpatient,Outpatient Default Percent / Case Rate,272," $2,078.51 "," $1,143.18 "," $1,712.69 ", See APC Packaged Rates ," $1,454.96 ", $810.62 ," $2,005.55 "," $2,014.28 "," $1,070.47 ", See APC Packaged Rates , See APC Packaged Rates ," $1,394.68 "," $1,394.68 ", See APC Packaged Rates , See APC Packaged Rates ," $1,933.01 "," $1,933.01 "," $1,933.01 "," $1,933.01 ", See APC Packaged Rates , $727.48 , $- , $- ," $2,014.28 "," $1,454.96 "
,61513819,Hospital Chargemaster,Cervical Kit,Outpatient,Outpatient Default Percent / Case Rate,272," $2,071.27 "," $1,139.20 "," $1,657.02 ", See APC Packaged Rates ," $1,449.89 ", $807.80 ," $1,998.57 "," $2,007.27 "," $1,066.75 ", See APC Packaged Rates , See APC Packaged Rates ," $1,389.82 "," $1,389.82 ", See APC Packaged Rates , See APC Packaged Rates ," $1,926.28 "," $1,926.28 "," $1,926.28 "," $1,926.28 ", See APC Packaged Rates , $724.94 ," $1,242.76 ", $724.94 ," $2,007.27 "," $1,449.89 "
,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
,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
,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," $1,359.12 ", $747.52 ," $1,087.30 ", See APC Packaged Rates , $951.38 , $530.06 ," $1,311.41 "," $1,317.12 ", $699.97 , See APC Packaged Rates , See APC Packaged Rates , $911.97 , $911.97 , See APC Packaged Rates , See APC Packaged Rates ," $1,263.98 "," $1,263.98 "," $1,263.98 "," $1,263.98 ", See APC Packaged Rates , $475.69 , $815.47 , $475.69 ," $1,317.12 ", $951.38
,61514181,Hospital Chargemaster,Loop Hf Resection 30Deg Mono,Outpatient,Outpatient Default Percent / Case Rate,272, $268.20 , $147.51 , $214.56 , See APC Packaged Rates , $187.74 , $104.60 , $258.79 , $259.91 , $138.13 , See APC Packaged Rates , See APC Packaged Rates , $179.96 , $179.96 , See APC Packaged Rates , See APC Packaged Rates , $249.43 , $249.43 , $249.43 , $249.43 , See APC Packaged Rates , $93.87 , $160.92 , $93.87 , $259.91 , $187.74
,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
,61514346,Hospital Chargemaster,Ethicon Securestrap Absorbabl,Outpatient,Outpatient Default Percent / Case Rate,272," $1,719.03 ", $945.47 ," $1,375.22 ", See APC Packaged Rates ," $1,203.32 ", $670.42 ," $1,658.69 "," $1,665.91 ", $885.33 , See APC Packaged Rates , See APC Packaged Rates ," $1,153.47 "," $1,153.47 ", See APC Packaged Rates , See APC Packaged Rates ," $1,598.70 "," $1,598.70 "," $1,598.70 "," $1,598.70 ", See APC Packaged Rates , $601.66 ," $1,031.42 ", $601.66 ," $1,665.91 "," $1,203.32 "
,61514348,Hospital Chargemaster,Stapler Echelon Flex Powered,Outpatient,Outpatient Default Percent / Case Rate,272," $1,071.46 ", $589.30 , $857.17 , See APC Packaged Rates , $750.02 , $417.87 ," $1,033.85 "," $1,038.35 ", $551.82 , See APC Packaged Rates , See APC Packaged Rates , $718.95 , $718.95 , See APC Packaged Rates , See APC Packaged Rates , $996.46 , $996.46 , $996.46 , $996.46 , See APC Packaged Rates , $375.01 , $642.88 , $375.01 ," $1,038.35 ", $750.02
,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," $1,285.76 ", $707.17 ," $1,028.61 ", See APC Packaged Rates , $900.03 , $501.45 ," $1,240.63 "," $1,246.03 ", $662.19 , See APC Packaged Rates , See APC Packaged Rates , $862.74 , $862.74 , See APC Packaged Rates , See APC Packaged Rates ," $1,195.76 "," $1,195.76 "," $1,195.76 "," $1,195.76 ", See APC Packaged Rates , $450.02 , $771.46 , $450.02 ," $1,246.03 ", $900.03
,61514409,Hospital Chargemaster,Reload 60Mm Gold,Outpatient,Outpatient Default Percent / Case Rate,272, $612.27 , $336.75 , $489.82 , See APC Packaged Rates , $428.59 , $238.79 , $590.78 , $593.35 , $315.33 , See APC Packaged Rates , See APC Packaged Rates , $410.83 , $410.83 , See APC Packaged Rates , See APC Packaged Rates , $569.41 , $569.41 , $569.41 , $569.41 , See APC Packaged Rates , $214.29 , $367.36 , $214.29 , $593.35 , $428.59
,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 "
,61514500,Hospital Chargemaster,Polaris Stent 7 X 24,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
,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, $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
,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 "
,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 "
,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
,61514624,Hospital Chargemaster,Trimano Beach Kit,Outpatient,Outpatient Default Percent / Case Rate,272, $196.88 , $108.28 , $157.50 , See APC Packaged Rates , $137.82 , $76.78 , $189.97 , $190.80 , $101.40 , See APC Packaged Rates , See APC Packaged Rates , $132.11 , $132.11 , See APC Packaged Rates , See APC Packaged Rates , $183.10 , $183.10 , $183.10 , $183.10 , See APC Packaged Rates , $68.91 , $118.13 , $68.91 , $190.80 , $137.82
,61514727,Hospital Chargemaster,Sheath Prosis 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
,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
,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
,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, $222.41 , $122.33 , $177.93 , See APC Packaged Rates , $155.69 , $86.74 , $214.60 , $215.54 , $114.55 , See APC Packaged Rates , See APC Packaged Rates , $149.24 , $149.24 , See APC Packaged Rates , See APC Packaged Rates , $206.84 , $206.84 , $206.84 , $206.84 , See APC Packaged Rates , $77.84 , $133.45 , $77.84 , $215.54 , $155.69
,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
,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, $297.68 , $163.72 , $238.14 , See APC Packaged Rates , $208.38 , $116.10 , $287.23 , $288.48 , $153.31 , See APC Packaged Rates , See APC Packaged Rates , $199.74 , $199.74 , See APC Packaged Rates , See APC Packaged Rates , $276.84 , $276.84 , $276.84 , $276.84 , See APC Packaged Rates , $104.19 , $178.61 , $104.19 , $288.48 , $208.38
,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
,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, $392.65 , $215.96 , $314.12 , See APC Packaged Rates , $274.86 , $153.13 , $378.87 , $380.52 , $202.22 , See APC Packaged Rates , See APC Packaged Rates , $263.47 , $263.47 , See APC Packaged Rates , See APC Packaged Rates , $365.16 , $365.16 , $365.16 , $365.16 , See APC Packaged Rates , $137.43 , $235.59 , $137.43 , $380.52 , $274.86
,61515337,Hospital Chargemaster,Trocar 12Mm X 100Mm,Outpatient,Outpatient Default Percent / Case Rate,272, $528.82 , $290.85 , $423.06 , See APC Packaged Rates , $370.17 , $206.24 , $510.26 , $512.48 , $272.35 , See APC Packaged Rates , See APC Packaged Rates , $354.84 , $354.84 , See APC Packaged Rates , See APC Packaged Rates , $491.80 , $491.80 , $491.80 , $491.80 , See APC Packaged Rates , $185.09 , $317.29 , $185.09 , $512.48 , $370.17
,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, $221.95 , $122.07 , $177.56 , See APC Packaged Rates , $155.37 , $86.56 , $214.16 , $215.09 , $114.31 , See APC Packaged Rates , See APC Packaged Rates , $148.93 , $148.93 , See APC Packaged Rates , See APC Packaged Rates , $206.41 , $206.41 , $206.41 , $206.41 , See APC Packaged Rates , $77.68 , $133.17 , $77.68 , $215.09 , $155.37
,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, $244.68 , $134.57 , $195.74 , See APC Packaged Rates , $171.28 , $95.43 , $236.09 , $237.12 , $126.02 , See APC Packaged Rates , See APC Packaged Rates , $164.18 , $164.18 , See APC Packaged Rates , See APC Packaged Rates , $227.55 , $227.55 , $227.55 , $227.55 , See APC Packaged Rates , $85.64 , $146.81 , $85.64 , $237.12 , $171.28
,61516094,Hospital Chargemaster,Botox Injetak Adjustable,Outpatient,Outpatient Default Percent / Case Rate,272, $195.62 , $107.59 , $156.50 , See APC Packaged Rates , $136.93 , $76.29 , $188.75 , $189.58 , $100.75 , See APC Packaged Rates , See APC Packaged Rates , $131.26 , $131.26 , See APC Packaged Rates , See APC Packaged Rates , $181.93 , $181.93 , $181.93 , $181.93 , See APC Packaged Rates , $68.47 , $117.37 , $68.47 , $189.58 , $136.93
,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
,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
,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, $394.00 , $216.70 , $315.20 , See APC Packaged Rates , $275.80 , $153.66 , $380.17 , $381.83 , $202.92 , See APC Packaged Rates , See APC Packaged Rates , $264.37 , $264.37 , See APC Packaged Rates , See APC Packaged Rates , $366.42 , $366.42 , $366.42 , $366.42 , See APC Packaged Rates , $137.90 , $236.40 , $137.90 , $381.83 , $275.80
,61516142,Hospital Chargemaster,Truclear Ultra Mini Shaver,Outpatient,Outpatient Default Percent / Case Rate,272," $2,952.87 "," $1,624.08 "," $2,362.30 ", See APC Packaged Rates ," $2,067.01 "," $1,151.62 "," $2,849.22 "," $2,861.63 "," $1,520.79 ", See APC Packaged Rates , See APC Packaged Rates ," $1,981.38 "," $1,981.38 ", See APC Packaged Rates , See APC Packaged Rates ," $2,746.17 "," $2,746.17 "," $2,746.17 "," $2,746.17 ", See APC Packaged Rates ," $1,033.50 "," $1,771.72 "," $1,033.50 "," $2,861.63 "," $2,067.01 "
,61516151,Hospital Chargemaster,Savory Gillard Wire Guide,Outpatient,Outpatient Default Percent / Case Rate,272, $371.70 , $204.44 , $297.36 , See APC Packaged Rates , $260.19 , $144.96 , $358.65 , $360.21 , $191.43 , See APC Packaged Rates , See APC Packaged Rates , $249.41 , $249.41 , See APC Packaged Rates , See APC Packaged Rates , $345.68 , $345.68 , $345.68 , $345.68 , See APC Packaged Rates , $130.10 , $223.02 , $130.10 , $360.21 , $260.19
,61516161,Hospital Chargemaster,Reamer Shaft Modified Trinkle,Outpatient,Outpatient Default Percent / Case Rate,272, $856.17 , $470.89 , $684.94 , See APC Packaged Rates , $599.32 , $333.91 , $826.12 , $829.71 , $440.94 , See APC Packaged Rates , See APC Packaged Rates , $574.49 , $574.49 , See APC Packaged Rates , See APC Packaged Rates , $796.24 , $796.24 , $796.24 , $796.24 , See APC Packaged Rates , $299.66 , $513.70 , $299.66 , $829.71 , $599.32
C1713,61516162,Hospital Chargemaster,Elastic Nail Insertion Sleeve,Outpatient,Outpatient Default Percent / Case Rate,272, $240.98 , $132.54 , $198.57 , See APC Packaged Rates , $168.69 , $93.98 , $232.52 , $233.53 , $124.11 , See APC Packaged Rates , See APC Packaged Rates , $161.70 , $161.70 , See APC Packaged Rates , See APC Packaged Rates , $224.11 , $224.11 , $224.11 , $224.11 , See APC Packaged Rates , $84.34 , $- , $- , $233.53 , $168.69
,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
,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
,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
,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
,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
,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, $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
,61532065,Hospital Chargemaster,Sphincterotome Biliary Wire,Outpatient,Outpatient Default Percent / Case Rate,272, $785.58 , $432.07 , $628.46 , See APC Packaged Rates , $549.91 , $306.38 , $758.01 , $761.31 , $404.59 , See APC Packaged Rates , See APC Packaged Rates , $527.12 , $527.12 , See APC Packaged Rates , See APC Packaged Rates , $730.59 , $730.59 , $730.59 , $730.59 , See APC Packaged Rates , $274.95 , $471.35 , $274.95 , $761.31 , $549.91
,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
,61532070,Hospital Chargemaster,Cytology Brush Biliary,Outpatient,Outpatient Default Percent / Case Rate,272, $349.98 , $192.49 , $279.98 , See APC Packaged Rates , $244.99 , $136.49 , $337.70 , $339.17 , $180.25 , See APC Packaged Rates , See APC Packaged Rates , $234.84 , $234.84 , See APC Packaged Rates , See APC Packaged Rates , $325.48 , $325.48 , $325.48 , $325.48 , See APC Packaged Rates , $122.49 , $209.99 , $122.49 , $339.17 , $244.99
,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, $711.24 , $391.18 , $568.99 , See APC Packaged Rates , $497.87 , $277.38 , $686.28 , $689.26 , $366.30 , See APC Packaged Rates , See APC Packaged Rates , $477.24 , $477.24 , See APC Packaged Rates , See APC Packaged Rates , $661.45 , $661.45 , $661.45 , $661.45 , See APC Packaged Rates , $248.93 , $426.74 , $248.93 , $689.26 , $497.87
,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
,61533055,Hospital Chargemaster,Probe Straight Fire 2.3Mm,Outpatient,Outpatient Default Percent / Case Rate,272, $703.97 , $387.18 , $563.18 , See APC Packaged Rates , $492.78 , $274.55 , $679.26 , $682.22 , $362.56 , See APC Packaged Rates , See APC Packaged Rates , $472.36 , $472.36 , See APC Packaged Rates , See APC Packaged Rates , $654.69 , $654.69 , $654.69 , $654.69 , See APC Packaged Rates , $246.39 , $422.38 , $246.39 , $682.22 , $492.78
