hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|[state],"To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, Jeff Davis Hospital,2/29/2024,2.0.0,Jeff Davis Hospital,"163 S. Tallahassee St. Hazlehurst, GA 31539-2921",580903829|GA,TRUE,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, SERVICE DESCRIPTION,CATEGORY,BILLING MSDRG | CPT | HCPCS,ITEM/SERVICE DESCRIPTION,BILLING REVENUE CODE,GROSS CHARGES,AMERIGROUP MEDICAID PLAN,AMERIGROUP MEDICAID REIMBURSEMENT METHOD,AMERIGROUP PEACHSTATE FOR KIDS PLAN,AMERIGROUP PEACHSTATE FOR KIDS REIMBURSEMENT METHOD,BCBS HMO PLAN,BCBS HMO REIMBURSEMENT METHOD,BCBS POS PLAN,BCBS POS REIMBURSEMENT METHOD,BCBS PPO PLAN,BCBS PPO REIMBURSEMENT METHOD,BCBS MEDICARE ADVANTAGE HMO PLAN,BCBS MEDICARE ADVANTAGE HMO REIMBURSEMENT METHOD,BCBS MEDICARE ADVANTAGE INDEMNITY PLAN,BCBS MEDICARE ADVANTAGE INDEMNITY REIMBURSEMENT METHOD,BCBS MEDICARE ADVANTAGE OPEN ACCESS PLAN,BCBS MEDICARE ADVANTAGE OPEN ACCESS REIMBURSEMENT METHOD,BCBS MEDICARE ADVANTAGE PAR PLAN,BCBS MEDICARE ADVANTAGE PAR REIMBURSEMENT METHOD,BCBS MEDICARE ADVANTAGE POS PLAN,BCBS MEDICARE ADVANTAGE POS REIMBURSEMENT METHOD,BCBS MEDICARE ADVANTAGE PPO PLAN,BCBS MEDICARE ADVANTAGE PPO REIMBURSEMENT METHOD,BEECH STREET PLAN,BEECH STREET REIMBURSEMENT METHOD,CARE IMPROVEMENT PLUS PLAN,CARE IMPROVEMENT PLUS REIMBURSEMENT METHOD,CARE SOURCE PLAN,CARE SOURCE REIMBURSEMENT METHOD,CHOICECARE PLAN,CHOICECARE REIMBURSEMENT METHOD,CHOICECARE MEDICARE PPO PLAN,CHOICECARE MEDICARE PPO REIMBURSEMENT METHOD,CIGNA PLAN,CIGNA REIMBURSEMENT METHOD,COMMUNITY CARE NETWORK PLAN,COMMUNITY CARE NETWORK REIMBURSEMENT METHOD,COVENTRY HMO PLAN,COVENTRY HMO REIMBURSEMENT METHOD,COVENTRY POS PLAN,COVENTRY POS REIMBURSEMENT METHOD,COVENTRY PPO PLAN,COVENTRY PPO REIMBURSEMENT METHOD,COVENTRY MEDICARE PLAN,COVENTRY MEDICARE REIMBURSEMENT METHOD,GEORGIA HOSPITAL NETWORK PLAN,GEORGIA HOSPITAL NETWORK REIMBURSEMENT METHOD,HUMANA EPO PLAN,HUMANA EPO REIMBURSEMENT METHOD,HUMANA HMO PLAN,HUMANA HMO REIMBURSEMENT METHOD,HUMANA POS PLAN,HUMANA POS REIMBURSEMENT METHOD,HUMANA PPO PLAN,HUMANA PPO REIMBURSEMENT METHOD,HUMANA MEDICAID PLAN,HUMANA MEDICAID REIMBURSEMENT METHOD,HUMANA MEDICARE HMO PLAN,HUMANA MEDICARE HMO REIMBURSEMENT METHOD,HUMANA MEDICARE PFFS PLAN,HUMANA MEDICARE PFFS REIMBURSEMENT METHOD,HUMANA MEDICARE POS PLAN,HUMANA MEDICARE POS REIMBURSEMENT METHOD,HUMANA MEDICARE PPO PLAN,HUMANA MEDICARE PPO REIMBURSEMENT METHOD,INDUSTRY BUYING GROUP PLAN,INDUSTRY BUYING GROUP REIMBURSEMENT METHOD,MEDICAID PLAN,MEDICAID REIMBURSEMENT METHOD,MEDICARE PLAN,MEDICARE REIMBURSEMENT METHOD,MEMORIAL HEALTH PARTNERS PLAN,MEMORIAL HEALTH PARTNERS REIMBURSEMENT METHOD,MOLINA MEDICAID PLAN,MOLINA MEDICAID REIMBURSEMENT METHOD,MULTIPLAN PLAN,MULTIPLAN REIMBURSEMENT METHOD,NOVANET PLAN,NOVANET REIMBURSEMENT METHOD,ONE HEALTH PLAN PPO PLAN,ONE HEALTH PLAN PPO REIMBURSEMENT METHOD,PEACH STATE PLAN,PEACH STATE REIMBURSEMENT METHOD,PEN NETWORK PLAN,PEN NETWORK REIMBURSEMENT METHOD,PRINCIPAL HEALTH CARE OF GEORGIA PLAN,PRINCIPAL HEALTH CARE OF GEORGIA REIMBURSEMENT METHOD,THREE RIVERS PROVIDER NETWORK PLAN,THREE RIVERS PROVIDER NETWORK REIMBURSEMENT METHOD,TRICARE PLAN,TRICARE REIMBURSEMENT METHOD,UHC HMO PLAN,UHC HMO REIMBURSEMENT METHOD,UHC INDEMNITY PLAN,UHC INDEMNITY REIMBURSEMENT METHOD,UHC PPO PLAN,UHC PPO REIMBURSEMENT METHOD,UHC MEDICAID PLAN,UHC MEDICAID REIMBURSEMENT METHOD,USA MANAGED CARE PLAN,USA MANAGED CARE REIMBURSEMENT METHOD,WELLCARE PLAN,WELLCARE REIMBURSEMENT METHOD,De-Identified Minimum Negotiated Rate,De-Identified Maximum Negotiated Rate,DISCOUNTED CASH PRICE Outpatient Medical Services,AMBULATORY,11042,DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/< TechFee,450,$166.00 ,$88.98 ,53.6% of total biled charges for outpatient setting,$88.98 ,53.6% of total biled charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$132.80 ,80% of total billed charges for outpatient setting,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$58.10 ,35% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$132.80 ,80% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$116.20 ,70% of total billed charges for outpatient setting,$116.20 ,70% of total billed charges for outpatient setting,$127.82 ,77% of total billed charges for outpatient setting,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$33.02 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$141.10 ,85% of total billed charges for outpatient setting,$32.37 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$51.46 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$149.40 ,90% of total billed charges for outpatient setting,$33.33 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$157.70 ,95% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$132.80 ,80% of total billed charges for outpatient setting,$33.02 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$154.38 ,93% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$33.33 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$33.02 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$32.37 ,$157.70 ,$58.10 Outpatient Medical Services,AMBULATORY,11042,SQ Tissue Less Than/Equal to 1st 20 sq cm,450,$166.00 ,$88.98 ,53.6% of total biled charges for outpatient setting,$88.98 ,53.6% of total biled charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$132.80 ,80% of total billed charges for outpatient setting,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$58.10 ,35% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$132.80 ,80% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$116.20 ,70% of total billed charges for outpatient setting,$116.20 ,70% of total billed charges for outpatient setting,$127.82 ,77% of total billed charges for outpatient setting,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$33.02 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$141.10 ,85% of total billed charges for outpatient setting,$32.37 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$51.46 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$149.40 ,90% of total billed charges for outpatient setting,$33.33 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$157.70 ,95% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$132.80 ,80% of total billed charges for outpatient setting,$33.02 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$154.38 ,93% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$33.33 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$33.02 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$32.37 ,$157.70 ,$58.10 Outpatient Medical Services,AMBULATORY,11043,DEBRIDE TISSUE/MUSCLE TechFee,450,$166.00 ,$88.98 ,53.6% of total biled charges for outpatient setting,$88.98 ,53.6% of total biled charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$132.80 ,80% of total billed charges for outpatient setting,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$58.10 ,35% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$132.80 ,80% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$116.20 ,70% of total billed charges for outpatient setting,$116.20 ,70% of total billed charges for outpatient setting,$127.82 ,77% of total billed charges for outpatient setting,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$33.02 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$141.10 ,85% of total billed charges for outpatient setting,$32.37 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$51.46 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$149.40 ,90% of total billed charges for outpatient setting,$33.33 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$157.70 ,95% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$132.80 ,80% of total billed charges for outpatient setting,$33.02 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$154.38 ,93% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$33.33 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$33.02 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$32.37 ,$157.70 ,$58.10 Outpatient Medical Services,AMBULATORY,11043,SQ Tissue/Muscle Less Than/Equal to 1st 20 sq cm,450,$166.00 ,$88.98 ,53.6% of total biled charges for outpatient setting,$88.98 ,53.6% of total biled charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$132.80 ,80% of total billed charges for outpatient setting,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$58.10 ,35% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$132.80 ,80% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$116.20 ,70% of total billed charges for outpatient setting,$116.20 ,70% of total billed charges for outpatient setting,$127.82 ,77% of total billed charges for outpatient setting,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$33.02 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$141.10 ,85% of total billed charges for outpatient setting,$32.37 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$51.46 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$149.40 ,90% of total billed charges for outpatient setting,$33.33 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$157.70 ,95% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$132.80 ,80% of total billed charges for outpatient setting,$33.02 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$154.38 ,93% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$33.33 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$33.02 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$32.37 ,$157.70 ,$58.10 Outpatient Medical Services,AMBULATORY,11045,Subcutaneous Tissue,450,$166.00 ,$88.98 ,53.6% of total biled charges for outpatient setting,$88.98 ,53.6% of total biled charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$132.80 ,80% of total billed charges for outpatient setting,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$58.10 ,35% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$132.80 ,80% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$116.20 ,70% of total billed charges for outpatient setting,$116.20 ,70% of total billed charges for outpatient setting,$127.82 ,77% of total billed charges for outpatient setting,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$33.02 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$141.10 ,85% of total billed charges for outpatient setting,$32.37 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$51.46 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$149.40 ,90% of total billed charges for outpatient setting,$33.33 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$157.70 ,95% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$132.80 ,80% of total billed charges for outpatient setting,$33.02 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$154.38 ,93% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$33.33 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$33.02 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$32.37 ,$157.70 ,$58.10 Outpatient Medical Services,AMBULATORY,11045,EACH ADDITIONAL 20 CM TechFee,450,$166.00 ,$88.98 ,53.6% of total biled charges for outpatient setting,$88.98 ,53.6% of total biled charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$132.80 ,80% of total billed charges for outpatient setting,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$58.10 ,35% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$132.80 ,80% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$116.20 ,70% of total billed charges for outpatient setting,$116.20 ,70% of total billed charges for outpatient setting,$127.82 ,77% of total billed charges for outpatient setting,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$33.02 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$141.10 ,85% of total billed charges for outpatient setting,$32.37 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$51.46 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$149.40 ,90% of total billed charges for outpatient setting,$33.33 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$157.70 ,95% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$132.80 ,80% of total billed charges for outpatient setting,$33.02 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$154.38 ,93% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$33.33 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$33.02 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$32.37 ,$157.70 ,$58.10 Outpatient Medical Services,AMBULATORY,11045,DEBRIDE SKIN EA ADDTL CHARGE,361,$553.57 ,$296.71 ,53.6% of total biled charges for outpatient setting,$296.71 ,53.6% of total biled charges for outpatient setting,$415.18 ,75% of total billed charges for outpatient setting,$415.18 ,75% of total billed charges for outpatient setting,$415.18 ,75% of total billed charges for outpatient setting,$175.04 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$175.04 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$175.04 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$175.04 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$175.04 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$175.04 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$442.86 ,80% of total billed charges for outpatient setting,$175.04 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$193.75 ,35% of total billed charges for outpatient setting,$470.53 ,85% of total billed charges for outpatient setting,$173.32 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$442.86 ,80% of total billed charges for outpatient setting,$470.53 ,85% of total billed charges for outpatient setting,$387.50 ,70% of total billed charges for outpatient setting,$387.50 ,70% of total billed charges for outpatient setting,$426.25 ,77% of total billed charges for outpatient setting,$173.32 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$470.53 ,85% of total billed charges for outpatient setting,$470.53 ,85% of total billed charges for outpatient setting,$470.53 ,85% of total billed charges for outpatient setting,$470.53 ,85% of total billed charges for outpatient setting,$470.53 ,85% of total billed charges for outpatient setting,$110.11 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$173.32 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$173.32 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$173.32 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$173.32 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$470.53 ,85% of total billed charges for outpatient setting,$107.95 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$171.61 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$498.21 ,90% of total billed charges for outpatient setting,$111.16 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$525.89 ,95% of total billed charges for outpatient setting,$470.53 ,85% of total billed charges for outpatient setting,$442.86 ,80% of total billed charges for outpatient setting,$110.11 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$470.53 ,85% of total billed charges for outpatient setting,$470.53 ,85% of total billed charges for outpatient setting,$470.53 ,85% of total billed charges for outpatient setting,$514.82 ,93% of total billed charges for outpatient setting,$415.18 ,75% of total billed charges for outpatient setting,$415.18 ,75% of total billed charges for outpatient setting,$415.18 ,75% of total billed charges for outpatient setting,$111.16 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$470.53 ,85% of total billed charges for outpatient setting,$110.11 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$107.95 ,$525.89 ,$193.75 Outpatient Medical Services,AMBULATORY,11046,Muscle and/or fascia,450,$140.00 ,$75.04 ,53.6% of total biled charges for outpatient setting,$75.04 ,53.6% of total biled charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$44.27 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$44.27 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$44.27 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$44.27 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$44.27 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$44.27 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$112.00 ,80% of total billed charges for outpatient setting,$44.27 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$49.00 ,35% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$43.83 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$112.00 ,80% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$98.00 ,70% of total billed charges for outpatient setting,$98.00 ,70% of total billed charges for outpatient setting,$107.80 ,77% of total billed charges for outpatient setting,$43.83 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$119.00 ,85% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$27.85 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$43.83 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$43.83 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$43.83 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$43.83 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$119.00 ,85% of total billed charges for outpatient setting,$27.30 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$43.40 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$126.00 ,90% of total billed charges for outpatient setting,$28.11 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$133.00 ,95% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$112.00 ,80% of total billed charges for outpatient setting,$27.85 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$130.20 ,93% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$28.11 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$27.85 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$27.30 ,$133.00 ,$49.00 Outpatient Medical Services,AMBULATORY,11046,EACH ADDITIONAL 20CM TechFee,450,$140.00 ,$75.04 ,53.6% of total biled charges for outpatient setting,$75.04 ,53.6% of total biled charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$44.27 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$44.27 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$44.27 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$44.27 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$44.27 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$44.27 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$112.00 ,80% of total billed charges for outpatient setting,$44.27 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$49.00 ,35% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$43.83 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$112.00 ,80% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$98.00 ,70% of total billed charges for outpatient setting,$98.00 ,70% of total billed charges for outpatient setting,$107.80 ,77% of total billed charges for outpatient setting,$43.83 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$119.00 ,85% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$27.85 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$43.83 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$43.83 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$43.83 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$43.83 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$119.00 ,85% of total billed charges for outpatient setting,$27.30 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$43.40 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$126.00 ,90% of total billed charges for outpatient setting,$28.11 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$133.00 ,95% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$112.00 ,80% of total billed charges for outpatient setting,$27.85 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$130.20 ,93% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$28.11 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$27.85 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$27.30 ,$133.00 ,$49.00 Outpatient Medical Services,AMBULATORY,11046,DEBRIDE MUSCLE FASCIA EA ADDTL CHARGE,361,$856.00 ,$458.82 ,53.6% of total biled charges for outpatient setting,$458.82 ,53.6% of total biled charges for outpatient setting,$642.00 ,75% of total billed charges for outpatient setting,$642.00 ,75% of total billed charges for outpatient setting,$642.00 ,75% of total billed charges for outpatient setting,$270.67 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$270.67 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$270.67 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$270.67 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$270.67 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$270.67 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$684.80 ,80% of total billed charges for outpatient setting,$270.67 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$299.60 ,35% of total billed charges for outpatient setting,$727.60 ,85% of total billed charges for outpatient setting,$268.01 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$684.80 ,80% of total billed charges for outpatient setting,$727.60 ,85% of total billed charges for outpatient setting,$599.20 ,70% of total billed charges for outpatient setting,$599.20 ,70% of total billed charges for outpatient setting,$659.12 ,77% of total billed charges for outpatient setting,$268.01 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$727.60 ,85% of total billed charges for outpatient setting,$727.60 ,85% of total billed charges for outpatient setting,$727.60 ,85% of total billed charges for outpatient setting,$727.60 ,85% of total billed charges for outpatient setting,$727.60 ,85% of total billed charges for outpatient setting,$170.26 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$268.01 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$268.01 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$268.01 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$268.01 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$727.60 ,85% of total billed charges for outpatient setting,$166.92 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$265.36 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$770.40 ,90% of total billed charges for outpatient setting,$171.88 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$813.20 ,95% of total billed charges for outpatient setting,$727.60 ,85% of total billed charges for outpatient setting,$684.80 ,80% of total billed charges for outpatient setting,$170.26 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$727.60 ,85% of total billed charges for outpatient setting,$727.60 ,85% of total billed charges for outpatient setting,$727.60 ,85% of total billed charges for outpatient setting,$796.08 ,93% of total billed charges for outpatient setting,$642.00 ,75% of total billed charges for outpatient setting,$642.00 ,75% of total billed charges for outpatient setting,$642.00 ,75% of total billed charges for outpatient setting,$171.88 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$727.60 ,85% of total billed charges for outpatient setting,$170.26 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$166.92 ,$813.20 ,$299.60 Outpatient Medical Services,AMBULATORY,11055,PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1 TechFee,N/A,$174.00 ,$93.26 ,53.6% of total biled charges for outpatient setting,$93.26 ,53.6% of total biled charges for outpatient setting,$130.50 ,75% of total billed charges for outpatient setting,$130.50 ,75% of total billed charges for outpatient setting,$130.50 ,75% of total billed charges for outpatient setting,$55.02 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$55.02 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$55.02 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$55.02 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$55.02 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$55.02 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$139.20 ,80% of total billed charges for outpatient setting,$55.02 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$60.90 ,35% of total billed charges for outpatient setting,$147.90 ,85% of total billed charges for outpatient setting,$54.48 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$139.20 ,80% of total billed charges for outpatient setting,$147.90 ,85% of total billed charges for outpatient setting,$121.80 ,70% of total billed charges for outpatient setting,$121.80 ,70% of total billed charges for outpatient setting,$133.98 ,77% of total billed charges for outpatient setting,$54.48 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$147.90 ,85% of total billed charges for outpatient setting,$147.90 ,85% of total billed charges for outpatient setting,$147.90 ,85% of total billed charges for outpatient setting,$147.90 ,85% of total billed charges for outpatient setting,$147.90 ,85% of total billed charges for outpatient setting,$34.61 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$54.48 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$54.48 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$54.48 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$54.48 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$147.90 ,85% of total billed charges for outpatient setting,$33.93 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$53.94 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$156.60 ,90% of total billed charges for outpatient setting,$34.94 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$165.30 ,95% of total billed charges for outpatient setting,$147.90 ,85% of total billed charges for outpatient setting,$139.20 ,80% of total billed charges for outpatient setting,$34.61 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$147.90 ,85% of total billed charges for outpatient setting,$147.90 ,85% of total billed charges for outpatient setting,$147.90 ,85% of total billed charges for outpatient setting,$161.82 ,93% of total billed charges for outpatient setting,$130.50 ,75% of total billed charges for outpatient setting,$130.50 ,75% of total billed charges for outpatient setting,$130.50 ,75% of total billed charges for outpatient setting,$34.94 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$147.90 ,85% of total billed charges for outpatient setting,$34.61 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$33.93 ,$165.30 ,$60.90 Outpatient Medical Services,AMBULATORY,11055,Paring/Cut Lesion Benign Single,450,$174.00 ,$93.26 ,53.6% of total biled charges for outpatient setting,$93.26 ,53.6% of total biled charges for outpatient setting,$130.50 ,75% of total billed charges for outpatient setting,$130.50 ,75% of total billed charges for outpatient setting,$130.50 ,75% of total billed charges for outpatient setting,$55.02 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$55.02 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$55.02 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$55.02 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$55.02 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$55.02 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$139.20 ,80% of total billed charges for outpatient setting,$55.02 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$60.90 ,35% of total billed charges for outpatient setting,$147.90 ,85% of total billed charges for outpatient setting,$54.48 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$139.20 ,80% of total billed charges for outpatient setting,$147.90 ,85% of total billed charges for outpatient setting,$121.80 ,70% of total billed charges for outpatient setting,$121.80 ,70% of total billed charges for outpatient setting,$133.98 ,77% of total billed charges for outpatient setting,$54.48 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$147.90 ,85% of total billed charges for outpatient setting,$147.90 ,85% of total billed charges for outpatient setting,$147.90 ,85% of total billed charges for outpatient setting,$147.90 ,85% of total billed charges for outpatient setting,$147.90 ,85% of total billed charges for outpatient setting,$34.61 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$54.48 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$54.48 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$54.48 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$54.48 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$147.90 ,85% of total billed charges for outpatient setting,$33.93 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$53.94 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$156.60 ,90% of total billed charges for outpatient setting,$34.94 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$165.30 ,95% of total billed charges for outpatient setting,$147.90 ,85% of total billed charges for outpatient setting,$139.20 ,80% of total billed charges for outpatient setting,$34.61 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$147.90 ,85% of total billed charges for outpatient setting,$147.90 ,85% of total billed charges for outpatient setting,$147.90 ,85% of total billed charges for outpatient setting,$161.82 ,93% of total billed charges for outpatient setting,$130.50 ,75% of total billed charges for outpatient setting,$130.50 ,75% of total billed charges for outpatient setting,$130.50 ,75% of total billed charges for outpatient setting,$34.94 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$147.90 ,85% of total billed charges for outpatient setting,$34.61 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$33.93 ,$165.30 ,$60.90 Outpatient Medical Services,AMBULATORY,11056,Paring/Cutting Benign Lesion,450,$144.00 ,$77.18 ,53.6% of total biled charges for outpatient setting,$77.18 ,53.6% of total biled charges for outpatient setting,$108.00 ,75% of total billed charges for outpatient setting,$108.00 ,75% of total billed charges for outpatient setting,$108.00 ,75% of total billed charges for outpatient setting,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$115.20 ,80% of total billed charges for outpatient setting,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$50.40 ,35% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$45.09 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$115.20 ,80% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$100.80 ,70% of total billed charges for outpatient setting,$100.80 ,70% of total billed charges for outpatient setting,$110.88 ,77% of total billed charges for outpatient setting,$45.09 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$122.40 ,85% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$28.64 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$45.09 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$45.09 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$45.09 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$45.09 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$122.40 ,85% of total billed charges for outpatient setting,$28.08 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$44.64 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$129.60 ,90% of total billed charges for outpatient setting,$28.92 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$136.80 ,95% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$115.20 ,80% of total billed charges for outpatient setting,$28.64 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$133.92 ,93% of total billed charges for outpatient setting,$108.00 ,75% of total billed charges for outpatient setting,$108.00 ,75% of total billed charges for outpatient setting,$108.00 ,75% of total billed charges for outpatient setting,$28.92 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$28.64 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$28.08 ,$136.80 ,$50.40 Outpatient Medical Services,AMBULATORY,11056,PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION 2 TO 4 LESIONS. TechFee,450,$144.00 ,$77.18 ,53.6% of total biled charges for outpatient setting,$77.18 ,53.6% of total biled charges for outpatient setting,$108.00 ,75% of total billed charges for outpatient setting,$108.00 ,75% of total billed charges for outpatient setting,$108.00 ,75% of total billed charges for outpatient setting,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$115.20 ,80% of total billed charges for outpatient setting,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$50.40 ,35% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$45.09 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$115.20 ,80% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$100.80 ,70% of total billed charges for outpatient setting,$100.80 ,70% of total billed charges for outpatient setting,$110.88 ,77% of total billed charges for outpatient setting,$45.09 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$122.40 ,85% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$28.64 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$45.09 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$45.09 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$45.09 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$45.09 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$122.40 ,85% of total billed charges for outpatient setting,$28.08 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$44.64 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$129.60 ,90% of total billed charges for outpatient setting,$28.92 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$136.80 ,95% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$115.20 ,80% of total billed charges for outpatient setting,$28.64 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$133.92 ,93% of total billed charges for outpatient setting,$108.00 ,75% of total billed charges for outpatient setting,$108.00 ,75% of total billed charges for outpatient setting,$108.00 ,75% of total billed charges for outpatient setting,$28.92 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$28.64 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$28.08 ,$136.80 ,$50.40 Outpatient Medical Services,AMBULATORY,12001,SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< TechFee,450,$615.39 ,$329.85 ,53.6% of total biled charges for outpatient setting,$329.85 ,53.6% of total biled charges for outpatient setting,$461.54 ,75% of total billed charges for outpatient setting,$461.54 ,75% of total billed charges for outpatient setting,$461.54 ,75% of total billed charges for outpatient setting,$194.59 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$194.59 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$194.59 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$194.59 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$194.59 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$194.59 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$492.31 ,80% of total billed charges for outpatient setting,$194.59 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$215.39 ,35% of total billed charges for outpatient setting,$523.08 ,85% of total billed charges for outpatient setting,$192.68 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$492.31 ,80% of total billed charges for outpatient setting,$523.08 ,85% of total billed charges for outpatient setting,$430.77 ,70% of total billed charges for outpatient setting,$430.77 ,70% of total billed charges for outpatient setting,$473.85 ,77% of total billed charges for outpatient setting,$192.68 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$523.08 ,85% of total billed charges for outpatient setting,$523.08 ,85% of total billed charges for outpatient setting,$523.08 ,85% of total billed charges for outpatient setting,$523.08 ,85% of total billed charges for outpatient setting,$523.08 ,85% of total billed charges for outpatient setting,$122.40 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$192.68 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$192.68 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$192.68 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$192.68 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$523.08 ,85% of total billed charges for outpatient setting,$120.00 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$190.77 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$553.85 ,90% of total billed charges for outpatient setting,$123.57 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$584.62 ,95% of total billed charges for outpatient setting,$523.08 ,85% of total billed charges for outpatient setting,$492.31 ,80% of total billed charges for outpatient setting,$122.40 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$523.08 ,85% of total billed charges for outpatient setting,$523.08 ,85% of total billed charges for outpatient setting,$523.08 ,85% of total billed charges for outpatient setting,$572.31 ,93% of total billed charges for outpatient setting,$461.54 ,75% of total billed charges for outpatient setting,$461.54 ,75% of total billed charges for outpatient setting,$461.54 ,75% of total billed charges for outpatient setting,$123.57 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$523.08 ,85% of total billed charges for outpatient setting,$122.40 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$120.00 ,$584.62 ,$215.39 Outpatient Medical Services,AMBULATORY,12001,Scalp/Neck/Trunk/Genital/Extremity <= 2.5 cm,450,$615.39 ,$329.85 ,53.6% of total biled charges for outpatient setting,$329.85 ,53.6% of total biled charges for outpatient setting,$461.54 ,75% of total billed charges for outpatient setting,$461.54 ,75% of total billed charges for outpatient setting,$461.54 ,75% of total billed charges for outpatient setting,$194.59 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$194.59 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$194.59 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$194.59 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$194.59 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$194.59 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$492.31 ,80% of total billed charges for outpatient setting,$194.59 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$215.39 ,35% of total billed charges for outpatient setting,$523.08 ,85% of total billed charges for outpatient setting,$192.68 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$492.31 ,80% of total billed charges for outpatient setting,$523.08 ,85% of total billed charges for outpatient setting,$430.77 ,70% of total billed charges for outpatient setting,$430.77 ,70% of total billed charges for outpatient setting,$473.85 ,77% of total billed charges for outpatient setting,$192.68 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$523.08 ,85% of total billed charges for outpatient setting,$523.08 ,85% of total billed charges for outpatient setting,$523.08 ,85% of total billed charges for outpatient setting,$523.08 ,85% of total billed charges for outpatient setting,$523.08 ,85% of total billed charges for outpatient setting,$122.40 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$192.68 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$192.68 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$192.68 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$192.68 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$523.08 ,85% of total billed charges for outpatient setting,$120.00 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$190.77 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$553.85 ,90% of total billed charges for outpatient setting,$123.57 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$584.62 ,95% of total billed charges for outpatient setting,$523.08 ,85% of total billed charges for outpatient setting,$492.31 ,80% of total billed charges for outpatient setting,$122.40 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$523.08 ,85% of total billed charges for outpatient setting,$523.08 ,85% of total billed charges for outpatient setting,$523.08 ,85% of total billed charges for outpatient setting,$572.31 ,93% of total billed charges for outpatient setting,$461.54 ,75% of total billed charges for outpatient setting,$461.54 ,75% of total billed charges for outpatient setting,$461.54 ,75% of total billed charges for outpatient setting,$123.57 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$523.08 ,85% of total billed charges for outpatient setting,$122.40 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$120.00 ,$584.62 ,$215.39 Outpatient Medical Services,AMBULATORY,12001,Scalp/Neck/Trunk/Genital/Extremity <= 2.5 cm,450,$615.39 ,$329.85 ,53.6% of total biled charges for outpatient setting,$329.85 ,53.6% of total biled charges for outpatient setting,$461.54 ,75% of total billed charges for outpatient setting,$461.54 ,75% of total billed charges for outpatient setting,$461.54 ,75% of total billed charges for outpatient setting,$194.59 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$194.59 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$194.59 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$194.59 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$194.59 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$194.59 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$492.31 ,80% of total billed charges for outpatient setting,$194.59 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$215.39 ,35% of total billed charges for outpatient setting,$523.08 ,85% of total billed charges for outpatient setting,$192.68 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$492.31 ,80% of total billed charges for outpatient setting,$523.08 ,85% of total billed charges for outpatient setting,$430.77 ,70% of total billed charges for outpatient setting,$430.77 ,70% of total billed charges for outpatient setting,$473.85 ,77% of total billed charges for outpatient setting,$192.68 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$523.08 ,85% of total billed charges for outpatient setting,$523.08 ,85% of total billed charges for outpatient setting,$523.08 ,85% of total billed charges for outpatient setting,$523.08 ,85% of total billed charges for outpatient setting,$523.08 ,85% of total billed charges for outpatient setting,$122.40 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$192.68 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$192.68 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$192.68 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$192.68 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$523.08 ,85% of total billed charges for outpatient setting,$120.00 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$190.77 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$553.85 ,90% of total billed charges for outpatient setting,$123.57 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$584.62 ,95% of total billed charges for outpatient setting,$523.08 ,85% of total billed charges for outpatient setting,$492.31 ,80% of total billed charges for outpatient setting,$122.40 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$523.08 ,85% of total billed charges for outpatient setting,$523.08 ,85% of total billed charges for outpatient setting,$523.08 ,85% of total billed charges for outpatient setting,$572.31 ,93% of total billed charges for outpatient setting,$461.54 ,75% of total billed charges for outpatient setting,$461.54 ,75% of total billed charges for outpatient setting,$461.54 ,75% of total billed charges for outpatient setting,$123.57 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$523.08 ,85% of total billed charges for outpatient setting,$122.40 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$120.00 ,$584.62 ,$215.39 Outpatient Medical Services,AMBULATORY,12001,REPAIR SIMPLE <=2.5 CM CHARGE,361,$313.17 ,$167.86 ,53.6% of total biled charges for outpatient setting,$167.86 ,53.6% of total biled charges for outpatient setting,$234.88 ,75% of total billed charges for outpatient setting,$234.88 ,75% of total billed charges for outpatient setting,$234.88 ,75% of total billed charges for outpatient setting,$99.02 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$99.02 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$99.02 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$99.02 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$99.02 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$99.02 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$250.54 ,80% of total billed charges for outpatient setting,$99.02 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$109.61 ,35% of total billed charges for outpatient setting,$266.19 ,85% of total billed charges for outpatient setting,$98.05 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$250.54 ,80% of total billed charges for outpatient setting,$266.19 ,85% of total billed charges for outpatient setting,$219.22 ,70% of total billed charges for outpatient setting,$219.22 ,70% of total billed charges for outpatient setting,$241.14 ,77% of total billed charges for outpatient setting,$98.05 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$266.19 ,85% of total billed charges for outpatient setting,$266.19 ,85% of total billed charges for outpatient setting,$266.19 ,85% of total billed charges for outpatient setting,$266.19 ,85% of total billed charges for outpatient setting,$266.19 ,85% of total billed charges for outpatient setting,$62.29 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$98.05 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$98.05 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$98.05 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$98.05 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$266.19 ,85% of total billed charges for outpatient setting,$61.07 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$97.08 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$281.85 ,90% of total billed charges for outpatient setting,$62.88 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$297.51 ,95% of total billed charges for outpatient setting,$266.19 ,85% of total billed charges for outpatient setting,$250.54 ,80% of total billed charges for outpatient setting,$62.29 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$266.19 ,85% of total billed charges for outpatient setting,$266.19 ,85% of total billed charges for outpatient setting,$266.19 ,85% of total billed charges for outpatient setting,$291.25 ,93% of total billed charges for outpatient setting,$234.88 ,75% of total billed charges for outpatient setting,$234.88 ,75% of total billed charges for outpatient setting,$234.88 ,75% of total billed charges for outpatient setting,$62.88 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$266.19 ,85% of total billed charges for outpatient setting,$62.29 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$61.07 ,$297.51 ,$109.61 Outpatient Medical Services,AMBULATORY,16030,DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE TechFee,450,$144.00 ,$77.18 ,53.6% of total biled charges for outpatient setting,$77.18 ,53.6% of total biled charges for outpatient setting,$108.00 ,75% of total billed charges for outpatient setting,$108.00 ,75% of total billed charges for outpatient setting,$108.00 ,75% of total billed charges for outpatient setting,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$115.20 ,80% of total billed charges for outpatient setting,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$50.40 ,35% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$45.09 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$115.20 ,80% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$100.80 ,70% of total billed charges for outpatient setting,$100.80 ,70% of total billed charges for outpatient setting,$110.88 ,77% of total billed charges for outpatient setting,$45.09 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$122.40 ,85% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$28.64 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$45.09 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$45.09 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$45.09 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$45.09 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$122.40 ,85% of total billed charges for outpatient setting,$28.08 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$44.64 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$129.60 ,90% of total billed charges for outpatient setting,$28.92 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$136.80 ,95% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$115.20 ,80% of total billed charges for outpatient setting,$28.64 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$133.92 ,93% of total billed charges for outpatient setting,$108.00 ,75% of total billed charges for outpatient setting,$108.00 ,75% of total billed charges for outpatient setting,$108.00 ,75% of total billed charges for outpatient setting,$28.92 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$28.64 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$28.08 ,$136.80 ,$50.40 Outpatient Medical Services,AMBULATORY,16030,Burn Dressings/Debridement Large,450,$144.00 ,$77.18 ,53.6% of total biled charges for outpatient setting,$77.18 ,53.6% of total biled charges for outpatient setting,$108.00 ,75% of total billed charges for outpatient setting,$108.00 ,75% of total billed charges for outpatient setting,$108.00 ,75% of total billed charges for outpatient setting,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$115.20 ,80% of total billed charges for outpatient setting,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$50.40 ,35% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$45.09 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$115.20 ,80% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$100.80 ,70% of total billed charges for outpatient setting,$100.80 ,70% of total billed charges for outpatient setting,$110.88 ,77% of total billed charges for outpatient setting,$45.09 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$122.40 ,85% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$28.64 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$45.09 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$45.09 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$45.09 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$45.09 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$122.40 ,85% of total billed charges for outpatient setting,$28.08 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$44.64 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$129.60 ,90% of total billed charges for outpatient setting,$28.92 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$136.80 ,95% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$115.20 ,80% of total billed charges for outpatient setting,$28.64 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$133.92 ,93% of total billed charges for outpatient setting,$108.00 ,75% of total billed charges for outpatient setting,$108.00 ,75% of total billed charges for outpatient setting,$108.00 ,75% of total billed charges for outpatient setting,$28.92 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$28.64 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$28.08 ,$136.80 ,$50.40 Outpatient Medical Services,AMBULATORY,17250,"Chemical cauterization of granulation tissue (proud flesh, sinus or fistula)",360,N/A,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,,,N/A Outpatient Medical Services,AMBULATORY,17250,Chemical Cauterization Granulation Tissue,450,$125.00 ,$67.00 ,53.6% of total biled charges for outpatient setting,$67.00 ,53.6% of total biled charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$39.