,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, $582.75 , $320.51 , $466.20 , See APC Packaged Rates , $407.93 , $227.27 , $562.30 , $564.74 , $300.13 , See APC Packaged Rates , See APC Packaged Rates , $391.03 , $391.03 , See APC Packaged Rates , See APC Packaged Rates , $541.96 , $541.96 , $541.96 , $541.96 , See APC Packaged Rates , $203.96 , $349.65 , $203.96 , $564.74 , $407.93
,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, $708.50 , $389.68 , $566.80 , See APC Packaged Rates , $495.95 , $276.32 , $683.63 , $686.61 , $364.89 , See APC Packaged Rates , See APC Packaged Rates , $475.40 , $475.40 , See APC Packaged Rates , See APC Packaged Rates , $658.91 , $658.91 , $658.91 , $658.91 , See APC Packaged Rates , $247.98 , $425.10 , $247.98 , $686.61 , $495.95
,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, $706.84 , $388.76 , $565.47 , See APC Packaged Rates , $494.79 , $275.67 , $682.03 , $685.00 , $364.04 , See APC Packaged Rates , See APC Packaged Rates , $474.29 , $474.29 , See APC Packaged Rates , See APC Packaged Rates , $657.36 , $657.36 , $657.36 , $657.36 , See APC Packaged Rates , $247.39 , $424.10 , $247.39 , $685.00 , $494.79
,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
,61533138,Hospital Chargemaster,Novagold High Performance,Outpatient,Outpatient Default Percent / Case Rate,272, $551.25 , $303.19 , $441.00 , See APC Packaged Rates , $385.88 , $214.99 , $531.90 , $534.22 , $283.90 , See APC Packaged Rates , See APC Packaged Rates , $369.89 , $369.89 , See APC Packaged Rates , See APC Packaged Rates , $512.66 , $512.66 , $512.66 , $512.66 , See APC Packaged Rates , $192.94 , $330.75 , $192.94 , $534.22 , $385.88
,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, $767.48 , $422.11 , $613.98 , See APC Packaged Rates , $537.24 , $299.32 , $740.54 , $743.76 , $395.27 , See APC Packaged Rates , See APC Packaged Rates , $514.98 , $514.98 , See APC Packaged Rates , See APC Packaged Rates , $713.76 , $713.76 , $713.76 , $713.76 , See APC Packaged Rates , $268.62 , $460.49 , $268.62 , $743.76 , $537.24
,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
C1892,61508816,Hospital Chargemaster,Lead Introducer 9Fr,Outpatient,Outpatient Default Percent / Case Rate,275, $168.53 , $92.69 , $138.87 , See APC Packaged Rates , $117.97 , $65.73 , $162.61 , $163.32 , $86.80 , See APC Packaged Rates , See APC Packaged Rates , $63.20 , $63.20 , See APC Packaged Rates , See APC Packaged Rates , $156.73 , $156.73 , $156.73 , $156.73 , See APC Packaged Rates , $58.99 , $- , $- , $163.32 , $117.97
C1779,61510173,Hospital Chargemaster,Pacing Lead #5076-58,Outpatient,Outpatient Default Percent / Case Rate,275," $1,044.40 ", $574.42 , $860.59 , See APC Packaged Rates , $731.08 , $407.32 ," $1,007.74 "," $1,012.13 ", $537.89 , See APC Packaged Rates , See APC Packaged Rates , $391.65 , $391.65 , See APC Packaged Rates , See APC Packaged Rates , $971.29 , $971.29 , $971.29 , $971.29 , See APC Packaged Rates , $365.54 , $- , $- ," $1,012.13 ", $731.08
C1898,61510928,Hospital Chargemaster,Pacing Lead,Outpatient,Outpatient Default Percent / Case Rate,275," $1,079.87 ", $593.93 , $889.81 , See APC Packaged Rates , $755.91 , $421.15 ," $1,041.97 "," $1,046.50 ", $556.15 , See APC Packaged Rates , See APC Packaged Rates , $404.95 , $404.95 , See APC Packaged Rates , See APC Packaged Rates ," $1,004.28 "," $1,004.28 "," $1,004.28 "," $1,004.28 ", See APC Packaged Rates , $377.95 , $- , $- ," $1,046.50 ", $755.91
,61514545,Hospital Chargemaster,Pacing Lead A-Lead,Outpatient,Outpatient Default Percent / Case Rate,275," $1,097.60 ", $603.68 , $878.08 , 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 , $658.56 , $384.16 ," $1,063.68 ", $768.32
C1785,61514878,Hospital Chargemaster,Pacemaker Azure Xt Dr Mri,Outpatient,Outpatient Default Percent / Case Rate,275," $9,778.67 "," $5,378.27 "," $8,057.62 ", See APC Packaged Rates ," $6,845.07 "," $3,813.68 "," $9,435.44 "," $9,476.51 "," $5,036.21 ", See APC Packaged Rates , See APC Packaged Rates ," $3,667.00 "," $3,667.00 ", See APC Packaged Rates , See APC Packaged Rates ," $9,094.16 "," $9,094.16 "," $9,094.16 "," $9,094.16 ", See APC Packaged Rates ," $3,422.53 ", $- , $- ," $9,476.51 "," $6,845.07 "
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 "
C1786,61515231,Hospital Chargemaster,Azure Xt Sr Mri Device,Outpatient,Outpatient Default Percent / Case Rate,275," $7,313.60 "," $4,022.48 "," $6,026.41 ", See APC Packaged Rates ," $5,119.52 "," $2,852.30 "," $7,056.89 "," $7,087.61 "," $3,766.65 ", See APC Packaged Rates , See APC Packaged Rates ," $2,742.60 "," $2,742.60 ", See APC Packaged Rates , See APC Packaged Rates ," $6,801.65 "," $6,801.65 "," $6,801.65 "," $6,801.65 ", See APC Packaged Rates ," $2,559.76 ", $- , $- ," $7,087.61 "," $5,119.52 "
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 "
C1898,61516202,Hospital Chargemaster,Lead 407645 Pkg Assy,Outpatient,Outpatient Default Percent / Case Rate,275," $1,084.30 ", $596.37 , $893.46 , See APC Packaged Rates , $759.01 , $422.88 ," $1,046.24 "," $1,050.80 ", $558.44 , See APC Packaged Rates , See APC Packaged Rates , $406.61 , $406.61 , See APC Packaged Rates , See APC Packaged Rates ," $1,008.40 "," $1,008.40 "," $1,008.40 "," $1,008.40 ", See APC Packaged Rates , $379.51 , $- , $- ," $1,050.80 ", $759.01
C1898,61516203,Hospital Chargemaster,Lead 407658 Pkg Assy,Outpatient,Outpatient Default Percent / Case Rate,275," $1,086.96 ", $597.83 , $895.66 , See APC Packaged Rates , $760.87 , $423.91 ," $1,048.81 "," $1,053.37 ", $559.81 , See APC Packaged Rates , See APC Packaged Rates , $407.61 , $407.61 , See APC Packaged Rates , See APC Packaged Rates ," $1,010.87 "," $1,010.87 "," $1,010.87 "," $1,010.87 ", See APC Packaged Rates , $380.44 , $- , $- ," $1,053.37 ", $760.87
C1721,61516215,Hospital Chargemaster,Defibrillator Dual Chamber,Outpatient,Outpatient Default Percent / Case Rate,275," $31,948.00 "," $17,571.40 "," $26,325.15 ", See APC Packaged Rates ," $22,363.60 "," $12,459.72 "," $30,826.63 "," $30,960.81 "," $16,453.86 ", See APC Packaged Rates , See APC Packaged Rates ," $11,980.50 "," $11,980.50 ", See APC Packaged Rates , See APC Packaged Rates ," $29,711.64 "," $29,711.64 "," $29,711.64 "," $29,711.64 ", See APC Packaged Rates ," $11,181.80 ", $- , $- ," $30,960.81 "," $22,363.60 "
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
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 "
C1788,61500154,Hospital Chargemaster,PowerPort 8 FR ISP,Outpatient,Outpatient Default Percent / Case Rate,278, $724.50 , $398.48 , $596.99 , See APC Packaged Rates , $507.15 , $282.56 , $699.07 , $702.11 , $373.13 , See APC Packaged Rates , See APC Packaged Rates , $241.26 , $241.26 , See APC Packaged Rates , See APC Packaged Rates , $673.79 , $673.79 , $673.79 , $673.79 , See APC Packaged Rates , $253.58 , $- , $- , $702.11 , $507.15
C1713,61500162,Hospital Chargemaster,T2 Recon 3.2mm X 400mm K Wire,Outpatient,Outpatient Default Percent / Case Rate,278, $279.72 , $153.85 , $230.49 , See APC Packaged Rates , $195.80 , $109.09 , $269.90 , $271.08 , $144.06 , See APC Packaged Rates , See APC Packaged Rates , $93.15 , $93.15 , See APC Packaged Rates , See APC Packaged Rates , $260.14 , $260.14 , $260.14 , $260.14 , See APC Packaged Rates , $97.90 , $- , $- , $271.08 , $195.80
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
C1713,61500165,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
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 "
C1713,61500196,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
C1713,61500198,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
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 "
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
C1713,61500282,Hospital Chargemaster,K-Wire Wdrill Tip,Outpatient,Outpatient Default Percent / Case Rate,278, $96.39 , $53.01 , $79.43 , See APC Packaged Rates , $67.47 , $37.59 , $93.01 , $93.41 , $49.64 , See APC Packaged Rates , See APC Packaged Rates , $32.10 , $32.10 , See APC Packaged Rates , See APC Packaged Rates , $89.64 , $89.64 , $89.64 , $89.64 , See APC Packaged Rates , $33.74 , $- , $- , $93.41 , $67.47
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, $252.00 , $138.60 , $207.65 , See APC Packaged Rates , $176.40 , $98.28 , $243.15 , $244.21 , $129.79 , See APC Packaged Rates , See APC Packaged Rates , $83.92 , $83.92 , See APC Packaged Rates , See APC Packaged Rates , $234.36 , $234.36 , $234.36 , $234.36 , See APC Packaged Rates , $88.20 , $- , $- , $244.21 , $176.40
C1875,61500297,Hospital Chargemaster,Stent inlay optima 7FRx26cm,Outpatient,Outpatient Default Percent / Case Rate,278, $252.00 , $138.60 , $207.65 , See APC Packaged Rates , $176.40 , $98.28 , $243.15 , $244.21 , $129.79 , See APC Packaged Rates , See APC Packaged Rates , $83.92 , $83.92 , See APC Packaged Rates , See APC Packaged Rates , $234.36 , $234.36 , $234.36 , $234.36 , See APC Packaged Rates , $88.20 , $- , $- , $244.21 , $176.40
C1875,61500298,Hospital Chargemaster,Stent inlay optima 7FRx26cm,Outpatient,Outpatient Default Percent / Case Rate,278, $252.00 , $138.60 , $207.65 , See APC Packaged Rates , $176.40 , $98.28 , $243.15 , $244.21 , $129.79 , See APC Packaged Rates , See APC Packaged Rates , $83.92 , $83.92 , See APC Packaged Rates , See APC Packaged Rates , $234.36 , $234.36 , $234.36 , $234.36 , See APC Packaged Rates , $88.20 , $- , $- , $244.21 , $176.40
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 "
C1713,61500318,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
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
C1713,61500346,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 "
C1713,61500348,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
,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, $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
A4649,61508483,Hospital Chargemaster,Goode T-Tubes,Outpatient,Outpatient Default Percent / Case Rate,278, $133.16 , $73.24 , $109.72 , See APC Packaged Rates , $93.21 , $51.93 , $128.49 , $129.05 , $68.58 , See APC Packaged Rates , See APC Packaged Rates , $44.34 , $44.34 , See APC Packaged Rates , See APC Packaged Rates , $123.84 , $123.84 , $123.84 , $123.84 , See APC Packaged Rates , $46.61 , $- , $- , $129.05 , $93.21
,61508610,Hospital Chargemaster,Gastrostomy Introduce,Outpatient,Outpatient Default Percent / Case Rate,278, $393.38 , $216.36 , $314.70 , See APC Packaged Rates , $275.37 , $153.42 , $379.57 , $381.22 , $202.60 , See APC Packaged Rates , See APC Packaged Rates , $131.00 , $131.00 , See APC Packaged Rates , See APC Packaged Rates , $365.84 , $365.84 , $365.84 , $365.84 , See APC Packaged Rates , $137.68 , $236.03 , $131.00 , $381.22 , $275.37
C1781,61509253,Hospital Chargemaster,"Mesh,Marlex 3x6",Outpatient,Outpatient Default Percent / Case Rate,278, $111.44 , $61.29 , $91.83 , See APC Packaged Rates , $78.01 , $43.46 , $107.53 , $108.00 , $57.39 , See APC Packaged Rates , See APC Packaged Rates , $37.11 , $37.11 , See APC Packaged Rates , See APC Packaged Rates , $103.64 , $103.64 , $103.64 , $103.64 , See APC Packaged Rates , $39.00 , $- , $- , $108.00 , $78.01
C1781,61509256,Hospital Chargemaster,"Mesh, Marlex 1x4",Outpatient,Outpatient Default Percent / Case Rate,278, $81.97 , $45.08 , $67.54 , See APC Packaged Rates , $57.38 , $31.97 , $79.09 , $79.44 , $42.22 , See APC Packaged Rates , See APC Packaged Rates , $27.30 , $27.30 , See APC Packaged Rates , See APC Packaged Rates , $76.23 , $76.23 , $76.23 , $76.23 , See APC Packaged Rates , $28.69 , $- , $- , $79.44 , $57.38
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, $421.70 , $231.94 , $347.48 , See APC Packaged Rates , $295.19 , $164.46 , $406.90 , $408.67 , $217.18 , See APC Packaged Rates , See APC Packaged Rates , $140.43 , $140.43 , See APC Packaged Rates , See APC Packaged Rates , $392.18 , $392.18 , $392.18 , $392.18 , See APC Packaged Rates , $147.60 , $- , $- , $408.67 , $295.19
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
C1713,61509687,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