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$39.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$39.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$39.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$39.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$39.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$100.00 ,80% of total billed charges for outpatient setting,$39.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$43.75 ,35% of total billed charges for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$39.14 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$100.00 ,80% of total billed charges for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$87.50 ,70% of total billed charges for outpatient setting,$87.50 ,70% of total billed charges for outpatient setting,$96.25 ,77% of total billed charges for outpatient setting,$39.14 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$106.25 ,85% of total billed charges for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$24.86 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$39.14 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$39.14 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$39.14 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$39.14 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$106.25 ,85% of total billed charges for outpatient setting,$24.38 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$38.75 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$112.50 ,90% of total billed charges for outpatient setting,$25.10 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$118.75 ,95% of total billed charges for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$100.00 ,80% of total billed charges for outpatient setting,$24.86 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$116.25 ,93% of total billed charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$25.10 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$24.86 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$24.38 ,$118.75 ,$43.75 Outpatient Medical Services,AMBULATORY,17250,EST PT VISIT LEV 4,361,$590.77 ,$316.65 ,53.6% of total biled charges for outpatient setting,$316.65 ,53.6% of total biled charges for outpatient setting,$443.08 ,75% of total billed charges for outpatient setting,$443.08 ,75% of total billed charges for outpatient setting,$443.08 ,75% of total billed charges for outpatient setting,$186.80 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$186.80 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$186.80 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$186.80 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$186.80 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$186.80 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$472.62 ,80% of total billed charges for outpatient setting,$186.80 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$206.77 ,35% of total billed charges for outpatient setting,$502.15 ,85% of total billed charges for outpatient setting,$184.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$472.62 ,80% of total billed charges for outpatient setting,$502.15 ,85% of total billed charges for outpatient setting,$413.54 ,70% of total billed charges for outpatient setting,$413.54 ,70% of total billed charges for outpatient setting,$454.89 ,77% of total billed charges for outpatient setting,$184.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$502.15 ,85% of total billed charges for outpatient setting,$502.15 ,85% of total billed charges for outpatient setting,$502.15 ,85% of total billed charges for outpatient setting,$502.15 ,85% of total billed charges for outpatient setting,$502.15 ,85% of total billed charges for outpatient setting,$117.50 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$184.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$184.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$184.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$184.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$502.15 ,85% of total billed charges for outpatient setting,$115.20 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$183.14 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$531.69 ,90% of total billed charges for outpatient setting,$118.63 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$561.23 ,95% of total billed charges for outpatient setting,$502.15 ,85% of total billed charges for outpatient setting,$472.62 ,80% of total billed charges for outpatient setting,$117.50 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$502.15 ,85% of total billed charges for outpatient setting,$502.15 ,85% of total billed charges for outpatient setting,$502.15 ,85% of total billed charges for outpatient setting,$549.42 ,93% of total billed charges for outpatient setting,$443.08 ,75% of total billed charges for outpatient setting,$443.08 ,75% of total billed charges for outpatient setting,$443.08 ,75% of total billed charges for outpatient setting,$118.63 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$502.15 ,85% of total billed charges for outpatient setting,$117.50 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$115.20 ,$561.23 ,$206.77 Outpatient Medical Services,AMBULATORY,17250,Blood draw or Accessing charge from IMPLANTABLE PORT I.E. PORTACATH,450,$125.00 ,$67.00 ,53.6% of total biled charges for outpatient setting,$67.00 ,53.6% of total biled charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$39.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$39.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$39.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$39.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$39.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$39.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$100.00 ,80% of total billed charges for outpatient setting,$39.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$43.75 ,35% of total billed charges for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$39.14 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$100.00 ,80% of total billed charges for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$87.50 ,70% of total billed charges for outpatient setting,$87.50 ,70% of total billed charges for outpatient setting,$96.25 ,77% of total billed charges for outpatient setting,$39.14 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$106.25 ,85% of total billed charges for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$24.86 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$39.14 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$39.14 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$39.14 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$39.14 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$106.25 ,85% of total billed charges for outpatient setting,$24.38 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$38.75 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$112.50 ,90% of total billed charges for outpatient setting,$25.10 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$118.75 ,95% of total billed charges for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$100.00 ,80% of total billed charges for outpatient setting,$24.86 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$116.25 ,93% of total billed charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$25.10 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$24.86 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$24.38 ,$118.75 ,$43.75 Outpatient Medical Services,AMBULATORY,29580,STRAPPING UNNA BOOT TechFee,450,$75.00 ,$40.20 ,53.6% of total biled charges for outpatient setting,$40.20 ,53.6% of total biled charges for outpatient setting,$56.25 ,75% of total billed charges for outpatient setting,$56.25 ,75% of total billed charges for outpatient setting,$56.25 ,75% of total billed charges for outpatient setting,$23.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$23.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$23.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$23.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$23.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$23.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$60.00 ,80% of total billed charges for outpatient setting,$23.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$26.25 ,35% of total billed charges for outpatient setting,$63.75 ,85% of total billed charges for outpatient setting,$23.48 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$60.00 ,80% of total billed charges for outpatient setting,$63.75 ,85% of total billed charges for outpatient setting,$52.50 ,70% of total billed charges for outpatient setting,$52.50 ,70% of total billed charges for outpatient setting,$57.75 ,77% of total billed charges for outpatient setting,$23.48 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$63.75 ,85% of total billed charges for outpatient setting,$63.75 ,85% of total billed charges for outpatient setting,$63.75 ,85% of total billed charges for outpatient setting,$63.75 ,85% of total billed charges for outpatient setting,$63.75 ,85% of total billed charges for outpatient setting,$14.92 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$23.48 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$23.48 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$23.48 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$23.48 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$63.75 ,85% of total billed charges for outpatient setting,$14.63 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$23.25 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$67.50 ,90% of total billed charges for outpatient setting,$15.06 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$71.25 ,95% of total billed charges for outpatient setting,$63.75 ,85% of total billed charges for outpatient setting,$60.00 ,80% of total billed charges for outpatient setting,$14.92 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$63.75 ,85% of total billed charges for outpatient setting,$63.75 ,85% of total billed charges for outpatient setting,$63.75 ,85% of total billed charges for outpatient setting,$69.75 ,93% of total billed charges for outpatient setting,$56.25 ,75% of total billed charges for outpatient setting,$56.25 ,75% of total billed charges for outpatient setting,$56.25 ,75% of total billed charges for outpatient setting,$15.06 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$63.75 ,85% of total billed charges for outpatient setting,$14.92 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$14.63 ,$71.25 ,$26.25 Outpatient Medical Services,AMBULATORY,29580,Strapping Unna Boot,450,$75.00 ,$40.20 ,53.6% of total biled charges for outpatient setting,$40.20 ,53.6% of total biled charges for outpatient setting,$56.25 ,75% of total billed charges for outpatient setting,$56.25 ,75% of total billed charges for outpatient setting,$56.25 ,75% of total billed charges for outpatient setting,$23.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$23.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$23.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$23.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$23.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$23.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$60.00 ,80% of total billed charges for outpatient setting,$23.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$26.25 ,35% of total billed charges for outpatient setting,$63.75 ,85% of total billed charges for outpatient setting,$23.48 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$60.00 ,80% of total billed charges for outpatient setting,$63.75 ,85% of total billed charges for outpatient setting,$52.50 ,70% of total billed charges for outpatient setting,$52.50 ,70% of total billed charges for outpatient setting,$57.75 ,77% of total billed charges for outpatient setting,$23.48 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$63.75 ,85% of total billed charges for outpatient setting,$63.75 ,85% of total billed charges for outpatient setting,$63.75 ,85% of total billed charges for outpatient setting,$63.75 ,85% of total billed charges for outpatient setting,$63.75 ,85% of total billed charges for outpatient setting,$14.92 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$23.48 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$23.48 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$23.48 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$23.48 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$63.75 ,85% of total billed charges for outpatient setting,$14.63 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$23.25 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$67.50 ,90% of total billed charges for outpatient setting,$15.06 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$71.25 ,95% of total billed charges for outpatient setting,$63.75 ,85% of total billed charges for outpatient setting,$60.00 ,80% of total billed charges for outpatient setting,$14.92 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$63.75 ,85% of total billed charges for outpatient setting,$63.75 ,85% of total billed charges for outpatient setting,$63.75 ,85% of total billed charges for outpatient setting,$69.75 ,93% of total billed charges for outpatient setting,$56.25 ,75% of total billed charges for outpatient setting,$56.25 ,75% of total billed charges for outpatient setting,$56.25 ,75% of total billed charges for outpatient setting,$15.06 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$63.75 ,85% of total billed charges for outpatient setting,$14.92 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$14.63 ,$71.25 ,$26.25 Outpatient Medical Services,AMBULATORY,29580,App of paste boot (Unna boot ),510,$240.93 ,$129.14 ,53.6% of total biled charges for outpatient setting,$129.14 ,53.6% of total biled charges for outpatient setting,$180.70 ,75% of total billed charges for outpatient setting,$180.70 ,75% of total billed charges for outpatient setting,$180.70 ,75% of total billed charges for outpatient setting,$76.18 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$76.18 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$76.18 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$76.18 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$76.18 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$76.18 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$192.74 ,80% of total billed charges for outpatient setting,$76.18 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$84.33 ,35% of total billed charges for outpatient setting,$204.79 ,85% of total billed charges for outpatient setting,$75.44 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$192.74 ,80% of total billed charges for outpatient setting,$204.79 ,85% of total billed charges for outpatient setting,$168.65 ,70% of total billed charges for outpatient setting,$168.65 ,70% of total billed charges for outpatient setting,$185.52 ,77% of total billed charges for outpatient setting,$75.44 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$204.79 ,85% of total billed charges for outpatient setting,$204.79 ,85% of total billed charges for outpatient setting,$204.79 ,85% of total billed charges for outpatient setting,$204.79 ,85% of total billed charges for outpatient setting,$204.79 ,85% of total billed charges for outpatient setting,$47.92 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$75.44 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$75.44 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$75.44 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$75.44 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$204.79 ,85% of total billed charges for outpatient setting,$46.98 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$74.69 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$216.84 ,90% of total billed charges for outpatient setting,$48.38 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$228.88 ,95% of total billed charges for outpatient setting,$204.79 ,85% of total billed charges for outpatient setting,$192.74 ,80% of total billed charges for outpatient setting,$47.92 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$204.79 ,85% of total billed charges for outpatient setting,$204.79 ,85% of total billed charges for outpatient setting,$204.79 ,85% of total billed charges for outpatient setting,$224.06 ,93% of total billed charges for outpatient setting,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$48.38 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$204.79 ,85% of total billed charges for outpatient setting,$47.92 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$46.98 ,$228.88 ,$84.33 Outpatient Medical Services,AMBULATORY,29581,DEBRIDE BONE 1ST 20CM,510,$473.43 ,$253.76 ,53.6% of total biled charges for outpatient setting,$253.76 ,53.6% of total biled charges for outpatient setting,$355.07 ,75% of total billed charges for outpatient setting,$355.07 ,75% of total billed charges for outpatient setting,$355.07 ,75% of total billed charges for outpatient setting,$149.70 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$149.70 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$149.70 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$149.70 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$149.70 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$149.70 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$378.74 ,80% of total billed charges for outpatient setting,$149.70 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$165.70 ,35% of total billed charges for outpatient setting,$402.42 ,85% of total billed charges for outpatient setting,$148.23 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$378.74 ,80% of total billed charges for outpatient setting,$402.42 ,85% of total billed charges for outpatient setting,$331.40 ,70% of total billed charges for outpatient setting,$331.40 ,70% of total billed charges for outpatient setting,$364.54 ,77% of total billed charges for outpatient setting,$148.23 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$402.42 ,85% of total billed charges for outpatient setting,$402.42 ,85% of total billed charges for outpatient setting,$402.42 ,85% of total billed charges for outpatient setting,$402.42 ,85% of total billed charges for outpatient setting,$402.42 ,85% of total billed charges for outpatient setting,$94.17 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$148.23 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$148.23 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$148.23 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$148.23 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$402.42 ,85% of total billed charges for outpatient setting,$92.32 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$146.76 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$426.09 ,90% of total billed charges for outpatient setting,$95.06 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$449.76 ,95% of total billed charges for outpatient setting,$402.42 ,85% of total billed charges for outpatient setting,$378.74 ,80% of total billed charges for outpatient setting,$94.17 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$402.42 ,85% of total billed charges for outpatient setting,$402.42 ,85% of total billed charges for outpatient setting,$402.42 ,85% of total billed charges for outpatient setting,$440.29 ,93% of total billed charges for outpatient setting,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$95.06 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$402.42 ,85% of total billed charges for outpatient setting,$94.17 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$92.32 ,$449.76 ,$165.70 Outpatient Medical Services,AMBULATORY,29581,DESTROY BENIGN/PREMAL LESION CHARGE,510,$473.43 ,$253.76 ,53.6% of total biled charges for outpatient setting,$253.76 ,53.6% of total biled charges for outpatient setting,$355.07 ,75% of total billed charges for outpatient setting,$355.07 ,75% of total billed charges for outpatient setting,$355.07 ,75% of total billed charges for outpatient setting,$149.70 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$149.70 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$149.70 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$149.70 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$149.70 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$149.70 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$378.74 ,80% of total billed charges for outpatient setting,$149.70 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$165.70 ,35% of total billed charges for outpatient setting,$402.42 ,85% of total billed charges for outpatient setting,$148.23 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$378.74 ,80% of total billed charges for outpatient setting,$402.42 ,85% of total billed charges for outpatient setting,$331.40 ,70% of total billed charges for outpatient setting,$331.40 ,70% of total billed charges for outpatient setting,$364.54 ,77% of total billed charges for outpatient setting,$148.23 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$402.42 ,85% of total billed charges for outpatient setting,$402.42 ,85% of total billed charges for outpatient setting,$402.42 ,85% of total billed charges for outpatient setting,$402.42 ,85% of total billed charges for outpatient setting,$402.42 ,85% of total billed charges for outpatient setting,$94.17 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$148.23 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$148.23 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$148.23 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$148.23 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$402.42 ,85% of total billed charges for outpatient setting,$92.32 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$146.76 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$426.09 ,90% of total billed charges for outpatient setting,$95.06 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$449.76 ,95% of total billed charges for outpatient setting,$402.42 ,85% of total billed charges for outpatient setting,$378.74 ,80% of total billed charges for outpatient setting,$94.17 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$402.42 ,85% of total billed charges for outpatient setting,$402.42 ,85% of total billed charges for outpatient setting,$402.42 ,85% of total billed charges for outpatient setting,$440.29 ,93% of total billed charges for outpatient setting,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$95.06 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$402.42 ,85% of total billed charges for outpatient setting,$94.17 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$92.32 ,$449.76 ,$165.70 Outpatient Medical Services,AMBULATORY,31500,INTUBATION,410,$480.00 ,$257.28 ,53.6% of total biled charges for outpatient setting,$257.28 ,53.6% of total biled charges for outpatient setting,$360.00 ,75% of total billed charges for outpatient setting,$360.00 ,75% of total billed charges for outpatient setting,$360.00 ,75% of total billed charges for outpatient setting,$151.78 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$151.78 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$151.78 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$151.78 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$151.78 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$151.78 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$384.00 ,80% of total billed charges for outpatient setting,$151.78 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$168.00 ,35% of total billed charges for outpatient setting,$408.00 ,85% of total billed charges for outpatient setting,$150.29 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$384.00 ,80% of total billed charges for outpatient setting,$408.00 ,85% of total billed charges for outpatient setting,$336.00 ,70% of total billed charges for outpatient setting,$336.00 ,70% of total billed charges for outpatient setting,$369.60 ,77% of total billed charges for outpatient setting,$150.29 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$408.00 ,85% of total billed charges for outpatient setting,$408.00 ,85% of total billed charges for outpatient setting,$408.00 ,85% of total billed charges for outpatient setting,$408.00 ,85% of total billed charges for outpatient setting,$408.00 ,85% of total billed charges for outpatient setting,$95.47 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$150.29 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$150.29 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$150.29 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$150.29 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$408.00 ,85% of total billed charges for outpatient setting,$93.60 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$148.80 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$432.00 ,90% of total billed charges for outpatient setting,$96.38 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$456.00 ,95% of total billed charges for outpatient setting,$408.00 ,85% of total billed charges for outpatient setting,$384.00 ,80% of total billed charges for outpatient setting,$95.47 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$408.00 ,85% of total billed charges for outpatient setting,$408.00 ,85% of total billed charges for outpatient setting,$408.00 ,85% of total billed charges for outpatient setting,$446.40 ,93% of total billed charges for outpatient setting,$360.00 ,75% of total billed charges for outpatient setting,$360.00 ,75% of total billed charges for outpatient setting,$360.00 ,75% of total billed charges for outpatient setting,$96.38 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$408.00 ,85% of total billed charges for outpatient setting,$95.47 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$93.60 ,$456.00 ,$168.00 Outpatient Medical Services,AMBULATORY,31500,Endotracheal Intubation,450,$166.00 ,$88.98 ,53.6% of total biled charges for outpatient setting,$88.98 ,53.6% of total biled charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$132.80 ,80% of total billed charges for outpatient setting,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$58.10 ,35% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$132.80 ,80% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$116.20 ,70% of total billed charges for outpatient setting,$116.20 ,70% of total billed charges for outpatient setting,$127.82 ,77% of total billed charges for outpatient setting,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$33.02 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$141.10 ,85% of total billed charges for outpatient setting,$32.37 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$51.46 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$149.40 ,90% of total billed charges for outpatient setting,$33.33 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$157.70 ,95% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$132.80 ,80% of total billed charges for outpatient setting,$33.02 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$154.38 ,93% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$33.33 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$33.02 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$32.37 ,$157.70 ,$58.10 Outpatient Medical Services,AMBULATORY,31500,INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE TechFee,450,$166.00 ,$88.98 ,53.6% of total biled charges for outpatient setting,$88.98 ,53.6% of total biled charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$132.80 ,80% of total billed charges for outpatient setting,$52.49 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$58.10 ,35% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$132.80 ,80% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$116.20 ,70% of total billed charges for outpatient setting,$116.20 ,70% of total billed charges for outpatient setting,$127.82 ,77% of total billed charges for outpatient setting,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$33.02 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$51.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$141.10 ,85% of total billed charges for outpatient setting,$32.37 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$51.46 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$149.40 ,90% of total billed charges for outpatient setting,$33.33 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$157.70 ,95% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$132.80 ,80% of total billed charges for outpatient setting,$33.02 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$154.38 ,93% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$124.50 ,75% of total billed charges for outpatient setting,$33.33 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$141.10 ,85% of total billed charges for outpatient setting,$33.02 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$32.37 ,$157.70 ,$58.10 Outpatient Medical Services,AMBULATORY,36415,COLLECTION: Venous Draw,300,$4.68 ,$2.51 ,53.6% of total biled charges for outpatient setting,$2.51 ,53.6% of total biled charges for outpatient setting,$2.34 ,75% of total billed charges for outpatient setting,$2.34 ,75% of total billed charges for outpatient setting,$2.34 ,75% of total billed charges for outpatient setting,$8.74 ,102% CMS Medicare OPPS fee schedule,$8.74 ,102% CMS Medicare OPPS fee schedule,$8.74 ,102% CMS Medicare OPPS fee schedule,$8.74 ,102% CMS Medicare OPPS fee schedule,$8.74 ,102% CMS Medicare OPPS fee schedule,$8.74 ,102% CMS Medicare OPPS fee schedule,$3.74 ,80% of total billed charges for outpatient setting,$8.74 ,102% CMS Medicare OPPS fee schedule,$1.64 ,35% of total billed charges for outpatient setting,$3.98 ,85% of total billed charges for outpatient setting,$8.92 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.74 ,80% of total billed charges for outpatient setting,$3.98 ,85% of total billed charges for outpatient setting,$3.28 ,70% of total billed charges for outpatient setting,$3.28 ,70% of total billed charges for outpatient setting,$3.60 ,77% of total billed charges for outpatient setting,$8.92 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.98 ,85% of total billed charges for outpatient setting,$3.98 ,85% of total billed charges for outpatient setting,$3.98 ,85% of total billed charges for outpatient setting,$3.98 ,85% of total billed charges for outpatient setting,$3.98 ,85% of total billed charges for outpatient setting,$0.93 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$8.92 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.92 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.92 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.92 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.98 ,85% of total billed charges for outpatient setting,$0.91 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$8.83 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.21 ,90% of total billed charges for outpatient setting,$0.94 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$4.45 ,95% of total billed charges for outpatient setting,$3.98 ,85% of total billed charges for outpatient setting,$3.74 ,80% of total billed charges for outpatient setting,$0.93 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$3.98 ,85% of total billed charges for outpatient setting,$3.98 ,85% of total billed charges for outpatient setting,$3.98 ,85% of total billed charges for outpatient setting,$4.35 ,93% of total billed charges for outpatient setting,$3.51 ,75% of total billed charges for outpatient setting,$3.51 ,75% of total billed charges for outpatient setting,$3.51 ,75% of total billed charges for outpatient setting,$0.94 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$3.98 ,85% of total billed charges for outpatient setting,$0.93 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$0.91 ,$8.92 ,$1.64 Outpatient Medical Services,AMBULATORY,36415,Collection of venous blood by venipuncture,300,$4.68 ,$2.51 ,53.6% of total biled charges for outpatient setting,$2.51 ,53.6% of total biled charges for outpatient setting,$2.34 ,75% of total billed charges for outpatient setting,$2.34 ,75% of total billed charges for outpatient setting,$2.34 ,75% of total billed charges for outpatient setting,$8.74 ,102% CMS Medicare OPPS fee schedule,$8.74 ,102% CMS Medicare OPPS fee schedule,$8.74 ,102% CMS Medicare OPPS fee schedule,$8.74 ,102% CMS Medicare OPPS fee schedule,$8.74 ,102% CMS Medicare OPPS fee schedule,$8.74 ,102% CMS Medicare OPPS fee schedule,$3.74 ,80% of total billed charges for outpatient setting,$8.74 ,102% CMS Medicare OPPS fee schedule,$1.64 ,35% of total billed charges for outpatient setting,$3.98 ,85% of total billed charges for outpatient setting,$8.92 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.74 ,80% of total billed charges for outpatient setting,$3.98 ,85% of total billed charges for outpatient setting,$3.28 ,70% of total billed charges for outpatient setting,$3.28 ,70% of total billed charges for outpatient setting,$3.60 ,77% of total billed charges for outpatient setting,$8.92 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.98 ,85% of total billed charges for outpatient setting,$3.98 ,85% of total billed charges for outpatient setting,$3.98 ,85% of total billed charges for outpatient setting,$3.98 ,85% of total billed charges for outpatient setting,$3.98 ,85% of total billed charges for outpatient setting,$0.93 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$8.92 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.92 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.92 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.92 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.98 ,85% of total billed charges for outpatient setting,$0.91 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$8.83 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.21 ,90% of total billed charges for outpatient setting,$0.94 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$4.45 ,95% of total billed charges for outpatient setting,$3.98 ,85% of total billed charges for outpatient setting,$3.74 ,80% of total billed charges for outpatient setting,$0.93 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$3.98 ,85% of total billed charges for outpatient setting,$3.98 ,85% of total billed charges for outpatient setting,$3.98 ,85% of total billed charges for outpatient setting,$4.35 ,93% of total billed charges for outpatient setting,$3.51 ,75% of total billed charges for outpatient setting,$3.51 ,75% of total billed charges for outpatient setting,$3.51 ,75% of total billed charges for outpatient setting,$0.94 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$3.98 ,85% of total billed charges for outpatient setting,$0.93 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$0.91 ,$8.92 ,$1.64 Outpatient Medical Services,AMBULATORY,36589,Removal Tunneled Central Venous Cath,450,$144.00 ,$77.18 ,53.6% of total biled charges for outpatient setting,$77.18 ,53.6% of total biled charges for outpatient setting,$108.00 ,75% of total billed charges for outpatient setting,$108.00 ,75% of total billed charges for outpatient setting,$108.00 ,75% of total billed charges for outpatient setting,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$115.20 ,80% of total billed charges for outpatient setting,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$50.40 ,35% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$45.09 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$115.20 ,80% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$100.80 ,70% of total billed charges for outpatient setting,$100.80 ,70% of total billed charges for outpatient setting,$110.88 ,77% of total billed charges for outpatient setting,$45.09 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$122.40 ,85% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$28.64 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$45.09 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$45.09 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$45.09 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$45.09 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$122.40 ,85% of total billed charges for outpatient setting,$28.08 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$44.64 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$129.60 ,90% of total billed charges for outpatient setting,$28.92 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$136.80 ,95% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$115.20 ,80% of total billed charges for outpatient setting,$28.64 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$133.92 ,93% of total billed charges for outpatient setting,$108.00 ,75% of total billed charges for outpatient setting,$108.00 ,75% of total billed charges for outpatient setting,$108.00 ,75% of total billed charges for outpatient setting,$28.92 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$28.64 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$28.08 ,$136.80 ,$50.40 Outpatient Medical Services,AMBULATORY,36589,RMVL TUN CVC W/O SUBQ PORT/PMP TechFee,450,$144.00 ,$77.18 ,53.6% of total biled charges for outpatient setting,$77.18 ,53.6% of total biled charges for outpatient setting,$108.00 ,75% of total billed charges for outpatient setting,$108.00 ,75% of total billed charges for outpatient setting,$108.00 ,75% of total billed charges for outpatient setting,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$115.20 ,80% of total billed charges for outpatient setting,$45.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$50.40 ,35% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$45.09 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$115.20 ,80% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$100.80 ,70% of total billed charges for outpatient setting,$100.80 ,70% of total billed charges for outpatient setting,$110.88 ,77% of total billed charges for outpatient setting,$45.09 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$122.40 ,85% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$28.64 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$45.09 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$45.09 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$45.09 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$45.09 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$122.40 ,85% of total billed charges for outpatient setting,$28.08 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$44.64 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$129.60 ,90% of total billed charges for outpatient setting,$28.92 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$136.80 ,95% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$115.20 ,80% of total billed charges for outpatient setting,$28.64 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$133.92 ,93% of total billed charges for outpatient setting,$108.00 ,75% of total billed charges for outpatient setting,$108.00 ,75% of total billed charges for outpatient setting,$108.00 ,75% of total billed charges for outpatient setting,$28.92 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$122.40 ,85% of total billed charges for outpatient setting,$28.64 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$28.08 ,$136.80 ,$50.40 Outpatient Medical Services,AMBULATORY,36600,COLLECTION: Arterial Draw,300,$111.95 ,$60.01 ,53.6% of total biled charges for outpatient setting,$60.01 ,53.6% of total biled charges for outpatient setting,$55.98 ,75% of total billed charges for outpatient setting,$55.98 ,75% of total billed charges for outpatient setting,$55.98 ,75% of total billed charges for outpatient setting,$35.40 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$35.40 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$35.40 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$35.40 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$35.40 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$35.40 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$89.56 ,80% of total billed charges for outpatient setting,$35.40 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$39.18 ,35% of total billed charges for outpatient setting,$95.16 ,85% of total billed charges for outpatient setting,$35.05 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$89.56 ,80% of total billed charges for outpatient setting,$95.16 ,85% of total billed charges for outpatient setting,$78.37 ,70% of total billed charges for outpatient setting,$78.37 ,70% of total billed charges for outpatient setting,$86.20 ,77% of total billed charges for outpatient setting,$35.05 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$95.16 ,85% of total billed charges for outpatient setting,$95.16 ,85% of total billed charges for outpatient setting,$95.16 ,85% of total billed charges for outpatient setting,$95.16 ,85% of total billed charges for outpatient setting,$95.16 ,85% of total billed charges for outpatient setting,$22.27 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$35.05 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$35.05 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$35.05 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$35.05 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$95.16 ,85% of total billed charges for outpatient setting,$21.83 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$34.70 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$100.76 ,90% of total billed charges for outpatient setting,$22.48 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$106.35 ,95% of total billed charges for outpatient setting,$95.16 ,85% of total billed charges for outpatient setting,$89.56 ,80% of total billed charges for outpatient setting,$22.27 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$95.16 ,85% of total billed charges for outpatient setting,$95.16 ,85% of total billed charges for outpatient setting,$95.16 ,85% of total billed charges for outpatient setting,$104.11 ,93% of total billed charges for outpatient setting,$83.96 ,75% of total billed charges for outpatient setting,$83.96 ,75% of total billed charges for outpatient setting,$83.96 ,75% of total billed charges for outpatient setting,$22.48 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$95.16 ,85% of total billed charges for outpatient setting,$22.27 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$21.83 ,$106.35 ,$39.18 Outpatient Medical Services,AMBULATORY,36600,Arterial Puncture,300,$111.95 ,$60.01 ,53.6% of total biled charges for outpatient setting,$60.01 ,53.6% of total biled charges for outpatient setting,$55.98 ,75% of total billed charges for outpatient setting,$55.98 ,75% of total billed charges for outpatient setting,$55.98 ,75% of total billed charges for outpatient setting,$35.40 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$35.40 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$35.40 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$35.40 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$35.40 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$35.40 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$89.56 ,80% of total billed charges for outpatient setting,$35.40 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$39.18 ,35% of total billed charges for outpatient setting,$95.16 ,85% of total billed charges for outpatient setting,$35.05 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$89.56 ,80% of total billed charges for outpatient setting,$95.16 ,85% of total billed charges for outpatient setting,$78.37 ,70% of total billed charges for outpatient setting,$78.37 ,70% of total billed charges for outpatient setting,$86.20 ,77% of total billed charges for outpatient setting,$35.05 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$95.16 ,85% of total billed charges for outpatient setting,$95.16 ,85% of total billed charges for outpatient setting,$95.16 ,85% of total billed charges for outpatient setting,$95.16 ,85% of total billed charges for outpatient setting,$95.16 ,85% of total billed charges for outpatient setting,$22.27 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$35.05 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$35.05 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$35.05 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$35.05 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$95.16 ,85% of total billed charges for outpatient setting,$21.83 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$34.70 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$100.76 ,90% of total billed charges for outpatient setting,$22.48 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$106.35 ,95% of total billed charges for outpatient setting,$95.16 ,85% of total billed charges for outpatient setting,$89.56 ,80% of total billed charges for outpatient setting,$22.27 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$95.16 ,85% of total billed charges for outpatient setting,$95.16 ,85% of total billed charges for outpatient setting,$95.16 ,85% of total billed charges for outpatient setting,$104.11 ,93% of total billed charges for outpatient setting,$83.96 ,75% of total billed charges for outpatient setting,$83.96 ,75% of total billed charges for outpatient setting,$83.96 ,75% of total billed charges for outpatient setting,$22.48 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$95.16 ,85% of total billed charges for outpatient setting,$22.27 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$21.83 ,$106.35 ,$39.18 Outpatient Medical Services,AMBULATORY,36600,Arterial Puncture,450,$125.00 ,$67.00 ,53.6% of total biled charges for outpatient setting,$67.00 ,53.6% of total biled charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$39.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$39.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$39.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$39.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$39.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$39.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$100.00 ,80% of total billed charges for outpatient setting,$39.