,61509741,Hospital Chargemaster,Tube Paprella Vent,Outpatient,Outpatient Default Percent / Case Rate,278, $49.40 , $27.17 , $39.52 , See APC Packaged Rates , $34.58 , $19.27 , $47.67 , $47.87 , $25.44 , See APC Packaged Rates , See APC Packaged Rates , $16.45 , $16.45 , See APC Packaged Rates , See APC Packaged Rates , $45.94 , $45.94 , $45.94 , $45.94 , See APC Packaged Rates , $17.29 , $29.64 , $16.45 , $47.87 , $34.58
C1713,61510006,Hospital Chargemaster,Screw Lag 85M,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
,61510015,Hospital Chargemaster,Universal Cement Restrictor,Outpatient,Outpatient Default Percent / Case Rate,278, $378.90 , $208.40 , $303.12 , See APC Packaged Rates , $265.23 , $147.77 , $365.60 , $367.19 , $195.14 , See APC Packaged Rates , See APC Packaged Rates , $126.17 , $126.17 , See APC Packaged Rates , See APC Packaged Rates , $352.38 , $352.38 , $352.38 , $352.38 , See APC Packaged Rates , $132.62 , $227.34 , $126.17 , $367.19 , $265.23
C1713,61510056,Hospital Chargemaster,Screw Cancellous Bone,Outpatient,Outpatient Default Percent / Case Rate,278, $353.85 , $194.62 , $291.57 , See APC Packaged Rates , $247.70 , $138.00 , $341.43 , $342.92 , $182.24 , See APC Packaged Rates , See APC Packaged Rates , $117.83 , $117.83 , See APC Packaged Rates , See APC Packaged Rates , $329.08 , $329.08 , $329.08 , $329.08 , See APC Packaged Rates , $123.85 , $- , $- , $342.92 , $247.70
C1713,61510057,Hospital Chargemaster,Screw Cancellous Bone,Outpatient,Outpatient Default Percent / Case Rate,278, $359.46 , $197.70 , $296.20 , See APC Packaged Rates , $251.62 , $140.19 , $346.84 , $348.35 , $185.13 , See APC Packaged Rates , See APC Packaged Rates , $119.70 , $119.70 , See APC Packaged Rates , See APC Packaged Rates , $334.30 , $334.30 , $334.30 , $334.30 , See APC Packaged Rates , $125.81 , $- , $- , $348.35 , $251.62
,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," $1,732.50 ", $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 "
C1713,61510109,Hospital Chargemaster,Cancellous Bone Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $314.58 , $173.02 , $259.21 , See APC Packaged Rates , $220.21 , $122.69 , $303.54 , $304.86 , $162.01 , See APC Packaged Rates , See APC Packaged Rates , $104.76 , $104.76 , See APC Packaged Rates , See APC Packaged Rates , $292.56 , $292.56 , $292.56 , $292.56 , See APC Packaged Rates , $110.10 , $- , $- , $304.86 , $220.21
,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 "
,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," $1,732.50 ", $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 "
C1713,61510381,Hospital Chargemaster,Lag Screw 80M,Outpatient,Outpatient Default Percent / Case Rate,278, $655.45 , $360.50 , $540.09 , See APC Packaged Rates , $458.82 , $255.63 , $632.44 , $635.20 , $337.57 , See APC Packaged Rates , See APC Packaged Rates , $218.26 , $218.26 , See APC Packaged Rates , See APC Packaged Rates , $609.57 , $609.57 , $609.57 , $609.57 , See APC Packaged Rates , $229.41 , $- , $- , $635.20 , $458.82
,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
C1713,61510685,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
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
,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 "
,61510888,Hospital Chargemaster,Thyroplasty Implant,Outpatient,Outpatient Default Percent / Case Rate,278," $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 , $729.02 , $729.02 , 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 ", $729.02 ," $2,121.60 "," $1,532.48 "
C1781,61510985,Hospital Chargemaster,Mesh 3Dmax Med Left,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
C1781,61510987,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
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
C1713,61511114,Hospital Chargemaster,Screw Locking 2.3 X 26M,Outpatient,Outpatient Default Percent / Case Rate,278, $220.50 , $121.28 , $181.69 , See APC Packaged Rates , $154.35 , $86.00 , $212.76 , $213.69 , $113.56 , See APC Packaged Rates , See APC Packaged Rates , $73.43 , $73.43 , See APC Packaged Rates , See APC Packaged Rates , $205.07 , $205.07 , $205.07 , $205.07 , See APC Packaged Rates , $77.18 , $- , $- , $213.69 , $154.35
C1769,61511121,Hospital Chargemaster,Guide Wire .054,Outpatient,Outpatient Default Percent / Case Rate,278, $50.40 , $27.72 , $41.53 , See APC Packaged Rates , $35.28 , $19.66 , $48.63 , $48.84 , $25.96 , See APC Packaged Rates , See APC Packaged Rates , $16.78 , $16.78 , See APC Packaged Rates , See APC Packaged Rates , $46.87 , $46.87 , $46.87 , $46.87 , See APC Packaged Rates , $17.64 , $- , $- , $48.84 , $35.28
,61511169,Hospital Chargemaster,Femoral Head Std 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 "
,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 "
C1713,61511304,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," $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 "
,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 "
,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 "
C1713,61511428,Hospital Chargemaster,Softsilk Interface Screw 7X30,Outpatient,Outpatient Default Percent / Case Rate,278, $365.09 , $200.80 , $300.83 , See APC Packaged Rates , $255.56 , $142.39 , $352.28 , $353.81 , $188.03 , See APC Packaged Rates , See APC Packaged Rates , $121.57 , $121.57 , See APC Packaged Rates , See APC Packaged Rates , $339.53 , $339.53 , $339.53 , $339.53 , See APC Packaged Rates , $127.78 , $- , $- , $353.81 , $255.56
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, $425.25 , $233.89 , $350.41 , See APC Packaged Rates , $297.68 , $165.85 , $410.32 , $412.11 , $219.01 , See APC Packaged Rates , See APC Packaged Rates , $141.61 , $141.61 , See APC Packaged Rates , See APC Packaged Rates , $395.48 , $395.48 , $395.48 , $395.48 , See APC Packaged Rates , $148.84 , $- , $- , $412.11 , $297.68
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
,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
,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 "
C1713,61511670,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 "
,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 "
C1713,61511695,Hospital Chargemaster,Femoral Component Cr #2 Left,Outpatient,Outpatient Default Percent / Case Rate,278," $4,698.75 "," $2,584.31 "," $3,871.77 ", See APC Packaged Rates ," $3,289.13 "," $1,832.51 "," $4,533.82 "," $4,553.56 "," $2,419.95 ", See APC Packaged Rates , See APC Packaged Rates ," $1,564.68 "," $1,564.68 ", See APC Packaged Rates , See APC Packaged Rates ," $4,369.84 "," $4,369.84 "," $4,369.84 "," $4,369.84 ", See APC Packaged Rates ," $1,644.56 ", $- , $- ," $4,553.56 "," $3,289.13 "
,61511738,Hospital Chargemaster,Cr Femoral Component #3 Right,Outpatient,Outpatient Default Percent / Case Rate,278," $4,698.75 "," $2,584.31 "," $3,759.00 ", See APC Packaged Rates ," $3,289.13 "," $1,832.51 "," $4,533.82 "," $4,553.56 "," $2,419.95 ", See APC Packaged Rates , See APC Packaged Rates ," $1,564.68 "," $1,564.68 ", See APC Packaged Rates , See APC Packaged Rates ," $4,369.84 "," $4,369.84 "," $4,369.84 "," $4,369.84 ", See APC Packaged Rates ," $1,644.56 "," $2,819.25 "," $1,564.68 "," $4,553.56 "," $3,289.13 "
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
,61511874,Hospital Chargemaster,C-Taper Neck Sleeve 10Mm,Outpatient,Outpatient Default Percent / Case Rate,278, $462.82 , $254.55 , $370.26 , See APC Packaged Rates , $323.97 , $180.50 , $446.58 , $448.52 , $238.36 , See APC Packaged Rates , See APC Packaged Rates , $154.12 , $154.12 , See APC Packaged Rates , See APC Packaged Rates , $430.42 , $430.42 , $430.42 , $430.42 , See APC Packaged Rates , $161.99 , $277.69 , $154.12 , $448.52 , $323.97
,61511915,Hospital Chargemaster,Asymmetric Patella A35 - 10 M,Outpatient,Outpatient Default Percent / Case Rate,278," $1,611.35 ", $886.24 ," $1,289.08 ", See APC Packaged Rates ," $1,127.95 ", $628.43 ," $1,554.79 "," $1,561.56 ", $829.88 , See APC Packaged Rates , See APC Packaged Rates , $536.58 , $536.58 , See APC Packaged Rates , See APC Packaged Rates ," $1,498.56 "," $1,498.56 "," $1,498.56 "," $1,498.56 ", See APC Packaged Rates , $563.97 , $966.81 , $536.58 ," $1,561.56 "," $1,127.95 "
C1713,61512051,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 "
C1713,61512052,Hospital Chargemaster,Femoral Component Pkr Size 3,Outpatient,Outpatient Default Percent / Case Rate,278," $4,410.00 "," $2,425.50 "," $3,633.84 ", 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 ", $- , $- ," $4,273.73 "," $3,087.00 "
,61512083,Hospital Chargemaster,Femoral Component #3 Lt,Outpatient,Outpatient Default Percent / Case Rate,278," $4,593.75 "," $2,526.56 "," $3,675.00 ", See APC Packaged Rates ," $3,215.63 "," $1,791.56 "," $4,432.51 "," $4,451.80 "," $2,365.87 ", See APC Packaged Rates , See APC Packaged Rates ," $1,529.72 "," $1,529.72 ", See APC Packaged Rates , See APC Packaged Rates ," $4,272.19 "," $4,272.19 "," $4,272.19 "," $4,272.19 ", See APC Packaged Rates ," $1,607.81 "," $2,756.25 "," $1,529.72 "," $4,451.80 "," $3,215.63 "
,61512093,Hospital Chargemaster,Asymmetric Patella Sz A32 10M,Outpatient,Outpatient Default Percent / Case Rate,278," $1,590.75 ", $874.91 ," $1,272.60 ", See APC Packaged Rates ," $1,113.53 ", $620.39 ," $1,534.91 "," $1,541.60 ", $819.27 , See APC Packaged Rates , See APC Packaged Rates , $529.72 , $529.72 , See APC Packaged Rates , See APC Packaged Rates ," $1,479.40 "," $1,479.40 "," $1,479.40 "," $1,479.40 ", See APC Packaged Rates , $556.76 , $954.45 , $529.72 ," $1,541.60 "," $1,113.53 "
,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 "
,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 "
,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
,61512318,Hospital Chargemaster,Cutterlinear Reload Blue 75Mm,Outpatient,Outpatient Default Percent / Case Rate,278, $406.24 , $223.43 , $324.99 , See APC Packaged Rates , $284.37 , $158.43 , $391.98 , $393.69 , $209.22 , See APC Packaged Rates , See APC Packaged Rates , $135.28 , $135.28 , See APC Packaged Rates , See APC Packaged Rates , $377.80 , $377.80 , $377.80 , $377.80 , See APC Packaged Rates , $142.18 , $243.74 , $135.28 , $393.69 , $284.37
C1713,61512496,Hospital Chargemaster,Tibial Insert Size 3 - 8M,Outpatient,Outpatient Default Percent / Case Rate,278," $1,890.00 "," $1,039.50 "," $1,557.36 ", 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 , $- , $- ," $1,831.60 "," $1,323.00 "
C1713,61512498,Hospital Chargemaster,Tibial Baseplate Size 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 "
,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
,61512511,Hospital Chargemaster,Stent Loop 6 X 22,Outpatient,Outpatient Default Percent / Case Rate,278, $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 , $57.26 , $57.26 , See APC Packaged Rates , See APC Packaged Rates , $159.92 , $159.92 , $159.92 , $159.92 , See APC Packaged Rates , $60.19 , $103.18 , $57.26 , $166.65 , $120.37
C2618,61512512,Hospital Chargemaster,Stent Loop 6 X 24,Outpatient,Outpatient Default Percent / Case Rate,278, $171.96 , $94.58 , $141.70 , See APC Packaged Rates , $120.37 , $67.06 , $165.92 , $166.65 , $88.56 , See APC Packaged Rates , See APC Packaged Rates , $57.26 , $57.26 , See APC Packaged Rates , See APC Packaged Rates , $159.92 , $159.92 , $159.92 , $159.92 , See APC Packaged Rates , $60.19 , $- , $- , $166.65 , $120.37
,61512513,Hospital Chargemaster,Stent Loop 6 X 26,Outpatient,Outpatient Default Percent / Case Rate,278, $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 , $57.26 , $57.26 , See APC Packaged Rates , See APC Packaged Rates , $159.92 , $159.92 , $159.92 , $159.92 , See APC Packaged Rates , $60.19 , $103.18 , $57.26 , $166.65 , $120.37
,61512514,Hospital Chargemaster,Stent Loop 6 X 28,Outpatient,Outpatient Default Percent / Case Rate,278, $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 , $57.26 , $57.26 , See APC Packaged Rates , See APC Packaged Rates , $159.92 , $159.92 , $159.92 , $159.92 , See APC Packaged Rates , $60.19 , $103.18 , $57.26 , $166.65 , $120.37
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
,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 "
C1713,61512852,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 "
,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 "
C1781,61512897,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
C1781,61512900,Hospital Chargemaster,Mesh 3D Max Large Light Right,Outpatient,Outpatient Default Percent / Case Rate,278, $595.82 , $327.70 , $490.96 , See APC Packaged Rates , $417.07 , $232.37 , $574.91 , $577.41 , $306.86 , See APC Packaged Rates , See APC Packaged Rates , $198.41 , $198.41 , See APC Packaged Rates , See APC Packaged Rates , $554.11 , $554.11 , $554.11 , $554.11 , See APC Packaged Rates , $208.54 , $- , $- , $577.41 , $417.07
,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 "
,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
,61512981,Hospital Chargemaster,Ventralex St Hernia Patch Sma,Outpatient,Outpatient Default Percent / Case Rate,278," $1,064.49 ", $585.47 , $851.59 , See APC Packaged Rates , $745.14 , $415.15 ," $1,027.13 "," $1,031.60 ", $548.23 , See APC Packaged Rates , See APC Packaged Rates , $354.48 , $354.48 , See APC Packaged Rates , See APC Packaged Rates , $989.98 , $989.98 , $989.98 , $989.98 , See APC Packaged Rates , $372.57 , $638.69 , $354.48 ," $1,031.60 ", $745.14
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
,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 "
,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 "
,61513147,Hospital Chargemaster,Contour Vl Stent 6Fr X 22-30C,Outpatient,Outpatient Default Percent / Case Rate,278, $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 , $57.26 , $57.26 , See APC Packaged Rates , See APC Packaged Rates , $159.92 , $159.92 , $159.92 , $159.92 , See APC Packaged Rates , $60.19 , $103.18 , $57.26 , $166.65 , $120.37
,61513186,Hospital Chargemaster,Stent Contour Vl Ureteral,Outpatient,Outpatient Default Percent / Case Rate,278, $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 , $57.26 , $57.26 , See APC Packaged Rates , See APC Packaged Rates , $159.92 , $159.92 , $159.92 , $159.92 , See APC Packaged Rates , $60.19 , $103.18 , $57.26 , $166.65 , $120.37
,61513300,Hospital Chargemaster,Femoral Head Lfit V40 26Mm,Outpatient,Outpatient Default Percent / Case Rate,278," $1,785.00 ", $981.75 ," $1,428.00 ", See APC Packaged Rates ," $1,249.50 ", $696.15 ," $1,722.35 "," $1,729.84 ", $919.31 , See APC Packaged Rates , See APC Packaged Rates , $594.41 , $594.41 , See APC Packaged Rates , See APC Packaged Rates ," $1,660.05 "," $1,660.05 "," $1,660.05 "," $1,660.05 ", See APC Packaged Rates , $624.75 ," $1,071.00 ", $594.41 ," $1,729.84 "," $1,249.50 "
C1713,61513321,Hospital Chargemaster,Screw Self Tap Cort 4.5X34Mm,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
C1713,61513324,Hospital Chargemaster,Accolade Ii 127 Deg Size 4,Outpatient,Outpatient Default Percent / Case Rate,278," $7,284.38 "," $4,006.41 "," $6,002.33 ", See APC Packaged Rates ," $5,099.07 "," $2,840.91 "," $7,028.70 "," $7,059.29 "," $3,751.60 ", See APC Packaged Rates , See APC Packaged Rates ," $2,425.70 "," $2,425.70 ", See APC Packaged Rates , See APC Packaged Rates ," $6,774.47 "," $6,774.47 "," $6,774.47 "," $6,774.47 ", See APC Packaged Rates ," $2,549.53 ", $- , $- ," $7,059.29 "," $5,099.07 "
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
,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 "
C1713,61513335,Hospital Chargemaster,Lag Screw 10.5X90M,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
C1713,61513343,Hospital Chargemaster,2.3 X 20M 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
C1713,61513345,Hospital Chargemaster,Locking Screw 2.3 X 28M,Outpatient,Outpatient Default Percent / Case Rate,278, $327.60 , $180.18 , $269.94 , See APC Packaged Rates , $229.32 , $127.76 , $316.10 , $317.48 , $168.72 , See APC Packaged Rates , See APC Packaged Rates , $109.09 , $109.09 , See APC Packaged Rates , See APC Packaged Rates , $304.67 , $304.67 , $304.67 , $304.67 , See APC Packaged Rates , $114.66 , $- , $- , $317.48 , $229.32
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
,61513430,Hospital Chargemaster,Stem Hip 127 Deg 30X99Mm Sz2,Outpatient,Outpatient Default Percent / Case Rate,278," $7,271.25 "," $3,999.19 "," $5,817.00 ", See APC Packaged Rates ," $5,089.88 "," $2,835.79 "," $7,016.03 "," $7,046.57 "," $3,744.84 ", See APC Packaged Rates , See APC Packaged Rates ," $2,421.33 "," $2,421.33 ", See APC Packaged Rates , See APC Packaged Rates ," $6,762.26 "," $6,762.26 "," $6,762.26 "," $6,762.26 ", See APC Packaged Rates ," $2,544.94 "," $4,362.75 "," $2,421.33 "," $7,046.57 "," $5,089.88 "
,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," $1,811.25 ", $996.19 ," $1,449.00 ", See APC Packaged Rates ," $1,267.88 ", $706.39 ," $1,747.68 "," $1,755.28 ", $932.83 , See APC Packaged Rates , See APC Packaged Rates , $603.15 , $603.15 , See APC Packaged Rates , See APC Packaged Rates ," $1,684.46 "," $1,684.46 "," $1,684.46 "," $1,684.46 ", See APC Packaged Rates , $633.94 ," $1,086.75 ", $603.15 ," $1,755.28 "," $1,267.88 "
,61513447,Hospital Chargemaster,Trident X3 Insert 36Mm,Outpatient,Outpatient Default Percent / Case Rate,278," $3,268.13 "," $1,797.47 "," $2,614.50 ", See APC Packaged Rates ," $2,287.69 "," $1,274.57 "," $3,153.42 "," $3,167.14 "," $1,683.15 ", See APC Packaged Rates , See APC Packaged Rates ," $1,088.29 "," $1,088.29 ", See APC Packaged Rates , See APC Packaged Rates ," $3,039.36 "," $3,039.36 "," $3,039.36 "," $3,039.36 ", See APC Packaged Rates ," $1,143.85 "," $1,960.88 "," $1,088.29 "," $3,167.14 "," $2,287.69 "
,61513484,Hospital Chargemaster,Accolade Ii Sz5 127 Deg Stem,Outpatient,Outpatient Default Percent / Case Rate,278," $7,271.25 "," $3,999.19 "," $5,817.00 ", See APC Packaged Rates ," $5,089.88 "," $2,835.79 "," $7,016.03 "," $7,046.57 "," $3,744.84 ", See APC Packaged Rates , See APC Packaged Rates ," $2,421.33 "," $2,421.33 ", See APC Packaged Rates , See APC Packaged Rates ," $6,762.26 "," $6,762.26 "," $6,762.26 "," $6,762.26 ", See APC Packaged Rates ," $2,544.94 "," $4,362.75 "," $2,421.33 "," $7,046.57 "," $5,089.88 "
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
,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
,61513648,Hospital Chargemaster,Insert Trident 36Mm 0 Degree,Outpatient,Outpatient Default Percent / Case Rate,278," $3,244.50 "," $1,784.48 "," $2,595.60 ", See APC Packaged Rates ," $2,271.15 "," $1,265.36 "," $3,130.62 "," $3,144.24 "," $1,670.98 ", See APC Packaged Rates , See APC Packaged Rates ," $1,080.42 "," $1,080.42 ", See APC Packaged Rates , See APC Packaged Rates ," $3,017.39 "," $3,017.39 "," $3,017.39 "," $3,017.39 ", See APC Packaged Rates ," $1,135.58 "," $1,946.70 "," $1,080.42 "," $3,144.24 "," $2,271.15 "
,61513655,Hospital Chargemaster,Trident Insert 36Mmid,Outpatient,Outpatient Default Percent / Case Rate,278," $3,339.00 "," $1,836.45 "," $2,671.20 ", See APC Packaged Rates ," $2,337.30 "," $1,302.21 "," $3,221.80 "," $3,235.82 "," $1,719.65 ", See APC Packaged Rates , See APC Packaged Rates ," $1,111.89 "," $1,111.89 ", See APC Packaged Rates , See APC Packaged Rates ," $3,105.27 "," $3,105.27 "," $3,105.27 "," $3,105.27 ", See APC Packaged Rates ," $1,168.65 "," $2,003.40 "," $1,111.89 "," $3,235.82 "," $2,337.30 "
C1713,61513656,Hospital Chargemaster,Accolade 88 127 Deg Sz 6,Outpatient,Outpatient Default Percent / Case Rate,278," $7,297.50 "," $4,013.63 "," $6,013.14 ", See APC Packaged Rates ," $5,108.25 "," $2,846.03 "," $7,041.36 "," $7,072.01 "," $3,758.36 ", See APC Packaged Rates , See APC Packaged Rates ," $2,430.07 "," $2,430.07 ", See APC Packaged Rates , See APC Packaged Rates ," $6,786.68 "," $6,786.68 "," $6,786.68 "," $6,786.68 ", See APC Packaged Rates ," $2,554.13 ", $- , $- ," $7,072.01 "," $5,108.25 "
,61513686,Hospital Chargemaster,Femoral Head Lfit V40 25Mm,Outpatient,Outpatient Default Percent / Case Rate,278," $1,837.50 "," $1,010.63 "," $1,470.00 ", See APC Packaged Rates ," $1,286.25 ", $716.63 ," $1,773.00 "," $1,780.72 ", $946.35 , See APC Packaged Rates , See APC Packaged Rates , $611.89 , $611.89 , See APC Packaged Rates , See APC Packaged Rates ," $1,708.88 "," $1,708.88 "," $1,708.88 "," $1,708.88 ", See APC Packaged Rates , $643.13 ," $1,102.50 ", $611.89 ," $1,780.72 "," $1,286.25 "
C1713,61513701,Hospital Chargemaster,Baseplate Tri Ts Size 3,Outpatient,Outpatient Default Percent / Case Rate,278," $5,171.25 "," $2,844.19 "," $4,261.11 ", See APC Packaged Rates ," $3,619.88 "," $2,016.79 "," $4,989.74 "," $5,011.46 "," $2,663.30 ", See APC Packaged Rates , See APC Packaged Rates ," $1,722.03 "," $1,722.03 ", See APC Packaged Rates , See APC Packaged Rates ," $4,809.26 "," $4,809.26 "," $4,809.26 "," $4,809.26 ", See APC Packaged Rates ," $1,809.94 ", $- , $- ," $5,011.46 "," $3,619.88 "
C1764,61513729,Hospital Chargemaster,Linq Implantable Eventrecorde,Outpatient,Outpatient Default Percent / Case Rate,278," $12,803.00 "," $7,041.65 "," $10,549.67 ", See APC Packaged Rates ," $8,962.10 "," $4,993.17 "," $12,353.61 "," $12,407.39 "," $6,593.80 ", See APC Packaged Rates , See APC Packaged Rates ," $4,263.40 "," $4,263.40 ", See APC Packaged Rates , See APC Packaged Rates ," $11,906.79 "," $11,906.79 "," $11,906.79 "," $11,906.79 ", See APC Packaged Rates ," $4,481.05 ", $- , $- ," $12,407.39 "," $8,962.10 "
,61513786,Hospital Chargemaster,Accolade Ii 127 Deg Size 3,Outpatient,Outpatient Default Percent / Case Rate,278," $7,293.13 "," $4,011.22 "," $5,834.50 ", See APC Packaged Rates ," $5,105.19 "," $2,844.32 "," $7,037.14 "," $7,067.77 "," $3,756.11 ", See APC Packaged Rates , See APC Packaged Rates ," $2,428.61 "," $2,428.61 ", See APC Packaged Rates , See APC Packaged Rates ," $6,782.61 "," $6,782.61 "," $6,782.61 "," $6,782.61 ", See APC Packaged Rates ," $2,552.60 "," $4,375.88 "," $2,428.61 "," $7,067.77 "," $5,105.19 "
,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," $3,275.62 "," $1,801.59 "," $2,699.11 ", See APC Packaged Rates ," $2,292.93 "," $1,277.49 "," $3,160.65 "," $3,174.40 "," $1,687.01 ", See APC Packaged Rates , See APC Packaged Rates ," $1,090.78 "," $1,090.78 ", See APC Packaged Rates , See APC Packaged Rates ," $3,046.33 "," $3,046.33 "," $3,046.33 "," $3,046.33 ", See APC Packaged Rates ," $1,146.47 ", $- , $- ," $3,174.40 "," $2,292.93 "
,61513830,Hospital Chargemaster,Insert Triathlon Cs Sz 6 9Mm,Outpatient,Outpatient Default Percent / Case Rate,278," $3,356.72 "," $1,846.20 "," $2,685.38 ", See APC Packaged Rates ," $2,349.70 "," $1,309.12 "," $3,238.90 "," $3,253.00 "," $1,728.78 ", See APC Packaged Rates , See APC Packaged Rates ," $1,117.79 "," $1,117.79 ", See APC Packaged Rates , See APC Packaged Rates ," $3,121.75 "," $3,121.75 "," $3,121.75 "," $3,121.75 ", See APC Packaged Rates ," $1,174.85 "," $2,014.03 "," $1,117.79 "," $3,253.00 "," $2,349.70 "
,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," $4,558.75 "," $2,507.31 "," $3,756.41 ", See APC Packaged Rates ," $3,191.13 "," $1,777.91 "," $4,398.74 "," $4,417.88 "," $2,347.85 ", See APC Packaged Rates , See APC Packaged Rates ," $1,518.06 "," $1,518.06 ", See APC Packaged Rates , See APC Packaged Rates ," $4,239.64 "," $4,239.64 "," $4,239.64 "," $4,239.64 ", See APC Packaged Rates ," $1,595.56 ", $- , $- ," $4,417.88 "," $3,191.13 "
,61513870,Hospital Chargemaster,Stem Cemented Tri 12 X 50Mm,Outpatient,Outpatient Default Percent / Case Rate,278," $3,916.50 "," $2,154.08 "," $3,133.20 ", See APC Packaged Rates ," $2,741.55 "," $1,527.44 "," $3,779.03 "," $3,795.48 "," $2,017.08 ", See APC Packaged Rates , See APC Packaged Rates ," $1,304.19 "," $1,304.19 ", See APC Packaged Rates , See APC Packaged Rates ," $3,642.35 "," $3,642.35 "," $3,642.35 "," $3,642.35 ", See APC Packaged Rates ," $1,370.78 "," $2,349.90 "," $1,304.19 "," $3,795.48 "," $2,741.55 "
,61513895,Hospital Chargemaster,Thiathlon Cs Ins Sz 3 9Mm X3,Outpatient,Outpatient Default Percent / Case Rate,278," $3,203.69 "," $1,762.03 "," $2,562.95 ", See APC Packaged Rates ," $2,242.58 "," $1,249.44 "," $3,091.24 "," $3,104.70 "," $1,649.96 ", See APC Packaged Rates , See APC Packaged Rates ," $1,066.83 "," $1,066.83 ", See APC Packaged Rates , See APC Packaged Rates ," $2,979.43 "," $2,979.43 "," $2,979.43 "," $2,979.43 ", See APC Packaged Rates ," $1,121.29 "," $1,922.21 "," $1,066.83 "," $3,104.70 "," $2,242.58 "
,61513978,Hospital Chargemaster,Insert Triathlon Sz3 11Mm X3,Outpatient,Outpatient Default Percent / Case Rate,278," $3,150.00 "," $1,732.50 "," $2,520.00 ", 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 "," $1,890.00 "," $1,048.95 "," $3,052.67 "," $2,205.00 "