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$43.75 ,35% of total billed charges for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$39.14 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$100.00 ,80% of total billed charges for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$87.50 ,70% of total billed charges for outpatient setting,$87.50 ,70% of total billed charges for outpatient setting,$96.25 ,77% of total billed charges for outpatient setting,$39.14 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$106.25 ,85% of total billed charges for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$24.86 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$39.14 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$39.14 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$39.14 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$39.14 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$106.25 ,85% of total billed charges for outpatient setting,$24.38 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$38.75 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$112.50 ,90% of total billed charges for outpatient setting,$25.10 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$118.75 ,95% of total billed charges for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$100.00 ,80% of total billed charges for outpatient setting,$24.86 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$116.25 ,93% of total billed charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$25.10 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$24.86 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$24.38 ,$118.75 ,$43.75 Outpatient Medical Services,AMBULATORY,36600,ARTERIAL PUNCTURE (BLOOD GAS),450,$125.00 ,$67.00 ,53.6% of total biled charges for outpatient setting,$67.00 ,53.6% of total biled charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$39.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$39.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$39.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$39.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$39.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$39.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$100.00 ,80% of total billed charges for outpatient setting,$39.53 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$43.75 ,35% of total billed charges for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$39.14 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$100.00 ,80% of total billed charges for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$87.50 ,70% of total billed charges for outpatient setting,$87.50 ,70% of total billed charges for outpatient setting,$96.25 ,77% of total billed charges for outpatient setting,$39.14 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$106.25 ,85% of total billed charges for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$24.86 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$39.14 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$39.14 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$39.14 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$39.14 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$106.25 ,85% of total billed charges for outpatient setting,$24.38 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$38.75 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$112.50 ,90% of total billed charges for outpatient setting,$25.10 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$118.75 ,95% of total billed charges for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$100.00 ,80% of total billed charges for outpatient setting,$24.86 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$116.25 ,93% of total billed charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$25.10 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$106.25 ,85% of total billed charges for outpatient setting,$24.86 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$24.38 ,$118.75 ,$43.75 Outpatient Medical Services,CARDIAC,93005,Electrocardiogram 12 Lead,730,$194.23 ,$104.11 ,53.6% of total biled charges for outpatient setting,$104.11 ,53.6% of total biled charges for outpatient setting,$145.67 ,75% of total billed charges for outpatient setting,$145.67 ,75% of total billed charges for outpatient setting,$145.67 ,75% of total billed charges for outpatient setting,$61.42 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$61.42 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$61.42 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$61.42 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$61.42 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$61.42 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$155.38 ,80% of total billed charges for outpatient setting,$61.42 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$67.98 ,35% of total billed charges for outpatient setting,$165.10 ,85% of total billed charges for outpatient setting,$60.81 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$155.38 ,80% of total billed charges for outpatient setting,$165.10 ,85% of total billed charges for outpatient setting,$135.96 ,70% of total billed charges for outpatient setting,$135.96 ,70% of total billed charges for outpatient setting,$149.56 ,77% of total billed charges for outpatient setting,$60.81 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$165.10 ,85% of total billed charges for outpatient setting,$165.10 ,85% of total billed charges for outpatient setting,$165.10 ,85% of total billed charges for outpatient setting,$165.10 ,85% of total billed charges for outpatient setting,$165.10 ,85% of total billed charges for outpatient setting,$38.63 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$60.81 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$60.81 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$60.81 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$60.81 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$165.10 ,85% of total billed charges for outpatient setting,$37.87 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$60.21 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$174.81 ,90% of total billed charges for outpatient setting,$39.00 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$184.52 ,95% of total billed charges for outpatient setting,$165.10 ,85% of total billed charges for outpatient setting,$155.38 ,80% of total billed charges for outpatient setting,$38.63 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$165.10 ,85% of total billed charges for outpatient setting,$165.10 ,85% of total billed charges for outpatient setting,$165.10 ,85% of total billed charges for outpatient setting,$180.63 ,93% of total billed charges for outpatient setting,$145.67 ,75% of total billed charges for outpatient setting,$145.67 ,75% of total billed charges for outpatient setting,$145.67 ,75% of total billed charges for outpatient setting,$39.00 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$165.10 ,85% of total billed charges for outpatient setting,$38.63 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$37.87 ,$184.52 ,$67.98 Outpatient Medical Services,CARDIAC,93005,ED EKG,450,$120.00 ,$64.32 ,53.6% of total biled charges for outpatient setting,$64.32 ,53.6% of total biled charges for outpatient setting,$90.00 ,75% of total billed charges for outpatient setting,$90.00 ,75% of total billed charges for outpatient setting,$90.00 ,75% of total billed charges for outpatient setting,$37.94 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$37.94 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$37.94 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$37.94 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$37.94 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$37.94 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$96.00 ,80% of total billed charges for outpatient setting,$37.94 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$42.00 ,35% of total billed charges for outpatient setting,$102.00 ,85% of total billed charges for outpatient setting,$37.57 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$96.00 ,80% of total billed charges for outpatient setting,$102.00 ,85% of total billed charges for outpatient setting,$84.00 ,70% of total billed charges for outpatient setting,$84.00 ,70% of total billed charges for outpatient setting,$92.40 ,77% of total billed charges for outpatient setting,$37.57 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$102.00 ,85% of total billed charges for outpatient setting,$102.00 ,85% of total billed charges for outpatient setting,$102.00 ,85% of total billed charges for outpatient setting,$102.00 ,85% of total billed charges for outpatient setting,$102.00 ,85% of total billed charges for outpatient setting,$23.87 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$37.57 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$37.57 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$37.57 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$37.57 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$102.00 ,85% of total billed charges for outpatient setting,$23.40 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$37.20 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$108.00 ,90% of total billed charges for outpatient setting,$24.10 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$114.00 ,95% of total billed charges for outpatient setting,$102.00 ,85% of total billed charges for outpatient setting,$96.00 ,80% of total billed charges for outpatient setting,$23.87 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$102.00 ,85% of total billed charges for outpatient setting,$102.00 ,85% of total billed charges for outpatient setting,$102.00 ,85% of total billed charges for outpatient setting,$111.60 ,93% of total billed charges for outpatient setting,$90.00 ,75% of total billed charges for outpatient setting,$90.00 ,75% of total billed charges for outpatient setting,$90.00 ,75% of total billed charges for outpatient setting,$24.10 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$102.00 ,85% of total billed charges for outpatient setting,$23.87 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$23.40 ,$114.00 ,$42.00 Outpatient Medical Services,CARDIAC,93930,US Upper Ext Arterial Duplex Bilateral,921,$765.00 ,$410.04 ,53.6% of total biled charges for outpatient setting,$410.04 ,53.6% of total biled charges for outpatient setting,$573.75 ,75% of total billed charges for outpatient setting,$573.75 ,75% of total billed charges for outpatient setting,$573.75 ,75% of total billed charges for outpatient setting,$241.89 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$241.89 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$241.89 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$241.89 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$241.89 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$241.89 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$612.00 ,80% of total billed charges for outpatient setting,$241.89 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$267.75 ,35% of total billed charges for outpatient setting,$650.25 ,85% of total billed charges for outpatient setting,$239.52 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$612.00 ,80% of total billed charges for outpatient setting,$650.25 ,85% of total billed charges for outpatient setting,$535.50 ,70% of total billed charges for outpatient setting,$535.50 ,70% of total billed charges for outpatient setting,$589.05 ,77% of total billed charges for outpatient setting,$239.52 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$650.25 ,85% of total billed charges for outpatient setting,$650.25 ,85% of total billed charges for outpatient setting,$650.25 ,85% of total billed charges for outpatient setting,$650.25 ,85% of total billed charges for outpatient setting,$650.25 ,85% of total billed charges for outpatient setting,$152.16 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$239.52 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$239.52 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$239.52 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$239.52 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$650.25 ,85% of total billed charges for outpatient setting,$149.18 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$237.15 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$688.50 ,90% of total billed charges for outpatient setting,$153.61 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$726.75 ,95% of total billed charges for outpatient setting,$650.25 ,85% of total billed charges for outpatient setting,$612.00 ,80% of total billed charges for outpatient setting,$152.16 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$650.25 ,85% of total billed charges for outpatient setting,$650.25 ,85% of total billed charges for outpatient setting,$650.25 ,85% of total billed charges for outpatient setting,$711.45 ,93% of total billed charges for outpatient setting,$573.75 ,75% of total billed charges for outpatient setting,$573.75 ,75% of total billed charges for outpatient setting,$573.75 ,75% of total billed charges for outpatient setting,$153.61 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$650.25 ,85% of total billed charges for outpatient setting,$152.16 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$149.18 ,$726.75 ,$267.75 Outpatient Medical Services,CARDIAC,93970,US Lower Ext Venous Duplex Bilateral,320,$635.00 ,$340.36 ,53.6% of total biled charges for outpatient setting,$340.36 ,53.6% of total biled charges for outpatient setting,$476.25 ,75% of total billed charges for outpatient setting,$476.25 ,75% of total billed charges for outpatient setting,$476.25 ,75% of total billed charges for outpatient setting,$200.79 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$200.79 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$200.79 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$200.79 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$200.79 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$200.79 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$508.00 ,80% of total billed charges for outpatient setting,$200.79 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$222.25 ,35% of total billed charges for outpatient setting,$539.75 ,85% of total billed charges for outpatient setting,$198.82 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$508.00 ,80% of total billed charges for outpatient setting,$539.75 ,85% of total billed charges for outpatient setting,$444.50 ,70% of total billed charges for outpatient setting,$444.50 ,70% of total billed charges for outpatient setting,$488.95 ,77% of total billed charges for outpatient setting,$198.82 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$539.75 ,85% of total billed charges for outpatient setting,$539.75 ,85% of total billed charges for outpatient setting,$539.75 ,85% of total billed charges for outpatient setting,$539.75 ,85% of total billed charges for outpatient setting,$539.75 ,85% of total billed charges for outpatient setting,$126.30 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$198.82 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$198.82 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$198.82 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$198.82 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$539.75 ,85% of total billed charges for outpatient setting,$123.83 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$196.85 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$571.50 ,90% of total billed charges for outpatient setting,$127.51 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$603.25 ,95% of total billed charges for outpatient setting,$539.75 ,85% of total billed charges for outpatient setting,$508.00 ,80% of total billed charges for outpatient setting,$126.30 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$539.75 ,85% of total billed charges for outpatient setting,$539.75 ,85% of total billed charges for outpatient setting,$539.75 ,85% of total billed charges for outpatient setting,$590.55 ,93% of total billed charges for outpatient setting,$476.25 ,75% of total billed charges for outpatient setting,$476.25 ,75% of total billed charges for outpatient setting,$476.25 ,75% of total billed charges for outpatient setting,$127.51 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$539.75 ,85% of total billed charges for outpatient setting,$126.30 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$123.83 ,$603.25 ,$222.25 Outpatient Medical Services,CARDIAC,93970,US Lower Ext Venous Duplex Left,921,$749.93 ,$401.96 ,53.6% of total biled charges for outpatient setting,$401.96 ,53.6% of total biled charges for outpatient setting,$562.45 ,75% of total billed charges for outpatient setting,$562.45 ,75% of total billed charges for outpatient setting,$562.45 ,75% of total billed charges for outpatient setting,$237.13 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$237.13 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$237.13 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$237.13 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$237.13 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$237.13 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$599.94 ,80% of total billed charges for outpatient setting,$237.13 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$262.48 ,35% of total billed charges for outpatient setting,$637.44 ,85% of total billed charges for outpatient setting,$234.80 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$599.94 ,80% of total billed charges for outpatient setting,$637.44 ,85% of total billed charges for outpatient setting,$524.95 ,70% of total billed charges for outpatient setting,$524.95 ,70% of total billed charges for outpatient setting,$577.45 ,77% of total billed charges for outpatient setting,$234.80 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$637.44 ,85% of total billed charges for outpatient setting,$637.44 ,85% of total billed charges for outpatient setting,$637.44 ,85% of total billed charges for outpatient setting,$637.44 ,85% of total billed charges for outpatient setting,$637.44 ,85% of total billed charges for outpatient setting,$149.16 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$234.80 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$234.80 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$234.80 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$234.80 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$637.44 ,85% of total billed charges for outpatient setting,$146.24 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$232.48 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$674.94 ,90% of total billed charges for outpatient setting,$150.59 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$712.43 ,95% of total billed charges for outpatient setting,$637.44 ,85% of total billed charges for outpatient setting,$599.94 ,80% of total billed charges for outpatient setting,$149.16 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$637.44 ,85% of total billed charges for outpatient setting,$637.44 ,85% of total billed charges for outpatient setting,$637.44 ,85% of total billed charges for outpatient setting,$697.43 ,93% of total billed charges for outpatient setting,$562.45 ,75% of total billed charges for outpatient setting,$562.45 ,75% of total billed charges for outpatient setting,$562.45 ,75% of total billed charges for outpatient setting,$150.59 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$637.44 ,85% of total billed charges for outpatient setting,$149.16 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$146.24 ,$712.43 ,$262.48 Outpatient Medical Services,CARDIAC,93970,US Upper Ext Venous Duplex Bilateral,320,$635.00 ,$340.36 ,53.6% of total biled charges for outpatient setting,$340.36 ,53.6% of total biled charges for outpatient setting,$476.25 ,75% of total billed charges for outpatient setting,$476.25 ,75% of total billed charges for outpatient setting,$476.25 ,75% of total billed charges for outpatient setting,$200.79 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$200.79 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$200.79 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$200.79 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$200.79 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$200.79 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$508.00 ,80% of total billed charges for outpatient setting,$200.79 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$222.25 ,35% of total billed charges for outpatient setting,$539.75 ,85% of total billed charges for outpatient setting,$198.82 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$508.00 ,80% of total billed charges for outpatient setting,$539.75 ,85% of total billed charges for outpatient setting,$444.50 ,70% of total billed charges for outpatient setting,$444.50 ,70% of total billed charges for outpatient setting,$488.95 ,77% of total billed charges for outpatient setting,$198.82 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$539.75 ,85% of total billed charges for outpatient setting,$539.75 ,85% of total billed charges for outpatient setting,$539.75 ,85% of total billed charges for outpatient setting,$539.75 ,85% of total billed charges for outpatient setting,$539.75 ,85% of total billed charges for outpatient setting,$126.30 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$198.82 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$198.82 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$198.82 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$198.82 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$539.75 ,85% of total billed charges for outpatient setting,$123.83 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$196.85 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$571.50 ,90% of total billed charges for outpatient setting,$127.51 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$603.25 ,95% of total billed charges for outpatient setting,$539.75 ,85% of total billed charges for outpatient setting,$508.00 ,80% of total billed charges for outpatient setting,$126.30 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$539.75 ,85% of total billed charges for outpatient setting,$539.75 ,85% of total billed charges for outpatient setting,$539.75 ,85% of total billed charges for outpatient setting,$590.55 ,93% of total billed charges for outpatient setting,$476.25 ,75% of total billed charges for outpatient setting,$476.25 ,75% of total billed charges for outpatient setting,$476.25 ,75% of total billed charges for outpatient setting,$127.51 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$539.75 ,85% of total billed charges for outpatient setting,$126.30 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$123.83 ,$603.25 ,$222.25 Outpatient Medical Services,CARDIAC,93971,US Lower Ext Venous Duplex Right,921,$231.66 ,$124.17 ,53.6% of total biled charges for outpatient setting,$124.17 ,53.6% of total biled charges for outpatient setting,$173.75 ,75% of total billed charges for outpatient setting,$173.75 ,75% of total billed charges for outpatient setting,$173.75 ,75% of total billed charges for outpatient setting,$73.25 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$73.25 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$73.25 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$73.25 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$73.25 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$73.25 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$185.33 ,80% of total billed charges for outpatient setting,$73.25 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$81.08 ,35% of total billed charges for outpatient setting,$196.91 ,85% of total billed charges for outpatient setting,$72.53 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$185.33 ,80% of total billed charges for outpatient setting,$196.91 ,85% of total billed charges for outpatient setting,$162.16 ,70% of total billed charges for outpatient setting,$162.16 ,70% of total billed charges for outpatient setting,$178.38 ,77% of total billed charges for outpatient setting,$72.53 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$196.91 ,85% of total billed charges for outpatient setting,$196.91 ,85% of total billed charges for outpatient setting,$196.91 ,85% of total billed charges for outpatient setting,$196.91 ,85% of total billed charges for outpatient setting,$196.91 ,85% of total billed charges for outpatient setting,$46.08 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$72.53 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$72.53 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$72.53 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$72.53 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$196.91 ,85% of total billed charges for outpatient setting,$45.17 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$71.81 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$208.49 ,90% of total billed charges for outpatient setting,$46.52 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$220.08 ,95% of total billed charges for outpatient setting,$196.91 ,85% of total billed charges for outpatient setting,$185.33 ,80% of total billed charges for outpatient setting,$46.08 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$196.91 ,85% of total billed charges for outpatient setting,$196.91 ,85% of total billed charges for outpatient setting,$196.91 ,85% of total billed charges for outpatient setting,$215.44 ,93% of total billed charges for outpatient setting,$173.75 ,75% of total billed charges for outpatient setting,$173.75 ,75% of total billed charges for outpatient setting,$173.75 ,75% of total billed charges for outpatient setting,$46.52 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$196.91 ,85% of total billed charges for outpatient setting,$46.08 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$45.17 ,$220.08 ,$81.08 Outpatient Medical Services,CARDIAC,93971,US Upper Ext Venous Duplex Right,921,$231.66 ,$124.17 ,53.6% of total biled charges for outpatient setting,$124.17 ,53.6% of total biled charges for outpatient setting,$173.75 ,75% of total billed charges for outpatient setting,$173.75 ,75% of total billed charges for outpatient setting,$173.75 ,75% of total billed charges for outpatient setting,$73.25 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$73.25 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$73.25 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$73.25 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$73.25 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$73.25 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$185.33 ,80% of total billed charges for outpatient setting,$73.25 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$81.08 ,35% of total billed charges for outpatient setting,$196.91 ,85% of total billed charges for outpatient setting,$72.53 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$185.33 ,80% of total billed charges for outpatient setting,$196.91 ,85% of total billed charges for outpatient setting,$162.16 ,70% of total billed charges for outpatient setting,$162.16 ,70% of total billed charges for outpatient setting,$178.38 ,77% of total billed charges for outpatient setting,$72.53 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$196.91 ,85% of total billed charges for outpatient setting,$196.91 ,85% of total billed charges for outpatient setting,$196.91 ,85% of total billed charges for outpatient setting,$196.91 ,85% of total billed charges for outpatient setting,$196.91 ,85% of total billed charges for outpatient setting,$46.08 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$72.53 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$72.53 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$72.53 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$72.53 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$196.91 ,85% of total billed charges for outpatient setting,$45.17 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$71.81 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$208.49 ,90% of total billed charges for outpatient setting,$46.52 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$220.08 ,95% of total billed charges for outpatient setting,$196.91 ,85% of total billed charges for outpatient setting,$185.33 ,80% of total billed charges for outpatient setting,$46.08 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$196.91 ,85% of total billed charges for outpatient setting,$196.91 ,85% of total billed charges for outpatient setting,$196.91 ,85% of total billed charges for outpatient setting,$215.44 ,93% of total billed charges for outpatient setting,$173.75 ,75% of total billed charges for outpatient setting,$173.75 ,75% of total billed charges for outpatient setting,$173.75 ,75% of total billed charges for outpatient setting,$46.52 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$196.91 ,85% of total billed charges for outpatient setting,$46.08 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$45.17 ,$220.08 ,$81.08 Outpatient Medical Services,EMERGENCY ROOM,99281,"ED VISIT FOR E&M PATIENT, LEV 1, MAY NOT REQ PRESENCE OF PHYSICIAN OR OTHER, CC",450,$75.09 ,$50.00 ,53.6% of total biled charges for outpatient setting,$50.00 ,53.6% of total biled charges for outpatient setting,$56.32 ,75% of total billed charges for outpatient setting,$56.32 ,75% of total billed charges for outpatient setting,$56.32 ,75% of total billed charges for outpatient setting,$23.74 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$23.74 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$23.74 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$23.74 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$23.74 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$23.74 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$60.07 ,80% of total billed charges for outpatient setting,$23.74 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$26.28 ,35% of total billed charges for outpatient setting,$63.83 ,85% of total billed charges for outpatient setting,$23.51 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$60.07 ,80% of total billed charges for outpatient setting,$63.83 ,85% of total billed charges for outpatient setting,$52.56 ,70% of total billed charges for outpatient setting,$52.56 ,70% of total billed charges for outpatient setting,$57.82 ,77% of total billed charges for outpatient setting,$23.51 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$63.83 ,85% of total billed charges for outpatient setting,$63.83 ,85% of total billed charges for outpatient setting,$63.83 ,85% of total billed charges for outpatient setting,$63.83 ,85% of total billed charges for outpatient setting,$63.83 ,85% of total billed charges for outpatient setting,$14.94 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$23.51 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$23.51 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$23.51 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$23.51 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$63.83 ,85% of total billed charges for outpatient setting,$14.64 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$23.28 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$67.58 ,90% of total billed charges for outpatient setting,$15.08 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$71.34 ,95% of total billed charges for outpatient setting,$63.83 ,85% of total billed charges for outpatient setting,$60.07 ,80% of total billed charges for outpatient setting,$14.94 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$63.83 ,85% of total billed charges for outpatient setting,$63.83 ,85% of total billed charges for outpatient setting,$63.83 ,85% of total billed charges for outpatient setting,$69.83 ,93% of total billed charges for outpatient setting,$56.32 ,75% of total billed charges for outpatient setting,$56.32 ,75% of total billed charges for outpatient setting,$56.32 ,75% of total billed charges for outpatient setting,$15.08 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$63.83 ,85% of total billed charges for outpatient setting,$14.94 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$14.64 ,$71.34 ,$26.28 Outpatient Medical Services,EMERGENCY ROOM,99282,"ED VISIT E&M PATIENT, LEV 2, REQ MED APPROP HSTRY/EXAM/MDM, CC",450,$139.69 ,$74.87 ,53.6% of total biled charges for outpatient setting,$74.87 ,53.6% of total biled charges for outpatient setting,$104.77 ,75% of total billed charges for outpatient setting,$104.77 ,75% of total billed charges for outpatient setting,$104.77 ,75% of total billed charges for outpatient setting,$44.17 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$44.17 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$44.17 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$44.17 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$44.17 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$44.17 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$111.75 ,80% of total billed charges for outpatient setting,$44.17 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$48.89 ,35% of total billed charges for outpatient setting,$118.74 ,85% of total billed charges for outpatient setting,$43.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$111.75 ,80% of total billed charges for outpatient setting,$118.74 ,85% of total billed charges for outpatient setting,$97.78 ,70% of total billed charges for outpatient setting,$97.78 ,70% of total billed charges for outpatient setting,$107.56 ,77% of total billed charges for outpatient setting,$43.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$118.74 ,85% of total billed charges for outpatient setting,$118.74 ,85% of total billed charges for outpatient setting,$118.74 ,85% of total billed charges for outpatient setting,$118.74 ,85% of total billed charges for outpatient setting,$118.74 ,85% of total billed charges for outpatient setting,$27.78 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$43.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$43.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$43.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$43.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$118.74 ,85% of total billed charges for outpatient setting,$27.24 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$43.30 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$125.72 ,90% of total billed charges for outpatient setting,$28.05 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$132.71 ,95% of total billed charges for outpatient setting,$118.74 ,85% of total billed charges for outpatient setting,$111.75 ,80% of total billed charges for outpatient setting,$27.78 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$118.74 ,85% of total billed charges for outpatient setting,$118.74 ,85% of total billed charges for outpatient setting,$118.74 ,85% of total billed charges for outpatient setting,$129.91 ,93% of total billed charges for outpatient setting,$104.77 ,75% of total billed charges for outpatient setting,$104.77 ,75% of total billed charges for outpatient setting,$104.77 ,75% of total billed charges for outpatient setting,$28.05 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$118.74 ,85% of total billed charges for outpatient setting,$27.78 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$27.24 ,$132.71 ,$48.89 Outpatient Medical Services,EMERGENCY ROOM,99283,"ED VISIT E&M PATIENT, LEV 3, REQ MED APPROP HSTRY/EXAM/LOW MDM, CC",450,$245.03 ,$131.34 ,53.6% of total biled charges for outpatient setting,$131.34 ,53.6% of total biled charges for outpatient setting,$183.77 ,75% of total billed charges for outpatient setting,$183.77 ,75% of total billed charges for outpatient setting,$183.77 ,75% of total billed charges for outpatient setting,$77.48 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$77.48 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$77.48 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$77.48 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$77.48 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$77.48 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$196.02 ,80% of total billed charges for outpatient setting,$77.48 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$85.76 ,35% of total billed charges for outpatient setting,$208.28 ,85% of total billed charges for outpatient setting,$76.72 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$196.02 ,80% of total billed charges for outpatient setting,$208.28 ,85% of total billed charges for outpatient setting,$171.52 ,70% of total billed charges for outpatient setting,$171.52 ,70% of total billed charges for outpatient setting,$188.67 ,77% of total billed charges for outpatient setting,$76.72 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$208.28 ,85% of total billed charges for outpatient setting,$208.28 ,85% of total billed charges for outpatient setting,$208.28 ,85% of total billed charges for outpatient setting,$208.28 ,85% of total billed charges for outpatient setting,$208.28 ,85% of total billed charges for outpatient setting,$48.74 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$76.72 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$76.72 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$76.72 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$76.72 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$208.28 ,85% of total billed charges for outpatient setting,$47.78 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$75.96 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$220.53 ,90% of total billed charges for outpatient setting,$49.20 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$232.78 ,95% of total billed charges for outpatient setting,$208.28 ,85% of total billed charges for outpatient setting,$196.02 ,80% of total billed charges for outpatient setting,$48.74 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$208.28 ,85% of total billed charges for outpatient setting,$208.28 ,85% of total billed charges for outpatient setting,$208.28 ,85% of total billed charges for outpatient setting,$227.88 ,93% of total billed charges for outpatient setting,$183.77 ,75% of total billed charges for outpatient setting,$183.77 ,75% of total billed charges for outpatient setting,$183.77 ,75% of total billed charges for outpatient setting,$49.20 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$208.28 ,85% of total billed charges for outpatient setting,$48.74 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$47.78 ,$232.78 ,$85.76 Outpatient Medical Services,EMERGENCY ROOM,99284,"ED VISIT E&M PATIENT, LEV 4, REQ MED APPROP HSTRY/EXAM/MODERATE MDM, CC",450,$731.05 ,$391.84 ,53.6% of total biled charges for outpatient setting,$391.84 ,53.6% of total biled charges for outpatient setting,$548.29 ,75% of total billed charges for outpatient setting,$548.29 ,75% of total billed charges for outpatient setting,$548.29 ,75% of total billed charges for outpatient setting,$231.16 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$231.16 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$231.16 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$231.16 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$231.16 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$231.16 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$584.84 ,80% of total billed charges for outpatient setting,$231.16 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$255.87 ,35% of total billed charges for outpatient setting,$621.39 ,85% of total billed charges for outpatient setting,$228.89 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$584.84 ,80% of total billed charges for outpatient setting,$621.39 ,85% of total billed charges for outpatient setting,$511.74 ,70% of total billed charges for outpatient setting,$511.74 ,70% of total billed charges for outpatient setting,$562.91 ,77% of total billed charges for outpatient setting,$228.89 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$621.39 ,85% of total billed charges for outpatient setting,$621.39 ,85% of total billed charges for outpatient setting,$621.39 ,85% of total billed charges for outpatient setting,$621.39 ,85% of total billed charges for outpatient setting,$621.39 ,85% of total billed charges for outpatient setting,$145.41 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$228.89 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$228.89 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$228.89 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$228.89 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$621.39 ,85% of total billed charges for outpatient setting,$142.55 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$226.63 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$657.95 ,90% of total billed charges for outpatient setting,$146.79 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$694.50 ,95% of total billed charges for outpatient setting,$621.39 ,85% of total billed charges for outpatient setting,$584.84 ,80% of total billed charges for outpatient setting,$145.41 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$621.39 ,85% of total billed charges for outpatient setting,$621.39 ,85% of total billed charges for outpatient setting,$621.39 ,85% of total billed charges for outpatient setting,$679.88 ,93% of total billed charges for outpatient setting,$548.29 ,75% of total billed charges for outpatient setting,$548.29 ,75% of total billed charges for outpatient setting,$548.29 ,75% of total billed charges for outpatient setting,$146.79 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$621.39 ,85% of total billed charges for outpatient setting,$145.41 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$142.55 ,$694.50 ,$255.87 Outpatient Medical Services,EMERGENCY ROOM,99285,"ED VISIT E&M PATIENT, LEV 5, REQ MED APPROP HSTRY/EXAM/HIGH MDM, CC",450,$548.11 ,$293.79 ,53.6% of total biled charges for outpatient setting,$293.79 ,53.6% of total biled charges for outpatient setting,$411.08 ,75% of total billed charges for outpatient setting,$411.08 ,75% of total billed charges for outpatient setting,$411.08 ,75% of total billed charges for outpatient setting,$173.31 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$173.31 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$173.31 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$173.31 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$173.31 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$173.31 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$438.49 ,80% of total billed charges for outpatient setting,$173.31 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$191.84 ,35% of total billed charges for outpatient setting,$465.89 ,85% of total billed charges for outpatient setting,$171.61 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$438.49 ,80% of total billed charges for outpatient setting,$465.89 ,85% of total billed charges for outpatient setting,$383.68 ,70% of total billed charges for outpatient setting,$383.68 ,70% of total billed charges for outpatient setting,$422.04 ,77% of total billed charges for outpatient setting,$171.61 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$465.89 ,85% of total billed charges for outpatient setting,$465.89 ,85% of total billed charges for outpatient setting,$465.89 ,85% of total billed charges for outpatient setting,$465.89 ,85% of total billed charges for outpatient setting,$465.89 ,85% of total billed charges for outpatient setting,$109.02 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$171.61 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$171.61 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$171.61 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$171.61 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$465.89 ,85% of total billed charges for outpatient setting,$106.88 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$169.91 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$493.30 ,90% of total billed charges for outpatient setting,$110.06 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$520.70 ,95% of total billed charges for outpatient setting,$465.89 ,85% of total billed charges for outpatient setting,$438.49 ,80% of total billed charges for outpatient setting,$109.02 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$465.89 ,85% of total billed charges for outpatient setting,$465.89 ,85% of total billed charges for outpatient setting,$465.89 ,85% of total billed charges for outpatient setting,$509.74 ,93% of total billed charges for outpatient setting,$411.08 ,75% of total billed charges for outpatient setting,$411.08 ,75% of total billed charges for outpatient setting,$411.08 ,75% of total billed charges for outpatient setting,$110.06 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$465.89 ,85% of total billed charges for outpatient setting,$109.02 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$106.88 ,$520.70 ,$191.84 Outpatient Medical Services,LAB,80048,CMP (BMP prior),301,$88.55 ,$11.18 ,100% Amerigroup fee schedule for outpatient setting,$11.18 ,100% Amerigroup fee schedule for outpatient setting,$44.28 ,75% of total billed charges for outpatient setting,$44.28 ,75% of total billed charges for outpatient setting,$44.28 ,75% of total billed charges for outpatient setting,$8.63 ,102% CMS Medicare OPPS fee schedule,$8.63 ,102% CMS Medicare OPPS fee schedule,$8.63 ,102% CMS Medicare OPPS fee schedule,$8.63 ,102% CMS Medicare OPPS fee schedule,$8.63 ,102% CMS Medicare OPPS fee schedule,$8.63 ,102% CMS Medicare OPPS fee schedule,$70.84 ,80% of total billed charges for outpatient setting,$8.63 ,102% CMS Medicare OPPS fee schedule,$11.18 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$75.27 ,85% of total billed charges for outpatient setting,$8.54 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$70.84 ,80% of total billed charges for outpatient setting,$75.27 ,85% of total billed charges for outpatient setting,$61.99 ,70% of total billed charges for outpatient setting,$61.99 ,70% of total billed charges for outpatient setting,$68.18 ,77% of total billed charges for outpatient setting,$8.54 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$75.27 ,85% of total billed charges for outpatient setting,$75.27 ,85% of total billed charges for outpatient setting,$75.27 ,85% of total billed charges for outpatient setting,$75.27 ,85% of total billed charges for outpatient setting,$75.27 ,85% of total billed charges for outpatient setting,$10.86 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.54 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.54 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.54 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.54 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$75.27 ,85% of total billed charges for outpatient setting,$10.65 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$8.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$79.70 ,90% of total billed charges for outpatient setting,$10.97 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$84.12 ,95% of total billed charges for outpatient setting,$75.27 ,85% of total billed charges for outpatient setting,$70.84 ,80% of total billed charges for outpatient setting,$10.86 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$75.27 ,85% of total billed charges for outpatient setting,$75.27 ,85% of total billed charges for outpatient setting,$75.27 ,85% of total billed charges for outpatient setting,$82.35 ,93% of total billed charges for outpatient setting,$66.41 ,75% of total billed charges for outpatient setting,$66.41 ,75% of total billed charges for outpatient setting,$66.41 ,75% of total billed charges for outpatient setting,$10.97 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$75.27 ,85% of total billed charges for outpatient setting,$10.86 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.46 ,$84.12 ,$30.99 Outpatient Medical Services,LAB,80048,Basic Metabolic Panel,301,$88.55 ,$11.18 ,100% Amerigroup fee schedule for outpatient setting,$11.18 ,100% Amerigroup fee schedule for outpatient setting,$44.28 ,75% of total billed charges for outpatient setting,$44.28 ,75% of total billed charges for outpatient setting,$44.28 ,75% of total billed charges for outpatient setting,$8.63 ,102% CMS Medicare OPPS fee schedule,$8.63 ,102% CMS Medicare OPPS fee schedule,$8.63 ,102% CMS Medicare OPPS fee schedule,$8.63 ,102% CMS Medicare OPPS fee schedule,$8.63 ,102% CMS Medicare OPPS fee schedule,$8.63 ,102% CMS Medicare OPPS fee schedule,$70.84 ,80% of total billed charges for outpatient setting,$8.63 ,102% CMS Medicare OPPS fee schedule,$11.18 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$75.27 ,85% of total billed charges for outpatient setting,$8.54 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$70.84 ,80% of total billed charges for outpatient setting,$75.27 ,85% of total billed charges for outpatient setting,$61.99 ,70% of total billed charges for outpatient setting,$61.99 ,70% of total billed charges for outpatient setting,$68.18 ,77% of total billed charges for outpatient setting,$8.54 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$75.27 ,85% of total billed charges for outpatient setting,$75.27 ,85% of total billed charges for outpatient setting,$75.27 ,85% of total billed charges for outpatient setting,$75.27 ,85% of total billed charges for outpatient setting,$75.27 ,85% of total billed charges for outpatient setting,$10.86 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.54 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.54 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.54 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.54 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$75.27 ,85% of total billed charges for outpatient setting,$10.65 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$8.