,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," $3,150.00 "," $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 "
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 "
C1713,61514120,Hospital Chargemaster,Triathlon Insert Cs X3 Sz2 9M,Outpatient,Outpatient Default Percent / Case Rate,278," $3,369.38 "," $1,853.16 "," $2,776.37 ", See APC Packaged Rates ," $2,358.57 "," $1,314.06 "," $3,251.11 "," $3,265.27 "," $1,735.30 ", See APC Packaged Rates , See APC Packaged Rates ," $1,122.00 "," $1,122.00 ", See APC Packaged Rates , See APC Packaged Rates ," $3,133.52 "," $3,133.52 "," $3,133.52 "," $3,133.52 ", See APC Packaged Rates ," $1,179.28 ", $- , $- ," $3,265.27 "," $2,358.57 "
,61514201,Hospital Chargemaster,K-Wire 1.25 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
,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," $4,866.75 "," $2,676.71 "," $4,010.20 ", See APC Packaged Rates ," $3,406.73 "," $1,898.03 "," $4,695.93 "," $4,716.37 "," $2,506.47 ", See APC Packaged Rates , See APC Packaged Rates ," $1,620.63 "," $1,620.63 ", See APC Packaged Rates , See APC Packaged Rates ," $4,526.08 "," $4,526.08 "," $4,526.08 "," $4,526.08 ", See APC Packaged Rates ," $1,703.36 ", $- , $- ," $4,716.37 "," $3,406.73 "
C1713,61514204,Hospital Chargemaster,Screw Locking T8 2.7/L14M,Outpatient,Outpatient Default Percent / Case Rate,278, $432.56 , $237.91 , $356.43 , See APC Packaged Rates , $302.79 , $168.70 , $417.38 , $419.19 , $222.78 , See APC Packaged Rates , See APC Packaged Rates , $144.04 , $144.04 , See APC Packaged Rates , See APC Packaged Rates , $402.28 , $402.28 , $402.28 , $402.28 , See APC Packaged Rates , $151.40 , $- , $- , $419.19 , $302.79
C1713,61514206,Hospital Chargemaster,Screw Locking T8 2.7/L18M,Outpatient,Outpatient Default Percent / Case Rate,278, $403.83 , $222.11 , $332.76 , See APC Packaged Rates , $282.68 , $157.49 , $389.66 , $391.35 , $207.98 , See APC Packaged Rates , See APC Packaged Rates , $134.48 , $134.48 , See APC Packaged Rates , See APC Packaged Rates , $375.56 , $375.56 , $375.56 , $375.56 , See APC Packaged Rates , $141.34 , $- , $- , $391.35 , $282.68
C1713,61514207,Hospital Chargemaster,Screw Locking T8 2.7/L22M,Outpatient,Outpatient Default Percent / Case Rate,278, $520.54 , $286.30 , $428.92 , See APC Packaged Rates , $364.38 , $203.01 , $502.27 , $504.46 , $268.09 , See APC Packaged Rates , See APC Packaged Rates , $173.34 , $173.34 , See APC Packaged Rates , See APC Packaged Rates , $484.10 , $484.10 , $484.10 , $484.10 , See APC Packaged Rates , $182.19 , $- , $- , $504.46 , $364.38
C1713,61514208,Hospital Chargemaster,Locking Screw T8 2.7/L24M,Outpatient,Outpatient Default Percent / Case Rate,278, $834.75 , $459.11 , $687.83 , See APC Packaged Rates , $584.33 , $325.55 , $805.45 , $808.96 , $429.91 , See APC Packaged Rates , See APC Packaged Rates , $277.97 , $277.97 , See APC Packaged Rates , See APC Packaged Rates , $776.32 , $776.32 , $776.32 , $776.32 , See APC Packaged Rates , $292.16 , $- , $- , $808.96 , $584.33
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 "
,61514235,Hospital Chargemaster,Femoral Component Beaded W/Pa,Outpatient,Outpatient Default Percent / Case Rate,278," $6,330.18 "," $3,481.60 "," $5,064.14 ", See APC Packaged Rates ," $4,431.13 "," $2,468.77 "," $6,107.99 "," $6,134.58 "," $3,260.17 ", See APC Packaged Rates , See APC Packaged Rates ," $2,107.95 "," $2,107.95 ", See APC Packaged Rates , See APC Packaged Rates ," $5,887.07 "," $5,887.07 "," $5,887.07 "," $5,887.07 ", See APC Packaged Rates ," $2,215.56 "," $3,798.11 "," $2,107.95 "," $6,134.58 "," $4,431.13 "
C1713,61514236,Hospital Chargemaster,Baseplate Tritanium Size 3,Outpatient,Outpatient Default Percent / Case Rate,278," $4,536.68 "," $2,495.17 "," $3,738.22 ", See APC Packaged Rates ," $3,175.68 "," $1,769.31 "," $4,377.44 "," $4,396.50 "," $2,336.48 ", See APC Packaged Rates , See APC Packaged Rates ," $1,510.71 "," $1,510.71 ", See APC Packaged Rates , See APC Packaged Rates ," $4,219.11 "," $4,219.11 "," $4,219.11 "," $4,219.11 ", See APC Packaged Rates ," $1,587.84 ", $- , $- ," $4,396.50 "," $3,175.68 "
C1713,61514237,Hospital Chargemaster,Patella AsyMetric Tritanium,Outpatient,Outpatient Default Percent / Case Rate,278," $2,081.74 "," $1,144.96 "," $1,715.35 ", See APC Packaged Rates ," $1,457.22 ", $811.88 ," $2,008.67 "," $2,017.41 "," $1,072.14 ", See APC Packaged Rates , See APC Packaged Rates , $693.22 , $693.22 , See APC Packaged Rates , See APC Packaged Rates ," $1,936.02 "," $1,936.02 "," $1,936.02 "," $1,936.02 ", See APC Packaged Rates , $728.61 , $- , $- ," $2,017.41 "," $1,457.22 "
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," $1,644.93 ", $904.71 ," $1,355.42 ", See APC Packaged Rates ," $1,151.45 ", $641.52 ," $1,587.19 "," $1,594.10 ", $847.17 , See APC Packaged Rates , See APC Packaged Rates , $547.76 , $547.76 , See APC Packaged Rates , See APC Packaged Rates ," $1,529.78 "," $1,529.78 "," $1,529.78 "," $1,529.78 ", See APC Packaged Rates , $575.73 , $- , $- ," $1,594.10 "," $1,151.45 "
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 "
C1781,61514300,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
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 "
C1713,61514388,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
,61514499,Hospital Chargemaster,Polaris Stent 7 X 22,Outpatient,Outpatient Default Percent / Case Rate,278, $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 , $57.26 , $57.26 , See APC Packaged Rates , See APC Packaged Rates , $159.92 , $159.92 , $159.92 , $159.92 , See APC Packaged Rates , $60.19 , $103.18 , $57.26 , $166.65 , $120.37
C1713,61514547,Hospital Chargemaster,Tri Ts Baseplate Size 1,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 "
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
C1713,61514591,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
C1713,61514617,Hospital Chargemaster,Triathlon Cr Fem Component,Outpatient,Outpatient Default Percent / Case Rate,278," $6,320.47 "," $3,476.26 "," $5,208.07 ", See APC Packaged Rates ," $4,424.33 "," $2,464.98 "," $6,098.62 "," $6,125.17 "," $3,255.17 ", See APC Packaged Rates , See APC Packaged Rates ," $2,104.72 "," $2,104.72 ", See APC Packaged Rates , See APC Packaged Rates ," $5,878.04 "," $5,878.04 "," $5,878.04 "," $5,878.04 ", See APC Packaged Rates ," $2,212.16 ", $- , $- ," $6,125.17 "," $4,424.33 "
,61514618,Hospital Chargemaster,Triathlon Tritanium BP Size 5,Outpatient,Outpatient Default Percent / Case Rate,278," $4,556.25 "," $2,505.94 "," $3,645.00 ", See APC Packaged Rates ," $3,189.38 "," $1,776.94 "," $4,396.33 "," $4,415.46 "," $2,346.56 ", See APC Packaged Rates , See APC Packaged Rates ," $1,517.23 "," $1,517.23 ", See APC Packaged Rates , See APC Packaged Rates ," $4,237.31 "," $4,237.31 "," $4,237.31 "," $4,237.31 ", See APC Packaged Rates ," $1,594.69 "," $2,733.75 "," $1,517.23 "," $4,415.46 "," $3,189.38 "
C1713,61514619,Hospital Chargemaster,Patella Tritanium A35 X 10,Outpatient,Outpatient Default Percent / Case Rate,278," $2,068.77 "," $1,137.82 "," $1,704.67 ", See APC Packaged Rates ," $1,448.14 ", $806.82 ," $1,996.16 "," $2,004.85 "," $1,065.46 ", See APC Packaged Rates , See APC Packaged Rates , $688.90 , $688.90 , See APC Packaged Rates , See APC Packaged Rates ," $1,923.96 "," $1,923.96 "," $1,923.96 "," $1,923.96 ", See APC Packaged Rates , $724.07 , $- , $- ," $2,004.85 "," $1,448.14 "
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
C1713,61514645,Hospital Chargemaster,Trident 0 Deg Insert 40M,Outpatient,Outpatient Default Percent / Case Rate,278," $3,339.00 "," $1,836.45 "," $2,751.34 ", See APC Packaged Rates ," $2,337.30 "," $1,302.21 "," $3,221.80 "," $3,235.82 "," $1,719.65 ", See APC Packaged Rates , See APC Packaged Rates ," $1,111.89 "," $1,111.89 ", See APC Packaged Rates , See APC Packaged Rates ," $3,105.27 "," $3,105.27 "," $3,105.27 "," $3,105.27 ", See APC Packaged Rates ," $1,168.65 ", $- , $- ," $3,235.82 "," $2,337.30 "
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 "
,61514655,Hospital Chargemaster,Triathlon Cruciate Ret Femora,Outpatient,Outpatient Default Percent / Case Rate,278," $6,162.19 "," $3,389.20 "," $4,929.75 ", See APC Packaged Rates ," $4,313.53 "," $2,403.25 "," $5,945.90 "," $5,971.78 "," $3,173.65 ", See APC Packaged Rates , See APC Packaged Rates ," $2,052.01 "," $2,052.01 ", See APC Packaged Rates , See APC Packaged Rates ," $5,730.84 "," $5,730.84 "," $5,730.84 "," $5,730.84 ", See APC Packaged Rates ," $2,156.77 "," $3,697.31 "," $2,052.01 "," $5,971.78 "," $4,313.53 "
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," $2,113.13 "," $1,162.22 "," $1,690.50 ", See APC Packaged Rates ," $1,479.19 ", $824.12 ," $2,038.96 "," $2,047.83 "," $1,088.30 ", See APC Packaged Rates , See APC Packaged Rates , $703.67 , $703.67 , See APC Packaged Rates , See APC Packaged Rates ," $1,965.21 "," $1,965.21 "," $1,965.21 "," $1,965.21 ", See APC Packaged Rates , $739.60 ," $1,267.88 ", $703.67 ," $2,047.83 "," $1,479.19 "
,61514673,Hospital Chargemaster,Triathlon Cr Fem Component,Outpatient,Outpatient Default Percent / Case Rate,278," $6,198.75 "," $3,409.31 "," $4,959.00 ", See APC Packaged Rates ," $4,339.13 "," $2,417.51 "," $5,981.17 "," $6,007.21 "," $3,192.48 ", See APC Packaged Rates , See APC Packaged Rates ," $2,064.18 "," $2,064.18 ", See APC Packaged Rates , See APC Packaged Rates ," $5,764.84 "," $5,764.84 "," $5,764.84 "," $5,764.84 ", See APC Packaged Rates ," $2,169.56 "," $3,719.25 "," $2,064.18 "," $6,007.21 "," $4,339.13 "
,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," $6,300.00 "," $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 "
C1713,61514681,Hospital Chargemaster,Triathlon Tritanium Baseplate,Outpatient,Outpatient Default Percent / Case Rate,278," $4,583.25 "," $2,520.79 "," $3,776.60 ", See APC Packaged Rates ," $3,208.28 "," $1,787.47 "," $4,422.38 "," $4,441.63 "," $2,360.47 ", See APC Packaged Rates , See APC Packaged Rates ," $1,526.22 "," $1,526.22 ", See APC Packaged Rates , See APC Packaged Rates ," $4,262.42 "," $4,262.42 "," $4,262.42 "," $4,262.42 ", See APC Packaged Rates ," $1,604.14 ", $- , $- ," $4,441.63 "," $3,208.28 "
,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 "
C1713,61514700,Hospital Chargemaster,Triathlon Tritanium Baseplate,Outpatient,Outpatient Default Percent / Case Rate,278," $4,569.42 "," $2,513.18 "," $3,765.20 ", See APC Packaged Rates ," $3,198.59 "," $1,782.07 "," $4,409.03 "," $4,428.22 "," $2,353.34 ", See APC Packaged Rates , See APC Packaged Rates ," $1,521.62 "," $1,521.62 ", See APC Packaged Rates , See APC Packaged Rates ," $4,249.56 "," $4,249.56 "," $4,249.56 "," $4,249.56 ", See APC Packaged Rates ," $1,599.30 ", $- , $- ," $4,428.22 "," $3,198.59 "
C1713,61514701,Hospital Chargemaster,Screw 35M Atz 5-5,Outpatient,Outpatient Default Percent / Case Rate,278," $1,704.15 ", $937.28 ," $1,404.22 ", See APC Packaged Rates ," $1,192.91 ", $664.62 ," $1,644.33 "," $1,651.49 ", $877.67 , See APC Packaged Rates , See APC Packaged Rates , $567.48 , $567.48 , See APC Packaged Rates , See APC Packaged Rates ," $1,584.86 "," $1,584.86 "," $1,584.86 "," $1,584.86 ", See APC Packaged Rates , $596.45 , $- , $- ," $1,651.49 "," $1,192.91 "
,61514703,Hospital Chargemaster,Triathlon Cr Fem Component,Outpatient,Outpatient Default Percent / Case Rate,278," $6,142.50 "," $3,378.38 "," $4,914.00 ", See APC Packaged Rates ," $4,299.75 "," $2,395.58 "," $5,926.90 "," $5,952.70 "," $3,163.51 ", See APC Packaged Rates , See APC Packaged Rates ," $2,045.45 "," $2,045.45 ", See APC Packaged Rates , See APC Packaged Rates ," $5,712.53 "," $5,712.53 "," $5,712.53 "," $5,712.53 ", See APC Packaged Rates ," $2,149.88 "," $3,685.50 "," $2,045.45 "," $5,952.70 "," $4,299.75 "
C1713,61514704,Hospital Chargemaster,Triathlon Tritanium Baseplate,Outpatient,Outpatient Default Percent / Case Rate,278," $4,581.40 "," $2,519.77 "," $3,775.07 ", See APC Packaged Rates ," $3,206.98 "," $1,786.75 "," $4,420.59 "," $4,439.83 "," $2,359.51 ", See APC Packaged Rates , See APC Packaged Rates ," $1,525.61 "," $1,525.61 ", See APC Packaged Rates , See APC Packaged Rates ," $4,260.70 "," $4,260.70 "," $4,260.70 "," $4,260.70 ", See APC Packaged Rates ," $1,603.49 ", $- , $- ," $4,439.83 "," $3,206.98 "