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$79.70 ,90% of total billed charges for outpatient setting,$10.97 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$84.12 ,95% of total billed charges for outpatient setting,$75.27 ,85% of total billed charges for outpatient setting,$70.84 ,80% of total billed charges for outpatient setting,$10.86 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$75.27 ,85% of total billed charges for outpatient setting,$75.27 ,85% of total billed charges for outpatient setting,$75.27 ,85% of total billed charges for outpatient setting,$82.35 ,93% of total billed charges for outpatient setting,$66.41 ,75% of total billed charges for outpatient setting,$66.41 ,75% of total billed charges for outpatient setting,$66.41 ,75% of total billed charges for outpatient setting,$17.78 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$75.27 ,85% of total billed charges for outpatient setting,$10.86 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.46 ,$84.12 ,$30.99 Outpatient Medical Services,LAB,80048,BMP (8) LC,301,$88.55 ,$11.18 ,100% Amerigroup fee schedule for outpatient setting,$11.18 ,100% Amerigroup fee schedule for outpatient setting,$44.28 ,75% of total billed charges for outpatient setting,$44.28 ,75% of total billed charges for outpatient setting,$44.28 ,75% of total billed charges for outpatient setting,$8.63 ,102% CMS Medicare OPPS fee schedule,$8.63 ,102% CMS Medicare OPPS fee schedule,$8.63 ,102% CMS Medicare OPPS fee schedule,$8.63 ,102% CMS Medicare OPPS fee schedule,$8.63 ,102% CMS Medicare OPPS fee schedule,$8.63 ,102% CMS Medicare OPPS fee schedule,$70.84 ,80% of total billed charges for outpatient setting,$8.63 ,102% CMS Medicare OPPS fee schedule,$11.18 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$75.27 ,85% of total billed charges for outpatient setting,$8.54 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$70.84 ,80% of total billed charges for outpatient setting,$75.27 ,85% of total billed charges for outpatient setting,$61.99 ,70% of total billed charges for outpatient setting,$61.99 ,70% of total billed charges for outpatient setting,$68.18 ,77% of total billed charges for outpatient setting,$8.54 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$75.27 ,85% of total billed charges for outpatient setting,$75.27 ,85% of total billed charges for outpatient setting,$75.27 ,85% of total billed charges for outpatient setting,$75.27 ,85% of total billed charges for outpatient setting,$75.27 ,85% of total billed charges for outpatient setting,$10.86 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.54 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.54 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.54 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.54 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$75.27 ,85% of total billed charges for outpatient setting,$10.65 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$8.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$79.70 ,90% of total billed charges for outpatient setting,$10.97 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$84.12 ,95% of total billed charges for outpatient setting,$75.27 ,85% of total billed charges for outpatient setting,$70.84 ,80% of total billed charges for outpatient setting,$10.86 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$75.27 ,85% of total billed charges for outpatient setting,$75.27 ,85% of total billed charges for outpatient setting,$75.27 ,85% of total billed charges for outpatient setting,$82.35 ,93% of total billed charges for outpatient setting,$66.41 ,75% of total billed charges for outpatient setting,$66.41 ,75% of total billed charges for outpatient setting,$66.41 ,75% of total billed charges for outpatient setting,$17.78 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$75.27 ,85% of total billed charges for outpatient setting,$10.86 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.46 ,$84.12 ,$30.99 Outpatient Medical Services,LAB,80048,Basic Metabolic Panel,300,$123.84 ,$11.18 ,100% Amerigroup fee schedule for outpatient setting,$11.18 ,100% Amerigroup fee schedule for outpatient setting,$61.92 ,75% of total billed charges for outpatient setting,$61.92 ,75% of total billed charges for outpatient setting,$61.92 ,75% of total billed charges for outpatient setting,$8.63 ,102% CMS Medicare OPPS fee schedule,$8.63 ,102% CMS Medicare OPPS fee schedule,$8.63 ,102% CMS Medicare OPPS fee schedule,$8.63 ,102% CMS Medicare OPPS fee schedule,$8.63 ,102% CMS Medicare OPPS fee schedule,$8.63 ,102% CMS Medicare OPPS fee schedule,$99.07 ,80% of total billed charges for outpatient setting,$8.63 ,102% CMS Medicare OPPS fee schedule,$11.18 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$105.26 ,85% of total billed charges for outpatient setting,$8.54 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$99.07 ,80% of total billed charges for outpatient setting,$105.26 ,85% of total billed charges for outpatient setting,$86.69 ,70% of total billed charges for outpatient setting,$86.69 ,70% of total billed charges for outpatient setting,$95.36 ,77% of total billed charges for outpatient setting,$8.54 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$105.26 ,85% of total billed charges for outpatient setting,$105.26 ,85% of total billed charges for outpatient setting,$105.26 ,85% of total billed charges for outpatient setting,$105.26 ,85% of total billed charges for outpatient setting,$105.26 ,85% of total billed charges for outpatient setting,$10.86 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.54 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.54 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.54 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.54 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$105.26 ,85% of total billed charges for outpatient setting,$10.65 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$8.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$111.46 ,90% of total billed charges for outpatient setting,$10.97 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$117.65 ,95% of total billed charges for outpatient setting,$105.26 ,85% of total billed charges for outpatient setting,$99.07 ,80% of total billed charges for outpatient setting,$10.86 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$105.26 ,85% of total billed charges for outpatient setting,$105.26 ,85% of total billed charges for outpatient setting,$105.26 ,85% of total billed charges for outpatient setting,$115.17 ,93% of total billed charges for outpatient setting,$92.88 ,75% of total billed charges for outpatient setting,$92.88 ,75% of total billed charges for outpatient setting,$92.88 ,75% of total billed charges for outpatient setting,$24.87 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$105.26 ,85% of total billed charges for outpatient setting,$10.86 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.46 ,$117.65 ,$43.34 Outpatient Medical Services,LAB,80051,Lytes,301,$62.00 ,$9.26 ,100% Amerigroup fee schedule for outpatient setting,$9.26 ,100% Amerigroup fee schedule for outpatient setting,$31.00 ,75% of total billed charges for outpatient setting,$31.00 ,75% of total billed charges for outpatient setting,$31.00 ,75% of total billed charges for outpatient setting,$7.15 ,102% CMS Medicare OPPS fee schedule,$7.15 ,102% CMS Medicare OPPS fee schedule,$7.15 ,102% CMS Medicare OPPS fee schedule,$7.15 ,102% CMS Medicare OPPS fee schedule,$7.15 ,102% CMS Medicare OPPS fee schedule,$7.15 ,102% CMS Medicare OPPS fee schedule,$49.60 ,80% of total billed charges for outpatient setting,$7.15 ,102% CMS Medicare OPPS fee schedule,$9.26 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$52.70 ,85% of total billed charges for outpatient setting,$7.08 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$49.60 ,80% of total billed charges for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$43.40 ,70% of total billed charges for outpatient setting,$43.40 ,70% of total billed charges for outpatient setting,$47.74 ,77% of total billed charges for outpatient setting,$7.08 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$9.00 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$7.08 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$7.08 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$7.08 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$7.08 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$8.82 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$7.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$55.80 ,90% of total billed charges for outpatient setting,$9.08 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$58.90 ,95% of total billed charges for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$49.60 ,80% of total billed charges for outpatient setting,$9.00 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$52.70 ,85% of total billed charges for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$57.66 ,93% of total billed charges for outpatient setting,$46.50 ,75% of total billed charges for outpatient setting,$46.50 ,75% of total billed charges for outpatient setting,$46.50 ,75% of total billed charges for outpatient setting,$12.45 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$52.70 ,85% of total billed charges for outpatient setting,$9.00 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$7.01 ,$58.90 ,$21.70 Outpatient Medical Services,LAB,80053,CMP,301,$197.00 ,$13.95 ,100% Amerigroup fee schedule for outpatient setting,$13.95 ,100% Amerigroup fee schedule for outpatient setting,$98.50 ,75% of total billed charges for outpatient setting,$98.50 ,75% of total billed charges for outpatient setting,$98.50 ,75% of total billed charges for outpatient setting,$10.77 ,102% CMS Medicare OPPS fee schedule,$10.77 ,102% CMS Medicare OPPS fee schedule,$10.77 ,102% CMS Medicare OPPS fee schedule,$10.77 ,102% CMS Medicare OPPS fee schedule,$10.77 ,102% CMS Medicare OPPS fee schedule,$10.77 ,102% CMS Medicare OPPS fee schedule,$157.60 ,80% of total billed charges for outpatient setting,$10.77 ,102% CMS Medicare OPPS fee schedule,$13.95 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$167.45 ,85% of total billed charges for outpatient setting,$10.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$157.60 ,80% of total billed charges for outpatient setting,$167.45 ,85% of total billed charges for outpatient setting,$137.90 ,70% of total billed charges for outpatient setting,$137.90 ,70% of total billed charges for outpatient setting,$151.69 ,77% of total billed charges for outpatient setting,$10.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$167.45 ,85% of total billed charges for outpatient setting,$167.45 ,85% of total billed charges for outpatient setting,$167.45 ,85% of total billed charges for outpatient setting,$167.45 ,85% of total billed charges for outpatient setting,$167.45 ,85% of total billed charges for outpatient setting,$13.56 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$10.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$10.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$10.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$10.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$167.45 ,85% of total billed charges for outpatient setting,$13.29 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$10.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$177.30 ,90% of total billed charges for outpatient setting,$13.69 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$187.15 ,95% of total billed charges for outpatient setting,$167.45 ,85% of total billed charges for outpatient setting,$157.60 ,80% of total billed charges for outpatient setting,$13.56 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$167.45 ,85% of total billed charges for outpatient setting,$167.45 ,85% of total billed charges for outpatient setting,$167.45 ,85% of total billed charges for outpatient setting,$183.21 ,93% of total billed charges for outpatient setting,$147.75 ,75% of total billed charges for outpatient setting,$147.75 ,75% of total billed charges for outpatient setting,$147.75 ,75% of total billed charges for outpatient setting,$39.56 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$167.45 ,85% of total billed charges for outpatient setting,$13.56 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$10.56 ,$187.15 ,$68.95 Outpatient Medical Services,LAB,80053,CMP 14 LC,301,$197.00 ,$13.95 ,100% Amerigroup fee schedule for outpatient setting,$13.95 ,100% Amerigroup fee schedule for outpatient setting,$98.50 ,75% of total billed charges for outpatient setting,$98.50 ,75% of total billed charges for outpatient setting,$98.50 ,75% of total billed charges for outpatient setting,$10.77 ,102% CMS Medicare OPPS fee schedule,$10.77 ,102% CMS Medicare OPPS fee schedule,$10.77 ,102% CMS Medicare OPPS fee schedule,$10.77 ,102% CMS Medicare OPPS fee schedule,$10.77 ,102% CMS Medicare OPPS fee schedule,$10.77 ,102% CMS Medicare OPPS fee schedule,$157.60 ,80% of total billed charges for outpatient setting,$10.77 ,102% CMS Medicare OPPS fee schedule,$13.95 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$167.45 ,85% of total billed charges for outpatient setting,$10.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$157.60 ,80% of total billed charges for outpatient setting,$167.45 ,85% of total billed charges for outpatient setting,$137.90 ,70% of total billed charges for outpatient setting,$137.90 ,70% of total billed charges for outpatient setting,$151.69 ,77% of total billed charges for outpatient setting,$10.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$167.45 ,85% of total billed charges for outpatient setting,$167.45 ,85% of total billed charges for outpatient setting,$167.45 ,85% of total billed charges for outpatient setting,$167.45 ,85% of total billed charges for outpatient setting,$167.45 ,85% of total billed charges for outpatient setting,$13.56 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$10.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$10.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$10.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$10.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$167.45 ,85% of total billed charges for outpatient setting,$13.29 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$10.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$177.30 ,90% of total billed charges for outpatient setting,$13.69 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$187.15 ,95% of total billed charges for outpatient setting,$167.45 ,85% of total billed charges for outpatient setting,$157.60 ,80% of total billed charges for outpatient setting,$13.56 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$167.45 ,85% of total billed charges for outpatient setting,$167.45 ,85% of total billed charges for outpatient setting,$167.45 ,85% of total billed charges for outpatient setting,$183.21 ,93% of total billed charges for outpatient setting,$147.75 ,75% of total billed charges for outpatient setting,$147.75 ,75% of total billed charges for outpatient setting,$147.75 ,75% of total billed charges for outpatient setting,$39.56 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$167.45 ,85% of total billed charges for outpatient setting,$13.56 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$10.56 ,$187.15 ,$68.95 Outpatient Medical Services,LAB,80061,Lipid Panel w/Rfx Direct LDL,301,$130.13 ,$17.69 ,100% Amerigroup fee schedule for outpatient setting,$17.69 ,100% Amerigroup fee schedule for outpatient setting,$65.07 ,75% of total billed charges for outpatient setting,$65.07 ,75% of total billed charges for outpatient setting,$65.07 ,75% of total billed charges for outpatient setting,$13.66 ,102% CMS Medicare OPPS fee schedule,$13.66 ,102% CMS Medicare OPPS fee schedule,$13.66 ,102% CMS Medicare OPPS fee schedule,$13.66 ,102% CMS Medicare OPPS fee schedule,$13.66 ,102% CMS Medicare OPPS fee schedule,$13.66 ,102% CMS Medicare OPPS fee schedule,$104.10 ,80% of total billed charges for outpatient setting,$13.66 ,102% CMS Medicare OPPS fee schedule,$17.69 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$110.61 ,85% of total billed charges for outpatient setting,$13.52 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$104.10 ,80% of total billed charges for outpatient setting,$110.61 ,85% of total billed charges for outpatient setting,$91.09 ,70% of total billed charges for outpatient setting,$91.09 ,70% of total billed charges for outpatient setting,$100.20 ,77% of total billed charges for outpatient setting,$13.52 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$110.61 ,85% of total billed charges for outpatient setting,$110.61 ,85% of total billed charges for outpatient setting,$110.61 ,85% of total billed charges for outpatient setting,$110.61 ,85% of total billed charges for outpatient setting,$110.61 ,85% of total billed charges for outpatient setting,$17.19 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$13.52 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.52 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.52 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.52 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$110.61 ,85% of total billed charges for outpatient setting,$16.85 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$13.39 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$117.12 ,90% of total billed charges for outpatient setting,$17.36 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$123.62 ,95% of total billed charges for outpatient setting,$110.61 ,85% of total billed charges for outpatient setting,$104.10 ,80% of total billed charges for outpatient setting,$17.19 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$110.61 ,85% of total billed charges for outpatient setting,$110.61 ,85% of total billed charges for outpatient setting,$110.61 ,85% of total billed charges for outpatient setting,$121.02 ,93% of total billed charges for outpatient setting,$97.60 ,75% of total billed charges for outpatient setting,$97.60 ,75% of total billed charges for outpatient setting,$97.60 ,75% of total billed charges for outpatient setting,$26.13 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$110.61 ,85% of total billed charges for outpatient setting,$17.19 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$13.39 ,$123.62 ,$45.55 Outpatient Medical Services,LAB,80061,Lipid Panel LC,301,$130.13 ,$17.69 ,100% Amerigroup fee schedule for outpatient setting,$17.69 ,100% Amerigroup fee schedule for outpatient setting,$65.07 ,75% of total billed charges for outpatient setting,$65.07 ,75% of total billed charges for outpatient setting,$65.07 ,75% of total billed charges for outpatient setting,$13.66 ,102% CMS Medicare OPPS fee schedule,$13.66 ,102% CMS Medicare OPPS fee schedule,$13.66 ,102% CMS Medicare OPPS fee schedule,$13.66 ,102% CMS Medicare OPPS fee schedule,$13.66 ,102% CMS Medicare OPPS fee schedule,$13.66 ,102% CMS Medicare OPPS fee schedule,$104.10 ,80% of total billed charges for outpatient setting,$13.66 ,102% CMS Medicare OPPS fee schedule,$17.69 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$110.61 ,85% of total billed charges for outpatient setting,$13.52 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$104.10 ,80% of total billed charges for outpatient setting,$110.61 ,85% of total billed charges for outpatient setting,$91.09 ,70% of total billed charges for outpatient setting,$91.09 ,70% of total billed charges for outpatient setting,$100.20 ,77% of total billed charges for outpatient setting,$13.52 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$110.61 ,85% of total billed charges for outpatient setting,$110.61 ,85% of total billed charges for outpatient setting,$110.61 ,85% of total billed charges for outpatient setting,$110.61 ,85% of total billed charges for outpatient setting,$110.61 ,85% of total billed charges for outpatient setting,$17.19 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$13.52 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.52 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.52 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.52 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$110.61 ,85% of total billed charges for outpatient setting,$16.85 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$13.39 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$117.12 ,90% of total billed charges for outpatient setting,$17.36 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$123.62 ,95% of total billed charges for outpatient setting,$110.61 ,85% of total billed charges for outpatient setting,$104.10 ,80% of total billed charges for outpatient setting,$17.19 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$110.61 ,85% of total billed charges for outpatient setting,$110.61 ,85% of total billed charges for outpatient setting,$110.61 ,85% of total billed charges for outpatient setting,$121.02 ,93% of total billed charges for outpatient setting,$97.60 ,75% of total billed charges for outpatient setting,$97.60 ,75% of total billed charges for outpatient setting,$97.60 ,75% of total billed charges for outpatient setting,$26.13 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$110.61 ,85% of total billed charges for outpatient setting,$17.19 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$13.39 ,$123.62 ,$45.55 Outpatient Medical Services,LAB,80069,Renal Pnl,301,$105.38 ,$11.47 ,100% Amerigroup fee schedule for outpatient setting,$11.47 ,100% Amerigroup fee schedule for outpatient setting,$52.69 ,75% of total billed charges for outpatient setting,$52.69 ,75% of total billed charges for outpatient setting,$52.69 ,75% of total billed charges for outpatient setting,$8.85 ,102% CMS Medicare OPPS fee schedule,$8.85 ,102% CMS Medicare OPPS fee schedule,$8.85 ,102% CMS Medicare OPPS fee schedule,$8.85 ,102% CMS Medicare OPPS fee schedule,$8.85 ,102% CMS Medicare OPPS fee schedule,$8.85 ,102% CMS Medicare OPPS fee schedule,$84.30 ,80% of total billed charges for outpatient setting,$8.85 ,102% CMS Medicare OPPS fee schedule,$11.47 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$89.57 ,85% of total billed charges for outpatient setting,$8.77 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$84.30 ,80% of total billed charges for outpatient setting,$89.57 ,85% of total billed charges for outpatient setting,$73.77 ,70% of total billed charges for outpatient setting,$73.77 ,70% of total billed charges for outpatient setting,$81.14 ,77% of total billed charges for outpatient setting,$8.77 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$89.57 ,85% of total billed charges for outpatient setting,$89.57 ,85% of total billed charges for outpatient setting,$89.57 ,85% of total billed charges for outpatient setting,$89.57 ,85% of total billed charges for outpatient setting,$89.57 ,85% of total billed charges for outpatient setting,$11.14 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.77 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.77 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.77 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.77 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$89.57 ,85% of total billed charges for outpatient setting,$10.92 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$8.68 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.84 ,90% of total billed charges for outpatient setting,$11.25 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$100.11 ,95% of total billed charges for outpatient setting,$89.57 ,85% of total billed charges for outpatient setting,$84.30 ,80% of total billed charges for outpatient setting,$11.14 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$89.57 ,85% of total billed charges for outpatient setting,$89.57 ,85% of total billed charges for outpatient setting,$89.57 ,85% of total billed charges for outpatient setting,$98.00 ,93% of total billed charges for outpatient setting,$79.04 ,75% of total billed charges for outpatient setting,$79.04 ,75% of total billed charges for outpatient setting,$79.04 ,75% of total billed charges for outpatient setting,$21.16 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$89.57 ,85% of total billed charges for outpatient setting,$11.14 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.68 ,$100.11 ,$36.88 Outpatient Medical Services,LAB,80076,Hep Fnct Pnl,301,$207.98 ,$10.79 ,100% Amerigroup fee schedule for outpatient setting,$10.79 ,100% Amerigroup fee schedule for outpatient setting,$103.99 ,75% of total billed charges for outpatient setting,$103.99 ,75% of total billed charges for outpatient setting,$103.99 ,75% of total billed charges for outpatient setting,$8.33 ,102% CMS Medicare OPPS fee schedule,$8.33 ,102% CMS Medicare OPPS fee schedule,$8.33 ,102% CMS Medicare OPPS fee schedule,$8.33 ,102% CMS Medicare OPPS fee schedule,$8.33 ,102% CMS Medicare OPPS fee schedule,$8.33 ,102% CMS Medicare OPPS fee schedule,$166.38 ,80% of total billed charges for outpatient setting,$8.33 ,102% CMS Medicare OPPS fee schedule,$10.79 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$176.78 ,85% of total billed charges for outpatient setting,$8.25 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$166.38 ,80% of total billed charges for outpatient setting,$176.78 ,85% of total billed charges for outpatient setting,$145.59 ,70% of total billed charges for outpatient setting,$145.59 ,70% of total billed charges for outpatient setting,$160.14 ,77% of total billed charges for outpatient setting,$8.25 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$176.78 ,85% of total billed charges for outpatient setting,$176.78 ,85% of total billed charges for outpatient setting,$176.78 ,85% of total billed charges for outpatient setting,$176.78 ,85% of total billed charges for outpatient setting,$176.78 ,85% of total billed charges for outpatient setting,$10.49 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.25 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.25 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.25 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.25 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$176.78 ,85% of total billed charges for outpatient setting,$10.28 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$8.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$187.18 ,90% of total billed charges for outpatient setting,$10.59 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$197.58 ,95% of total billed charges for outpatient setting,$176.78 ,85% of total billed charges for outpatient setting,$166.38 ,80% of total billed charges for outpatient setting,$10.49 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$176.78 ,85% of total billed charges for outpatient setting,$176.78 ,85% of total billed charges for outpatient setting,$176.78 ,85% of total billed charges for outpatient setting,$193.42 ,93% of total billed charges for outpatient setting,$155.99 ,75% of total billed charges for outpatient setting,$155.99 ,75% of total billed charges for outpatient setting,$155.99 ,75% of total billed charges for outpatient setting,$41.76 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$176.78 ,85% of total billed charges for outpatient setting,$10.49 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.17 ,$197.58 ,$72.79 Outpatient Medical Services,LAB,80076,Hepatic Function Panel (7) LC,301,$207.98 ,$10.79 ,100% Amerigroup fee schedule for outpatient setting,$10.79 ,100% Amerigroup fee schedule for outpatient setting,$103.99 ,75% of total billed charges for outpatient setting,$103.99 ,75% of total billed charges for outpatient setting,$103.99 ,75% of total billed charges for outpatient setting,$8.33 ,102% CMS Medicare OPPS fee schedule,$8.33 ,102% CMS Medicare OPPS fee schedule,$8.33 ,102% CMS Medicare OPPS fee schedule,$8.33 ,102% CMS Medicare OPPS fee schedule,$8.33 ,102% CMS Medicare OPPS fee schedule,$8.33 ,102% CMS Medicare OPPS fee schedule,$166.38 ,80% of total billed charges for outpatient setting,$8.33 ,102% CMS Medicare OPPS fee schedule,$10.79 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$176.78 ,85% of total billed charges for outpatient setting,$8.25 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$166.38 ,80% of total billed charges for outpatient setting,$176.78 ,85% of total billed charges for outpatient setting,$145.59 ,70% of total billed charges for outpatient setting,$145.59 ,70% of total billed charges for outpatient setting,$160.14 ,77% of total billed charges for outpatient setting,$8.25 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$176.78 ,85% of total billed charges for outpatient setting,$176.78 ,85% of total billed charges for outpatient setting,$176.78 ,85% of total billed charges for outpatient setting,$176.78 ,85% of total billed charges for outpatient setting,$176.78 ,85% of total billed charges for outpatient setting,$10.49 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.25 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.25 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.25 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.25 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$176.78 ,85% of total billed charges for outpatient setting,$10.28 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$8.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$187.18 ,90% of total billed charges for outpatient setting,$10.59 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$197.58 ,95% of total billed charges for outpatient setting,$176.78 ,85% of total billed charges for outpatient setting,$166.38 ,80% of total billed charges for outpatient setting,$10.49 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$176.78 ,85% of total billed charges for outpatient setting,$176.78 ,85% of total billed charges for outpatient setting,$176.78 ,85% of total billed charges for outpatient setting,$193.42 ,93% of total billed charges for outpatient setting,$155.99 ,75% of total billed charges for outpatient setting,$155.99 ,75% of total billed charges for outpatient setting,$155.99 ,75% of total billed charges for outpatient setting,$41.76 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$176.78 ,85% of total billed charges for outpatient setting,$10.49 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.17 ,$197.58 ,$72.79 Outpatient Medical Services,LAB,80156,Carbamazepine Level,300,$62.00 ,$19.23 ,100% Amerigroup fee schedule for outpatient setting,$19.23 ,100% Amerigroup fee schedule for outpatient setting,$31.00 ,75% of total billed charges for outpatient setting,$31.00 ,75% of total billed charges for outpatient setting,$31.00 ,75% of total billed charges for outpatient setting,$14.86 ,102% CMS Medicare OPPS fee schedule,$14.86 ,102% CMS Medicare OPPS fee schedule,$14.86 ,102% CMS Medicare OPPS fee schedule,$14.86 ,102% CMS Medicare OPPS fee schedule,$14.86 ,102% CMS Medicare OPPS fee schedule,$14.86 ,102% CMS Medicare OPPS fee schedule,$49.60 ,80% of total billed charges for outpatient setting,$14.86 ,102% CMS Medicare OPPS fee schedule,$19.23 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$52.70 ,85% of total billed charges for outpatient setting,$14.72 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$49.60 ,80% of total billed charges for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$43.40 ,70% of total billed charges for outpatient setting,$43.40 ,70% of total billed charges for outpatient setting,$47.74 ,77% of total billed charges for outpatient setting,$14.72 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$18.68 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$14.72 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$14.72 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$14.72 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$14.72 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$18.31 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$14.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$55.80 ,90% of total billed charges for outpatient setting,$18.86 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$58.90 ,95% of total billed charges for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$49.60 ,80% of total billed charges for outpatient setting,$18.68 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$52.70 ,85% of total billed charges for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$57.66 ,93% of total billed charges for outpatient setting,$46.50 ,75% of total billed charges for outpatient setting,$46.50 ,75% of total billed charges for outpatient setting,$46.50 ,75% of total billed charges for outpatient setting,$12.45 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$52.70 ,85% of total billed charges for outpatient setting,$18.68 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$12.45 ,$58.90 ,$21.70 Outpatient Medical Services,LAB,80162,Digoxin Lvl,300,$62.00 ,$17.54 ,100% Amerigroup fee schedule for outpatient setting,$17.54 ,100% Amerigroup fee schedule for outpatient setting,$31.00 ,75% of total billed charges for outpatient setting,$31.00 ,75% of total billed charges for outpatient setting,$31.00 ,75% of total billed charges for outpatient setting,$13.55 ,102% CMS Medicare OPPS fee schedule,$13.55 ,102% CMS Medicare OPPS fee schedule,$13.55 ,102% CMS Medicare OPPS fee schedule,$13.55 ,102% CMS Medicare OPPS fee schedule,$13.55 ,102% CMS Medicare OPPS fee schedule,$13.55 ,102% CMS Medicare OPPS fee schedule,$49.60 ,80% of total billed charges for outpatient setting,$13.55 ,102% CMS Medicare OPPS fee schedule,$17.54 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$52.70 ,85% of total billed charges for outpatient setting,$13.41 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$49.60 ,80% of total billed charges for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$43.40 ,70% of total billed charges for outpatient setting,$43.40 ,70% of total billed charges for outpatient setting,$47.74 ,77% of total billed charges for outpatient setting,$13.41 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$17.03 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$13.41 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.41 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.41 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.41 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$16.70 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$13.28 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$55.80 ,90% of total billed charges for outpatient setting,$17.20 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$58.90 ,95% of total billed charges for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$49.60 ,80% of total billed charges for outpatient setting,$17.03 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$52.70 ,85% of total billed charges for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$57.66 ,93% of total billed charges for outpatient setting,$46.50 ,75% of total billed charges for outpatient setting,$46.50 ,75% of total billed charges for outpatient setting,$46.50 ,75% of total billed charges for outpatient setting,$12.45 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$52.70 ,85% of total billed charges for outpatient setting,$17.03 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$12.45 ,$58.90 ,$21.70 Outpatient Medical Services,LAB,80164,Valproic Acid Lvl,300,$44.33 ,$14.98 ,100% Amerigroup fee schedule for outpatient setting,$14.98 ,100% Amerigroup fee schedule for outpatient setting,$22.17 ,75% of total billed charges for outpatient setting,$22.17 ,75% of total billed charges for outpatient setting,$22.17 ,75% of total billed charges for outpatient setting,$13.81 ,102% CMS Medicare OPPS fee schedule,$13.81 ,102% CMS Medicare OPPS fee schedule,$13.81 ,102% CMS Medicare OPPS fee schedule,$13.81 ,102% CMS Medicare OPPS fee schedule,$13.81 ,102% CMS Medicare OPPS fee schedule,$13.81 ,102% CMS Medicare OPPS fee schedule,$35.46 ,80% of total billed charges for outpatient setting,$13.81 ,102% CMS Medicare OPPS fee schedule,$14.98 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$37.68 ,85% of total billed charges for outpatient setting,$13.68 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$35.46 ,80% of total billed charges for outpatient setting,$37.68 ,85% of total billed charges for outpatient setting,$31.03 ,70% of total billed charges for outpatient setting,$31.03 ,70% of total billed charges for outpatient setting,$34.13 ,77% of total billed charges for outpatient setting,$13.68 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$37.68 ,85% of total billed charges for outpatient setting,$37.68 ,85% of total billed charges for outpatient setting,$37.68 ,85% of total billed charges for outpatient setting,$37.68 ,85% of total billed charges for outpatient setting,$37.68 ,85% of total billed charges for outpatient setting,$14.56 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$13.68 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.68 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.68 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.68 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$37.68 ,85% of total billed charges for outpatient setting,$14.27 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$13.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$39.90 ,90% of total billed charges for outpatient setting,$14.70 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$42.11 ,95% of total billed charges for outpatient setting,$37.68 ,85% of total billed charges for outpatient setting,$35.46 ,80% of total billed charges for outpatient setting,$14.56 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$37.68 ,85% of total billed charges for outpatient setting,$37.68 ,85% of total billed charges for outpatient setting,$37.68 ,85% of total billed charges for outpatient setting,$41.23 ,93% of total billed charges for outpatient setting,$33.25 ,75% of total billed charges for outpatient setting,$33.25 ,75% of total billed charges for outpatient setting,$33.25 ,75% of total billed charges for outpatient setting,$8.90 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$37.68 ,85% of total billed charges for outpatient setting,$14.56 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.90 ,$42.11 ,$15.52 Outpatient Medical Services,LAB,80185,Phenytoin Lvl,300,$52.20 ,$17.50 ,100% Amerigroup fee schedule for outpatient setting,$17.50 ,100% Amerigroup fee schedule for outpatient setting,$26.10 ,75% of total billed charges for outpatient setting,$26.10 ,75% of total billed charges for outpatient setting,$26.10 ,75% of total billed charges for outpatient setting,$13.52 ,102% CMS Medicare OPPS fee schedule,$13.52 ,102% CMS Medicare OPPS fee schedule,$13.52 ,102% CMS Medicare OPPS fee schedule,$13.52 ,102% CMS Medicare OPPS fee schedule,$13.52 ,102% CMS Medicare OPPS fee schedule,$13.52 ,102% CMS Medicare OPPS fee schedule,$41.76 ,80% of total billed charges for outpatient setting,$13.52 ,102% CMS Medicare OPPS fee schedule,$17.50 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$44.37 ,85% of total billed charges for outpatient setting,$13.38 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$41.76 ,80% of total billed charges for outpatient setting,$44.37 ,85% of total billed charges for outpatient setting,$36.54 ,70% of total billed charges for outpatient setting,$36.54 ,70% of total billed charges for outpatient setting,$40.19 ,77% of total billed charges for outpatient setting,$13.38 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$44.37 ,85% of total billed charges for outpatient setting,$44.37 ,85% of total billed charges for outpatient setting,$44.37 ,85% of total billed charges for outpatient setting,$44.37 ,85% of total billed charges for outpatient setting,$44.37 ,85% of total billed charges for outpatient setting,$17.00 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$13.38 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.38 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.38 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.38 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$44.37 ,85% of total billed charges for outpatient setting,$16.67 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$13.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$46.98 ,90% of total billed charges for outpatient setting,$17.17 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$49.59 ,95% of total billed charges for outpatient setting,$44.37 ,85% of total billed charges for outpatient setting,$41.76 ,80% of total billed charges for outpatient setting,$17.00 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$44.37 ,85% of total billed charges for outpatient setting,$44.37 ,85% of total billed charges for outpatient setting,$44.37 ,85% of total billed charges for outpatient setting,$48.55 ,93% of total billed charges for outpatient setting,$39.15 ,75% of total billed charges for outpatient setting,$39.15 ,75% of total billed charges for outpatient setting,$39.15 ,75% of total billed charges for outpatient setting,$10.48 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$44.37 ,85% of total billed charges for outpatient setting,$17.00 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$10.48 ,$49.59 ,$18.27 Outpatient Medical Services,LAB,80197,"Tacrolimus (FK506), Blood LC/MS LC",300,$96.00 ,$18.11 ,100% Amerigroup fee schedule for outpatient setting,$18.11 ,100% Amerigroup fee schedule for outpatient setting,$48.00 ,75% of total billed charges for outpatient setting,$48.00 ,75% of total billed charges for outpatient setting,$48.00 ,75% of total billed charges for outpatient setting,$14.00 ,102% CMS Medicare OPPS fee schedule,$14.00 ,102% CMS Medicare OPPS fee schedule,$14.00 ,102% CMS Medicare OPPS fee schedule,$14.00 ,102% CMS Medicare OPPS fee schedule,$14.00 ,102% CMS Medicare OPPS fee schedule,$14.00 ,102% CMS Medicare OPPS fee schedule,$76.80 ,80% of total billed charges for outpatient setting,$14.00 ,102% CMS Medicare OPPS fee schedule,$18.11 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$81.60 ,85% of total billed charges for outpatient setting,$13.87 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$76.80 ,80% of total billed charges for outpatient setting,$81.60 ,85% of total billed charges for outpatient setting,$67.20 ,70% of total billed charges for outpatient setting,$67.20 ,70% of total billed charges for outpatient setting,$73.92 ,77% of total billed charges for outpatient setting,$13.87 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$81.60 ,85% of total billed charges for outpatient setting,$81.60 ,85% of total billed charges for outpatient setting,$81.60 ,85% of total billed charges for outpatient setting,$81.60 ,85% of total billed charges for outpatient setting,$81.60 ,85% of total billed charges for outpatient setting,$17.60 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$13.87 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.87 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.87 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.87 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$81.60 ,85% of total billed charges for outpatient setting,$17.25 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$13.73 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$86.40 ,90% of total billed charges for outpatient setting,$17.77 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$91.20 ,95% of total billed charges for outpatient setting,$81.60 ,85% of total billed charges for outpatient setting,$76.80 ,80% of total billed charges for outpatient setting,$17.60 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$81.60 ,85% of total billed charges for outpatient setting,$81.60 ,85% of total billed charges for outpatient setting,$81.60 ,85% of total billed charges for outpatient setting,$89.28 ,93% of total billed charges for outpatient setting,$72.00 ,75% of total billed charges for outpatient setting,$72.00 ,75% of total billed charges for outpatient setting,$72.00 ,75% of total billed charges for outpatient setting,$19.28 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$81.60 ,85% of total billed charges for outpatient setting,$17.60 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$13.73 ,$91.20 ,$33.60 Outpatient Medical Services,LAB,80202,Vancomycin Lvl,300,$151.01 ,$14.98 ,100% Amerigroup fee schedule for outpatient setting,$14.98 ,100% Amerigroup fee schedule for outpatient setting,$75.51 ,75% of total billed charges for outpatient setting,$75.51 ,75% of total billed charges for outpatient setting,$75.51 ,75% of total billed charges for outpatient setting,$13.81 ,102% CMS Medicare OPPS fee schedule,$13.81 ,102% CMS Medicare OPPS fee schedule,$13.81 ,102% CMS Medicare OPPS fee schedule,$13.81 ,102% CMS Medicare OPPS fee schedule,$13.81 ,102% CMS Medicare OPPS fee schedule,$13.81 ,102% CMS Medicare OPPS fee schedule,$120.81 ,80% of total billed charges for outpatient setting,$13.81 ,102% CMS Medicare OPPS fee schedule,$14.98 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$128.36 ,85% of total billed charges for outpatient setting,$13.68 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$120.81 ,80% of total billed charges for outpatient setting,$128.36 ,85% of total billed charges for outpatient setting,$105.71 ,70% of total billed charges for outpatient setting,$105.71 ,70% of total billed charges for outpatient setting,$116.28 ,77% of total billed charges for outpatient setting,$13.68 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$128.36 ,85% of total billed charges for outpatient setting,$128.36 ,85% of total billed charges for outpatient setting,$128.36 ,85% of total billed charges for outpatient setting,$128.36 ,85% of total billed charges for outpatient setting,$128.36 ,85% of total billed charges for outpatient setting,$14.56 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$13.68 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.68 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.68 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.68 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$128.36 ,85% of total billed charges for outpatient setting,$14.27 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$13.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$135.91 ,90% of total billed charges for outpatient setting,$14.70 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$143.46 ,95% of total billed charges for outpatient setting,$128.36 ,85% of total billed charges for outpatient setting,$120.81 ,80% of total billed charges for outpatient setting,$14.56 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$128.36 ,85% of total billed charges for outpatient setting,$128.36 ,85% of total billed charges for outpatient setting,$128.36 ,85% of total billed charges for outpatient setting,$140.44 ,93% of total billed charges for outpatient setting,$113.26 ,75% of total billed charges for outpatient setting,$113.26 ,75% of total billed charges for outpatient setting,$113.26 ,75% of total billed charges for outpatient setting,$30.32 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$128.36 ,85% of total billed charges for outpatient setting,$14.56 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$13.54 ,$143.46 ,$52.85 Outpatient Medical Services,LAB,80202,Vancomycin Lvl Peak,300,$151.01 ,$14.98 ,100% Amerigroup fee schedule for outpatient setting,$14.98 ,100% Amerigroup fee schedule for outpatient setting,$75.51 ,75% of total billed charges for outpatient setting,$75.51 ,75% of total billed charges for outpatient setting,$75.51 ,75% of total billed charges for outpatient setting,$13.81 ,102% CMS Medicare OPPS fee schedule,$13.81 ,102% CMS Medicare OPPS fee schedule,$13.81 ,102% CMS Medicare OPPS fee schedule,$13.81 ,102% CMS Medicare OPPS fee schedule,$13.81 ,102% CMS Medicare OPPS fee schedule,$13.81 ,102% CMS Medicare OPPS fee schedule,$120.81 ,80% of total billed charges for outpatient setting,$13.81 ,102% CMS Medicare OPPS fee schedule,$14.98 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$128.36 ,85% of total billed charges for outpatient setting,$13.68 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$120.81 ,80% of total billed charges for outpatient setting,$128.36 ,85% of total billed charges for outpatient setting,$105.71 ,70% of total billed charges for outpatient setting,$105.71 ,70% of total billed charges for outpatient setting,$116.28 ,77% of total billed charges for outpatient setting,$13.68 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$128.36 ,85% of total billed charges for outpatient setting,$128.36 ,85% of total billed charges for outpatient setting,$128.36 ,85% of total billed charges for outpatient setting,$128.36 ,85% of total billed charges for outpatient setting,$128.36 ,85% of total billed charges for outpatient setting,$14.56 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$13.68 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.68 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.68 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.68 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$128.36 ,85% of total billed charges for outpatient setting,$14.27 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$13.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$135.91 ,90% of total billed charges for outpatient setting,$14.70 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$143.46 ,95% of total billed charges for outpatient setting,$128.36 ,85% of total billed charges for outpatient setting,$120.81 ,80% of total billed charges for outpatient setting,$14.56 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$128.36 ,85% of total billed charges for outpatient setting,$128.36 ,85% of total billed charges for outpatient setting,$128.36 ,85% of total billed charges for outpatient setting,$140.44 ,93% of total billed charges for outpatient setting,$113.26 ,75% of total billed charges for outpatient setting,$113.26 ,75% of total billed charges for outpatient setting,$113.26 ,75% of total billed charges for outpatient setting,$30.32 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$128.36 ,85% of total billed charges for outpatient setting,$14.56 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$13.54 ,$143.46 ,$52.85 Outpatient Medical Services,LAB,80202,Vancomycin Lvl Trough,300,$151.01 ,$14.98 ,100% Amerigroup fee schedule for outpatient setting,$14.98 ,100% Amerigroup fee schedule for outpatient setting,$75.51 ,75% of total billed charges for outpatient setting,$75.51 ,75% of total billed charges for outpatient setting,$75.51 ,75% of total billed charges for outpatient setting,$13.81 ,102% CMS Medicare OPPS fee schedule,$13.81 ,102% CMS Medicare OPPS fee schedule,$13.81 ,102% CMS Medicare OPPS fee schedule,$13.81 ,102% CMS Medicare OPPS fee schedule,$13.81 ,102% CMS Medicare OPPS fee schedule,$13.81 ,102% CMS Medicare OPPS fee schedule,$120.81 ,80% of total billed charges for outpatient setting,$13.81 ,102% CMS Medicare OPPS fee schedule,$14.98 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$128.36 ,85% of total billed charges for outpatient setting,$13.68 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$120.81 ,80% of total billed charges for outpatient setting,$128.36 ,85% of total billed charges for outpatient setting,$105.71 ,70% of total billed charges for outpatient setting,$105.71 ,70% of total billed charges for outpatient setting,$116.28 ,77% of total billed charges for outpatient setting,$13.68 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$128.36 ,85% of total billed charges for outpatient setting,$128.36 ,85% of total billed charges for outpatient setting,$128.36 ,85% of total billed charges for outpatient setting,$128.36 ,85% of total billed charges for outpatient setting,$128.36 ,85% of total billed charges for outpatient setting,$14.56 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$13.68 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.68 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.68 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.68 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$128.36 ,85% of total billed charges for outpatient setting,$14.27 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$13.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$135.91 ,90% of total billed charges for outpatient setting,$14.70 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$143.46 ,95% of total billed charges for outpatient setting,$128.36 ,85% of total billed charges for outpatient setting,$120.81 ,80% of total billed charges for outpatient setting,$14.56 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$128.36 ,85% of total billed charges for outpatient setting,$128.36 ,85% of total billed charges for outpatient setting,$128.36 ,85% of total billed charges for outpatient setting,$140.44 ,93% of total billed charges for outpatient setting,$113.26 ,75% of total billed charges for outpatient setting,$113.26 ,75% of total billed charges for outpatient setting,$113.26 ,75% of total billed charges for outpatient setting,$30.32 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$128.36 ,85% of total billed charges for outpatient setting,$14.56 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$13.54 ,$143.46 ,$52.85 Outpatient Medical Services,LAB,80307,80307 PANEL DRUG SCREEN,300,$45.00 ,$24.12 ,53.6% of total biled charges for outpatient setting,$24.12 ,53.6% of total biled charges for outpatient setting,$22.50 ,75% of total billed charges for outpatient setting,$22.50 ,75% of total billed charges for outpatient setting,$22.50 ,75% of total billed charges for outpatient setting,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$36.00 ,80% of total billed charges for outpatient setting,$63.38 ,102% CMS Medicare OPPS fee schedule,$64.22 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$38.25 ,85% of total billed charges for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$36.00 ,80% of total billed charges for outpatient setting,$38.25 ,85% of total billed charges for outpatient setting,$31.50 ,70% of total billed charges for outpatient setting,$31.50 ,70% of total billed charges for outpatient setting,$34.65 ,77% of total billed charges for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$38.25 ,85% of total billed charges for outpatient setting,$38.25 ,85% of total billed charges for outpatient setting,$38.25 ,85% of total billed charges for outpatient setting,$38.25 ,85% of total billed charges for outpatient setting,$38.25 ,85% of total billed charges for outpatient setting,$62.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$38.25 ,85% of total billed charges for outpatient setting,$61.16 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$62.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$40.50 ,90% of total billed charges for outpatient setting,$62.99 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$42.75 ,95% of total billed charges for outpatient setting,$38.25 ,85% of total billed charges for outpatient setting,$36.00 ,80% of total billed charges for outpatient setting,$62.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$38.25 ,85% of total billed charges for outpatient setting,$38.25 ,85% of total billed charges for outpatient setting,$38.25 ,85% of total billed charges for outpatient setting,$41.85 ,93% of total billed charges for outpatient setting,$33.75 ,75% of total billed charges for outpatient setting,$33.75 ,75% of total billed charges for outpatient setting,$33.75 ,75% of total billed charges for outpatient setting,$9.04 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$38.25 ,85% of total billed charges for outpatient setting,$62.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$9.04 ,$64.22 ,$45.00 Outpatient Medical Services,LAB,80307,Forensic 7 Drug Screen for City of Hazlehurst,300,$40.00 ,$21.44 ,53.6% of total biled charges for outpatient setting,$21.44 ,53.6% of total biled charges for outpatient setting,$20.00 ,75% of total billed charges for outpatient setting,$20.00 ,75% of total billed charges for outpatient setting,$20.00 ,75% of total billed charges for outpatient setting,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$32.00 ,80% of total billed charges for outpatient setting,$63.38 ,102% CMS Medicare OPPS fee schedule,$64.22 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$34.00 ,85% of total billed charges for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$32.00 ,80% of total billed charges for outpatient setting,$34.00 ,85% of total billed charges for outpatient setting,$28.00 ,70% of total billed charges for outpatient setting,$28.00 ,70% of total billed charges for outpatient setting,$30.80 ,77% of total billed charges for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$34.00 ,85% of total billed charges for outpatient setting,$34.00 ,85% of total billed charges for outpatient setting,$34.00 ,85% of total billed charges for outpatient setting,$34.00 ,85% of total billed charges for outpatient setting,$34.00 ,85% of total billed charges for outpatient setting,$62.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$34.00 ,85% of total billed charges for outpatient setting,$61.16 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$62.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$36.00 ,90% of total billed charges for outpatient setting,$62.99 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$38.00 ,95% of total billed charges for outpatient setting,$34.00 ,85% of total billed charges for outpatient setting,$32.00 ,80% of total billed charges for outpatient setting,$62.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$34.00 ,85% of total billed charges for outpatient setting,$34.00 ,85% of total billed charges for outpatient setting,$34.00 ,85% of total billed charges for outpatient setting,$37.20 ,93% of total billed charges for outpatient setting,$30.00 ,75% of total billed charges for outpatient setting,$30.00 ,75% of total billed charges for outpatient setting,$30.00 ,75% of total billed charges for outpatient setting,$8.03 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$34.00 ,85% of total billed charges for outpatient setting,$62.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.03 ,$64.22 ,$40.00 Outpatient Medical Services,LAB,80307,Forensic 5 Drug Screen,300,$40.00 ,$21.44 ,53.6% of total biled charges for outpatient setting,$21.44 ,53.6% of total biled charges for outpatient setting,$20.00 ,75% of total billed charges for outpatient setting,$20.00 ,75% of total billed charges for outpatient setting,$20.00 ,75% of total billed charges for outpatient setting,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$32.00 ,80% of total billed charges for outpatient setting,$63.38 ,102% CMS Medicare OPPS fee schedule,$64.22 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$34.00 ,85% of total billed charges for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$32.00 ,80% of total billed charges for outpatient setting,$34.00 ,85% of total billed charges for outpatient setting,$28.00 ,70% of total billed charges for outpatient setting,$28.00 ,70% of total billed charges for outpatient setting,$30.80 ,77% of total billed charges for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$34.00 ,85% of total billed charges for outpatient setting,$34.00 ,85% of total billed charges for outpatient setting,$34.00 ,85% of total billed charges for outpatient setting,$34.00 ,85% of total billed charges for outpatient setting,$34.00 ,85% of total billed charges for outpatient setting,$62.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$34.00 ,85% of total billed charges for outpatient setting,$61.16 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$62.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$36.00 ,90% of total billed charges for outpatient setting,$62.99 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$38.00 ,95% of total billed charges for outpatient setting,$34.00 ,85% of total billed charges for outpatient setting,$32.00 ,80% of total billed charges for outpatient setting,$62.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$34.00 ,85% of total billed charges for outpatient setting,$34.00 ,85% of total billed charges for outpatient setting,$34.00 ,85% of total billed charges for outpatient setting,$37.20 ,93% of total billed charges for outpatient setting,$30.00 ,75% of total billed charges for outpatient setting,$30.00 ,75% of total billed charges for outpatient setting,$30.00 ,75% of total billed charges for outpatient setting,$8.03 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$34.00 ,85% of total billed charges for outpatient setting,$62.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.03 ,$64.22 ,$40.00 Outpatient Medical Services,LAB,80307,Forensic 7 Drug Screen,300,$62.14 ,$33.31 ,53.6% of total biled charges for outpatient setting,$33.31 ,53.6% of total biled charges for outpatient setting,$31.07 ,75% of total billed charges for outpatient setting,$31.07 ,75% of total billed charges for outpatient setting,$31.07 ,75% of total billed charges for outpatient setting,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$49.71 ,80% of total billed charges for outpatient setting,$63.38 ,102% CMS Medicare OPPS fee schedule,$64.22 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$52.82 ,85% of total billed charges for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$49.71 ,80% of total billed charges for outpatient setting,$52.82 ,85% of total billed charges for outpatient setting,$43.50 ,70% of total billed charges for outpatient setting,$43.50 ,70% of total billed charges for outpatient setting,$47.85 ,77% of total billed charges for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$52.82 ,85% of total billed charges for outpatient setting,$52.82 ,85% of total billed charges for outpatient setting,$52.82 ,85% of total billed charges for outpatient setting,$52.82 ,85% of total billed charges for outpatient setting,$52.82 ,85% of total billed charges for outpatient setting,$62.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$52.82 ,85% of total billed charges for outpatient setting,$61.16 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$62.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$55.93 ,90% of total billed charges for outpatient setting,$62.99 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$59.03 ,95% of total billed charges for outpatient setting,$52.82 ,85% of total billed charges for outpatient setting,$49.71 ,80% of total billed charges for outpatient setting,$62.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$52.82 ,85% of total billed charges for outpatient setting,$52.82 ,85% of total billed charges for outpatient setting,$52.82 ,85% of total billed charges for outpatient setting,$57.79 ,93% of total billed charges for outpatient setting,$46.61 ,75% of total billed charges for outpatient setting,$46.61 ,75% of total billed charges for outpatient setting,$46.61 ,75% of total billed charges for outpatient setting,$12.48 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$52.82 ,85% of total billed charges for outpatient setting,$62.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$12.48 ,$64.22 ,$62.14 Outpatient Medical Services,LAB,80307,"DRUG SCREEN, SERUM",300,$80.00 ,$42.88 ,53.6% of total biled charges for outpatient setting,$42.88 ,53.6% of total biled charges for outpatient setting,$40.00 ,75% of total billed charges for outpatient setting,$40.00 ,75% of total billed charges for outpatient setting,$40.00 ,75% of total billed charges for outpatient setting,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$64.00 ,80% of total billed charges for outpatient setting,$63.38 ,102% CMS Medicare OPPS fee schedule,$64.22 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$68.00 ,85% of total billed charges for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$64.00 ,80% of total billed charges for outpatient setting,$68.00 ,85% of total billed charges for outpatient setting,$56.00 ,70% of total billed charges for outpatient setting,$56.00 ,70% of total billed charges for outpatient setting,$61.60 ,77% of total billed charges for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$68.00 ,85% of total billed charges for outpatient setting,$68.00 ,85% of total billed charges for outpatient setting,$68.00 ,85% of total billed charges for outpatient setting,$68.00 ,85% of total billed charges for outpatient setting,$68.00 ,85% of total billed charges for outpatient setting,$62.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$68.00 ,85% of total billed charges for outpatient setting,$61.16 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$62.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$72.00 ,90% of total billed charges for outpatient setting,$62.99 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$76.00 ,95% of total billed charges for outpatient setting,$68.00 ,85% of total billed charges for outpatient setting,$64.00 ,80% of total billed charges for outpatient setting,$62.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$68.00 ,85% of total billed charges for outpatient setting,$68.00 ,85% of total billed charges for outpatient setting,$68.00 ,85% of total billed charges for outpatient setting,$74.40 ,93% of total billed charges for outpatient setting,$60.00 ,75% of total billed charges for outpatient setting,$60.00 ,75% of total billed charges for outpatient setting,$60.00 ,75% of total billed charges for outpatient setting,$16.06 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$68.00 ,85% of total billed charges for outpatient setting,$62.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$16.06 ,$76.00 ,$80.00 Outpatient Medical Services,LAB,80307,Forensic 10 Drug Screen Profile Ref Lab,300,$45.00 ,$24.12 ,53.6% of total biled charges for outpatient setting,$24.12 ,53.6% of total biled charges for outpatient setting,$22.50 ,75% of total billed charges for outpatient setting,$22.50 ,75% of total billed charges for outpatient setting,$22.50 ,75% of total billed charges for outpatient setting,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$36.00 ,80% of total billed charges for outpatient setting,$63.38 ,102% CMS Medicare OPPS fee schedule,$64.22 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$38.25 ,85% of total billed charges for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$36.00 ,80% of total billed charges for outpatient setting,$38.25 ,85% of total billed charges for outpatient setting,$31.50 ,70% of total billed charges for outpatient setting,$31.50 ,70% of total billed charges for outpatient setting,$34.65 ,77% of total billed charges for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$38.25 ,85% of total billed charges for outpatient setting,$38.25 ,85% of total billed charges for outpatient setting,$38.25 ,85% of total billed charges for outpatient setting,$38.25 ,85% of total billed charges for outpatient setting,$38.25 ,85% of total billed charges for outpatient setting,$62.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$38.25 ,85% of total billed charges for outpatient setting,$61.16 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$62.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$40.50 ,90% of total billed charges for outpatient setting,$62.99 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$42.75 ,95% of total billed charges for outpatient setting,$38.25 ,85% of total billed charges for outpatient setting,$36.00 ,80% of total billed charges for outpatient setting,$62.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$38.25 ,85% of total billed charges for outpatient setting,$38.25 ,85% of total billed charges for outpatient setting,$38.25 ,85% of total billed charges for outpatient setting,$41.85 ,93% of total billed charges for outpatient setting,$33.75 ,75% of total billed charges for outpatient setting,$33.75 ,75% of total billed charges for outpatient setting,$33.75 ,75% of total billed charges for outpatient setting,$9.04 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$38.25 ,85% of total billed charges for outpatient setting,$62.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$9.04 ,$64.22 ,$45.00 Outpatient Medical Services,LAB,80307,Acetaminophen Level,300,$93.35 ,$50.04 ,53.6% of total biled charges for outpatient setting,$50.04 ,53.6% of total biled charges for outpatient setting,$46.68 ,75% of total billed charges for outpatient setting,$46.68 ,75% of total billed charges for outpatient setting,$46.68 ,75% of total billed charges for outpatient setting,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$74.68 ,80% of total billed charges for outpatient setting,$63.38 ,102% CMS Medicare OPPS fee schedule,$64.22 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$79.35 ,85% of total billed charges for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$74.68 ,80% of total billed charges for outpatient setting,$79.35 ,85% of total billed charges for outpatient setting,$65.35 ,70% of total billed charges for outpatient setting,$65.35 ,70% of total billed charges for outpatient setting,$71.88 ,77% of total billed charges for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$79.35 ,85% of total billed charges for outpatient setting,$79.35 ,85% of total billed charges for outpatient setting,$79.35 ,85% of total billed charges for outpatient setting,$79.35 ,85% of total billed charges for outpatient setting,$79.35 ,85% of total billed charges for outpatient setting,$62.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$79.35 ,85% of total billed charges for outpatient setting,$61.16 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$62.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$84.02 ,90% of total billed charges for outpatient setting,$62.99 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$88.68 ,95% of total billed charges for outpatient setting,$79.35 ,85% of total billed charges for outpatient setting,$74.68 ,80% of total billed charges for outpatient setting,$62.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$79.35 ,85% of total billed charges for outpatient setting,$79.35 ,85% of total billed charges for outpatient setting,$79.35 ,85% of total billed charges for outpatient setting,$86.82 ,93% of total billed charges for outpatient setting,$70.01 ,75% of total billed charges for outpatient setting,$70.01 ,75% of total billed charges for outpatient setting,$70.01 ,75% of total billed charges for outpatient setting,$18.74 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$79.35 ,85% of total billed charges for outpatient setting,$62.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$18.74 ,$88.68 ,$32.67 Outpatient Medical Services,LAB,80307,Salicylate Level,300,$93.35 ,$50.04 ,53.6% of total biled charges for outpatient setting,$50.04 ,53.6% of total biled charges for outpatient setting,$46.68 ,75% of total billed charges for outpatient setting,$46.68 ,75% of total billed charges for outpatient setting,$46.68 ,75% of total billed charges for outpatient setting,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$74.68 ,80% of total billed charges for outpatient setting,$63.38 ,102% CMS Medicare OPPS fee schedule,$64.22 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$79.35 ,85% of total billed charges for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$74.68 ,80% of total billed charges for outpatient setting,$79.35 ,85% of total billed charges for outpatient setting,$65.35 ,70% of total billed charges for outpatient setting,$65.35 ,70% of total billed charges for outpatient setting,$71.88 ,77% of total billed charges for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$79.35 ,85% of total billed charges for outpatient setting,$79.35 ,85% of total billed charges for outpatient setting,$79.35 ,85% of total billed charges for outpatient setting,$79.35 ,85% of total billed charges for outpatient setting,$79.35 ,85% of total billed charges for outpatient setting,$62.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$79.35 ,85% of total billed charges for outpatient setting,$61.16 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$62.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$84.02 ,90% of total billed charges for outpatient setting,$62.99 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$88.68 ,95% of total billed charges for outpatient setting,$79.35 ,85% of total billed charges for outpatient setting,$74.68 ,80% of total billed charges for outpatient setting,$62.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$79.35 ,85% of total billed charges for outpatient setting,$79.35 ,85% of total billed charges for outpatient setting,$79.35 ,85% of total billed charges for outpatient setting,$86.82 ,93% of total billed charges for outpatient setting,$70.01 ,75% of total billed charges for outpatient setting,$70.01 ,75% of total billed charges for outpatient setting,$70.01 ,75% of total billed charges for outpatient setting,$18.74 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$79.35 ,85% of total billed charges for outpatient setting,$62.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$18.74 ,$88.68 ,$32.67 Outpatient Medical Services,LAB,80307,Drug Screen POC,300,$45.00 ,$24.12 ,53.6% of total biled charges for outpatient setting,$24.12 ,53.6% of total biled charges for outpatient setting,$22.50 ,75% of total billed charges for outpatient setting,$22.50 ,75% of total billed charges for outpatient setting,$22.50 ,75% of total billed charges for outpatient setting,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$36.00 ,80% of total billed charges for outpatient setting,$63.38 ,102% CMS Medicare OPPS fee schedule,$64.22 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$38.25 ,85% of total billed charges for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$36.00 ,80% of total billed charges for outpatient setting,$38.25 ,85% of total billed charges for outpatient setting,$31.50 ,70% of total billed charges for outpatient setting,$31.50 ,70% of total billed charges for outpatient setting,$34.65 ,77% of total billed charges for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$38.25 ,85% of total billed charges for outpatient setting,$38.25 ,85% of total billed charges for outpatient setting,$38.25 ,85% of total billed charges for outpatient setting,$38.25 ,85% of total billed charges for outpatient setting,$38.25 ,85% of total billed charges for outpatient setting,$62.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$38.25 ,85% of total billed charges for outpatient setting,$61.16 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$62.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$40.50 ,90% of total billed charges for outpatient setting,$62.99 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$42.75 ,95% of total billed charges for outpatient setting,$38.25 ,85% of total billed charges for outpatient setting,$36.00 ,80% of total billed charges for outpatient setting,$62.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$38.25 ,85% of total billed charges for outpatient setting,$38.25 ,85% of total billed charges for outpatient setting,$38.25 ,85% of total billed charges for outpatient setting,$41.85 ,93% of total billed charges for outpatient setting,$33.75 ,75% of total billed charges for outpatient setting,$33.75 ,75% of total billed charges for outpatient setting,$33.75 ,75% of total billed charges for outpatient setting,$9.04 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$38.25 ,85% of total billed charges for outpatient setting,$62.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$9.04 ,$64.22 ,$45.00 Outpatient Medical Services,LAB,80307,Drug Screening POC,300,N/A,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,N/A,Not seperately reimbursable,$63.38 ,102% CMS Medicare OPPS fee schedule,$64.22 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,N/A,Not seperately reimbursable,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$62.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,N/A,Not seperately reimbursable,$61.16 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$62.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,N/A,Not seperately reimbursable,$62.99 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$62.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,N/A,Not seperately reimbursable,$62.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$61.16 ,$64.22 ,N/A Outpatient Medical Services,LAB,80307,Drug Screen- Collection Only DOT,300,$50.00 ,$26.80 ,53.6% of total biled charges for outpatient setting,$26.80 ,53.6% of total biled charges for outpatient setting,$25.00 ,75% of total billed charges for outpatient setting,$25.00 ,75% of total billed charges for outpatient setting,$25.00 ,75% of total billed charges for outpatient setting,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$40.00 ,80% of total billed charges for outpatient setting,$63.38 ,102% CMS Medicare OPPS fee schedule,$64.22 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$42.50 ,85% of total billed charges for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$40.00 ,80% of total billed charges for outpatient setting,$42.50 ,85% of total billed charges for outpatient setting,$35.00 ,70% of total billed charges for outpatient setting,$35.00 ,70% of total billed charges for outpatient setting,$38.50 ,77% of total billed charges for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$42.50 ,85% of total billed charges for outpatient setting,$42.50 ,85% of total billed charges for outpatient setting,$42.50 ,85% of total billed charges for outpatient setting,$42.50 ,85% of total billed charges for outpatient setting,$42.50 ,85% of total billed charges for outpatient setting,$62.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$42.50 ,85% of total billed charges for outpatient setting,$61.16 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$62.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$45.00 ,90% of total billed charges for outpatient setting,$62.99 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$47.50 ,95% of total billed charges for outpatient setting,$42.50 ,85% of total billed charges for outpatient setting,$40.00 ,80% of total billed charges for outpatient setting,$62.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$42.50 ,85% of total billed charges for outpatient setting,$42.50 ,85% of total billed charges for outpatient setting,$42.50 ,85% of total billed charges for outpatient setting,$46.50 ,93% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$10.04 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$42.50 ,85% of total billed charges for outpatient setting,$62.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$10.04 ,$64.22 ,$50.00 Outpatient Medical Services,LAB,80307,Drug Screen Note: LC,300,$29.00 ,$15.54 ,53.6% of total biled charges for outpatient setting,$15.54 ,53.6% of total biled charges for outpatient setting,$14.50 ,75% of total billed charges for outpatient setting,$14.50 ,75% of total billed charges for outpatient setting,$14.50 ,75% of total billed charges for outpatient setting,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$63.38 ,102% CMS Medicare OPPS fee schedule,$23.20 ,80% of total billed charges for outpatient setting,$63.38 ,102% CMS Medicare OPPS fee schedule,$64.22 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$24.65 ,85% of total billed charges for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$23.20 ,80% of total billed charges for outpatient setting,$24.65 ,85% of total billed charges for outpatient setting,$20.30 ,70% of total billed charges for outpatient setting,$20.30 ,70% of total billed charges for outpatient setting,$22.33 ,77% of total billed charges for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$24.65 ,85% of total billed charges for outpatient setting,$24.65 ,85% of total billed charges for outpatient setting,$24.65 ,85% of total billed charges for outpatient setting,$24.65 ,85% of total billed charges for outpatient setting,$24.65 ,85% of total billed charges for outpatient setting,$62.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.76 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$24.65 ,85% of total billed charges for outpatient setting,$61.16 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$62.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$26.10 ,90% of total billed charges for outpatient setting,$62.99 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$27.55 ,95% of total billed charges for outpatient setting,$24.65 ,85% of total billed charges for outpatient setting,$23.20 ,80% of total billed charges for outpatient setting,$62.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$24.65 ,85% of total billed charges for outpatient setting,$24.65 ,85% of total billed charges for outpatient setting,$24.65 ,85% of total billed charges for outpatient setting,$26.97 ,93% of total billed charges for outpatient setting,$21.75 ,75% of total billed charges for outpatient setting,$21.75 ,75% of total billed charges for outpatient setting,$21.75 ,75% of total billed charges for outpatient setting,$5.82 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$24.65 ,85% of total billed charges for outpatient setting,$62.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.82 ,$64.22 ,$29.00 Outpatient Medical Services,LAB,80320,Alcohol Level,301,$18.05 ,$9.67 ,53.6% of total biled charges for outpatient setting,$9.67 ,53.6% of total biled charges for outpatient setting,$9.03 ,75% of total billed charges for outpatient setting,$9.03 ,75% of total billed charges for outpatient setting,$9.03 ,75% of total billed charges for outpatient setting,$5.71 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$5.71 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$5.71 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$5.71 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$5.71 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$5.71 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$14.44 ,80% of total billed charges for outpatient setting,$5.71 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$14.27 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$15.34 ,85% of total billed charges for outpatient setting,$5.65 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$14.44 ,80% of total billed charges for outpatient setting,$15.34 ,85% of total billed charges for outpatient setting,$12.64 ,70% of total billed charges for outpatient setting,$12.64 ,70% of total billed charges for outpatient setting,$13.90 ,77% of total billed charges for outpatient setting,$5.65 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$15.34 ,85% of total billed charges for outpatient setting,$15.34 ,85% of total billed charges for outpatient setting,$15.34 ,85% of total billed charges for outpatient setting,$15.34 ,85% of total billed charges for outpatient setting,$15.34 ,85% of total billed charges for outpatient setting,$13.86 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.65 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$5.65 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$5.65 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$5.65 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$15.34 ,85% of total billed charges for outpatient setting,$13.59 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$5.60 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$16.25 ,90% of total billed charges for outpatient setting,$14.00 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$17.15 ,95% of total billed charges for outpatient setting,$15.34 ,85% of total billed charges for outpatient setting,$14.44 ,80% of total billed charges for outpatient setting,$13.86 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$15.34 ,85% of total billed charges for outpatient setting,$15.34 ,85% of total billed charges for outpatient setting,$15.34 ,85% of total billed charges for outpatient setting,$16.79 ,93% of total billed charges for outpatient setting,$13.54 ,75% of total billed charges for outpatient setting,$13.54 ,75% of total billed charges for outpatient setting,$13.54 ,75% of total billed charges for outpatient setting,$3.62 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$15.34 ,85% of total billed charges for outpatient setting,$13.86 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.62 ,$17.15 ,$6.32 Outpatient Medical Services,LAB,81000,UA Microscopic Only,300,$23.60 ,$4.19 ,100% Amerigroup fee schedule for outpatient setting,$4.19 ,100% Amerigroup fee schedule for outpatient setting,$11.80 ,75% of total billed charges for outpatient setting,$11.80 ,75% of total billed charges for outpatient setting,$11.80 ,75% of total billed charges for outpatient setting,$4.10 ,102% CMS Medicare OPPS fee schedule,$4.10 ,102% CMS Medicare OPPS fee schedule,$4.10 ,102% CMS Medicare OPPS fee schedule,$4.10 ,102% CMS Medicare OPPS fee schedule,$4.10 ,102% CMS Medicare OPPS fee schedule,$4.10 ,102% CMS Medicare OPPS fee schedule,$18.88 ,80% of total billed charges for outpatient setting,$4.10 ,102% CMS Medicare OPPS fee schedule,$4.19 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$20.06 ,85% of total billed charges for outpatient setting,$4.06 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$18.88 ,80% of total billed charges for outpatient setting,$20.06 ,85% of total billed charges for outpatient setting,$16.52 ,70% of total billed charges for outpatient setting,$16.52 ,70% of total billed charges for outpatient setting,$18.17 ,77% of total billed charges for outpatient setting,$4.06 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$20.06 ,85% of total billed charges for outpatient setting,$20.06 ,85% of total billed charges for outpatient setting,$20.06 ,85% of total billed charges for outpatient setting,$20.06 ,85% of total billed charges for outpatient setting,$20.06 ,85% of total billed charges for outpatient setting,$4.07 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.06 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.06 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.06 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.06 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$20.06 ,85% of total billed charges for outpatient setting,$3.99 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$4.02 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$21.24 ,90% of total billed charges for outpatient setting,$4.11 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$22.42 ,95% of total billed charges for outpatient setting,$20.06 ,85% of total billed charges for outpatient setting,$18.88 ,80% of total billed charges for outpatient setting,$4.07 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$20.06 ,85% of total billed charges for outpatient setting,$20.06 ,85% of total billed charges for outpatient setting,$20.06 ,85% of total billed charges for outpatient setting,$21.95 ,93% of total billed charges for outpatient setting,$17.70 ,75% of total billed charges for outpatient setting,$17.70 ,75% of total billed charges for outpatient setting,$17.70 ,75% of total billed charges for outpatient setting,$4.74 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$20.06 ,85% of total billed charges for outpatient setting,$4.07 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.99 ,$22.42 ,$8.26 Outpatient Medical Services,LAB,81002,U Spec Grav,300,$31.46 ,$3.37 ,100% Amerigroup fee schedule for outpatient setting,$3.37 ,100% Amerigroup fee schedule for outpatient setting,$15.73 ,75% of total billed charges for outpatient setting,$15.73 ,75% of total billed charges for outpatient setting,$15.73 ,75% of total billed charges for outpatient setting,$3.55 ,102% CMS Medicare OPPS fee schedule,$3.55 ,102% CMS Medicare OPPS fee schedule,$3.55 ,102% CMS Medicare OPPS fee schedule,$3.55 ,102% CMS Medicare OPPS fee schedule,$3.55 ,102% CMS Medicare OPPS fee schedule,$3.55 ,102% CMS Medicare OPPS fee schedule,$25.17 ,80% of total billed charges for outpatient setting,$3.55 ,102% CMS Medicare OPPS fee schedule,$3.37 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$26.74 ,85% of total billed charges for outpatient setting,$3.51 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$25.17 ,80% of total billed charges for outpatient setting,$26.74 ,85% of total billed charges for outpatient setting,$22.02 ,70% of total billed charges for outpatient setting,$22.02 ,70% of total billed charges for outpatient setting,$24.22 ,77% of total billed charges for outpatient setting,$3.51 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$26.74 ,85% of total billed charges for outpatient setting,$26.74 ,85% of total billed charges for outpatient setting,$26.74 ,85% of total billed charges for outpatient setting,$26.74 ,85% of total billed charges for outpatient setting,$26.74 ,85% of total billed charges for outpatient setting,$3.27 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.51 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.51 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.51 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.51 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$26.74 ,85% of total billed charges for outpatient setting,$3.21 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$3.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$28.31 ,90% of total billed charges for outpatient setting,$3.31 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$29.89 ,95% of total billed charges for outpatient setting,$26.74 ,85% of total billed charges for outpatient setting,$25.17 ,80% of total billed charges for outpatient setting,$3.27 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$26.74 ,85% of total billed charges for outpatient setting,$26.74 ,85% of total billed charges for outpatient setting,$26.74 ,85% of total billed charges for outpatient setting,$29.26 ,93% of total billed charges for outpatient setting,$23.60 ,75% of total billed charges for outpatient setting,$23.60 ,75% of total billed charges for outpatient setting,$23.60 ,75% of total billed charges for outpatient setting,$6.32 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$26.74 ,85% of total billed charges for outpatient setting,$3.27 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.21 ,$29.89 ,$11.01 Outpatient Medical Services,LAB,81002,UA w Micro if Ind & Cult if Ind,300,$31.46 ,$3.37 ,100% Amerigroup fee schedule for outpatient setting,$3.37 ,100% Amerigroup fee schedule for outpatient setting,$15.73 ,75% of total billed charges for outpatient setting,$15.73 ,75% of total billed charges for outpatient setting,$15.73 ,75% of total billed charges for outpatient setting,$3.55 ,102% CMS Medicare OPPS fee schedule,$3.55 ,102% CMS Medicare OPPS fee schedule,$3.55 ,102% CMS Medicare OPPS fee schedule,$3.55 ,102% CMS Medicare OPPS fee schedule,$3.55 ,102% CMS Medicare OPPS fee schedule,$3.55 ,102% CMS Medicare OPPS fee schedule,$25.17 ,80% of total billed charges for outpatient setting,$3.55 ,102% CMS Medicare OPPS fee schedule,$3.37 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$26.74 ,85% of total billed charges for outpatient setting,$3.51 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$25.17 ,80% of total billed charges for outpatient setting,$26.74 ,85% of total billed charges for outpatient setting,$22.02 ,70% of total billed charges for outpatient setting,$22.02 ,70% of total billed charges for outpatient setting,$24.22 ,77% of total billed charges for outpatient setting,$3.51 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$26.74 ,85% of total billed charges for outpatient setting,$26.74 ,85% of total billed charges for outpatient setting,$26.74 ,85% of total billed charges for outpatient setting,$26.74 ,85% of total billed charges for outpatient setting,$26.74 ,85% of total billed charges for outpatient setting,$3.27 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.51 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.51 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.51 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.51 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$26.74 ,85% of total billed charges for outpatient setting,$3.21 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$3.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$28.31 ,90% of total billed charges for outpatient setting,$3.31 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$29.89 ,95% of total billed charges for outpatient setting,$26.74 ,85% of total billed charges for outpatient setting,$25.17 ,80% of total billed charges for outpatient setting,$3.27 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$26.74 ,85% of total billed charges for outpatient setting,$26.74 ,85% of total billed charges for outpatient setting,$26.74 ,85% of total billed charges for outpatient setting,$29.26 ,93% of total billed charges for outpatient setting,$23.60 ,75% of total billed charges for outpatient setting,$23.60 ,75% of total billed charges for outpatient setting,$23.60 ,75% of total billed charges for outpatient setting,$6.32 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$26.74 ,85% of total billed charges for outpatient setting,$3.27 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.21 ,$29.89 ,$11.01 Outpatient Medical Services,LAB,81002,81002 Urinalysis Dipstick,300,$31.46 ,$3.37 ,100% Amerigroup fee schedule for outpatient setting,$3.37 ,100% Amerigroup fee schedule for outpatient setting,$15.73 ,75% of total billed charges for outpatient setting,$15.73 ,75% of total billed charges for outpatient setting,$15.73 ,75% of total billed charges for outpatient setting,$3.55 ,102% CMS Medicare OPPS fee schedule,$3.55 ,102% CMS Medicare OPPS fee schedule,$3.55 ,102% CMS Medicare OPPS fee schedule,$3.55 ,102% CMS Medicare OPPS fee schedule,$3.55 ,102% CMS Medicare OPPS fee schedule,$3.55 ,102% CMS Medicare OPPS fee schedule,$25.17 ,80% of total billed charges for outpatient setting,$3.55 ,102% CMS Medicare OPPS fee schedule,$3.37 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$26.74 ,85% of total billed charges for outpatient setting,$3.51 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$25.17 ,80% of total billed charges for outpatient setting,$26.74 ,85% of total billed charges for outpatient setting,$22.02 ,70% of total billed charges for outpatient setting,$22.02 ,70% of total billed charges for outpatient setting,$24.22 ,77% of total billed charges for outpatient setting,$3.51 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$26.74 ,85% of total billed charges for outpatient setting,$26.74 ,85% of total billed charges for outpatient setting,$26.74 ,85% of total billed charges for outpatient setting,$26.74 ,85% of total billed charges for outpatient setting,$26.74 ,85% of total billed charges for outpatient setting,$3.27 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.51 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.51 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.51 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.51 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$26.74 ,85% of total billed charges for outpatient setting,$3.21 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$3.