,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
,61514728,Hospital Chargemaster,Triathlon Cr Fem Component,Outpatient,Outpatient Default Percent / Case Rate,278," $6,240.94 "," $3,432.52 "," $4,992.75 ", See APC Packaged Rates ," $4,368.66 "," $2,433.97 "," $6,021.88 "," $6,048.09 "," $3,214.21 ", See APC Packaged Rates , See APC Packaged Rates ," $2,078.23 "," $2,078.23 ", See APC Packaged Rates , See APC Packaged Rates ," $5,804.07 "," $5,804.07 "," $5,804.07 "," $5,804.07 ", See APC Packaged Rates ," $2,184.33 "," $3,744.56 "," $2,078.23 "," $6,048.09 "," $4,368.66 "
,61514729,Hospital Chargemaster,Patella Tritanium Asymmetric,Outpatient,Outpatient Default Percent / Case Rate,278," $2,070.00 "," $1,138.50 "," $1,656.00 ", See APC Packaged Rates ," $1,449.00 ", $807.30 ," $1,997.34 "," $2,006.04 "," $1,066.09 ", See APC Packaged Rates , See APC Packaged Rates , $689.31 , $689.31 , See APC Packaged Rates , See APC Packaged Rates ," $1,925.10 "," $1,925.10 "," $1,925.10 "," $1,925.10 ", See APC Packaged Rates , $724.50 ," $1,242.00 ", $689.31 ," $2,006.04 "," $1,449.00 "
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 "
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
C1713,61514799,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, $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
C1713,61514811,Hospital Chargemaster,Screw Hexalobe 3.5M 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
C1713,61514814,Hospital Chargemaster,Screw Hexalobe 3.5M X 16M,Outpatient,Outpatient Default Percent / Case Rate,278, $472.50 , $259.88 , $389.34 , See APC Packaged Rates , $330.75 , $184.28 , $455.92 , $457.90 , $243.35 , See APC Packaged Rates , See APC Packaged Rates , $157.34 , $157.34 , See APC Packaged Rates , See APC Packaged Rates , $439.43 , $439.43 , $439.43 , $439.43 , See APC Packaged Rates , $165.38 , $- , $- , $457.90 , $330.75
,61514855,Hospital Chargemaster,Tibial Insert X3 Triatholon T,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 "
C1713,61514927,Hospital Chargemaster,Triathlon Cr Fem Comp Beaded,Outpatient,Outpatient Default Percent / Case Rate,278," $6,232.50 "," $3,427.88 "," $5,135.58 ", See APC Packaged Rates ," $4,362.75 "," $2,430.68 "," $6,013.74 "," $6,039.92 "," $3,209.86 ", See APC Packaged Rates , See APC Packaged Rates ," $2,075.42 "," $2,075.42 ", See APC Packaged Rates , See APC Packaged Rates ," $5,796.23 "," $5,796.23 "," $5,796.23 "," $5,796.23 ", See APC Packaged Rates ," $2,181.38 ", $- , $- ," $6,039.92 "," $4,362.75 "
,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," $3,962.70 "," $2,179.49 "," $3,170.16 ", See APC Packaged Rates ," $2,773.89 "," $1,545.45 "," $3,823.61 "," $3,840.25 "," $2,040.87 ", See APC Packaged Rates , See APC Packaged Rates ," $1,319.58 "," $1,319.58 ", See APC Packaged Rates , See APC Packaged Rates ," $3,685.31 "," $3,685.31 "," $3,685.31 "," $3,685.31 ", See APC Packaged Rates ," $1,386.95 "," $2,377.62 "," $1,319.58 "," $3,840.25 "," $2,773.89 "
C1713,61514945,Hospital Chargemaster,Low Profile Hex Screw 6.5M,Outpatient,Outpatient Default Percent / Case Rate,278, $292.14 , $160.68 , $240.72 , See APC Packaged Rates , $204.50 , $113.93 , $281.89 , $283.11 , $150.46 , See APC Packaged Rates , See APC Packaged Rates , $97.28 , $97.28 , See APC Packaged Rates , See APC Packaged Rates , $271.69 , $271.69 , $271.69 , $271.69 , See APC Packaged Rates , $102.25 , $- , $- , $283.11 , $204.50
,61514947,Hospital Chargemaster,Tritanium 11 Clusterhole 54E,Outpatient,Outpatient Default Percent / Case Rate,278," $4,134.38 "," $2,273.91 "," $3,307.50 ", See APC Packaged Rates ," $2,894.07 "," $1,612.41 "," $3,989.26 "," $4,006.63 "," $2,129.29 ", See APC Packaged Rates , See APC Packaged Rates ," $1,376.75 "," $1,376.75 ", See APC Packaged Rates , See APC Packaged Rates ," $3,844.97 "," $3,844.97 "," $3,844.97 "," $3,844.97 ", See APC Packaged Rates ," $1,447.03 "," $2,480.63 "," $1,376.75 "," $4,006.63 "," $2,894.07 "
C1713,61514948,Hospital Chargemaster,Hex Screw 6.5M/20M Low,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
,61514953,Hospital Chargemaster,Trident Ii Tritanium Cluster,Outpatient,Outpatient Default Percent / Case Rate,278," $4,140.94 "," $2,277.52 "," $3,312.75 ", See APC Packaged Rates ," $2,898.66 "," $1,614.97 "," $3,995.59 "," $4,012.98 "," $2,132.67 ", See APC Packaged Rates , See APC Packaged Rates ," $1,378.93 "," $1,378.93 ", See APC Packaged Rates , See APC Packaged Rates ," $3,851.07 "," $3,851.07 "," $3,851.07 "," $3,851.07 ", See APC Packaged Rates ," $1,449.33 "," $2,484.56 "," $1,378.93 "," $4,012.98 "," $2,898.66 "
,61514966,Hospital Chargemaster,Trident 11 TritClusterhole 58,Outpatient,Outpatient Default Percent / Case Rate,278," $4,126.50 "," $2,269.58 "," $3,301.20 ", See APC Packaged Rates ," $2,888.55 "," $1,609.34 "," $3,981.66 "," $3,998.99 "," $2,125.23 ", See APC Packaged Rates , See APC Packaged Rates ," $1,374.12 "," $1,374.12 ", See APC Packaged Rates , See APC Packaged Rates ," $3,837.65 "," $3,837.65 "," $3,837.65 "," $3,837.65 ", See APC Packaged Rates ," $1,444.28 "," $2,475.90 "," $1,374.12 "," $3,998.99 "," $2,888.55 "
,61514988,Hospital Chargemaster,Trident Ii Tritanium Cluster,Outpatient,Outpatient Default Percent / Case Rate,278," $4,147.50 "," $2,281.13 "," $3,318.00 ", See APC Packaged Rates ," $2,903.25 "," $1,617.53 "," $4,001.92 "," $4,019.34 "," $2,136.05 ", See APC Packaged Rates , See APC Packaged Rates ," $1,381.12 "," $1,381.12 ", See APC Packaged Rates , See APC Packaged Rates ," $3,857.18 "," $3,857.18 "," $3,857.18 "," $3,857.18 ", See APC Packaged Rates ," $1,451.63 "," $2,488.50 "," $1,381.12 "," $4,019.34 "," $2,903.25 "
C1713,61515000,Hospital Chargemaster,Trident Ii Tritanium,Outpatient,Outpatient Default Percent / Case Rate,278," $4,124.53 "," $2,268.49 "," $3,398.61 ", See APC Packaged Rates ," $2,887.17 "," $1,608.57 "," $3,979.76 "," $3,997.08 "," $2,124.22 ", See APC Packaged Rates , See APC Packaged Rates ," $1,373.47 "," $1,373.47 ", See APC Packaged Rates , See APC Packaged Rates ," $3,835.81 "," $3,835.81 "," $3,835.81 "," $3,835.81 ", See APC Packaged Rates ," $1,443.59 ", $- , $- ," $3,997.08 "," $2,887.17 "
C1713,61515036,Hospital Chargemaster,Triathlon Cr Fem Component,Outpatient,Outpatient Default Percent / Case Rate,278," $6,122.81 "," $3,367.55 "," $5,045.20 ", See APC Packaged Rates ," $4,285.97 "," $2,387.90 "," $5,907.90 "," $5,933.62 "," $3,153.37 ", See APC Packaged Rates , See APC Packaged Rates ," $2,038.90 "," $2,038.90 ", See APC Packaged Rates , See APC Packaged Rates ," $5,694.21 "," $5,694.21 "," $5,694.21 "," $5,694.21 ", See APC Packaged Rates ," $2,142.98 ", $- , $- ," $5,933.62 "," $4,285.97 "
,61515054,Hospital Chargemaster,Accolade C Cs 127 Nk,Outpatient,Outpatient Default Percent / Case Rate,278," $4,158.00 "," $2,286.90 "," $3,326.40 ", See APC Packaged Rates ," $2,910.60 "," $1,621.62 "," $4,012.05 "," $4,029.52 "," $2,141.45 ", See APC Packaged Rates , See APC Packaged Rates ," $1,384.61 "," $1,384.61 ", See APC Packaged Rates , See APC Packaged Rates ," $3,866.94 "," $3,866.94 "," $3,866.94 "," $3,866.94 ", See APC Packaged Rates ," $1,455.30 "," $2,494.80 "," $1,384.61 "," $4,029.52 "," $2,910.60 "
C1713,61515136,Hospital Chargemaster,Lock Screw 10 FlTrd 2.7ML12M,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
C1713,61515137,Hospital Chargemaster,Lock Screw 10 FlTrd 2.7M L14M,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
C1713,61515138,Hospital Chargemaster,Lock Screw 10 Fl/Trd 2.7M/16M,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
C1713,61515139,Hospital Chargemaster,Lock Screw 10 FlTrd 2.7ML18M,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
C1713,61515140,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, $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
C1713,61515143,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
C1713,61515155,Hospital Chargemaster,Triathlon Cr Fen Component,Outpatient,Outpatient Default Percent / Case Rate,278," $6,158.25 "," $3,387.04 "," $5,074.40 ", See APC Packaged Rates ," $4,310.78 "," $2,401.72 "," $5,942.10 "," $5,967.96 "," $3,171.62 ", See APC Packaged Rates , See APC Packaged Rates ," $2,050.70 "," $2,050.70 ", See APC Packaged Rates , See APC Packaged Rates ," $5,727.17 "," $5,727.17 "," $5,727.17 "," $5,727.17 ", See APC Packaged Rates ," $2,155.39 ", $- , $- ," $5,967.96 "," $4,310.78 "
C1713,61515156,Hospital Chargemaster,GaMa 3 S Nail Right,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 "
C1713,61515161,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
C1713,61515165,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
C1713,61515180,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, $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
C1713,61515182,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
C1713,61515184,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, $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
C1713,61515189,Hospital Chargemaster,Screw Bone 10 FTred 2.7M L24M,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
C1713,61515190,Hospital Chargemaster,Screw Bone 10 FThrd 2.7M L28M,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
C1713,61515195,Hospital Chargemaster,Screw Locking 4M 4.0M/L28M,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
C1713,61515196,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, $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
C1713,61515200,Hospital Chargemaster,Screw Cortex Ti A 3.5Mm/L24Mm,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
C1713,61515205,Hospital Chargemaster,Screw Cortex Ti A 3.5Mm/L44Mm,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
C1713,61515208,Hospital Chargemaster,Plate Volaer Narrow Rt8H XSrt,Outpatient,Outpatient Default Percent / Case Rate,278," $1,989.92 "," $1,094.46 "," $1,639.69 ", See APC Packaged Rates ," $1,392.94 ", $776.07 ," $1,920.07 "," $1,928.43 "," $1,024.85 ", See APC Packaged Rates , See APC Packaged Rates , $662.64 , $662.64 , See APC Packaged Rates , See APC Packaged Rates ," $1,850.63 "," $1,850.63 "," $1,850.63 "," $1,850.63 ", See APC Packaged Rates , $696.47 , $- , $- ," $1,928.43 "," $1,392.94 "
C1713,61515209,Hospital Chargemaster,Screw Lock T8 Thr 2.7M/L20M,Outpatient,Outpatient Default Percent / Case Rate,278, $336.42 , $185.03 , $277.21 , See APC Packaged Rates , $235.49 , $131.20 , $324.61 , $326.02 , $173.26 , See APC Packaged Rates , See APC Packaged Rates , $112.03 , $112.03 , See APC Packaged Rates , See APC Packaged Rates , $312.87 , $312.87 , $312.87 , $312.87 , See APC Packaged Rates , $117.75 , $- , $- , $326.02 , $235.49
C1713,61515216,Hospital Chargemaster,Tibia Plate Distal Medial,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 "
C1713,61515217,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
C1713,61515223,Hospital Chargemaster,Locking Screw T2 F/T 5Mx65M,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
C1713,61515226,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
C1713,61515235,Hospital Chargemaster,Acu-Loc 2 Vdr Plt Std R,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 "
C1713,61515237,Hospital Chargemaster,Screw Lock T2 F/T 5Mx47.5M,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
C1713,61515239,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
C1713,61515254,Hospital Chargemaster,6.5M Low Profi Hex Screw 30M,Outpatient,Outpatient Default Percent / Case Rate,278, $275.31 , $151.42 , $226.86 , See APC Packaged Rates , $192.72 , $107.37 , $265.65 , $266.80 , $141.79 , See APC Packaged Rates , See APC Packaged Rates , $91.68 , $91.68 , See APC Packaged Rates , See APC Packaged Rates , $256.04 , $256.04 , $256.04 , $256.04 , See APC Packaged Rates , $96.36 , $- , $- , $266.80 , $192.72
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," $4,282.74 "," $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 "
C1713,61515259,Hospital Chargemaster,Screw Cortical Self Tap,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