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$28.31 ,90% of total billed charges for outpatient setting,$3.31 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$29.89 ,95% of total billed charges for outpatient setting,$26.74 ,85% of total billed charges for outpatient setting,$25.17 ,80% of total billed charges for outpatient setting,$3.27 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$26.74 ,85% of total billed charges for outpatient setting,$26.74 ,85% of total billed charges for outpatient setting,$26.74 ,85% of total billed charges for outpatient setting,$29.26 ,93% of total billed charges for outpatient setting,$23.60 ,75% of total billed charges for outpatient setting,$23.60 ,75% of total billed charges for outpatient setting,$23.60 ,75% of total billed charges for outpatient setting,$6.32 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$26.74 ,85% of total billed charges for outpatient setting,$3.27 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.21 ,$29.89 ,$11.01 Outpatient Medical Services,LAB,81025,Pregnancy Test Urine,300,$144.72 ,$8.36 ,100% Amerigroup fee schedule for outpatient setting,$8.36 ,100% Amerigroup fee schedule for outpatient setting,$72.36 ,75% of total billed charges for outpatient setting,$72.36 ,75% of total billed charges for outpatient setting,$72.36 ,75% of total billed charges for outpatient setting,$8.78 ,102% CMS Medicare OPPS fee schedule,$8.78 ,102% CMS Medicare OPPS fee schedule,$8.78 ,102% CMS Medicare OPPS fee schedule,$8.78 ,102% CMS Medicare OPPS fee schedule,$8.78 ,102% CMS Medicare OPPS fee schedule,$8.78 ,102% CMS Medicare OPPS fee schedule,$115.78 ,80% of total billed charges for outpatient setting,$8.78 ,102% CMS Medicare OPPS fee schedule,$8.36 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$123.01 ,85% of total billed charges for outpatient setting,$8.70 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$115.78 ,80% of total billed charges for outpatient setting,$123.01 ,85% of total billed charges for outpatient setting,$101.30 ,70% of total billed charges for outpatient setting,$101.30 ,70% of total billed charges for outpatient setting,$111.43 ,77% of total billed charges for outpatient setting,$8.70 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$123.01 ,85% of total billed charges for outpatient setting,$123.01 ,85% of total billed charges for outpatient setting,$123.01 ,85% of total billed charges for outpatient setting,$123.01 ,85% of total billed charges for outpatient setting,$123.01 ,85% of total billed charges for outpatient setting,$8.12 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.70 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.70 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.70 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.70 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$123.01 ,85% of total billed charges for outpatient setting,$7.96 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$130.25 ,90% of total billed charges for outpatient setting,$8.20 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$137.48 ,95% of total billed charges for outpatient setting,$123.01 ,85% of total billed charges for outpatient setting,$115.78 ,80% of total billed charges for outpatient setting,$8.12 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$123.01 ,85% of total billed charges for outpatient setting,$123.01 ,85% of total billed charges for outpatient setting,$123.01 ,85% of total billed charges for outpatient setting,$134.59 ,93% of total billed charges for outpatient setting,$108.54 ,75% of total billed charges for outpatient setting,$108.54 ,75% of total billed charges for outpatient setting,$108.54 ,75% of total billed charges for outpatient setting,$29.06 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$123.01 ,85% of total billed charges for outpatient setting,$8.12 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$7.96 ,$137.48 ,$50.65 Outpatient Medical Services,LAB,82009,Ketones Serum,300,$21.45 ,$4.34 ,100% Amerigroup fee schedule for outpatient setting,$4.34 ,100% Amerigroup fee schedule for outpatient setting,$10.73 ,75% of total billed charges for outpatient setting,$10.73 ,75% of total billed charges for outpatient setting,$10.73 ,75% of total billed charges for outpatient setting,$4.61 ,102% CMS Medicare OPPS fee schedule,$4.61 ,102% CMS Medicare OPPS fee schedule,$4.61 ,102% CMS Medicare OPPS fee schedule,$4.61 ,102% CMS Medicare OPPS fee schedule,$4.61 ,102% CMS Medicare OPPS fee schedule,$4.61 ,102% CMS Medicare OPPS fee schedule,$17.16 ,80% of total billed charges for outpatient setting,$4.61 ,102% CMS Medicare OPPS fee schedule,$4.34 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$18.23 ,85% of total billed charges for outpatient setting,$4.57 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$17.16 ,80% of total billed charges for outpatient setting,$18.23 ,85% of total billed charges for outpatient setting,$15.02 ,70% of total billed charges for outpatient setting,$15.02 ,70% of total billed charges for outpatient setting,$16.52 ,77% of total billed charges for outpatient setting,$4.57 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$18.23 ,85% of total billed charges for outpatient setting,$18.23 ,85% of total billed charges for outpatient setting,$18.23 ,85% of total billed charges for outpatient setting,$18.23 ,85% of total billed charges for outpatient setting,$18.23 ,85% of total billed charges for outpatient setting,$4.21 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.57 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.57 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.57 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.57 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$18.23 ,85% of total billed charges for outpatient setting,$4.13 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$4.52 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$19.31 ,90% of total billed charges for outpatient setting,$4.25 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$20.38 ,95% of total billed charges for outpatient setting,$18.23 ,85% of total billed charges for outpatient setting,$17.16 ,80% of total billed charges for outpatient setting,$4.21 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$18.23 ,85% of total billed charges for outpatient setting,$18.23 ,85% of total billed charges for outpatient setting,$18.23 ,85% of total billed charges for outpatient setting,$19.95 ,93% of total billed charges for outpatient setting,$16.09 ,75% of total billed charges for outpatient setting,$16.09 ,75% of total billed charges for outpatient setting,$16.09 ,75% of total billed charges for outpatient setting,$4.31 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$18.23 ,85% of total billed charges for outpatient setting,$4.21 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.13 ,$20.38 ,$7.51 Outpatient Medical Services,LAB,82040,Albumin Level,300,$62.00 ,$3.80 ,100% Amerigroup fee schedule for outpatient setting,$3.80 ,100% Amerigroup fee schedule for outpatient setting,$31.00 ,75% of total billed charges for outpatient setting,$31.00 ,75% of total billed charges for outpatient setting,$31.00 ,75% of total billed charges for outpatient setting,$5.05 ,102% CMS Medicare OPPS fee schedule,$5.05 ,102% CMS Medicare OPPS fee schedule,$5.05 ,102% CMS Medicare OPPS fee schedule,$5.05 ,102% CMS Medicare OPPS fee schedule,$5.05 ,102% CMS Medicare OPPS fee schedule,$5.05 ,102% CMS Medicare OPPS fee schedule,$49.60 ,80% of total billed charges for outpatient setting,$5.05 ,102% CMS Medicare OPPS fee schedule,$3.80 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$52.70 ,85% of total billed charges for outpatient setting,$5.00 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$49.60 ,80% of total billed charges for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$43.40 ,70% of total billed charges for outpatient setting,$43.40 ,70% of total billed charges for outpatient setting,$47.74 ,77% of total billed charges for outpatient setting,$5.00 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$3.69 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.00 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.00 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.00 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.00 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$3.62 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$4.95 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$55.80 ,90% of total billed charges for outpatient setting,$3.73 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$58.90 ,95% of total billed charges for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$49.60 ,80% of total billed charges for outpatient setting,$3.69 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$52.70 ,85% of total billed charges for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$52.70 ,85% of total billed charges for outpatient setting,$57.66 ,93% of total billed charges for outpatient setting,$46.50 ,75% of total billed charges for outpatient setting,$46.50 ,75% of total billed charges for outpatient setting,$46.50 ,75% of total billed charges for outpatient setting,$12.45 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$52.70 ,85% of total billed charges for outpatient setting,$3.69 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.62 ,$58.90 ,$21.70 Outpatient Medical Services,LAB,82043,Microalbumin Level Urine,300,$54.34 ,$7.64 ,100% Amerigroup fee schedule for outpatient setting,$7.64 ,100% Amerigroup fee schedule for outpatient setting,$27.17 ,75% of total billed charges for outpatient setting,$27.17 ,75% of total billed charges for outpatient setting,$27.17 ,75% of total billed charges for outpatient setting,$5.90 ,102% CMS Medicare OPPS fee schedule,$5.90 ,102% CMS Medicare OPPS fee schedule,$5.90 ,102% CMS Medicare OPPS fee schedule,$5.90 ,102% CMS Medicare OPPS fee schedule,$5.90 ,102% CMS Medicare OPPS fee schedule,$5.90 ,102% CMS Medicare OPPS fee schedule,$43.47 ,80% of total billed charges for outpatient setting,$5.90 ,102% CMS Medicare OPPS fee schedule,$7.64 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$46.19 ,85% of total billed charges for outpatient setting,$5.84 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$43.47 ,80% of total billed charges for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$38.04 ,70% of total billed charges for outpatient setting,$38.04 ,70% of total billed charges for outpatient setting,$41.84 ,77% of total billed charges for outpatient setting,$5.84 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$7.43 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.84 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.84 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.84 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.84 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$7.28 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$5.78 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$48.91 ,90% of total billed charges for outpatient setting,$7.50 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$51.62 ,95% of total billed charges for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$43.47 ,80% of total billed charges for outpatient setting,$7.43 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$46.19 ,85% of total billed charges for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$50.54 ,93% of total billed charges for outpatient setting,$40.76 ,75% of total billed charges for outpatient setting,$40.76 ,75% of total billed charges for outpatient setting,$40.76 ,75% of total billed charges for outpatient setting,$10.91 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$46.19 ,85% of total billed charges for outpatient setting,$7.43 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.78 ,$51.62 ,$19.02 Outpatient Medical Services,LAB,82043,Microalbumin/Creatinine Ratio Urine,300,$54.34 ,$7.64 ,100% Amerigroup fee schedule for outpatient setting,$7.64 ,100% Amerigroup fee schedule for outpatient setting,$27.17 ,75% of total billed charges for outpatient setting,$27.17 ,75% of total billed charges for outpatient setting,$27.17 ,75% of total billed charges for outpatient setting,$5.90 ,102% CMS Medicare OPPS fee schedule,$5.90 ,102% CMS Medicare OPPS fee schedule,$5.90 ,102% CMS Medicare OPPS fee schedule,$5.90 ,102% CMS Medicare OPPS fee schedule,$5.90 ,102% CMS Medicare OPPS fee schedule,$5.90 ,102% CMS Medicare OPPS fee schedule,$43.47 ,80% of total billed charges for outpatient setting,$5.90 ,102% CMS Medicare OPPS fee schedule,$7.64 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$46.19 ,85% of total billed charges for outpatient setting,$5.84 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$43.47 ,80% of total billed charges for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$38.04 ,70% of total billed charges for outpatient setting,$38.04 ,70% of total billed charges for outpatient setting,$41.84 ,77% of total billed charges for outpatient setting,$5.84 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$7.43 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.84 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.84 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.84 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.84 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$7.28 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$5.78 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$48.91 ,90% of total billed charges for outpatient setting,$7.50 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$51.62 ,95% of total billed charges for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$43.47 ,80% of total billed charges for outpatient setting,$7.43 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$46.19 ,85% of total billed charges for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$50.54 ,93% of total billed charges for outpatient setting,$40.76 ,75% of total billed charges for outpatient setting,$40.76 ,75% of total billed charges for outpatient setting,$40.76 ,75% of total billed charges for outpatient setting,$10.91 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$46.19 ,85% of total billed charges for outpatient setting,$7.43 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.78 ,$51.62 ,$19.02 Outpatient Medical Services,LAB,82043,BUN and Creatinine,300,$54.34 ,$7.64 ,100% Amerigroup fee schedule for outpatient setting,$7.64 ,100% Amerigroup fee schedule for outpatient setting,$27.17 ,75% of total billed charges for outpatient setting,$27.17 ,75% of total billed charges for outpatient setting,$27.17 ,75% of total billed charges for outpatient setting,$5.90 ,102% CMS Medicare OPPS fee schedule,$5.90 ,102% CMS Medicare OPPS fee schedule,$5.90 ,102% CMS Medicare OPPS fee schedule,$5.90 ,102% CMS Medicare OPPS fee schedule,$5.90 ,102% CMS Medicare OPPS fee schedule,$5.90 ,102% CMS Medicare OPPS fee schedule,$43.47 ,80% of total billed charges for outpatient setting,$5.90 ,102% CMS Medicare OPPS fee schedule,$7.64 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$46.19 ,85% of total billed charges for outpatient setting,$5.84 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$43.47 ,80% of total billed charges for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$38.04 ,70% of total billed charges for outpatient setting,$38.04 ,70% of total billed charges for outpatient setting,$41.84 ,77% of total billed charges for outpatient setting,$5.84 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$7.43 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.84 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.84 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.84 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.84 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$7.28 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$5.78 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$48.91 ,90% of total billed charges for outpatient setting,$7.50 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$51.62 ,95% of total billed charges for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$43.47 ,80% of total billed charges for outpatient setting,$7.43 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$46.19 ,85% of total billed charges for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$50.54 ,93% of total billed charges for outpatient setting,$40.76 ,75% of total billed charges for outpatient setting,$40.76 ,75% of total billed charges for outpatient setting,$40.76 ,75% of total billed charges for outpatient setting,$10.91 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$46.19 ,85% of total billed charges for outpatient setting,$7.43 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.78 ,$51.62 ,$19.02 Outpatient Medical Services,LAB,82043,"Albumin/Creatinine Ratio,Urine LC",300,$54.34 ,$7.64 ,100% Amerigroup fee schedule for outpatient setting,$7.64 ,100% Amerigroup fee schedule for outpatient setting,$27.17 ,75% of total billed charges for outpatient setting,$27.17 ,75% of total billed charges for outpatient setting,$27.17 ,75% of total billed charges for outpatient setting,$5.90 ,102% CMS Medicare OPPS fee schedule,$5.90 ,102% CMS Medicare OPPS fee schedule,$5.90 ,102% CMS Medicare OPPS fee schedule,$5.90 ,102% CMS Medicare OPPS fee schedule,$5.90 ,102% CMS Medicare OPPS fee schedule,$5.90 ,102% CMS Medicare OPPS fee schedule,$43.47 ,80% of total billed charges for outpatient setting,$5.90 ,102% CMS Medicare OPPS fee schedule,$7.64 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$46.19 ,85% of total billed charges for outpatient setting,$5.84 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$43.47 ,80% of total billed charges for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$38.04 ,70% of total billed charges for outpatient setting,$38.04 ,70% of total billed charges for outpatient setting,$41.84 ,77% of total billed charges for outpatient setting,$5.84 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$7.43 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.84 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.84 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.84 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.84 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$7.28 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$5.78 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$48.91 ,90% of total billed charges for outpatient setting,$7.50 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$51.62 ,95% of total billed charges for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$43.47 ,80% of total billed charges for outpatient setting,$7.43 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$46.19 ,85% of total billed charges for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$46.19 ,85% of total billed charges for outpatient setting,$50.54 ,93% of total billed charges for outpatient setting,$40.76 ,75% of total billed charges for outpatient setting,$40.76 ,75% of total billed charges for outpatient setting,$40.76 ,75% of total billed charges for outpatient setting,$10.91 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$46.19 ,85% of total billed charges for outpatient setting,$7.43 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.78 ,$51.62 ,$19.02 Outpatient Medical Services,LAB,82075,Breath Alcohol,300,$29.00 ,$10.61 ,100% Amerigroup fee schedule for outpatient setting,$10.61 ,100% Amerigroup fee schedule for outpatient setting,$14.50 ,75% of total billed charges for outpatient setting,$14.50 ,75% of total billed charges for outpatient setting,$14.50 ,75% of total billed charges for outpatient setting,$30.60 ,102% CMS Medicare OPPS fee schedule,$30.60 ,102% CMS Medicare OPPS fee schedule,$30.60 ,102% CMS Medicare OPPS fee schedule,$30.60 ,102% CMS Medicare OPPS fee schedule,$30.60 ,102% CMS Medicare OPPS fee schedule,$30.60 ,102% CMS Medicare OPPS fee schedule,$23.20 ,80% of total billed charges for outpatient setting,$30.60 ,102% CMS Medicare OPPS fee schedule,$10.15 ,35% of total billed charges for outpatient setting,$24.65 ,85% of total billed charges for outpatient setting,$30.30 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$23.20 ,80% of total billed charges for outpatient setting,$24.65 ,85% of total billed charges for outpatient setting,$20.30 ,70% of total billed charges for outpatient setting,$20.30 ,70% of total billed charges for outpatient setting,$22.33 ,77% of total billed charges for outpatient setting,$30.30 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$24.65 ,85% of total billed charges for outpatient setting,$24.65 ,85% of total billed charges for outpatient setting,$24.65 ,85% of total billed charges for outpatient setting,$24.65 ,85% of total billed charges for outpatient setting,$24.65 ,85% of total billed charges for outpatient setting,$5.77 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$30.30 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$30.30 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$30.30 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$30.30 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$24.65 ,85% of total billed charges for outpatient setting,$5.66 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$30.00 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$26.10 ,90% of total billed charges for outpatient setting,$5.82 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$27.55 ,95% of total billed charges for outpatient setting,$24.65 ,85% of total billed charges for outpatient setting,$23.20 ,80% of total billed charges for outpatient setting,$5.77 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$24.65 ,85% of total billed charges for outpatient setting,$24.65 ,85% of total billed charges for outpatient setting,$24.65 ,85% of total billed charges for outpatient setting,$26.97 ,93% of total billed charges for outpatient setting,$21.75 ,75% of total billed charges for outpatient setting,$21.75 ,75% of total billed charges for outpatient setting,$21.75 ,75% of total billed charges for outpatient setting,$5.82 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$24.65 ,85% of total billed charges for outpatient setting,$5.77 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$5.66 ,$30.60 ,$10.15 Outpatient Medical Services,LAB,82075,Breath Alcohol NIDA,300,$29.00 ,$10.61 ,100% Amerigroup fee schedule for outpatient setting,$10.61 ,100% Amerigroup fee schedule for outpatient setting,$14.50 ,75% of total billed charges for outpatient setting,$14.50 ,75% of total billed charges for outpatient setting,$14.50 ,75% of total billed charges for outpatient setting,$30.60 ,102% CMS Medicare OPPS fee schedule,$30.60 ,102% CMS Medicare OPPS fee schedule,$30.60 ,102% CMS Medicare OPPS fee schedule,$30.60 ,102% CMS Medicare OPPS fee schedule,$30.60 ,102% CMS Medicare OPPS fee schedule,$30.60 ,102% CMS Medicare OPPS fee schedule,$23.20 ,80% of total billed charges for outpatient setting,$30.60 ,102% CMS Medicare OPPS fee schedule,$10.15 ,35% of total billed charges for outpatient setting,$24.65 ,85% of total billed charges for outpatient setting,$30.30 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$23.20 ,80% of total billed charges for outpatient setting,$24.65 ,85% of total billed charges for outpatient setting,$20.30 ,70% of total billed charges for outpatient setting,$20.30 ,70% of total billed charges for outpatient setting,$22.33 ,77% of total billed charges for outpatient setting,$30.30 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$24.65 ,85% of total billed charges for outpatient setting,$24.65 ,85% of total billed charges for outpatient setting,$24.65 ,85% of total billed charges for outpatient setting,$24.65 ,85% of total billed charges for outpatient setting,$24.65 ,85% of total billed charges for outpatient setting,$5.77 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$30.30 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$30.30 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$30.30 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$30.30 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$24.65 ,85% of total billed charges for outpatient setting,$5.66 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$30.00 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$26.10 ,90% of total billed charges for outpatient setting,$5.82 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$27.55 ,95% of total billed charges for outpatient setting,$24.65 ,85% of total billed charges for outpatient setting,$23.20 ,80% of total billed charges for outpatient setting,$5.77 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$24.65 ,85% of total billed charges for outpatient setting,$24.65 ,85% of total billed charges for outpatient setting,$24.65 ,85% of total billed charges for outpatient setting,$26.97 ,93% of total billed charges for outpatient setting,$21.75 ,75% of total billed charges for outpatient setting,$21.75 ,75% of total billed charges for outpatient setting,$21.75 ,75% of total billed charges for outpatient setting,$5.82 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$24.65 ,85% of total billed charges for outpatient setting,$5.77 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$5.66 ,$30.60 ,$10.15 Outpatient Medical Services,LAB,82140,Ammonia Level,301,$65.78 ,$13.06 ,100% Amerigroup fee schedule for outpatient setting,$13.06 ,100% Amerigroup fee schedule for outpatient setting,$32.89 ,75% of total billed charges for outpatient setting,$32.89 ,75% of total billed charges for outpatient setting,$32.89 ,75% of total billed charges for outpatient setting,$14.86 ,102% CMS Medicare OPPS fee schedule,$14.86 ,102% CMS Medicare OPPS fee schedule,$14.86 ,102% CMS Medicare OPPS fee schedule,$14.86 ,102% CMS Medicare OPPS fee schedule,$14.86 ,102% CMS Medicare OPPS fee schedule,$14.86 ,102% CMS Medicare OPPS fee schedule,$52.62 ,80% of total billed charges for outpatient setting,$14.86 ,102% CMS Medicare OPPS fee schedule,$13.06 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$55.91 ,85% of total billed charges for outpatient setting,$14.72 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$52.62 ,80% of total billed charges for outpatient setting,$55.91 ,85% of total billed charges for outpatient setting,$46.05 ,70% of total billed charges for outpatient setting,$46.05 ,70% of total billed charges for outpatient setting,$50.65 ,77% of total billed charges for outpatient setting,$14.72 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$55.91 ,85% of total billed charges for outpatient setting,$55.91 ,85% of total billed charges for outpatient setting,$55.91 ,85% of total billed charges for outpatient setting,$55.91 ,85% of total billed charges for outpatient setting,$55.91 ,85% of total billed charges for outpatient setting,$12.69 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$14.72 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$14.72 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$14.72 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$14.72 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$55.91 ,85% of total billed charges for outpatient setting,$12.44 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$14.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$59.20 ,90% of total billed charges for outpatient setting,$12.81 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$62.49 ,95% of total billed charges for outpatient setting,$55.91 ,85% of total billed charges for outpatient setting,$52.62 ,80% of total billed charges for outpatient setting,$12.69 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$55.91 ,85% of total billed charges for outpatient setting,$55.91 ,85% of total billed charges for outpatient setting,$55.91 ,85% of total billed charges for outpatient setting,$61.18 ,93% of total billed charges for outpatient setting,$49.34 ,75% of total billed charges for outpatient setting,$49.34 ,75% of total billed charges for outpatient setting,$49.34 ,75% of total billed charges for outpatient setting,$13.21 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$55.91 ,85% of total billed charges for outpatient setting,$12.69 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$12.44 ,$62.49 ,$23.02 Outpatient Medical Services,LAB,82150,Amylase Level,301,$192.34 ,$8.56 ,100% Amerigroup fee schedule for outpatient setting,$8.56 ,100% Amerigroup fee schedule for outpatient setting,$96.17 ,75% of total billed charges for outpatient setting,$96.17 ,75% of total billed charges for outpatient setting,$96.17 ,75% of total billed charges for outpatient setting,$6.61 ,102% CMS Medicare OPPS fee schedule,$6.61 ,102% CMS Medicare OPPS fee schedule,$6.61 ,102% CMS Medicare OPPS fee schedule,$6.61 ,102% CMS Medicare OPPS fee schedule,$6.61 ,102% CMS Medicare OPPS fee schedule,$6.61 ,102% CMS Medicare OPPS fee schedule,$153.87 ,80% of total billed charges for outpatient setting,$6.61 ,102% CMS Medicare OPPS fee schedule,$8.56 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$163.49 ,85% of total billed charges for outpatient setting,$6.54 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$153.87 ,80% of total billed charges for outpatient setting,$163.49 ,85% of total billed charges for outpatient setting,$134.64 ,70% of total billed charges for outpatient setting,$134.64 ,70% of total billed charges for outpatient setting,$148.10 ,77% of total billed charges for outpatient setting,$6.54 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$163.49 ,85% of total billed charges for outpatient setting,$163.49 ,85% of total billed charges for outpatient setting,$163.49 ,85% of total billed charges for outpatient setting,$163.49 ,85% of total billed charges for outpatient setting,$163.49 ,85% of total billed charges for outpatient setting,$8.31 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$6.54 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.54 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.54 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.54 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$163.49 ,85% of total billed charges for outpatient setting,$8.15 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$6.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$173.11 ,90% of total billed charges for outpatient setting,$8.39 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$182.72 ,95% of total billed charges for outpatient setting,$163.49 ,85% of total billed charges for outpatient setting,$153.87 ,80% of total billed charges for outpatient setting,$8.31 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$163.49 ,85% of total billed charges for outpatient setting,$163.49 ,85% of total billed charges for outpatient setting,$163.49 ,85% of total billed charges for outpatient setting,$178.88 ,93% of total billed charges for outpatient setting,$144.26 ,75% of total billed charges for outpatient setting,$144.26 ,75% of total billed charges for outpatient setting,$144.26 ,75% of total billed charges for outpatient setting,$38.62 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$163.49 ,85% of total billed charges for outpatient setting,$8.31 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$6.48 ,$182.72 ,$67.32 Outpatient Medical Services,LAB,82247,Bili Ind,301,$37.00 ,$6.64 ,100% Amerigroup fee schedule for outpatient setting,$6.64 ,100% Amerigroup fee schedule for outpatient setting,$18.50 ,75% of total billed charges for outpatient setting,$18.50 ,75% of total billed charges for outpatient setting,$18.50 ,75% of total billed charges for outpatient setting,$5.12 ,102% CMS Medicare OPPS fee schedule,$5.12 ,102% CMS Medicare OPPS fee schedule,$5.12 ,102% CMS Medicare OPPS fee schedule,$5.12 ,102% CMS Medicare OPPS fee schedule,$5.12 ,102% CMS Medicare OPPS fee schedule,$5.12 ,102% CMS Medicare OPPS fee schedule,$29.60 ,80% of total billed charges for outpatient setting,$5.12 ,102% CMS Medicare OPPS fee schedule,$6.64 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$31.45 ,85% of total billed charges for outpatient setting,$5.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$29.60 ,80% of total billed charges for outpatient setting,$31.45 ,85% of total billed charges for outpatient setting,$25.90 ,70% of total billed charges for outpatient setting,$25.90 ,70% of total billed charges for outpatient setting,$28.49 ,77% of total billed charges for outpatient setting,$5.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$31.45 ,85% of total billed charges for outpatient setting,$31.45 ,85% of total billed charges for outpatient setting,$31.45 ,85% of total billed charges for outpatient setting,$31.45 ,85% of total billed charges for outpatient setting,$31.45 ,85% of total billed charges for outpatient setting,$6.45 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$31.45 ,85% of total billed charges for outpatient setting,$6.32 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$5.02 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$33.30 ,90% of total billed charges for outpatient setting,$6.51 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$35.15 ,95% of total billed charges for outpatient setting,$31.45 ,85% of total billed charges for outpatient setting,$29.60 ,80% of total billed charges for outpatient setting,$6.45 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$31.45 ,85% of total billed charges for outpatient setting,$31.45 ,85% of total billed charges for outpatient setting,$31.45 ,85% of total billed charges for outpatient setting,$34.41 ,93% of total billed charges for outpatient setting,$27.75 ,75% of total billed charges for outpatient setting,$27.75 ,75% of total billed charges for outpatient setting,$27.75 ,75% of total billed charges for outpatient setting,$7.43 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$31.45 ,85% of total billed charges for outpatient setting,$6.45 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.02 ,$35.15 ,$12.95 Outpatient Medical Services,LAB,82247,Bili Total,300,$7.00 ,$6.64 ,100% Amerigroup fee schedule for outpatient setting,$6.64 ,100% Amerigroup fee schedule for outpatient setting,$3.50 ,75% of total billed charges for outpatient setting,$3.50 ,75% of total billed charges for outpatient setting,$3.50 ,75% of total billed charges for outpatient setting,$5.12 ,102% CMS Medicare OPPS fee schedule,$5.12 ,102% CMS Medicare OPPS fee schedule,$5.12 ,102% CMS Medicare OPPS fee schedule,$5.12 ,102% CMS Medicare OPPS fee schedule,$5.12 ,102% CMS Medicare OPPS fee schedule,$5.12 ,102% CMS Medicare OPPS fee schedule,$5.60 ,80% of total billed charges for outpatient setting,$5.12 ,102% CMS Medicare OPPS fee schedule,$6.64 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$5.95 ,85% of total billed charges for outpatient setting,$5.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.60 ,80% of total billed charges for outpatient setting,$5.95 ,85% of total billed charges for outpatient setting,$4.90 ,70% of total billed charges for outpatient setting,$4.90 ,70% of total billed charges for outpatient setting,$5.39 ,77% of total billed charges for outpatient setting,$5.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.95 ,85% of total billed charges for outpatient setting,$5.95 ,85% of total billed charges for outpatient setting,$5.95 ,85% of total billed charges for outpatient setting,$5.95 ,85% of total billed charges for outpatient setting,$5.95 ,85% of total billed charges for outpatient setting,$6.45 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.95 ,85% of total billed charges for outpatient setting,$6.32 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$5.02 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.30 ,90% of total billed charges for outpatient setting,$6.51 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$6.65 ,95% of total billed charges for outpatient setting,$5.95 ,85% of total billed charges for outpatient setting,$5.60 ,80% of total billed charges for outpatient setting,$6.45 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.95 ,85% of total billed charges for outpatient setting,$5.95 ,85% of total billed charges for outpatient setting,$5.95 ,85% of total billed charges for outpatient setting,$6.51 ,93% of total billed charges for outpatient setting,$5.25 ,75% of total billed charges for outpatient setting,$5.25 ,75% of total billed charges for outpatient setting,$5.25 ,75% of total billed charges for outpatient setting,$1.41 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$5.95 ,85% of total billed charges for outpatient setting,$6.45 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$1.41 ,$6.65 ,$2.45 Outpatient Medical Services,LAB,82247,Bilirubin Total and Direct,301,$37.00 ,$6.64 ,100% Amerigroup fee schedule for outpatient setting,$6.64 ,100% Amerigroup fee schedule for outpatient setting,$18.50 ,75% of total billed charges for outpatient setting,$18.50 ,75% of total billed charges for outpatient setting,$18.50 ,75% of total billed charges for outpatient setting,$5.12 ,102% CMS Medicare OPPS fee schedule,$5.12 ,102% CMS Medicare OPPS fee schedule,$5.12 ,102% CMS Medicare OPPS fee schedule,$5.12 ,102% CMS Medicare OPPS fee schedule,$5.12 ,102% CMS Medicare OPPS fee schedule,$5.12 ,102% CMS Medicare OPPS fee schedule,$29.60 ,80% of total billed charges for outpatient setting,$5.12 ,102% CMS Medicare OPPS fee schedule,$6.64 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$31.45 ,85% of total billed charges for outpatient setting,$5.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$29.60 ,80% of total billed charges for outpatient setting,$31.45 ,85% of total billed charges for outpatient setting,$25.90 ,70% of total billed charges for outpatient setting,$25.90 ,70% of total billed charges for outpatient setting,$28.49 ,77% of total billed charges for outpatient setting,$5.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$31.45 ,85% of total billed charges for outpatient setting,$31.45 ,85% of total billed charges for outpatient setting,$31.45 ,85% of total billed charges for outpatient setting,$31.45 ,85% of total billed charges for outpatient setting,$31.45 ,85% of total billed charges for outpatient setting,$6.45 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$31.45 ,85% of total billed charges for outpatient setting,$6.32 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$5.02 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$33.30 ,90% of total billed charges for outpatient setting,$6.51 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$35.15 ,95% of total billed charges for outpatient setting,$31.45 ,85% of total billed charges for outpatient setting,$29.60 ,80% of total billed charges for outpatient setting,$6.45 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$31.45 ,85% of total billed charges for outpatient setting,$31.45 ,85% of total billed charges for outpatient setting,$31.45 ,85% of total billed charges for outpatient setting,$34.41 ,93% of total billed charges for outpatient setting,$27.75 ,75% of total billed charges for outpatient setting,$27.75 ,75% of total billed charges for outpatient setting,$27.75 ,75% of total billed charges for outpatient setting,$7.43 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$31.45 ,85% of total billed charges for outpatient setting,$6.45 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.02 ,$35.15 ,$12.95 Outpatient Medical Services,LAB,82247,Bilirubin Neonatal,301,$37.00 ,$6.64 ,100% Amerigroup fee schedule for outpatient setting,$6.64 ,100% Amerigroup fee schedule for outpatient setting,$18.50 ,75% of total billed charges for outpatient setting,$18.50 ,75% of total billed charges for outpatient setting,$18.50 ,75% of total billed charges for outpatient setting,$5.12 ,102% CMS Medicare OPPS fee schedule,$5.12 ,102% CMS Medicare OPPS fee schedule,$5.12 ,102% CMS Medicare OPPS fee schedule,$5.12 ,102% CMS Medicare OPPS fee schedule,$5.12 ,102% CMS Medicare OPPS fee schedule,$5.12 ,102% CMS Medicare OPPS fee schedule,$29.60 ,80% of total billed charges for outpatient setting,$5.12 ,102% CMS Medicare OPPS fee schedule,$6.64 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$31.45 ,85% of total billed charges for outpatient setting,$5.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$29.60 ,80% of total billed charges for outpatient setting,$31.45 ,85% of total billed charges for outpatient setting,$25.90 ,70% of total billed charges for outpatient setting,$25.90 ,70% of total billed charges for outpatient setting,$28.49 ,77% of total billed charges for outpatient setting,$5.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$31.45 ,85% of total billed charges for outpatient setting,$31.45 ,85% of total billed charges for outpatient setting,$31.45 ,85% of total billed charges for outpatient setting,$31.45 ,85% of total billed charges for outpatient setting,$31.45 ,85% of total billed charges for outpatient setting,$6.45 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$31.45 ,85% of total billed charges for outpatient setting,$6.32 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$5.02 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$33.30 ,90% of total billed charges for outpatient setting,$6.51 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$35.15 ,95% of total billed charges for outpatient setting,$31.45 ,85% of total billed charges for outpatient setting,$29.60 ,80% of total billed charges for outpatient setting,$6.45 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$31.45 ,85% of total billed charges for outpatient setting,$31.45 ,85% of total billed charges for outpatient setting,$31.45 ,85% of total billed charges for outpatient setting,$34.41 ,93% of total billed charges for outpatient setting,$27.75 ,75% of total billed charges for outpatient setting,$27.75 ,75% of total billed charges for outpatient setting,$27.75 ,75% of total billed charges for outpatient setting,$7.43 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$31.45 ,85% of total billed charges for outpatient setting,$6.45 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.02 ,$35.15 ,$12.95 Outpatient Medical Services,LAB,82248,Bilirubin Direct,300,$7.00 ,$6.64 ,100% Amerigroup fee schedule for outpatient setting,$6.64 ,100% Amerigroup fee schedule for outpatient setting,$3.50 ,75% of total billed charges for outpatient setting,$3.50 ,75% of total billed charges for outpatient setting,$3.50 ,75% of total billed charges for outpatient setting,$5.12 ,102% CMS Medicare OPPS fee schedule,$5.12 ,102% CMS Medicare OPPS fee schedule,$5.12 ,102% CMS Medicare OPPS fee schedule,$5.12 ,102% CMS Medicare OPPS fee schedule,$5.12 ,102% CMS Medicare OPPS fee schedule,$5.12 ,102% CMS Medicare OPPS fee schedule,$5.60 ,80% of total billed charges for outpatient setting,$5.12 ,102% CMS Medicare OPPS fee schedule,$6.64 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$5.95 ,85% of total billed charges for outpatient setting,$5.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.60 ,80% of total billed charges for outpatient setting,$5.95 ,85% of total billed charges for outpatient setting,$4.90 ,70% of total billed charges for outpatient setting,$4.90 ,70% of total billed charges for outpatient setting,$5.39 ,77% of total billed charges for outpatient setting,$5.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.95 ,85% of total billed charges for outpatient setting,$5.95 ,85% of total billed charges for outpatient setting,$5.95 ,85% of total billed charges for outpatient setting,$5.95 ,85% of total billed charges for outpatient setting,$5.95 ,85% of total billed charges for outpatient setting,$6.45 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.95 ,85% of total billed charges for outpatient setting,$6.32 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$5.02 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.30 ,90% of total billed charges for outpatient setting,$6.51 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$6.65 ,95% of total billed charges for outpatient setting,$5.95 ,85% of total billed charges for outpatient setting,$5.60 ,80% of total billed charges for outpatient setting,$6.45 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.95 ,85% of total billed charges for outpatient setting,$5.95 ,85% of total billed charges for outpatient setting,$5.95 ,85% of total billed charges for outpatient setting,$6.51 ,93% of total billed charges for outpatient setting,$5.25 ,75% of total billed charges for outpatient setting,$5.25 ,75% of total billed charges for outpatient setting,$5.25 ,75% of total billed charges for outpatient setting,$1.41 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$5.95 ,85% of total billed charges for outpatient setting,$6.45 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$1.41 ,$6.65 ,$2.45 Outpatient Medical Services,LAB,82270,Fecal Occult Blood (Guaiac FOB),300,$40.00 ,$4.24 ,100% Amerigroup fee schedule for outpatient setting,$4.24 ,100% Amerigroup fee schedule for outpatient setting,$20.00 ,75% of total billed charges for outpatient setting,$20.00 ,75% of total billed charges for outpatient setting,$20.00 ,75% of total billed charges for outpatient setting,$4.47 ,102% CMS Medicare OPPS fee schedule,$4.47 ,102% CMS Medicare OPPS fee schedule,$4.47 ,102% CMS Medicare OPPS fee schedule,$4.47 ,102% CMS Medicare OPPS fee schedule,$4.47 ,102% CMS Medicare OPPS fee schedule,$4.47 ,102% CMS Medicare OPPS fee schedule,$32.00 ,80% of total billed charges for outpatient setting,$4.47 ,102% CMS Medicare OPPS fee schedule,$4.24 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$34.00 ,85% of total billed charges for outpatient setting,$4.42 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$32.00 ,80% of total billed charges for outpatient setting,$34.00 ,85% of total billed charges for outpatient setting,$28.00 ,70% of total billed charges for outpatient setting,$28.00 ,70% of total billed charges for outpatient setting,$30.80 ,77% of total billed charges for outpatient setting,$4.42 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$34.00 ,85% of total billed charges for outpatient setting,$34.00 ,85% of total billed charges for outpatient setting,$34.00 ,85% of total billed charges for outpatient setting,$34.00 ,85% of total billed charges for outpatient setting,$34.00 ,85% of total billed charges for outpatient setting,$4.12 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.42 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.42 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.42 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.42 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$34.00 ,85% of total billed charges for outpatient setting,$4.04 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$4.38 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$36.00 ,90% of total billed charges for outpatient setting,$4.16 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$38.00 ,95% of total billed charges for outpatient setting,$34.00 ,85% of total billed charges for outpatient setting,$32.00 ,80% of total billed charges for outpatient setting,$4.12 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$34.00 ,85% of total billed charges for outpatient setting,$34.00 ,85% of total billed charges for outpatient setting,$34.00 ,85% of total billed charges for outpatient setting,$37.20 ,93% of total billed charges for outpatient setting,$30.00 ,75% of total billed charges for outpatient setting,$30.00 ,75% of total billed charges for outpatient setting,$30.00 ,75% of total billed charges for outpatient setting,$8.03 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$34.00 ,85% of total billed charges for outpatient setting,$4.12 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.04 ,$38.00 ,$14.00 Outpatient Medical Services,LAB,82271,Guaiac Gast,300,$49.00 ,$4.24 ,100% Amerigroup fee schedule for outpatient setting,$4.24 ,100% Amerigroup fee schedule for outpatient setting,$24.50 ,75% of total billed charges for outpatient setting,$24.50 ,75% of total billed charges for outpatient setting,$24.50 ,75% of total billed charges for outpatient setting,$5.43 ,102% CMS Medicare OPPS fee schedule,$5.43 ,102% CMS Medicare OPPS fee schedule,$5.43 ,102% CMS Medicare OPPS fee schedule,$5.43 ,102% CMS Medicare OPPS fee schedule,$5.43 ,102% CMS Medicare OPPS fee schedule,$5.43 ,102% CMS Medicare OPPS fee schedule,$39.20 ,80% of total billed charges for outpatient setting,$5.43 ,102% CMS Medicare OPPS fee schedule,$4.24 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$41.65 ,85% of total billed charges for outpatient setting,$5.37 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$41.65 ,85% of total billed charges for outpatient setting,$34.30 ,70% of total billed charges for outpatient setting,$34.30 ,70% of total billed charges for outpatient setting,$37.73 ,77% of total billed charges for outpatient setting,$5.37 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$41.65 ,85% of total billed charges for outpatient setting,$41.65 ,85% of total billed charges for outpatient setting,$41.65 ,85% of total billed charges for outpatient setting,$41.65 ,85% of total billed charges for outpatient setting,$41.65 ,85% of total billed charges for outpatient setting,$4.12 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.37 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.37 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.37 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.37 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$41.65 ,85% of total billed charges for outpatient setting,$4.04 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$5.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$44.10 ,90% of total billed charges for outpatient setting,$4.16 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$46.55 ,95% of total billed charges for outpatient setting,$41.65 ,85% of total billed charges for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$4.12 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$41.65 ,85% of total billed charges for outpatient setting,$41.65 ,85% of total billed charges for outpatient setting,$41.65 ,85% of total billed charges for outpatient setting,$45.57 ,93% of total billed charges for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$9.84 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$41.65 ,85% of total billed charges for outpatient setting,$4.12 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.04 ,$46.55 ,$17.15 Outpatient Medical Services,LAB,82272,Occult Blood Digital Rectal,300,$28.60 ,$4.24 ,100% Amerigroup fee schedule for outpatient setting,$4.24 ,100% Amerigroup fee schedule for outpatient setting,$14.30 ,75% of total billed charges for outpatient setting,$14.30 ,75% of total billed charges for outpatient setting,$14.30 ,75% of total billed charges for outpatient setting,$4.31 ,102% CMS Medicare OPPS fee schedule,$4.31 ,102% CMS Medicare OPPS fee schedule,$4.31 ,102% CMS Medicare OPPS fee schedule,$4.31 ,102% CMS Medicare OPPS fee schedule,$4.31 ,102% CMS Medicare OPPS fee schedule,$4.31 ,102% CMS Medicare OPPS fee schedule,$22.88 ,80% of total billed charges for outpatient setting,$4.31 ,102% CMS Medicare OPPS fee schedule,$4.24 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$24.31 ,85% of total billed charges for outpatient setting,$4.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$22.88 ,80% of total billed charges for outpatient setting,$24.31 ,85% of total billed charges for outpatient setting,$20.02 ,70% of total billed charges for outpatient setting,$20.02 ,70% of total billed charges for outpatient setting,$22.02 ,77% of total billed charges for outpatient setting,$4.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$24.31 ,85% of total billed charges for outpatient setting,$24.31 ,85% of total billed charges for outpatient setting,$24.31 ,85% of total billed charges for outpatient setting,$24.31 ,85% of total billed charges for outpatient setting,$24.31 ,85% of total billed charges for outpatient setting,$4.12 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$24.31 ,85% of total billed charges for outpatient setting,$4.04 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$4.23 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$25.74 ,90% of total billed charges for outpatient setting,$4.16 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$27.17 ,95% of total billed charges for outpatient setting,$24.31 ,85% of total billed charges for outpatient setting,$22.88 ,80% of total billed charges for outpatient setting,$4.12 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$24.31 ,85% of total billed charges for outpatient setting,$24.31 ,85% of total billed charges for outpatient setting,$24.31 ,85% of total billed charges for outpatient setting,$26.60 ,93% of total billed charges for outpatient setting,$21.45 ,75% of total billed charges for outpatient setting,$21.45 ,75% of total billed charges for outpatient setting,$21.45 ,75% of total billed charges for outpatient setting,$5.74 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$24.31 ,85% of total billed charges for outpatient setting,$4.12 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.04 ,$27.17 ,$10.01 Outpatient Medical Services,LAB,82272,Occult Blood Screen,300,$28.60 ,$4.24 ,100% Amerigroup fee schedule for outpatient setting,$4.24 ,100% Amerigroup fee schedule for outpatient setting,$14.30 ,75% of total billed charges for outpatient setting,$14.30 ,75% of total billed charges for outpatient setting,$14.30 ,75% of total billed charges for outpatient setting,$4.31 ,102% CMS Medicare OPPS fee schedule,$4.31 ,102% CMS Medicare OPPS fee schedule,$4.31 ,102% CMS Medicare OPPS fee schedule,$4.31 ,102% CMS Medicare OPPS fee schedule,$4.31 ,102% CMS Medicare OPPS fee schedule,$4.31 ,102% CMS Medicare OPPS fee schedule,$22.88 ,80% of total billed charges for outpatient setting,$4.31 ,102% CMS Medicare OPPS fee schedule,$4.24 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$24.31 ,85% of total billed charges for outpatient setting,$4.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$22.88 ,80% of total billed charges for outpatient setting,$24.31 ,85% of total billed charges for outpatient setting,$20.02 ,70% of total billed charges for outpatient setting,$20.02 ,70% of total billed charges for outpatient setting,$22.02 ,77% of total billed charges for outpatient setting,$4.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$24.31 ,85% of total billed charges for outpatient setting,$24.31 ,85% of total billed charges for outpatient setting,$24.31 ,85% of total billed charges for outpatient setting,$24.31 ,85% of total billed charges for outpatient setting,$24.31 ,85% of total billed charges for outpatient setting,$4.12 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$24.31 ,85% of total billed charges for outpatient setting,$4.04 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$4.23 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$25.74 ,90% of total billed charges for outpatient setting,$4.16 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$27.17 ,95% of total billed charges for outpatient setting,$24.31 ,85% of total billed charges for outpatient setting,$22.88 ,80% of total billed charges for outpatient setting,$4.12 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$24.31 ,85% of total billed charges for outpatient setting,$24.31 ,85% of total billed charges for outpatient setting,$24.31 ,85% of total billed charges for outpatient setting,$26.60 ,93% of total billed charges for outpatient setting,$21.45 ,75% of total billed charges for outpatient setting,$21.45 ,75% of total billed charges for outpatient setting,$21.45 ,75% of total billed charges for outpatient setting,$5.74 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$24.31 ,85% of total billed charges for outpatient setting,$4.12 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.04 ,$27.17 ,$10.01 Outpatient Medical Services,LAB,82272,Occult Bld Diag,306,$16.00 ,$4.24 ,100% Amerigroup fee schedule for outpatient setting,$4.24 ,100% Amerigroup fee schedule for outpatient setting,$8.00 ,75% of total billed charges for outpatient setting,$8.00 ,75% of total billed charges for outpatient setting,$8.00 ,75% of total billed charges for outpatient setting,$4.31 ,102% CMS Medicare OPPS fee schedule,$4.31 ,102% CMS Medicare OPPS fee schedule,$4.31 ,102% CMS Medicare OPPS fee schedule,$4.31 ,102% CMS Medicare OPPS fee schedule,$4.31 ,102% CMS Medicare OPPS fee schedule,$4.31 ,102% CMS Medicare OPPS fee schedule,$12.80 ,80% of total billed charges for outpatient setting,$4.31 ,102% CMS Medicare OPPS fee schedule,$4.24 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$13.60 ,85% of total billed charges for outpatient setting,$4.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.80 ,80% of total billed charges for outpatient setting,$13.60 ,85% of total billed charges for outpatient setting,$11.20 ,70% of total billed charges for outpatient setting,$11.20 ,70% of total billed charges for outpatient setting,$12.32 ,77% of total billed charges for outpatient setting,$4.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.60 ,85% of total billed charges for outpatient setting,$13.60 ,85% of total billed charges for outpatient setting,$13.60 ,85% of total billed charges for outpatient setting,$13.60 ,85% of total billed charges for outpatient setting,$13.60 ,85% of total billed charges for outpatient setting,$4.12 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.60 ,85% of total billed charges for outpatient setting,$4.04 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$4.23 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$14.40 ,90% of total billed charges for outpatient setting,$4.16 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$15.20 ,95% of total billed charges for outpatient setting,$13.60 ,85% of total billed charges for outpatient setting,$12.80 ,80% of total billed charges for outpatient setting,$4.12 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$13.60 ,85% of total billed charges for outpatient setting,$13.60 ,85% of total billed charges for outpatient setting,$13.60 ,85% of total billed charges for outpatient setting,$14.88 ,93% of total billed charges for outpatient setting,$12.00 ,75% of total billed charges for outpatient setting,$12.00 ,75% of total billed charges for outpatient setting,$12.00 ,75% of total billed charges for outpatient setting,$3.21 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$13.60 ,85% of total billed charges for outpatient setting,$4.12 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.21 ,$15.20 ,$5.60 Outpatient Medical Services,LAB,82272,Occult Bld Diag II,306,$16.00 ,$4.24 ,100% Amerigroup fee schedule for outpatient setting,$4.24 ,100% Amerigroup fee schedule for outpatient setting,$8.00 ,75% of total billed charges for outpatient setting,$8.00 ,75% of total billed charges for outpatient setting,$8.00 ,75% of total billed charges for outpatient setting,$4.31 ,102% CMS Medicare OPPS fee schedule,$4.31 ,102% CMS Medicare OPPS fee schedule,$4.31 ,102% CMS Medicare OPPS fee schedule,$4.31 ,102% CMS Medicare OPPS fee schedule,$4.31 ,102% CMS Medicare OPPS fee schedule,$4.31 ,102% CMS Medicare OPPS fee schedule,$12.80 ,80% of total billed charges for outpatient setting,$4.31 ,102% CMS Medicare OPPS fee schedule,$4.24 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$13.60 ,85% of total billed charges for outpatient setting,$4.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.80 ,80% of total billed charges for outpatient setting,$13.60 ,85% of total billed charges for outpatient setting,$11.20 ,70% of total billed charges for outpatient setting,$11.20 ,70% of total billed charges for outpatient setting,$12.32 ,77% of total billed charges for outpatient setting,$4.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.60 ,85% of total billed charges for outpatient setting,$13.60 ,85% of total billed charges for outpatient setting,$13.60 ,85% of total billed charges for outpatient setting,$13.60 ,85% of total billed charges for outpatient setting,$13.60 ,85% of total billed charges for outpatient setting,$4.12 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.60 ,85% of total billed charges for outpatient setting,$4.04 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$4.23 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$14.40 ,90% of total billed charges for outpatient setting,$4.16 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$15.20 ,95% of total billed charges for outpatient setting,$13.60 ,85% of total billed charges for outpatient setting,$12.80 ,80% of total billed charges for outpatient setting,$4.12 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$13.60 ,85% of total billed charges for outpatient setting,$13.60 ,85% of total billed charges for outpatient setting,$13.60 ,85% of total billed charges for outpatient setting,$14.88 ,93% of total billed charges for outpatient setting,$12.00 ,75% of total billed charges for outpatient setting,$12.00 ,75% of total billed charges for outpatient setting,$12.00 ,75% of total billed charges for outpatient setting,$3.21 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$13.60 ,85% of total billed charges for outpatient setting,$4.12 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.21 ,$15.20 ,$5.60 Outpatient Medical Services,LAB,82272,Occult Bld Diag III,306,$16.00 ,$4.24 ,100% Amerigroup fee schedule for outpatient setting,$4.24 ,100% Amerigroup fee schedule for outpatient setting,$8.00 ,75% of total billed charges for outpatient setting,$8.00 ,75% of total billed charges for outpatient setting,$8.00 ,75% of total billed charges for outpatient setting,$4.31 ,102% CMS Medicare OPPS fee schedule,$4.31 ,102% CMS Medicare OPPS fee schedule,$4.31 ,102% CMS Medicare OPPS fee schedule,$4.31 ,102% CMS Medicare OPPS fee schedule,$4.31 ,102% CMS Medicare OPPS fee schedule,$4.31 ,102% CMS Medicare OPPS fee schedule,$12.80 ,80% of total billed charges for outpatient setting,$4.31 ,102% CMS Medicare OPPS fee schedule,$4.24 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$13.60 ,85% of total billed charges for outpatient setting,$4.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.80 ,80% of total billed charges for outpatient setting,$13.60 ,85% of total billed charges for outpatient setting,$11.20 ,70% of total billed charges for outpatient setting,$11.20 ,70% of total billed charges for outpatient setting,$12.32 ,77% of total billed charges for outpatient setting,$4.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.60 ,85% of total billed charges for outpatient setting,$13.60 ,85% of total billed charges for outpatient setting,$13.60 ,85% of total billed charges for outpatient setting,$13.60 ,85% of total billed charges for outpatient setting,$13.60 ,85% of total billed charges for outpatient setting,$4.12 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.60 ,85% of total billed charges for outpatient setting,$4.04 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$4.23 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$14.40 ,90% of total billed charges for outpatient setting,$4.16 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$15.20 ,95% of total billed charges for outpatient setting,$13.60 ,85% of total billed charges for outpatient setting,$12.80 ,80% of total billed charges for outpatient setting,$4.12 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$13.60 ,85% of total billed charges for outpatient setting,$13.60 ,85% of total billed charges for outpatient setting,$13.60 ,85% of total billed charges for outpatient setting,$14.88 ,93% of total billed charges for outpatient setting,$12.00 ,75% of total billed charges for outpatient setting,$12.00 ,75% of total billed charges for outpatient setting,$12.00 ,75% of total billed charges for outpatient setting,$3.21 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$13.60 ,85% of total billed charges for outpatient setting,$4.12 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.21 ,$15.20 ,$5.60 Outpatient Medical Services,LAB,82306,Vitamin D 25 Hydroxy Level,300,$142.77 ,$39.08 ,100% Amerigroup fee schedule for outpatient setting,$39.08 ,100% Amerigroup fee schedule for outpatient setting,$71.39 ,75% of total billed charges for outpatient setting,$71.39 ,75% of total billed charges for outpatient setting,$71.39 ,75% of total billed charges for outpatient setting,$30.19 ,102% CMS Medicare OPPS fee schedule,$30.19 ,102% CMS Medicare OPPS fee schedule,$30.19 ,102% CMS Medicare OPPS fee schedule,$30.19 ,102% CMS Medicare OPPS fee schedule,$30.19 ,102% CMS Medicare OPPS fee schedule,$30.19 ,102% CMS Medicare OPPS fee schedule,$114.22 ,80% of total billed charges for outpatient setting,$30.19 ,102% CMS Medicare OPPS fee schedule,$39.08 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$121.35 ,85% of total billed charges for outpatient setting,$29.90 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$114.22 ,80% of total billed charges for outpatient setting,$121.35 ,85% of total billed charges for outpatient setting,$99.94 ,70% of total billed charges for outpatient setting,$99.94 ,70% of total billed charges for outpatient setting,$109.93 ,77% of total billed charges for outpatient setting,$29.90 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$121.35 ,85% of total billed charges for outpatient setting,$121.35 ,85% of total billed charges for outpatient setting,$121.35 ,85% of total billed charges for outpatient setting,$121.35 ,85% of total billed charges for outpatient setting,$121.35 ,85% of total billed charges for outpatient setting,$37.96 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$29.90 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$29.90 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$29.90 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$29.90 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$121.35 ,85% of total billed charges for outpatient setting,$37.22 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$29.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$128.49 ,90% of total billed charges for outpatient setting,$38.34 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$135.63 ,95% of total billed charges for outpatient setting,$121.35 ,85% of total billed charges for outpatient setting,$114.22 ,80% of total billed charges for outpatient setting,$37.96 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$121.35 ,85% of total billed charges for outpatient setting,$121.35 ,85% of total billed charges for outpatient setting,$121.35 ,85% of total billed charges for outpatient setting,$132.78 ,93% of total billed charges for outpatient setting,$107.08 ,75% of total billed charges for outpatient setting,$107.08 ,75% of total billed charges for outpatient setting,$107.08 ,75% of total billed charges for outpatient setting,$28.67 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$121.35 ,85% of total billed charges for outpatient setting,$37.96 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$28.67 ,$135.63 ,$49.97 Outpatient Medical Services,LAB,82310,Calcium Level Total,301,$51.00 ,$6.67 ,100% Amerigroup fee schedule for outpatient setting,$6.67 ,100% Amerigroup fee schedule for outpatient setting,$25.50 ,75% of total billed charges for outpatient setting,$25.50 ,75% of total billed charges for outpatient setting,$25.50 ,75% of total billed charges for outpatient setting,$5.26 ,102% CMS Medicare OPPS fee schedule,$5.26 ,102% CMS Medicare OPPS fee schedule,$5.26 ,102% CMS Medicare OPPS fee schedule,$5.26 ,102% CMS Medicare OPPS fee schedule,$5.26 ,102% CMS Medicare OPPS fee schedule,$5.26 ,102% CMS Medicare OPPS fee schedule,$40.80 ,80% of total billed charges for outpatient setting,$5.26 ,102% CMS Medicare OPPS fee schedule,$6.67 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$43.35 ,85% of total billed charges for outpatient setting,$5.21 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$40.80 ,80% of total billed charges for outpatient setting,$43.35 ,85% of total billed charges for outpatient setting,$35.70 ,70% of total billed charges for outpatient setting,$35.70 ,70% of total billed charges for outpatient setting,$39.27 ,77% of total billed charges for outpatient setting,$5.21 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$43.35 ,85% of total billed charges for outpatient setting,$43.35 ,85% of total billed charges for outpatient setting,$43.35 ,85% of total billed charges for outpatient setting,$43.35 ,85% of total billed charges for outpatient setting,$43.35 ,85% of total billed charges for outpatient setting,$6.48 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.21 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.21 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.21 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.21 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$43.35 ,85% of total billed charges for outpatient setting,$6.35 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$5.16 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$45.90 ,90% of total billed charges for outpatient setting,$6.54 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$48.45 ,95% of total billed charges for outpatient setting,$43.35 ,85% of total billed charges for outpatient setting,$40.80 ,80% of total billed charges for outpatient setting,$6.48 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$43.35 ,85% of total billed charges for outpatient setting,$43.35 ,85% of total billed charges for outpatient setting,$43.35 ,85% of total billed charges for outpatient setting,$47.43 ,93% of total billed charges for outpatient setting,$38.25 ,75% of total billed charges for outpatient setting,$38.25 ,75% of total billed charges for outpatient setting,$38.25 ,75% of total billed charges for outpatient setting,$10.24 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$43.35 ,85% of total billed charges for outpatient setting,$6.48 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.16 ,$48.45 ,$17.85 Outpatient Medical Services,LAB,82378,Carcinoembryonic Antigen,300,$64.00 ,$25.05 ,100% Amerigroup fee schedule for outpatient setting,$25.05 ,100% Amerigroup fee schedule for outpatient setting,$32.00 ,75% of total billed charges for outpatient setting,$32.00 ,75% of total billed charges for outpatient setting,$32.00 ,75% of total billed charges for outpatient setting,$19.34 ,102% CMS Medicare OPPS fee schedule,$19.34 ,102% CMS Medicare OPPS fee schedule,$19.34 ,102% CMS Medicare OPPS fee schedule,$19.34 ,102% CMS Medicare OPPS fee schedule,$19.34 ,102% CMS Medicare OPPS fee schedule,$19.34 ,102% CMS Medicare OPPS fee schedule,$51.20 ,80% of total billed charges for outpatient setting,$19.34 ,102% CMS Medicare OPPS fee schedule,$25.05 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$54.40 ,85% of total billed charges for outpatient setting,$19.15 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$51.20 ,80% of total billed charges for outpatient setting,$54.40 ,85% of total billed charges for outpatient setting,$44.80 ,70% of total billed charges for outpatient setting,$44.80 ,70% of total billed charges for outpatient setting,$49.28 ,77% of total billed charges for outpatient setting,$19.15 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$54.40 ,85% of total billed charges for outpatient setting,$54.40 ,85% of total billed charges for outpatient setting,$54.40 ,85% of total billed charges for outpatient setting,$54.40 ,85% of total billed charges for outpatient setting,$54.40 ,85% of total billed charges for outpatient setting,$24.34 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$19.15 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$19.15 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$19.15 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$19.15 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$54.40 ,85% of total billed charges for outpatient setting,$23.86 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$18.96 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$57.60 ,90% of total billed charges for outpatient setting,$24.58 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$60.80 ,95% of total billed charges for outpatient setting,$54.40 ,85% of total billed charges for outpatient setting,$51.20 ,80% of total billed charges for outpatient setting,$24.34 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$54.40 ,85% of total billed charges for outpatient setting,$54.40 ,85% of total billed charges for outpatient setting,$54.40 ,85% of total billed charges for outpatient setting,$59.52 ,93% of total billed charges for outpatient setting,$48.00 ,75% of total billed charges for outpatient setting,$48.00 ,75% of total billed charges for outpatient setting,$48.00 ,75% of total billed charges for outpatient setting,$12.85 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$54.40 ,85% of total billed charges for outpatient setting,$24.34 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$12.85 ,$60.80 ,$22.40 Outpatient Medical Services,LAB,82436,Chloride Level Urine,300,$42.00 ,$6.64 ,100% Amerigroup fee schedule for outpatient setting,$6.64 ,100% Amerigroup fee schedule for outpatient setting,$21.00 ,75% of total billed charges for outpatient setting,$21.00 ,75% of total billed charges for outpatient setting,$21.00 ,75% of total billed charges for outpatient setting,$5.87 ,102% CMS Medicare OPPS fee schedule,$5.87 ,102% CMS Medicare OPPS fee schedule,$5.87 ,102% CMS Medicare OPPS fee schedule,$5.87 ,102% CMS Medicare OPPS fee schedule,$5.87 ,102% CMS Medicare OPPS fee schedule,$5.87 ,102% CMS Medicare OPPS fee schedule,$33.60 ,80% of total billed charges for outpatient setting,$5.87 ,102% CMS Medicare OPPS fee schedule,$6.64 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$35.70 ,85% of total billed charges for outpatient setting,$5.81 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$33.60 ,80% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$29.40 ,70% of total billed charges for outpatient setting,$29.40 ,70% of total billed charges for outpatient setting,$32.34 ,77% of total billed charges for outpatient setting,$5.81 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$6.45 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.81 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.81 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.81 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.81 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$6.32 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$5.75 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$37.80 ,90% of total billed charges for outpatient setting,$6.51 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$39.90 ,95% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$33.60 ,80% of total billed charges for outpatient setting,$6.45 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$39.06 ,93% of total billed charges for outpatient setting,$31.50 ,75% of total billed charges for outpatient setting,$31.50 ,75% of total billed charges for outpatient setting,$31.50 ,75% of total billed charges for outpatient setting,$8.43 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$35.70 ,85% of total billed charges for outpatient setting,$6.45 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.75 ,$39.90 ,$14.70 Outpatient Medical Services,LAB,82436,Chloride Level 24 Hour Urine,300,$42.00 ,$6.64 ,100% Amerigroup fee schedule for outpatient setting,$6.64 ,100% Amerigroup fee schedule for outpatient setting,$21.00 ,75% of total billed charges for outpatient setting,$21.00 ,75% of total billed charges for outpatient setting,$21.00 ,75% of total billed charges for outpatient setting,$5.87 ,102% CMS Medicare OPPS fee schedule,$5.87 ,102% CMS Medicare OPPS fee schedule,$5.87 ,102% CMS Medicare OPPS fee schedule,$5.87 ,102% CMS Medicare OPPS fee schedule,$5.87 ,102% CMS Medicare OPPS fee schedule,$5.87 ,102% CMS Medicare OPPS fee schedule,$33.60 ,80% of total billed charges for outpatient setting,$5.87 ,102% CMS Medicare OPPS fee schedule,$6.64 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$35.70 ,85% of total billed charges for outpatient setting,$5.81 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$33.60 ,80% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$29.40 ,70% of total billed charges for outpatient setting,$29.40 ,70% of total billed charges for outpatient setting,$32.34 ,77% of total billed charges for outpatient setting,$5.81 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$6.45 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.81 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.81 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.81 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.81 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$6.32 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$5.75 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$37.80 ,90% of total billed charges for outpatient setting,$6.51 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$39.90 ,95% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$33.60 ,80% of total billed charges for outpatient setting,$6.45 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$39.06 ,93% of total billed charges for outpatient setting,$31.50 ,75% of total billed charges for outpatient setting,$31.50 ,75% of total billed charges for outpatient setting,$31.50 ,75% of total billed charges for outpatient setting,$8.43 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$35.70 ,85% of total billed charges for outpatient setting,$6.45 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.75 ,$39.90 ,$14.70 Outpatient Medical Services,LAB,82465,Cholesterol Total,301,$60.00 ,$5.74 ,100% Amerigroup fee schedule for outpatient setting,$5.74 ,100% Amerigroup fee schedule for outpatient setting,$30.00 ,75% of total billed charges for outpatient setting,$30.00 ,75% of total billed charges for outpatient setting,$30.00 ,75% of total billed charges for outpatient setting,$4.44 ,102% CMS Medicare OPPS fee schedule,$4.44 ,102% CMS Medicare OPPS fee schedule,$4.44 ,102% CMS Medicare OPPS fee schedule,$4.44 ,102% CMS Medicare OPPS fee schedule,$4.44 ,102% CMS Medicare OPPS fee schedule,$4.44 ,102% CMS Medicare OPPS fee schedule,$48.00 ,80% of total billed charges for outpatient setting,$4.44 ,102% CMS Medicare OPPS fee schedule,$5.74 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$51.00 ,85% of total billed charges for outpatient setting,$4.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$48.00 ,80% of total billed charges for outpatient setting,$51.00 ,85% of total billed charges for outpatient setting,$42.00 ,70% of total billed charges for outpatient setting,$42.00 ,70% of total billed charges for outpatient setting,$46.20 ,77% of total billed charges for outpatient setting,$4.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$51.00 ,85% of total billed charges for outpatient setting,$51.00 ,85% of total billed charges for outpatient setting,$51.00 ,85% of total billed charges for outpatient setting,$51.00 ,85% of total billed charges for outpatient setting,$51.00 ,85% of total billed charges for outpatient setting,$5.58 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$51.00 ,85% of total billed charges for outpatient setting,$5.47 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$4.35 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$54.00 ,90% of total billed charges for outpatient setting,$5.63 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$57.00 ,95% of total billed charges for outpatient setting,$51.00 ,85% of total billed charges for outpatient setting,$48.00 ,80% of total billed charges for outpatient setting,$5.58 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$51.00 ,85% of total billed charges for outpatient setting,$51.00 ,85% of total billed charges for outpatient setting,$51.00 ,85% of total billed charges for outpatient setting,$55.80 ,93% of total billed charges for outpatient setting,$45.00 ,75% of total billed charges for outpatient setting,$45.00 ,75% of total billed charges for outpatient setting,$45.00 ,75% of total billed charges for outpatient setting,$12.05 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$51.00 ,85% of total billed charges for outpatient setting,$5.58 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.35 ,$57.00 ,$21.00 Outpatient Medical Services,LAB,82550,Cardiac Profile addon 2,301,$45.76 ,$6.67 ,100% Amerigroup fee schedule for outpatient setting,$6.67 ,100% Amerigroup fee schedule for outpatient setting,$22.88 ,75% of total billed charges for outpatient setting,$22.88 ,75% of total billed charges for outpatient setting,$22.88 ,75% of total billed charges for outpatient setting,$6.64 ,102% CMS Medicare OPPS fee schedule,$6.64 ,102% CMS Medicare OPPS fee schedule,$6.64 ,102% CMS Medicare OPPS fee schedule,$6.64 ,102% CMS Medicare OPPS fee schedule,$6.64 ,102% CMS Medicare OPPS fee schedule,$6.64 ,102% CMS Medicare OPPS fee schedule,$36.61 ,80% of total billed charges for outpatient setting,$6.64 ,102% CMS Medicare OPPS fee schedule,$6.67 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$38.90 ,85% of total billed charges for outpatient setting,$6.58 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$36.61 ,80% of total billed charges for outpatient setting,$38.90 ,85% of total billed charges for outpatient setting,$32.03 ,70% of total billed charges for outpatient setting,$32.03 ,70% of total billed charges for outpatient setting,$35.24 ,77% of total billed charges for outpatient setting,$6.58 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$38.90 ,85% of total billed charges for outpatient setting,$38.90 ,85% of total billed charges for outpatient setting,$38.90 ,85% of total billed charges for outpatient setting,$38.90 ,85% of total billed charges for outpatient setting,$38.90 ,85% of total billed charges for outpatient setting,$6.48 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$6.58 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.58 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.58 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.58 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$38.90 ,85% of total billed charges for outpatient setting,$6.35 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$6.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$41.18 ,90% of total billed charges for outpatient setting,$6.54 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$43.47 ,95% of total billed charges for outpatient setting,$38.90 ,85% of total billed charges for outpatient setting,$36.61 ,80% of total billed charges for outpatient setting,$6.48 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$38.90 ,85% of total billed charges for outpatient setting,$38.90 ,85% of total billed charges for outpatient setting,$38.90 ,85% of total billed charges for outpatient setting,$42.56 ,93% of total billed charges for outpatient setting,$34.32 ,75% of total billed charges for outpatient setting,$34.32 ,75% of total billed charges for outpatient setting,$34.32 ,75% of total billed charges for outpatient setting,$9.19 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$38.90 ,85% of total billed charges for outpatient setting,$6.48 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$6.35 ,$43.47 ,$16.02 Outpatient Medical Services,LAB,82550,"CPK Isoenzymes - BB, MB, MM SF",301,$45.76 ,$6.67 ,100% Amerigroup fee schedule for outpatient setting,$6.67 ,100% Amerigroup fee schedule for outpatient setting,$22.88 ,75% of total billed charges for outpatient setting,$22.88 ,75% of total billed charges for outpatient setting,$22.88 ,75% of total billed charges for outpatient setting,$6.64 ,102% CMS Medicare OPPS fee schedule,$6.64 ,102% CMS Medicare OPPS fee schedule,$6.64 ,102% CMS Medicare OPPS fee schedule,$6.64 ,102% CMS Medicare OPPS fee schedule,$6.64 ,102% CMS Medicare OPPS fee schedule,$6.64 ,102% CMS Medicare OPPS fee schedule,$36.61 ,80% of total billed charges for outpatient setting,$6.64 ,102% CMS Medicare OPPS fee schedule,$6.67 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$38.90 ,85% of total billed charges for outpatient setting,$6.58 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$36.61 ,80% of total billed charges for outpatient setting,$38.90 ,85% of total billed charges for outpatient setting,$32.03 ,70% of total billed charges for outpatient setting,$32.03 ,70% of total billed charges for outpatient setting,$35.24 ,77% of total billed charges for outpatient setting,$6.58 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$38.90 ,85% of total billed charges for outpatient setting,$38.90 ,85% of total billed charges for outpatient setting,$38.90 ,85% of total billed charges for outpatient setting,$38.90 ,85% of total billed charges for outpatient setting,$38.90 ,85% of total billed charges for outpatient setting,$6.48 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$6.58 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.58 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.58 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.58 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$38.90 ,85% of total billed charges for outpatient setting,$6.35 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$6.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$41.18 ,90% of total billed charges for outpatient setting,$6.54 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$43.47 ,95% of total billed charges for outpatient setting,$38.90 ,85% of total billed charges for outpatient setting,$36.61 ,80% of total billed charges for outpatient setting,$6.48 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$38.90 ,85% of total billed charges for outpatient setting,$38.90 ,85% of total billed charges for outpatient setting,$38.90 ,85% of total billed charges for outpatient setting,$42.56 ,93% of total billed charges for outpatient setting,$34.32 ,75% of total billed charges for outpatient setting,$34.32 ,75% of total billed charges for outpatient setting,$34.32 ,75% of total billed charges for outpatient setting,$9.19 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$38.90 ,85% of total billed charges for outpatient setting,$6.48 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$6.35 ,$43.47 ,$16.02 Outpatient Medical Services,LAB,82553,Cardiac Profile Addon 1,301,$76.51 ,$15.25 ,100% Amerigroup fee schedule for outpatient setting,$15.25 ,100% Amerigroup fee schedule for outpatient setting,$38.26 ,75% of total billed charges for outpatient setting,$38.26 ,75% of total billed charges for outpatient setting,$38.26 ,75% of total billed charges for outpatient setting,$11.78 ,102% CMS Medicare OPPS fee schedule,$11.78 ,102% CMS Medicare OPPS fee schedule,$11.78 ,102% CMS Medicare OPPS fee schedule,$11.78 ,102% CMS Medicare OPPS fee schedule,$11.78 ,102% CMS Medicare OPPS fee schedule,$11.78 ,102% CMS Medicare OPPS fee schedule,$61.21 ,80% of total billed charges for outpatient setting,$11.78 ,102% CMS Medicare OPPS fee schedule,$15.25 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$65.03 ,85% of total billed charges for outpatient setting,$11.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$61.21 ,80% of total billed charges for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$53.56 ,70% of total billed charges for outpatient setting,$53.56 ,70% of total billed charges for outpatient setting,$58.91 ,77% of total billed charges for outpatient setting,$11.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$14.81 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$11.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$11.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$11.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$11.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$14.52 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$11.55 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$68.86 ,90% of total billed charges for outpatient setting,$14.96 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$72.68 ,95% of total billed charges for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$61.21 ,80% of total billed charges for outpatient setting,$14.81 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$65.03 ,85% of total billed charges for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$71.15 ,93% of total billed charges for outpatient setting,$57.38 ,75% of total billed charges for outpatient setting,$57.38 ,75% of total billed charges for outpatient setting,$57.38 ,75% of total billed charges for outpatient setting,$15.36 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$65.03 ,85% of total billed charges for outpatient setting,$14.81 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$11.55 ,$72.68 ,$26.78 Outpatient Medical Services,LAB,82553,"CK, CKMB and %MB Panel",301,$76.51 ,$15.25 ,100% Amerigroup fee schedule for outpatient setting,$15.25 ,100% Amerigroup fee schedule for outpatient setting,$38.26 ,75% of total billed charges for outpatient setting,$38.26 ,75% of total billed charges for outpatient setting,$38.26 ,75% of total billed charges for outpatient setting,$11.78 ,102% CMS Medicare OPPS fee schedule,$11.78 ,102% CMS Medicare OPPS fee schedule,$11.78 ,102% CMS Medicare OPPS fee schedule,$11.78 ,102% CMS Medicare OPPS fee schedule,$11.78 ,102% CMS Medicare OPPS fee schedule,$11.78 ,102% CMS Medicare OPPS fee schedule,$61.21 ,80% of total billed charges for outpatient setting,$11.78 ,102% CMS Medicare OPPS fee schedule,$15.25 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$65.03 ,85% of total billed charges for outpatient setting,$11.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$61.21 ,80% of total billed charges for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$53.56 ,70% of total billed charges for outpatient setting,$53.56 ,70% of total billed charges for outpatient setting,$58.91 ,77% of total billed charges for outpatient setting,$11.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$14.81 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$11.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$11.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$11.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$11.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$14.52 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$11.55 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$68.86 ,90% of total billed charges for outpatient setting,$14.96 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$72.68 ,95% of total billed charges for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$61.21 ,80% of total billed charges for outpatient setting,$14.81 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$65.03 ,85% of total billed charges for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$71.15 ,93% of total billed charges for outpatient setting,$57.38 ,75% of total billed charges for outpatient setting,$57.38 ,75% of total billed charges for outpatient setting,$57.38 ,75% of total billed charges for outpatient setting,$15.36 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$65.03 ,85% of total billed charges for outpatient setting,$14.81 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$11.55 ,$72.68 ,$26.78 Outpatient Medical Services,LAB,82553,Creatine Kinase,301,$76.51 ,$15.25 ,100% Amerigroup fee schedule for outpatient setting,$15.25 ,100% Amerigroup fee schedule for outpatient setting,$38.26 ,75% of total billed charges for outpatient setting,$38.26 ,75% of total billed charges for outpatient setting,$38.26 ,75% of total billed charges for outpatient setting,$11.78 ,102% CMS Medicare OPPS fee schedule,$11.78 ,102% CMS Medicare OPPS fee schedule,$11.78 ,102% CMS Medicare OPPS fee schedule,$11.78 ,102% CMS Medicare OPPS fee schedule,$11.78 ,102% CMS Medicare OPPS fee schedule,$11.78 ,102% CMS Medicare OPPS fee schedule,$61.21 ,80% of total billed charges for outpatient setting,$11.78 ,102% CMS Medicare OPPS fee schedule,$15.25 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$65.03 ,85% of total billed charges for outpatient setting,$11.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$61.21 ,80% of total billed charges for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$53.56 ,70% of total billed charges for outpatient setting,$53.56 ,70% of total billed charges for outpatient setting,$58.91 ,77% of total billed charges for outpatient setting,$11.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$14.81 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$11.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$11.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$11.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$11.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$14.52 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$11.55 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$68.86 ,90% of total billed charges for outpatient setting,$14.96 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$72.68 ,95% of total billed charges for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$61.21 ,80% of total billed charges for outpatient setting,$14.81 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$65.03 ,85% of total billed charges for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$71.15 ,93% of total billed charges for outpatient setting,$57.38 ,75% of total billed charges for outpatient setting,$57.38 ,75% of total billed charges for outpatient setting,$57.38 ,75% of total billed charges for outpatient setting,$15.36 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$65.03 ,85% of total billed charges for outpatient setting,$14.81 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$11.55 ,$72.68 ,$26.78 Outpatient Medical Services,LAB,82553,CK-MB,301,$76.51 ,$15.25 ,100% Amerigroup fee schedule for outpatient setting,$15.25 ,100% Amerigroup fee schedule for outpatient setting,$38.26 ,75% of total billed charges for outpatient setting,$38.26 ,75% of total billed charges for outpatient setting,$38.26 ,75% of total billed charges for outpatient setting,$11.78 ,102% CMS Medicare OPPS fee schedule,$11.78 ,102% CMS Medicare OPPS fee schedule,$11.78 ,102% CMS Medicare OPPS fee schedule,$11.78 ,102% CMS Medicare OPPS fee schedule,$11.78 ,102% CMS Medicare OPPS fee schedule,$11.78 ,102% CMS Medicare OPPS fee schedule,$61.21 ,80% of total billed charges for outpatient setting,$11.78 ,102% CMS Medicare OPPS fee schedule,$15.25 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$65.03 ,85% of total billed charges for outpatient setting,$11.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$61.21 ,80% of total billed charges for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$53.56 ,70% of total billed charges for outpatient setting,$53.56 ,70% of total billed charges for outpatient setting,$58.91 ,77% of total billed charges for outpatient setting,$11.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$14.81 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$11.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$11.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$11.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$11.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$14.52 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$11.55 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$68.86 ,90% of total billed charges for outpatient setting,$14.96 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$72.68 ,95% of total billed charges for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$61.21 ,80% of total billed charges for outpatient setting,$14.81 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$65.03 ,85% of total billed charges for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$65.03 ,85% of total billed charges for outpatient setting,$71.15 ,93% of total billed charges for outpatient setting,$57.38 ,75% of total billed charges for outpatient setting,$57.38 ,75% of total billed charges for outpatient setting,$57.38 ,75% of total billed charges for outpatient setting,$15.36 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$65.03 ,85% of total billed charges for outpatient setting,$14.81 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$11.55 ,$72.68 ,$26.78 Outpatient Medical Services,LAB,82553,CK-MB,300,$107.00 ,$15.25 ,100% Amerigroup fee schedule for outpatient setting,$15.25 ,100% Amerigroup fee schedule for outpatient setting,$53.50 ,75% of total billed charges for outpatient setting,$53.50 ,75% of total billed charges for outpatient setting,$53.50 ,75% of total billed charges for outpatient setting,$11.78 ,102% CMS Medicare OPPS fee schedule,$11.78 ,102% CMS Medicare OPPS fee schedule,$11.78 ,102% CMS Medicare OPPS fee schedule,$11.78 ,102% CMS Medicare OPPS fee schedule,$11.78 ,102% CMS Medicare OPPS fee schedule,$11.78 ,102% CMS Medicare OPPS fee schedule,$85.60 ,80% of total billed charges for outpatient setting,$11.78 ,102% CMS Medicare OPPS fee schedule,$15.25 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$90.95 ,85% of total billed charges for outpatient setting,$11.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$85.60 ,80% of total billed charges for outpatient setting,$90.95 ,85% of total billed charges for outpatient setting,$74.90 ,70% of total billed charges for outpatient setting,$74.90 ,70% of total billed charges for outpatient setting,$82.39 ,77% of total billed charges for outpatient setting,$11.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$90.95 ,85% of total billed charges for outpatient setting,$90.95 ,85% of total billed charges for outpatient setting,$90.95 ,85% of total billed charges for outpatient setting,$90.95 ,85% of total billed charges for outpatient setting,$90.95 ,85% of total billed charges for outpatient setting,$14.81 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$11.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$11.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$11.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$11.67 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$90.95 ,85% of total billed charges for outpatient setting,$14.52 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$11.55 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$96.30 ,90% of total billed charges for outpatient setting,$14.96 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$101.65 ,95% of total billed charges for outpatient setting,$90.95 ,85% of total billed charges for outpatient setting,$85.60 ,80% of total billed charges for outpatient setting,$14.81 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$90.95 ,85% of total billed charges for outpatient setting,$90.95 ,85% of total billed charges for outpatient setting,$90.95 ,85% of total billed charges for outpatient setting,$99.51 ,93% of total billed charges for outpatient setting,$80.25 ,75% of total billed charges for outpatient setting,$80.25 ,75% of total billed charges for outpatient setting,$80.25 ,75% of total billed charges for outpatient setting,$21.49 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$90.95 ,85% of total billed charges for outpatient setting,$14.81 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$11.55 ,$101.65 ,$37.45 Outpatient Medical Services,LAB,82565,Creatinine,301,$124.80 ,$6.67 ,100% Amerigroup fee schedule for outpatient setting,$6.67 ,100% Amerigroup fee schedule for outpatient setting,$62.40 ,75% of total billed charges for outpatient setting,$62.40 ,75% of total billed charges for outpatient setting,$62.40 ,75% of total billed charges for outpatient setting,$5.22 ,102% CMS Medicare OPPS fee schedule,$5.22 ,102% CMS Medicare OPPS fee schedule,$5.22 ,102% CMS Medicare OPPS fee schedule,$5.22 ,102% CMS Medicare OPPS fee schedule,$5.22 ,102% CMS Medicare OPPS fee schedule,$5.22 ,102% CMS Medicare OPPS fee schedule,$99.84 ,80% of total billed charges for outpatient setting,$5.22 ,102% CMS Medicare OPPS fee schedule,$6.67 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$106.08 ,85% of total billed charges for outpatient setting,$5.17 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$99.84 ,80% of total billed charges for outpatient setting,$106.08 ,85% of total billed charges for outpatient setting,$87.36 ,70% of total billed charges for outpatient setting,$87.36 ,70% of total billed charges for outpatient setting,$96.10 ,77% of total billed charges for outpatient setting,$5.17 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$106.08 ,85% of total billed charges for outpatient setting,$106.08 ,85% of total billed charges for outpatient setting,$106.08 ,85% of total billed charges for outpatient setting,$106.08 ,85% of total billed charges for outpatient setting,$106.08 ,85% of total billed charges for outpatient setting,$6.48 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.17 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.17 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.17 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.17 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$106.08 ,85% of total billed charges for outpatient setting,$6.35 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$5.12 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$112.32 ,90% of total billed charges for outpatient setting,$6.54 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$118.56 ,95% of total billed charges for outpatient setting,$106.08 ,85% of total billed charges for outpatient setting,$99.84 ,80% of total billed charges for outpatient setting,$6.48 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$106.08 ,85% of total billed charges for outpatient setting,$106.08 ,85% of total billed charges for outpatient setting,$106.08 ,85% of total billed charges for outpatient setting,$116.06 ,93% of total billed charges for outpatient setting,$93.60 ,75% of total billed charges for outpatient setting,$93.60 ,75% of total billed charges for outpatient setting,$93.60 ,75% of total billed charges for outpatient setting,$25.06 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$106.08 ,85% of total billed charges for outpatient setting,$6.48 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.12 ,$118.56 ,$43.68 Outpatient Medical Services,LAB,82570,Protein/Creatinine Ratio Urine addon,300,$63.23 ,$6.84 ,100% Amerigroup fee schedule for outpatient setting,$6.84 ,100% Amerigroup fee schedule for outpatient setting,$31.62 ,75% of total billed charges for outpatient setting,$31.62 ,75% of total billed charges for outpatient setting,$31.62 ,75% of total billed charges for outpatient setting,$5.28 ,102% CMS Medicare OPPS fee schedule,$5.28 ,102% CMS Medicare OPPS fee schedule,$5.28 ,102% CMS Medicare OPPS fee schedule,$5.28 ,102% CMS Medicare OPPS fee schedule,$5.28 ,102% CMS Medicare OPPS fee schedule,$5.28 ,102% CMS Medicare OPPS fee schedule,$50.58 ,80% of total billed charges for outpatient setting,$5.28 ,102% CMS Medicare OPPS fee schedule,$6.84 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$53.75 ,85% of total billed charges for outpatient setting,$5.