C1713,61515260,Hospital Chargemaster,Compression Screw,Outpatient,Outpatient Default Percent / Case Rate,278, $163.86 , $90.12 , $135.02 , See APC Packaged Rates , $114.70 , $63.91 , $158.11 , $158.80 , $84.39 , See APC Packaged Rates , See APC Packaged Rates , $54.57 , $54.57 , See APC Packaged Rates , See APC Packaged Rates , $152.39 , $152.39 , $152.39 , $152.39 , See APC Packaged Rates , $57.35 , $- , $- , $158.80 , $114.70
C1713,61515261,Hospital Chargemaster,Hip Plate Srt Barr 130Deg 3 H,Outpatient,Outpatient Default Percent / Case Rate,278," $1,017.45 ", $559.60 , $838.38 , See APC Packaged Rates , $712.22 , $396.81 , $981.74 , $986.01 , $524.01 , See APC Packaged Rates , See APC Packaged Rates , $338.81 , $338.81 , See APC Packaged Rates , See APC Packaged Rates , $946.23 , $946.23 , $946.23 , $946.23 , See APC Packaged Rates , $356.11 , $- , $- , $986.01 , $712.22
C1713,61515263,Hospital Chargemaster,Fibula Plate Dis/Lat 3 Hole,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
C1713,61515264,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," $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 "
C1713,61515266,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
C1713,61515281,Hospital Chargemaster,"Acu-Loc 2 Vdr Pit, Narrow R",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 "
C1713,61515282,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
C1713,61515293,Hospital Chargemaster,Screw Locking 5.0M /L50M,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
C1713,61515295,Hospital Chargemaster,Screw Locking 5.0M/L75M,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
C1713,61515296,Hospital Chargemaster,Screw Locking 5.0M/L80M,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
C1713,61515306,Hospital Chargemaster,Locking Screw 4.0M/L65M,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
C1713,61515307,Hospital Chargemaster,Locking Screw 4.0M/L70M,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
C1713,61515314,Hospital Chargemaster,GaMa Nail 3S Rt 10X420Mx125,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 "
C1713,61515315,Hospital Chargemaster,Plate Olecranon 4 Hole Right,Outpatient,Outpatient Default Percent / Case Rate,278," $2,354.94 "," $1,295.22 "," $1,940.47 ", See APC Packaged Rates ," $1,648.46 ", $918.43 ," $2,272.28 "," $2,282.17 "," $1,212.84 ", See APC Packaged Rates , See APC Packaged Rates , $784.20 , $784.20 , See APC Packaged Rates , See APC Packaged Rates ," $2,190.09 "," $2,190.09 "," $2,190.09 "," $2,190.09 ", See APC Packaged Rates , $824.23 , $- , $- ," $2,282.17 "," $1,648.46 "
C1713,61515320,Hospital Chargemaster,Nail GaMa 3S Lft 10X340Mx125,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 "
C1713,61515328,Hospital Chargemaster,GaMa Nail 3S Rt 10X400M X125,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
C1713,61515329,Hospital Chargemaster,Screw Asnis Iii Can 8.0X100,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
C1713,61515333,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
C1713,61515360,Hospital Chargemaster,Triathlon Pkr Insert Xx,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
C1713,61515362,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
C1713,61515368,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
C1713,61515372,Hospital Chargemaster,Nail Tibial T2/Std 9M X 345M,Outpatient,Outpatient Default Percent / Case Rate,278," $2,999.87 "," $1,649.93 "," $2,471.89 ", See APC Packaged Rates ," $2,099.91 "," $1,169.95 "," $2,894.57 "," $2,907.17 "," $1,544.99 ", See APC Packaged Rates , See APC Packaged Rates , $998.96 , $998.96 , See APC Packaged Rates , See APC Packaged Rates ," $2,789.88 "," $2,789.88 "," $2,789.88 "," $2,789.88 ", See APC Packaged Rates ," $1,049.95 ", $- , $- ," $2,907.17 "," $2,099.91 "
C1713,61515377,Hospital Chargemaster,Crew Locking 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
C1713,61515379,Hospital Chargemaster,Screw 5M Locking 5.0M/L36M,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
C1713,61515380,Hospital Chargemaster,Screw Periprosthetic Locking,Outpatient,Outpatient Default Percent / Case Rate,278, $442.89 , $243.59 , $364.94 , See APC Packaged Rates , $310.02 , $172.73 , $427.34 , $429.20 , $228.10 , See APC Packaged Rates , See APC Packaged Rates , $147.48 , $147.48 , See APC Packaged Rates , See APC Packaged Rates , $411.89 , $411.89 , $411.89 , $411.89 , See APC Packaged Rates , $155.01 , $- , $- , $429.20 , $310.02
C1713,61515381,Hospital Chargemaster,Screw Periprosthetic Locking,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
C1713,61515382,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, $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
C1713,61515385,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
C1713,61515395,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
C1713,61515412,Hospital Chargemaster,Self Tap Cortical Screw,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
C1713,61515414,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
C1713,61515415,Hospital Chargemaster,Asnis Iii Ss Cannulated Scr,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
C1713,61515419,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, $921.06 , $506.58 , $758.95 , See APC Packaged Rates , $644.74 , $359.21 , $888.73 , $892.60 , $474.36 , See APC Packaged Rates , See APC Packaged Rates , $306.71 , $306.71 , See APC Packaged Rates , See APC Packaged Rates , $856.59 , $856.59 , $856.59 , $856.59 , See APC Packaged Rates , $322.37 , $- , $- , $892.60 , $644.74
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
C1713,61515437,Hospital Chargemaster,Plate Lateral Superior 3H/Rt,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 "
C1713,61515438,Hospital Chargemaster,Screw Bone T 10 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
C1713,61515443,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
C1713,61515445,Hospital Chargemaster,Screw Bone T8 Full Thread,Outpatient,Outpatient Default Percent / Case Rate,278, $198.42 , $109.13 , $163.50 , See APC Packaged Rates , $138.89 , $77.38 , $191.46 , $192.29 , $102.19 , See APC Packaged Rates , See APC Packaged Rates , $66.07 , $66.07 , See APC Packaged Rates , See APC Packaged Rates , $184.53 , $184.53 , $184.53 , $184.53 , See APC Packaged Rates , $69.45 , $- , $- , $192.29 , $138.89
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," $4,452.59 "," $2,448.92 "," $3,668.93 ", See APC Packaged Rates ," $3,116.81 "," $1,736.51 "," $4,296.30 "," $4,315.00 "," $2,293.17 ", See APC Packaged Rates , See APC Packaged Rates ," $1,482.71 "," $1,482.71 ", See APC Packaged Rates , See APC Packaged Rates ," $4,140.91 "," $4,140.91 "," $4,140.91 "," $4,140.91 ", See APC Packaged Rates ," $1,558.41 ", $- , $- ," $4,315.00 "," $3,116.81 "
C1713,61515455,Hospital Chargemaster,Acu-Loc 2 Vdr Plt Std Long R,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 "
C1713,61515463,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
C1713,61515466,Hospital Chargemaster,OneThird Tubular Plate 14 Hol,Outpatient,Outpatient Default Percent / Case Rate,278," $1,158.82 ", $637.35 , $954.87 , See APC Packaged Rates , $811.17 , $451.94 ," $1,118.15 "," $1,123.01 ", $596.82 , See APC Packaged Rates , See APC Packaged Rates , $385.89 , $385.89 , See APC Packaged Rates , See APC Packaged Rates ," $1,077.70 "," $1,077.70 "," $1,077.70 "," $1,077.70 ", See APC Packaged Rates , $405.59 , $- , $- ," $1,123.01 ", $811.17
C1713,61515467,Hospital Chargemaster,OneThird Tubular Plate 16 Hol,Outpatient,Outpatient Default Percent / Case Rate,278," $1,273.86 ", $700.62 ," $1,049.66 ", See APC Packaged Rates , $891.70 , $496.81 ," $1,229.15 "," $1,234.50 ", $656.06 , See APC Packaged Rates , See APC Packaged Rates , $424.20 , $424.20 , See APC Packaged Rates , See APC Packaged Rates ," $1,184.69 "," $1,184.69 "," $1,184.69 "," $1,184.69 ", See APC Packaged Rates , $445.85 , $- , $- ," $1,234.50 ", $891.70
C1713,61515469,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 "
C1713,61515479,Hospital Chargemaster,Prox Lateral Humerus Plate,Outpatient,Outpatient Default Percent / Case Rate,278," $5,041.07 "," $2,772.59 "," $4,153.84 ", See APC Packaged Rates ," $3,528.75 "," $1,966.02 "," $4,864.13 "," $4,885.30 "," $2,596.25 ", See APC Packaged Rates , See APC Packaged Rates ," $1,678.68 "," $1,678.68 ", See APC Packaged Rates , See APC Packaged Rates ," $4,688.20 "," $4,688.20 "," $4,688.20 "," $4,688.20 ", See APC Packaged Rates ," $1,764.37 ", $- , $- ," $4,885.30 "," $3,528.75 "
C1713,61515488,Hospital Chargemaster,Prox Lateral Tibia Plate F,Outpatient,Outpatient Default Percent / Case Rate,278," $4,296.29 "," $2,362.96 "," $3,540.14 ", See APC Packaged Rates ," $3,007.40 "," $1,675.55 "," $4,145.49 "," $4,163.53 "," $2,212.68 ", See APC Packaged Rates , See APC Packaged Rates ," $1,430.66 "," $1,430.66 ", See APC Packaged Rates , See APC Packaged Rates ," $3,995.55 "," $3,995.55 "," $3,995.55 "," $3,995.55 ", See APC Packaged Rates ," $1,503.70 ", $- , $- ," $4,163.53 "," $3,007.40 "
C1713,61515490,Hospital Chargemaster,Prox Lateral Tibia Plate F,Outpatient,Outpatient Default Percent / Case Rate,278," $4,471.61 "," $2,459.39 "," $3,684.61 ", See APC Packaged Rates ," $3,130.13 "," $1,743.93 "," $4,314.66 "," $4,333.44 "," $2,302.97 ", See APC Packaged Rates , See APC Packaged Rates ," $1,489.05 "," $1,489.05 ", See APC Packaged Rates , See APC Packaged Rates ," $4,158.60 "," $4,158.60 "," $4,158.60 "," $4,158.60 ", See APC Packaged Rates ," $1,565.06 ", $- , $- ," $4,333.44 "," $3,130.13 "
C1713,61515502,Hospital Chargemaster,Distal Medial Tibia Plate For,Outpatient,Outpatient Default Percent / Case Rate,278," $4,383.23 "," $2,410.78 "," $3,611.78 ", See APC Packaged Rates ," $3,068.26 "," $1,709.46 "," $4,229.38 "," $4,247.79 "," $2,257.45 ", See APC Packaged Rates , See APC Packaged Rates ," $1,459.62 "," $1,459.62 ", See APC Packaged Rates , See APC Packaged Rates ," $4,076.40 "," $4,076.40 "," $4,076.40 "," $4,076.40 ", See APC Packaged Rates ," $1,534.13 ", $- , $- ," $4,247.79 "," $3,068.26 "
C1713,61515537,Hospital Chargemaster,Superior Plate Decreased 8 H,Outpatient,Outpatient Default Percent / Case Rate,278," $2,344.42 "," $1,289.43 "," $1,931.80 ", See APC Packaged Rates ," $1,641.09 ", $914.32 ," $2,262.13 "," $2,271.98 "," $1,207.42 ", See APC Packaged Rates , See APC Packaged Rates , $780.69 , $780.69 , See APC Packaged Rates , See APC Packaged Rates ," $2,180.31 "," $2,180.31 "," $2,180.31 "," $2,180.31 ", See APC Packaged Rates , $820.55 , $- , $- ," $2,271.98 "," $1,641.09 "
C1713,61515541,Hospital Chargemaster,Superior Plate Decreased 6 H,Outpatient,Outpatient Default Percent / Case Rate,278," $2,576.83 "," $1,417.26 "," $2,123.31 ", See APC Packaged Rates ," $1,803.78 "," $1,004.96 "," $2,486.38 "," $2,497.21 "," $1,327.12 ", See APC Packaged Rates , See APC Packaged Rates , $858.08 , $858.08 , See APC Packaged Rates , See APC Packaged Rates ," $2,396.45 "," $2,396.45 "," $2,396.45 "," $2,396.45 ", See APC Packaged Rates , $901.89 , $- , $- ," $2,497.21 "," $1,803.78 "
C1713,61515542,Hospital Chargemaster,Superior Plate Decreased 8 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 "
C1713,61515545,Hospital Chargemaster,Superior Plate Increased 8 H,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 "
C1713,61515602,Hospital Chargemaster,Variax Comp Plate 7 HoleL90 W,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
C1713,61515652,Hospital Chargemaster,Lock Screw T8 Full Thread 2,Outpatient,Outpatient Default Percent / Case Rate,278, $371.70 , $204.44 , $306.28 , See APC Packaged Rates , $260.19 , $144.96 , $358.65 , $360.21 , $191.43 , See APC Packaged Rates , See APC Packaged Rates , $123.78 , $123.78 , See APC Packaged Rates , See APC Packaged Rates , $345.68 , $345.68 , $345.68 , $345.68 , See APC Packaged Rates , $130.10 , $- , $- , $360.21 , $260.19
C1713,61515654,Hospital Chargemaster,Lock Screw T8 Full Thread 2,Outpatient,Outpatient Default Percent / Case Rate,278, $336.97 , $185.33 , $277.66 , See APC Packaged Rates , $235.88 , $131.42 , $325.14 , $326.56 , $173.55 , See APC Packaged Rates , See APC Packaged Rates , $112.21 , $112.21 , See APC Packaged Rates , See APC Packaged Rates , $313.38 , $313.38 , $313.38 , $313.38 , See APC Packaged Rates , $117.94 , $- , $- , $326.56 , $235.88
C1713,61515667,Hospital Chargemaster,Bonescrew T8 Full Thread 2.7M,Outpatient,Outpatient Default Percent / Case Rate,278, $205.29 , $112.91 , $169.16 , See APC Packaged Rates , $143.70 , $80.06 , $198.08 , $198.95 , $105.73 , See APC Packaged Rates , See APC Packaged Rates , $68.36 , $68.36 , See APC Packaged Rates , See APC Packaged Rates , $190.92 , $190.92 , $190.92 , $190.92 , See APC Packaged Rates , $71.85 , $- , $- , $198.95 , $143.70
C1713,61515668,Hospital Chargemaster,Bonescrew T8 Full Thread 2.7M,Outpatient,Outpatient Default Percent / Case Rate,278, $216.72 , $119.20 , $178.58 , See APC Packaged Rates , $151.70 , $84.52 , $209.11 , $210.02 , $111.62 , See APC Packaged Rates , See APC Packaged Rates , $72.17 , $72.17 , See APC Packaged Rates , See APC Packaged Rates , $201.55 , $201.55 , $201.55 , $201.55 , See APC Packaged Rates , $75.85 , $- , $- , $210.02 , $151.70
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
C1713,61515708,Hospital Chargemaster,Bonescrew T10 Full Thread 2.7,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
C1713,61515711,Hospital Chargemaster,Bonescrew T10 Full Thread 2.7,Outpatient,Outpatient Default Percent / Case Rate,278, $217.48 , $119.61 , $179.20 , See APC Packaged Rates , $152.24 , $84.82 , $209.85 , $210.76 , $112.01 , See APC Packaged Rates , See APC Packaged Rates , $72.42 , $72.42 , See APC Packaged Rates , See APC Packaged Rates , $202.26 , $202.26 , $202.26 , $202.26 , See APC Packaged Rates , $76.12 , $- , $- , $210.76 , $152.24
C1713,61515725,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, $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
C1713,61515732,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
C1713,61515733,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
C1713,61515735,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
C1713,61515737,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, $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
C1713,61515739,Hospital Chargemaster,Bonescrew T10 Full Thread 3.5,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
C1713,61515741,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
C1713,61515745,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
C1713,61515747,Hospital Chargemaster,4M Lock Screw 4.0M / L24M,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
C1713,61515750,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, $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
C1713,61515752,Hospital Chargemaster,4M Lock Screw 4.0M / L40M,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
C1713,61515753,Hospital Chargemaster,4M Lock Screw 4.0M / L44M,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
C1713,61515758,Hospital Chargemaster,4M Lock Screw 4.0M / L75M,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
C1713,61515759,Hospital Chargemaster,4M Lock Screw 4.0M / L80M,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
C1713,61515766,Hospital Chargemaster,5M Lock Screw 5.0M / L20M,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, $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
C1713,61515778,Hospital Chargemaster,5M Lock Screw 5.0M / L60M,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
C1713,61515780,Hospital Chargemaster,5M Lock Screw 5.0M / L85M,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
C1713,61515784,Hospital Chargemaster,Periprosthetic Lock Screw 5,Outpatient,Outpatient Default Percent / Case Rate,278, $442.89 , $243.59 , $364.94 , See APC Packaged Rates , $310.02 , $172.73 , $427.34 , $429.20 , $228.10 , See APC Packaged Rates , See APC Packaged Rates , $147.48 , $147.48 , See APC Packaged Rates , See APC Packaged Rates , $411.89 , $411.89 , $411.89 , $411.89 , See APC Packaged Rates , $155.01 , $- , $- , $429.20 , $310.02
C1713,61515785,Hospital Chargemaster,Periprosthetic Lock Screw 5,Outpatient,Outpatient Default Percent / Case Rate,278, $442.89 , $243.59 , $364.94 , See APC Packaged Rates , $310.02 , $172.73 , $427.34 , $429.20 , $228.10 , See APC Packaged Rates , See APC Packaged Rates , $147.48 , $147.48 , See APC Packaged Rates , See APC Packaged Rates , $411.89 , $411.89 , $411.89 , $411.89 , See APC Packaged Rates , $155.01 , $- , $- , $429.20 , $310.02
C1713,61515814,Hospital Chargemaster,"Drill Bit, Ao, Scaled2.6 X 2",Outpatient,Outpatient Default Percent / Case Rate,278, $353.43 , $194.39 , $291.23 , See APC Packaged Rates , $247.40 , $137.84 , $341.02 , $342.51 , $182.02 , See APC Packaged Rates , See APC Packaged Rates , $117.69 , $117.69 , See APC Packaged Rates , See APC Packaged Rates , $328.69 , $328.69 , $328.69 , $328.69 , See APC Packaged Rates , $123.70 , $- , $- , $342.51 , $247.40
C1713,61515821,Hospital Chargemaster,Asnis Iii Ss Cann Scr 6.5X60M,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
C1713,61515822,Hospital Chargemaster,Asnis Iii Ss Cann Scr 6.5X75M,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
C1713,61515823,Hospital Chargemaster,Asnis Iii Ss Cann Scr6.5X100M,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
C1713,61515831,Hospital Chargemaster,Asnis Iii Ss Cann Scr 6.5X70M,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
C1713,61515848,Hospital Chargemaster,Asnis Iii Ss Cann Scr 8X75M P,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
C1713,61515853,Hospital Chargemaster,Distal Lateral Fibula Plate 6,Outpatient,Outpatient Default Percent / Case Rate,278," $1,360.17 ", $748.09 ," $1,120.78 ", See APC Packaged Rates , $952.12 , $530.47 ," $1,312.43 "," $1,318.14 ", $700.51 , See APC Packaged Rates , See APC Packaged Rates , $452.94 , $452.94 , See APC Packaged Rates , See APC Packaged Rates ," $1,264.96 "," $1,264.96 "," $1,264.96 "," $1,264.96 ", See APC Packaged Rates , $476.06 , $- , $- ," $1,318.14 ", $952.12
C1713,61515856,Hospital Chargemaster,Distal Lateral Fibula Plate 9,Outpatient,Outpatient Default Percent / Case Rate,278," $1,475.84 ", $811.71 ," $1,216.09 ", See APC Packaged Rates ," $1,033.09 ", $575.58 ," $1,424.04 "," $1,430.24 ", $760.09 , See APC Packaged Rates , See APC Packaged Rates , $491.45 , $491.45 , See APC Packaged Rates , See APC Packaged Rates ," $1,372.53 "," $1,372.53 "," $1,372.53 "," $1,372.53 ", See APC Packaged Rates , $516.54 , $- , $- ," $1,430.24 "," $1,033.09 "
C1713,61515912,Hospital Chargemaster,Volar Dr Plate Inter R,Outpatient,Outpatient Default Percent / Case Rate,278," $2,055.73 "," $1,130.65 "," $1,693.92 ", See APC Packaged Rates ," $1,439.01 ", $801.73 ," $1,983.57 "," $1,992.21 "," $1,058.74 ", See APC Packaged Rates , See APC Packaged Rates , $684.56 , $684.56 , See APC Packaged Rates , See APC Packaged Rates ," $1,911.83 "," $1,911.83 "," $1,911.83 "," $1,911.83 ", See APC Packaged Rates , $719.51 , $- , $- ," $1,992.21 "," $1,439.01 "
C1713,61515913,Hospital Chargemaster,Volar Dr Plate Inter R,Outpatient,Outpatient Default Percent / Case Rate,278," $1,989.92 "," $1,094.46 "," $1,639.69 ", See APC Packaged Rates ," $1,392.94 ", $776.07 ," $1,920.07 "," $1,928.43 "," $1,024.85 ", See APC Packaged Rates , See APC Packaged Rates , $662.64 , $662.64 , See APC Packaged Rates , See APC Packaged Rates ," $1,850.63 "," $1,850.63 "," $1,850.63 "," $1,850.63 ", See APC Packaged Rates , $696.47 , $- , $- ," $1,928.43 "," $1,392.94 "
C1713,61515915,Hospital Chargemaster,Volar Dr Plate Stand Lt 10,Outpatient,Outpatient Default Percent / Case Rate,278," $2,187.36 "," $1,203.05 "," $1,802.38 ", See APC Packaged Rates ," $1,531.15 ", $853.07 ," $2,110.58 "," $2,119.77 "," $1,126.53 ", See APC Packaged Rates , See APC Packaged Rates , $728.39 , $728.39 , See APC Packaged Rates , See APC Packaged Rates ," $2,034.24 "," $2,034.24 "," $2,034.24 "," $2,034.24 ", See APC Packaged Rates , $765.58 , $- , $- ," $2,119.77 "," $1,531.15 "
C1713,61515925,Hospital Chargemaster,4.0 X30M 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
C1713,61515928,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
C1713,61515930,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, $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
C1713,61515932,Hospital Chargemaster,4.0 X50M 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
C1713,61515933,Hospital Chargemaster,4.0 X55M 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
C1713,61515934,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, $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
C1713,61516048,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
C1713,61516091,Hospital Chargemaster,Rest Mod Conical Distal Stem,Outpatient,Outpatient Default Percent / Case Rate,278," $10,574.55 "," $5,816.00 "," $8,713.43 ", 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 ", $- , $- ," $10,247.80 "," $7,402.19 "
C1713,61516103,Hospital Chargemaster,Ti Lag Screw 10.5X80M,Outpatient,Outpatient Default Percent / Case Rate,278," $1,058.31 ", $582.07 , $872.05 , See APC Packaged Rates , $740.82 , $412.74 ," $1,021.16 "," $1,025.61 ", $545.05 , See APC Packaged Rates , See APC Packaged Rates , $352.42 , $352.42 , See APC Packaged Rates , See APC Packaged Rates , $984.23 , $984.23 , $984.23 , $984.23 , See APC Packaged Rates , $370.41 , $- , $- ," $1,025.61 ", $740.82
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 "
C1713,61516112,Hospital Chargemaster,Cortex Screw 3.5Mm / L60Mm,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
,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
C1713,61516150,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
C1713,61516159,Hospital Chargemaster,Lfit Head 40M/+12 V40,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 "
C1713,61516171,Hospital Chargemaster,Cancellous Ti Screw,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
C1713,61516175,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
C1713,61516180,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 "
,61516187,Hospital Chargemaster,Biliary Stent 5Cm X 10 Fr,Outpatient,Outpatient Default Percent / Case Rate,278, $427.35 , $235.04 , $341.88 , See APC Packaged Rates , $299.15 , $166.67 , $412.35 , $414.14 , $220.09 , See APC Packaged Rates , See APC Packaged Rates , $142.31 , $142.31 , See APC Packaged Rates , See APC Packaged Rates , $397.44 , $397.44 , $397.44 , $397.44 , See APC Packaged Rates , $149.57 , $256.41 , $142.31 , $414.14 , $299.15
,61516188,Hospital Chargemaster,Biliary Stent 7Cm X 10Fr,Outpatient,Outpatient Default Percent / Case Rate,278, $437.85 , $240.82 , $350.28 , See APC Packaged Rates , $306.50 , $170.76 , $422.48 , $424.32 , $225.50 , See APC Packaged Rates , See APC Packaged Rates , $145.80 , $145.80 , See APC Packaged Rates , See APC Packaged Rates , $407.20 , $407.20 , $407.20 , $407.20 , See APC Packaged Rates , $153.25 , $262.71 , $145.80 , $424.32 , $306.50
C2625,61516189,Hospital Chargemaster,Biliary Stent 9Cm X 10Fr,Outpatient,Outpatient Default Percent / Case Rate,278, $469.35 , $258.14 , $386.74 , See APC Packaged Rates , $328.55 , $183.05 , $452.88 , $454.85 , $241.72 , See APC Packaged Rates , See APC Packaged Rates , $156.29 , $156.29 , See APC Packaged Rates , See APC Packaged Rates , $436.50 , $436.50 , $436.50 , $436.50 , See APC Packaged Rates , $164.27 , $- , $- , $454.85 , $328.55
,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, $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
C1713,61516193,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
C1713,61516196,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
C1713,61516204,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
C1713,61516211,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
C1713,61516287,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
C1713,61516295,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, $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
C1713,61516334,Hospital Chargemaster,Cable Sleeve Set 2.0M D/M,Outpatient,Outpatient Default Percent / Case Rate,278," $1,188.81 ", $653.85 , $979.58 , 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 , $- , $- ," $1,152.08 ", $832.17
C1713,61516346,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
C1713,61516347,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
C1713,61516359,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
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
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, $250.00 , $194.57 , $206.00 , See APC Packaged Rates , $175.00 , $97.50 , $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 , $175.00
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,