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$50.58 ,80% of total billed charges for outpatient setting,$53.75 ,85% of total billed charges for outpatient setting,$44.26 ,70% of total billed charges for outpatient setting,$44.26 ,70% of total billed charges for outpatient setting,$48.69 ,77% of total billed charges for outpatient setting,$5.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$53.75 ,85% of total billed charges for outpatient setting,$53.75 ,85% of total billed charges for outpatient setting,$53.75 ,85% of total billed charges for outpatient setting,$53.75 ,85% of total billed charges for outpatient setting,$53.75 ,85% of total billed charges for outpatient setting,$6.64 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$53.75 ,85% of total billed charges for outpatient setting,$6.51 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$5.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$56.91 ,90% of total billed charges for outpatient setting,$6.71 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$60.07 ,95% of total billed charges for outpatient setting,$53.75 ,85% of total billed charges for outpatient setting,$50.58 ,80% of total billed charges for outpatient setting,$6.64 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$53.75 ,85% of total billed charges for outpatient setting,$53.75 ,85% of total billed charges for outpatient setting,$53.75 ,85% of total billed charges for outpatient setting,$58.80 ,93% of total billed charges for outpatient setting,$47.42 ,75% of total billed charges for outpatient setting,$47.42 ,75% of total billed charges for outpatient setting,$47.42 ,75% of total billed charges for outpatient setting,$12.70 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$53.75 ,85% of total billed charges for outpatient setting,$6.64 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.18 ,$60.07 ,$22.13 Outpatient Medical Services,LAB,82570,Creatinine Level 24 Hour Urine,300,$63.23 ,$6.84 ,100% Amerigroup fee schedule for outpatient setting,$6.84 ,100% Amerigroup fee schedule for outpatient setting,$31.62 ,75% of total billed charges for outpatient setting,$31.62 ,75% of total billed charges for outpatient setting,$31.62 ,75% of total billed charges for outpatient setting,$5.28 ,102% CMS Medicare OPPS fee schedule,$5.28 ,102% CMS Medicare OPPS fee schedule,$5.28 ,102% CMS Medicare OPPS fee schedule,$5.28 ,102% CMS Medicare OPPS fee schedule,$5.28 ,102% CMS Medicare OPPS fee schedule,$5.28 ,102% CMS Medicare OPPS fee schedule,$50.58 ,80% of total billed charges for outpatient setting,$5.28 ,102% CMS Medicare OPPS fee schedule,$6.84 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$53.75 ,85% of total billed charges for outpatient setting,$5.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$50.58 ,80% of total billed charges for outpatient setting,$53.75 ,85% of total billed charges for outpatient setting,$44.26 ,70% of total billed charges for outpatient setting,$44.26 ,70% of total billed charges for outpatient setting,$48.69 ,77% of total billed charges for outpatient setting,$5.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$53.75 ,85% of total billed charges for outpatient setting,$53.75 ,85% of total billed charges for outpatient setting,$53.75 ,85% of total billed charges for outpatient setting,$53.75 ,85% of total billed charges for outpatient setting,$53.75 ,85% of total billed charges for outpatient setting,$6.64 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$53.75 ,85% of total billed charges for outpatient setting,$6.51 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$5.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$56.91 ,90% of total billed charges for outpatient setting,$6.71 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$60.07 ,95% of total billed charges for outpatient setting,$53.75 ,85% of total billed charges for outpatient setting,$50.58 ,80% of total billed charges for outpatient setting,$6.64 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$53.75 ,85% of total billed charges for outpatient setting,$53.75 ,85% of total billed charges for outpatient setting,$53.75 ,85% of total billed charges for outpatient setting,$58.80 ,93% of total billed charges for outpatient setting,$47.42 ,75% of total billed charges for outpatient setting,$47.42 ,75% of total billed charges for outpatient setting,$47.42 ,75% of total billed charges for outpatient setting,$12.70 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$53.75 ,85% of total billed charges for outpatient setting,$6.64 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.18 ,$60.07 ,$22.13 Outpatient Medical Services,LAB,82570,Creatinine Urine,300,$63.23 ,$6.84 ,100% Amerigroup fee schedule for outpatient setting,$6.84 ,100% Amerigroup fee schedule for outpatient setting,$31.62 ,75% of total billed charges for outpatient setting,$31.62 ,75% of total billed charges for outpatient setting,$31.62 ,75% of total billed charges for outpatient setting,$5.28 ,102% CMS Medicare OPPS fee schedule,$5.28 ,102% CMS Medicare OPPS fee schedule,$5.28 ,102% CMS Medicare OPPS fee schedule,$5.28 ,102% CMS Medicare OPPS fee schedule,$5.28 ,102% CMS Medicare OPPS fee schedule,$5.28 ,102% CMS Medicare OPPS fee schedule,$50.58 ,80% of total billed charges for outpatient setting,$5.28 ,102% CMS Medicare OPPS fee schedule,$6.84 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$53.75 ,85% of total billed charges for outpatient setting,$5.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$50.58 ,80% of total billed charges for outpatient setting,$53.75 ,85% of total billed charges for outpatient setting,$44.26 ,70% of total billed charges for outpatient setting,$44.26 ,70% of total billed charges for outpatient setting,$48.69 ,77% of total billed charges for outpatient setting,$5.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$53.75 ,85% of total billed charges for outpatient setting,$53.75 ,85% of total billed charges for outpatient setting,$53.75 ,85% of total billed charges for outpatient setting,$53.75 ,85% of total billed charges for outpatient setting,$53.75 ,85% of total billed charges for outpatient setting,$6.64 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$53.75 ,85% of total billed charges for outpatient setting,$6.51 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$5.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$56.91 ,90% of total billed charges for outpatient setting,$6.71 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$60.07 ,95% of total billed charges for outpatient setting,$53.75 ,85% of total billed charges for outpatient setting,$50.58 ,80% of total billed charges for outpatient setting,$6.64 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$53.75 ,85% of total billed charges for outpatient setting,$53.75 ,85% of total billed charges for outpatient setting,$53.75 ,85% of total billed charges for outpatient setting,$58.80 ,93% of total billed charges for outpatient setting,$47.42 ,75% of total billed charges for outpatient setting,$47.42 ,75% of total billed charges for outpatient setting,$47.42 ,75% of total billed charges for outpatient setting,$12.70 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$53.75 ,85% of total billed charges for outpatient setting,$6.64 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.18 ,$60.07 ,$22.13 Outpatient Medical Services,LAB,82575,Creat Clear,300,$55.00 ,$12.47 ,100% Amerigroup fee schedule for outpatient setting,$12.47 ,100% Amerigroup fee schedule for outpatient setting,$27.50 ,75% of total billed charges for outpatient setting,$27.50 ,75% of total billed charges for outpatient setting,$27.50 ,75% of total billed charges for outpatient setting,$9.65 ,102% CMS Medicare OPPS fee schedule,$9.65 ,102% CMS Medicare OPPS fee schedule,$9.65 ,102% CMS Medicare OPPS fee schedule,$9.65 ,102% CMS Medicare OPPS fee schedule,$9.65 ,102% CMS Medicare OPPS fee schedule,$9.65 ,102% CMS Medicare OPPS fee schedule,$44.00 ,80% of total billed charges for outpatient setting,$9.65 ,102% CMS Medicare OPPS fee schedule,$12.47 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$46.75 ,85% of total billed charges for outpatient setting,$9.55 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$44.00 ,80% of total billed charges for outpatient setting,$46.75 ,85% of total billed charges for outpatient setting,$38.50 ,70% of total billed charges for outpatient setting,$38.50 ,70% of total billed charges for outpatient setting,$42.35 ,77% of total billed charges for outpatient setting,$9.55 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$46.75 ,85% of total billed charges for outpatient setting,$46.75 ,85% of total billed charges for outpatient setting,$46.75 ,85% of total billed charges for outpatient setting,$46.75 ,85% of total billed charges for outpatient setting,$46.75 ,85% of total billed charges for outpatient setting,$12.12 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$9.55 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.55 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.55 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.55 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$46.75 ,85% of total billed charges for outpatient setting,$11.88 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$9.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$49.50 ,90% of total billed charges for outpatient setting,$12.24 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$52.25 ,95% of total billed charges for outpatient setting,$46.75 ,85% of total billed charges for outpatient setting,$44.00 ,80% of total billed charges for outpatient setting,$12.12 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$46.75 ,85% of total billed charges for outpatient setting,$46.75 ,85% of total billed charges for outpatient setting,$46.75 ,85% of total billed charges for outpatient setting,$51.15 ,93% of total billed charges for outpatient setting,$41.25 ,75% of total billed charges for outpatient setting,$41.25 ,75% of total billed charges for outpatient setting,$41.25 ,75% of total billed charges for outpatient setting,$11.04 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$46.75 ,85% of total billed charges for outpatient setting,$12.12 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$9.46 ,$52.25 ,$19.25 Outpatient Medical Services,LAB,82607,Vitamin B12 Level,300,$122.27 ,$19.90 ,100% Amerigroup fee schedule for outpatient setting,$19.90 ,100% Amerigroup fee schedule for outpatient setting,$61.14 ,75% of total billed charges for outpatient setting,$61.14 ,75% of total billed charges for outpatient setting,$61.14 ,75% of total billed charges for outpatient setting,$15.38 ,102% CMS Medicare OPPS fee schedule,$15.38 ,102% CMS Medicare OPPS fee schedule,$15.38 ,102% CMS Medicare OPPS fee schedule,$15.38 ,102% CMS Medicare OPPS fee schedule,$15.38 ,102% CMS Medicare OPPS fee schedule,$15.38 ,102% CMS Medicare OPPS fee schedule,$97.82 ,80% of total billed charges for outpatient setting,$15.38 ,102% CMS Medicare OPPS fee schedule,$19.90 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$103.93 ,85% of total billed charges for outpatient setting,$15.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$97.82 ,80% of total billed charges for outpatient setting,$103.93 ,85% of total billed charges for outpatient setting,$85.59 ,70% of total billed charges for outpatient setting,$85.59 ,70% of total billed charges for outpatient setting,$94.15 ,77% of total billed charges for outpatient setting,$15.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$103.93 ,85% of total billed charges for outpatient setting,$103.93 ,85% of total billed charges for outpatient setting,$103.93 ,85% of total billed charges for outpatient setting,$103.93 ,85% of total billed charges for outpatient setting,$103.93 ,85% of total billed charges for outpatient setting,$19.33 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$15.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$15.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$15.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$15.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$103.93 ,85% of total billed charges for outpatient setting,$18.95 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$15.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$110.04 ,90% of total billed charges for outpatient setting,$19.52 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$116.16 ,95% of total billed charges for outpatient setting,$103.93 ,85% of total billed charges for outpatient setting,$97.82 ,80% of total billed charges for outpatient setting,$19.33 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$103.93 ,85% of total billed charges for outpatient setting,$103.93 ,85% of total billed charges for outpatient setting,$103.93 ,85% of total billed charges for outpatient setting,$113.71 ,93% of total billed charges for outpatient setting,$91.70 ,75% of total billed charges for outpatient setting,$91.70 ,75% of total billed charges for outpatient setting,$91.70 ,75% of total billed charges for outpatient setting,$24.55 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$103.93 ,85% of total billed charges for outpatient setting,$19.33 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$15.08 ,$116.16 ,$42.79 Outpatient Medical Services,LAB,82607,Vitamin B12 Level,301,$117.37 ,$19.90 ,100% Amerigroup fee schedule for outpatient setting,$19.90 ,100% Amerigroup fee schedule for outpatient setting,$58.69 ,75% of total billed charges for outpatient setting,$58.69 ,75% of total billed charges for outpatient setting,$58.69 ,75% of total billed charges for outpatient setting,$15.38 ,102% CMS Medicare OPPS fee schedule,$15.38 ,102% CMS Medicare OPPS fee schedule,$15.38 ,102% CMS Medicare OPPS fee schedule,$15.38 ,102% CMS Medicare OPPS fee schedule,$15.38 ,102% CMS Medicare OPPS fee schedule,$15.38 ,102% CMS Medicare OPPS fee schedule,$93.90 ,80% of total billed charges for outpatient setting,$15.38 ,102% CMS Medicare OPPS fee schedule,$19.90 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$99.76 ,85% of total billed charges for outpatient setting,$15.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$93.90 ,80% of total billed charges for outpatient setting,$99.76 ,85% of total billed charges for outpatient setting,$82.16 ,70% of total billed charges for outpatient setting,$82.16 ,70% of total billed charges for outpatient setting,$90.37 ,77% of total billed charges for outpatient setting,$15.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$99.76 ,85% of total billed charges for outpatient setting,$99.76 ,85% of total billed charges for outpatient setting,$99.76 ,85% of total billed charges for outpatient setting,$99.76 ,85% of total billed charges for outpatient setting,$99.76 ,85% of total billed charges for outpatient setting,$19.33 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$15.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$15.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$15.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$15.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$99.76 ,85% of total billed charges for outpatient setting,$18.95 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$15.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$105.63 ,90% of total billed charges for outpatient setting,$19.52 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$111.50 ,95% of total billed charges for outpatient setting,$99.76 ,85% of total billed charges for outpatient setting,$93.90 ,80% of total billed charges for outpatient setting,$19.33 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$99.76 ,85% of total billed charges for outpatient setting,$99.76 ,85% of total billed charges for outpatient setting,$99.76 ,85% of total billed charges for outpatient setting,$109.15 ,93% of total billed charges for outpatient setting,$88.03 ,75% of total billed charges for outpatient setting,$88.03 ,75% of total billed charges for outpatient setting,$88.03 ,75% of total billed charges for outpatient setting,$23.57 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$99.76 ,85% of total billed charges for outpatient setting,$19.33 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$15.08 ,$111.50 ,$41.08 Outpatient Medical Services,LAB,82607,Vitamin B12 Level,300,$122.27 ,$19.90 ,100% Amerigroup fee schedule for outpatient setting,$19.90 ,100% Amerigroup fee schedule for outpatient setting,$61.14 ,75% of total billed charges for outpatient setting,$61.14 ,75% of total billed charges for outpatient setting,$61.14 ,75% of total billed charges for outpatient setting,$15.38 ,102% CMS Medicare OPPS fee schedule,$15.38 ,102% CMS Medicare OPPS fee schedule,$15.38 ,102% CMS Medicare OPPS fee schedule,$15.38 ,102% CMS Medicare OPPS fee schedule,$15.38 ,102% CMS Medicare OPPS fee schedule,$15.38 ,102% CMS Medicare OPPS fee schedule,$97.82 ,80% of total billed charges for outpatient setting,$15.38 ,102% CMS Medicare OPPS fee schedule,$19.90 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$103.93 ,85% of total billed charges for outpatient setting,$15.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$97.82 ,80% of total billed charges for outpatient setting,$103.93 ,85% of total billed charges for outpatient setting,$85.59 ,70% of total billed charges for outpatient setting,$85.59 ,70% of total billed charges for outpatient setting,$94.15 ,77% of total billed charges for outpatient setting,$15.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$103.93 ,85% of total billed charges for outpatient setting,$103.93 ,85% of total billed charges for outpatient setting,$103.93 ,85% of total billed charges for outpatient setting,$103.93 ,85% of total billed charges for outpatient setting,$103.93 ,85% of total billed charges for outpatient setting,$19.33 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$15.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$15.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$15.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$15.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$103.93 ,85% of total billed charges for outpatient setting,$18.95 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$15.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$110.04 ,90% of total billed charges for outpatient setting,$19.52 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$116.16 ,95% of total billed charges for outpatient setting,$103.93 ,85% of total billed charges for outpatient setting,$97.82 ,80% of total billed charges for outpatient setting,$19.33 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$103.93 ,85% of total billed charges for outpatient setting,$103.93 ,85% of total billed charges for outpatient setting,$103.93 ,85% of total billed charges for outpatient setting,$113.71 ,93% of total billed charges for outpatient setting,$91.70 ,75% of total billed charges for outpatient setting,$91.70 ,75% of total billed charges for outpatient setting,$91.70 ,75% of total billed charges for outpatient setting,$24.55 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$103.93 ,85% of total billed charges for outpatient setting,$19.33 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$15.08 ,$116.16 ,$42.79 Outpatient Medical Services,LAB,82607,Vitamin B12 LC,301,$117.37 ,$19.90 ,100% Amerigroup fee schedule for outpatient setting,$19.90 ,100% Amerigroup fee schedule for outpatient setting,$58.69 ,75% of total billed charges for outpatient setting,$58.69 ,75% of total billed charges for outpatient setting,$58.69 ,75% of total billed charges for outpatient setting,$15.38 ,102% CMS Medicare OPPS fee schedule,$15.38 ,102% CMS Medicare OPPS fee schedule,$15.38 ,102% CMS Medicare OPPS fee schedule,$15.38 ,102% CMS Medicare OPPS fee schedule,$15.38 ,102% CMS Medicare OPPS fee schedule,$15.38 ,102% CMS Medicare OPPS fee schedule,$93.90 ,80% of total billed charges for outpatient setting,$15.38 ,102% CMS Medicare OPPS fee schedule,$19.90 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$99.76 ,85% of total billed charges for outpatient setting,$15.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$93.90 ,80% of total billed charges for outpatient setting,$99.76 ,85% of total billed charges for outpatient setting,$82.16 ,70% of total billed charges for outpatient setting,$82.16 ,70% of total billed charges for outpatient setting,$90.37 ,77% of total billed charges for outpatient setting,$15.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$99.76 ,85% of total billed charges for outpatient setting,$99.76 ,85% of total billed charges for outpatient setting,$99.76 ,85% of total billed charges for outpatient setting,$99.76 ,85% of total billed charges for outpatient setting,$99.76 ,85% of total billed charges for outpatient setting,$19.33 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$15.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$15.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$15.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$15.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$99.76 ,85% of total billed charges for outpatient setting,$18.95 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$15.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$105.63 ,90% of total billed charges for outpatient setting,$19.52 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$111.50 ,95% of total billed charges for outpatient setting,$99.76 ,85% of total billed charges for outpatient setting,$93.90 ,80% of total billed charges for outpatient setting,$19.33 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$99.76 ,85% of total billed charges for outpatient setting,$99.76 ,85% of total billed charges for outpatient setting,$99.76 ,85% of total billed charges for outpatient setting,$109.15 ,93% of total billed charges for outpatient setting,$88.03 ,75% of total billed charges for outpatient setting,$88.03 ,75% of total billed charges for outpatient setting,$88.03 ,75% of total billed charges for outpatient setting,$23.57 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$99.76 ,85% of total billed charges for outpatient setting,$19.33 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$15.08 ,$111.50 ,$41.08 Outpatient Medical Services,LAB,82652,"Vitamin D, 25-Hydroxy LC",300,$258.00 ,$50.82 ,100% Amerigroup fee schedule for outpatient setting,$50.82 ,100% Amerigroup fee schedule for outpatient setting,$129.00 ,75% of total billed charges for outpatient setting,$129.00 ,75% of total billed charges for outpatient setting,$129.00 ,75% of total billed charges for outpatient setting,$39.27 ,102% CMS Medicare OPPS fee schedule,$39.27 ,102% CMS Medicare OPPS fee schedule,$39.27 ,102% CMS Medicare OPPS fee schedule,$39.27 ,102% CMS Medicare OPPS fee schedule,$39.27 ,102% CMS Medicare OPPS fee schedule,$39.27 ,102% CMS Medicare OPPS fee schedule,$206.40 ,80% of total billed charges for outpatient setting,$39.27 ,102% CMS Medicare OPPS fee schedule,$50.82 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$219.30 ,85% of total billed charges for outpatient setting,$38.89 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$206.40 ,80% of total billed charges for outpatient setting,$219.30 ,85% of total billed charges for outpatient setting,$180.60 ,70% of total billed charges for outpatient setting,$180.60 ,70% of total billed charges for outpatient setting,$198.66 ,77% of total billed charges for outpatient setting,$38.89 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$219.30 ,85% of total billed charges for outpatient setting,$219.30 ,85% of total billed charges for outpatient setting,$219.30 ,85% of total billed charges for outpatient setting,$219.30 ,85% of total billed charges for outpatient setting,$219.30 ,85% of total billed charges for outpatient setting,$49.37 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$38.89 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$38.89 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$38.89 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$38.89 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$219.30 ,85% of total billed charges for outpatient setting,$48.40 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$38.50 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$232.20 ,90% of total billed charges for outpatient setting,$49.85 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$245.10 ,95% of total billed charges for outpatient setting,$219.30 ,85% of total billed charges for outpatient setting,$206.40 ,80% of total billed charges for outpatient setting,$49.37 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$219.30 ,85% of total billed charges for outpatient setting,$219.30 ,85% of total billed charges for outpatient setting,$219.30 ,85% of total billed charges for outpatient setting,$239.94 ,93% of total billed charges for outpatient setting,$193.50 ,75% of total billed charges for outpatient setting,$193.50 ,75% of total billed charges for outpatient setting,$193.50 ,75% of total billed charges for outpatient setting,$51.81 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$219.30 ,85% of total billed charges for outpatient setting,$49.37 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$38.50 ,$245.10 ,$90.30 Outpatient Medical Services,LAB,82728,Ferritin,300,$68.64 ,$17.99 ,100% Amerigroup fee schedule for outpatient setting,$17.99 ,100% Amerigroup fee schedule for outpatient setting,$34.32 ,75% of total billed charges for outpatient setting,$34.32 ,75% of total billed charges for outpatient setting,$34.32 ,75% of total billed charges for outpatient setting,$13.90 ,102% CMS Medicare OPPS fee schedule,$13.90 ,102% CMS Medicare OPPS fee schedule,$13.90 ,102% CMS Medicare OPPS fee schedule,$13.90 ,102% CMS Medicare OPPS fee schedule,$13.90 ,102% CMS Medicare OPPS fee schedule,$13.90 ,102% CMS Medicare OPPS fee schedule,$54.91 ,80% of total billed charges for outpatient setting,$13.90 ,102% CMS Medicare OPPS fee schedule,$17.99 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$58.34 ,85% of total billed charges for outpatient setting,$13.77 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$54.91 ,80% of total billed charges for outpatient setting,$58.34 ,85% of total billed charges for outpatient setting,$48.05 ,70% of total billed charges for outpatient setting,$48.05 ,70% of total billed charges for outpatient setting,$52.85 ,77% of total billed charges for outpatient setting,$13.77 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$58.34 ,85% of total billed charges for outpatient setting,$58.34 ,85% of total billed charges for outpatient setting,$58.34 ,85% of total billed charges for outpatient setting,$58.34 ,85% of total billed charges for outpatient setting,$58.34 ,85% of total billed charges for outpatient setting,$17.47 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$13.77 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.77 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.77 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.77 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$58.34 ,85% of total billed charges for outpatient setting,$17.13 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$13.63 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$61.78 ,90% of total billed charges for outpatient setting,$17.64 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$65.21 ,95% of total billed charges for outpatient setting,$58.34 ,85% of total billed charges for outpatient setting,$54.91 ,80% of total billed charges for outpatient setting,$17.47 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$58.34 ,85% of total billed charges for outpatient setting,$58.34 ,85% of total billed charges for outpatient setting,$58.34 ,85% of total billed charges for outpatient setting,$63.84 ,93% of total billed charges for outpatient setting,$51.48 ,75% of total billed charges for outpatient setting,$51.48 ,75% of total billed charges for outpatient setting,$51.48 ,75% of total billed charges for outpatient setting,$13.78 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$58.34 ,85% of total billed charges for outpatient setting,$17.47 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$13.63 ,$65.21 ,$24.02 Outpatient Medical Services,LAB,82728,"Ferritin, Serum LC",300,$68.64 ,$17.99 ,100% Amerigroup fee schedule for outpatient setting,$17.99 ,100% Amerigroup fee schedule for outpatient setting,$34.32 ,75% of total billed charges for outpatient setting,$34.32 ,75% of total billed charges for outpatient setting,$34.32 ,75% of total billed charges for outpatient setting,$13.90 ,102% CMS Medicare OPPS fee schedule,$13.90 ,102% CMS Medicare OPPS fee schedule,$13.90 ,102% CMS Medicare OPPS fee schedule,$13.90 ,102% CMS Medicare OPPS fee schedule,$13.90 ,102% CMS Medicare OPPS fee schedule,$13.90 ,102% CMS Medicare OPPS fee schedule,$54.91 ,80% of total billed charges for outpatient setting,$13.90 ,102% CMS Medicare OPPS fee schedule,$17.99 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$58.34 ,85% of total billed charges for outpatient setting,$13.77 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$54.91 ,80% of total billed charges for outpatient setting,$58.34 ,85% of total billed charges for outpatient setting,$48.05 ,70% of total billed charges for outpatient setting,$48.05 ,70% of total billed charges for outpatient setting,$52.85 ,77% of total billed charges for outpatient setting,$13.77 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$58.34 ,85% of total billed charges for outpatient setting,$58.34 ,85% of total billed charges for outpatient setting,$58.34 ,85% of total billed charges for outpatient setting,$58.34 ,85% of total billed charges for outpatient setting,$58.34 ,85% of total billed charges for outpatient setting,$17.47 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$13.77 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.77 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.77 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.77 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$58.34 ,85% of total billed charges for outpatient setting,$17.13 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$13.63 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$61.78 ,90% of total billed charges for outpatient setting,$17.64 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$65.21 ,95% of total billed charges for outpatient setting,$58.34 ,85% of total billed charges for outpatient setting,$54.91 ,80% of total billed charges for outpatient setting,$17.47 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$58.34 ,85% of total billed charges for outpatient setting,$58.34 ,85% of total billed charges for outpatient setting,$58.34 ,85% of total billed charges for outpatient setting,$63.84 ,93% of total billed charges for outpatient setting,$51.48 ,75% of total billed charges for outpatient setting,$51.48 ,75% of total billed charges for outpatient setting,$51.48 ,75% of total billed charges for outpatient setting,$13.78 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$58.34 ,85% of total billed charges for outpatient setting,$17.47 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$13.63 ,$65.21 ,$24.02 Outpatient Medical Services,LAB,82746,Folate Level,300,$43.00 ,$19.41 ,100% Amerigroup fee schedule for outpatient setting,$19.41 ,100% Amerigroup fee schedule for outpatient setting,$21.50 ,75% of total billed charges for outpatient setting,$21.50 ,75% of total billed charges for outpatient setting,$21.50 ,75% of total billed charges for outpatient setting,$14.99 ,102% CMS Medicare OPPS fee schedule,$14.99 ,102% CMS Medicare OPPS fee schedule,$14.99 ,102% CMS Medicare OPPS fee schedule,$14.99 ,102% CMS Medicare OPPS fee schedule,$14.99 ,102% CMS Medicare OPPS fee schedule,$14.99 ,102% CMS Medicare OPPS fee schedule,$34.40 ,80% of total billed charges for outpatient setting,$14.99 ,102% CMS Medicare OPPS fee schedule,$19.41 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$36.55 ,85% of total billed charges for outpatient setting,$14.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$34.40 ,80% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$30.10 ,70% of total billed charges for outpatient setting,$30.10 ,70% of total billed charges for outpatient setting,$33.11 ,77% of total billed charges for outpatient setting,$14.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$18.86 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$14.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$14.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$14.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$14.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$18.49 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$14.70 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$38.70 ,90% of total billed charges for outpatient setting,$19.04 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$40.85 ,95% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$34.40 ,80% of total billed charges for outpatient setting,$18.86 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$36.55 ,85% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$39.99 ,93% of total billed charges for outpatient setting,$32.25 ,75% of total billed charges for outpatient setting,$32.25 ,75% of total billed charges for outpatient setting,$32.25 ,75% of total billed charges for outpatient setting,$8.63 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$36.55 ,85% of total billed charges for outpatient setting,$18.86 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.63 ,$40.85 ,$15.05 Outpatient Medical Services,LAB,82746,Folate Level,301,$56.49 ,$19.41 ,100% Amerigroup fee schedule for outpatient setting,$19.41 ,100% Amerigroup fee schedule for outpatient setting,$28.25 ,75% of total billed charges for outpatient setting,$28.25 ,75% of total billed charges for outpatient setting,$28.25 ,75% of total billed charges for outpatient setting,$14.99 ,102% CMS Medicare OPPS fee schedule,$14.99 ,102% CMS Medicare OPPS fee schedule,$14.99 ,102% CMS Medicare OPPS fee schedule,$14.99 ,102% CMS Medicare OPPS fee schedule,$14.99 ,102% CMS Medicare OPPS fee schedule,$14.99 ,102% CMS Medicare OPPS fee schedule,$45.19 ,80% of total billed charges for outpatient setting,$14.99 ,102% CMS Medicare OPPS fee schedule,$19.41 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$48.02 ,85% of total billed charges for outpatient setting,$14.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$45.19 ,80% of total billed charges for outpatient setting,$48.02 ,85% of total billed charges for outpatient setting,$39.54 ,70% of total billed charges for outpatient setting,$39.54 ,70% of total billed charges for outpatient setting,$43.50 ,77% of total billed charges for outpatient setting,$14.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$48.02 ,85% of total billed charges for outpatient setting,$48.02 ,85% of total billed charges for outpatient setting,$48.02 ,85% of total billed charges for outpatient setting,$48.02 ,85% of total billed charges for outpatient setting,$48.02 ,85% of total billed charges for outpatient setting,$18.86 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$14.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$14.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$14.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$14.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$48.02 ,85% of total billed charges for outpatient setting,$18.49 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$14.70 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$50.84 ,90% of total billed charges for outpatient setting,$19.04 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$53.67 ,95% of total billed charges for outpatient setting,$48.02 ,85% of total billed charges for outpatient setting,$45.19 ,80% of total billed charges for outpatient setting,$18.86 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$48.02 ,85% of total billed charges for outpatient setting,$48.02 ,85% of total billed charges for outpatient setting,$48.02 ,85% of total billed charges for outpatient setting,$52.54 ,93% of total billed charges for outpatient setting,$42.37 ,75% of total billed charges for outpatient setting,$42.37 ,75% of total billed charges for outpatient setting,$42.37 ,75% of total billed charges for outpatient setting,$11.34 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$48.02 ,85% of total billed charges for outpatient setting,$18.86 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$11.34 ,$53.67 ,$19.77 Outpatient Medical Services,LAB,82747,Folate,301,$43.00 ,$22.87 ,100% Amerigroup fee schedule for outpatient setting,$22.87 ,100% Amerigroup fee schedule for outpatient setting,$21.50 ,75% of total billed charges for outpatient setting,$21.50 ,75% of total billed charges for outpatient setting,$21.50 ,75% of total billed charges for outpatient setting,$18.00 ,102% CMS Medicare OPPS fee schedule,$18.00 ,102% CMS Medicare OPPS fee schedule,$18.00 ,102% CMS Medicare OPPS fee schedule,$18.00 ,102% CMS Medicare OPPS fee schedule,$18.00 ,102% CMS Medicare OPPS fee schedule,$18.00 ,102% CMS Medicare OPPS fee schedule,$34.40 ,80% of total billed charges for outpatient setting,$18.00 ,102% CMS Medicare OPPS fee schedule,$22.87 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$36.55 ,85% of total billed charges for outpatient setting,$17.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$34.40 ,80% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$30.10 ,70% of total billed charges for outpatient setting,$30.10 ,70% of total billed charges for outpatient setting,$33.11 ,77% of total billed charges for outpatient setting,$17.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$22.22 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$17.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$17.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$17.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$17.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$21.78 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$17.65 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$38.70 ,90% of total billed charges for outpatient setting,$22.43 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$40.85 ,95% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$34.40 ,80% of total billed charges for outpatient setting,$22.22 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$36.55 ,85% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$39.99 ,93% of total billed charges for outpatient setting,$32.25 ,75% of total billed charges for outpatient setting,$32.25 ,75% of total billed charges for outpatient setting,$32.25 ,75% of total billed charges for outpatient setting,$8.63 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$36.55 ,85% of total billed charges for outpatient setting,$22.22 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.63 ,$40.85 ,$15.05 Outpatient Medical Services,LAB,82747,Folate,300,$30.75 ,$22.87 ,100% Amerigroup fee schedule for outpatient setting,$22.87 ,100% Amerigroup fee schedule for outpatient setting,$15.38 ,75% of total billed charges for outpatient setting,$15.38 ,75% of total billed charges for outpatient setting,$15.38 ,75% of total billed charges for outpatient setting,$18.00 ,102% CMS Medicare OPPS fee schedule,$18.00 ,102% CMS Medicare OPPS fee schedule,$18.00 ,102% CMS Medicare OPPS fee schedule,$18.00 ,102% CMS Medicare OPPS fee schedule,$18.00 ,102% CMS Medicare OPPS fee schedule,$18.00 ,102% CMS Medicare OPPS fee schedule,$24.60 ,80% of total billed charges for outpatient setting,$18.00 ,102% CMS Medicare OPPS fee schedule,$22.87 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$26.14 ,85% of total billed charges for outpatient setting,$17.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$24.60 ,80% of total billed charges for outpatient setting,$26.14 ,85% of total billed charges for outpatient setting,$21.53 ,70% of total billed charges for outpatient setting,$21.53 ,70% of total billed charges for outpatient setting,$23.68 ,77% of total billed charges for outpatient setting,$17.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$26.14 ,85% of total billed charges for outpatient setting,$26.14 ,85% of total billed charges for outpatient setting,$26.14 ,85% of total billed charges for outpatient setting,$26.14 ,85% of total billed charges for outpatient setting,$26.14 ,85% of total billed charges for outpatient setting,$22.22 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$17.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$17.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$17.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$17.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$26.14 ,85% of total billed charges for outpatient setting,$21.78 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$17.65 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$27.68 ,90% of total billed charges for outpatient setting,$22.43 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$29.21 ,95% of total billed charges for outpatient setting,$26.14 ,85% of total billed charges for outpatient setting,$24.60 ,80% of total billed charges for outpatient setting,$22.22 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$26.14 ,85% of total billed charges for outpatient setting,$26.14 ,85% of total billed charges for outpatient setting,$26.14 ,85% of total billed charges for outpatient setting,$28.60 ,93% of total billed charges for outpatient setting,$23.06 ,75% of total billed charges for outpatient setting,$23.06 ,75% of total billed charges for outpatient setting,$23.06 ,75% of total billed charges for outpatient setting,$6.17 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$26.14 ,85% of total billed charges for outpatient setting,$22.22 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$6.17 ,$29.21 ,$10.76 Outpatient Medical Services,LAB,82747,Vitamin B12 and Folate LC,300,$30.75 ,$22.87 ,100% Amerigroup fee schedule for outpatient setting,$22.87 ,100% Amerigroup fee schedule for outpatient setting,$15.38 ,75% of total billed charges for outpatient setting,$15.38 ,75% of total billed charges for outpatient setting,$15.38 ,75% of total billed charges for outpatient setting,$18.00 ,102% CMS Medicare OPPS fee schedule,$18.00 ,102% CMS Medicare OPPS fee schedule,$18.00 ,102% CMS Medicare OPPS fee schedule,$18.00 ,102% CMS Medicare OPPS fee schedule,$18.00 ,102% CMS Medicare OPPS fee schedule,$18.00 ,102% CMS Medicare OPPS fee schedule,$24.60 ,80% of total billed charges for outpatient setting,$18.00 ,102% CMS Medicare OPPS fee schedule,$22.87 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$26.14 ,85% of total billed charges for outpatient setting,$17.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$24.60 ,80% of total billed charges for outpatient setting,$26.14 ,85% of total billed charges for outpatient setting,$21.53 ,70% of total billed charges for outpatient setting,$21.53 ,70% of total billed charges for outpatient setting,$23.68 ,77% of total billed charges for outpatient setting,$17.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$26.14 ,85% of total billed charges for outpatient setting,$26.14 ,85% of total billed charges for outpatient setting,$26.14 ,85% of total billed charges for outpatient setting,$26.14 ,85% of total billed charges for outpatient setting,$26.14 ,85% of total billed charges for outpatient setting,$22.22 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$17.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$17.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$17.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$17.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$26.14 ,85% of total billed charges for outpatient setting,$21.78 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$17.65 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$27.68 ,90% of total billed charges for outpatient setting,$22.43 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$29.21 ,95% of total billed charges for outpatient setting,$26.14 ,85% of total billed charges for outpatient setting,$24.60 ,80% of total billed charges for outpatient setting,$22.22 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$26.14 ,85% of total billed charges for outpatient setting,$26.14 ,85% of total billed charges for outpatient setting,$26.14 ,85% of total billed charges for outpatient setting,$28.60 ,93% of total billed charges for outpatient setting,$23.06 ,75% of total billed charges for outpatient setting,$23.06 ,75% of total billed charges for outpatient setting,$23.06 ,75% of total billed charges for outpatient setting,$6.17 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$26.14 ,85% of total billed charges for outpatient setting,$22.22 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$6.17 ,$29.21 ,$10.76 Outpatient Medical Services,LAB,82803,Blood Gas Arterial,300,$188.76 ,$25.56 ,100% Amerigroup fee schedule for outpatient setting,$25.56 ,100% Amerigroup fee schedule for outpatient setting,$94.38 ,75% of total billed charges for outpatient setting,$94.38 ,75% of total billed charges for outpatient setting,$94.38 ,75% of total billed charges for outpatient setting,$26.59 ,102% CMS Medicare OPPS fee schedule,$26.59 ,102% CMS Medicare OPPS fee schedule,$26.59 ,102% CMS Medicare OPPS fee schedule,$26.59 ,102% CMS Medicare OPPS fee schedule,$26.59 ,102% CMS Medicare OPPS fee schedule,$26.59 ,102% CMS Medicare OPPS fee schedule,$151.01 ,80% of total billed charges for outpatient setting,$26.59 ,102% CMS Medicare OPPS fee schedule,$25.56 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$160.45 ,85% of total billed charges for outpatient setting,$26.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$151.01 ,80% of total billed charges for outpatient setting,$160.45 ,85% of total billed charges for outpatient setting,$132.13 ,70% of total billed charges for outpatient setting,$132.13 ,70% of total billed charges for outpatient setting,$145.35 ,77% of total billed charges for outpatient setting,$26.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$160.45 ,85% of total billed charges for outpatient setting,$160.45 ,85% of total billed charges for outpatient setting,$160.45 ,85% of total billed charges for outpatient setting,$160.45 ,85% of total billed charges for outpatient setting,$160.45 ,85% of total billed charges for outpatient setting,$24.83 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$26.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$26.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$26.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$26.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$160.45 ,85% of total billed charges for outpatient setting,$24.34 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$26.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$169.88 ,90% of total billed charges for outpatient setting,$25.07 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$179.32 ,95% of total billed charges for outpatient setting,$160.45 ,85% of total billed charges for outpatient setting,$151.01 ,80% of total billed charges for outpatient setting,$24.83 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$160.45 ,85% of total billed charges for outpatient setting,$160.45 ,85% of total billed charges for outpatient setting,$160.45 ,85% of total billed charges for outpatient setting,$175.55 ,93% of total billed charges for outpatient setting,$141.57 ,75% of total billed charges for outpatient setting,$141.57 ,75% of total billed charges for outpatient setting,$141.57 ,75% of total billed charges for outpatient setting,$37.90 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$160.45 ,85% of total billed charges for outpatient setting,$24.83 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$24.34 ,$179.32 ,$66.07 Outpatient Medical Services,LAB,82803,VBG,300,$188.76 ,$25.56 ,100% Amerigroup fee schedule for outpatient setting,$25.56 ,100% Amerigroup fee schedule for outpatient setting,$94.38 ,75% of total billed charges for outpatient setting,$94.38 ,75% of total billed charges for outpatient setting,$94.38 ,75% of total billed charges for outpatient setting,$26.59 ,102% CMS Medicare OPPS fee schedule,$26.59 ,102% CMS Medicare OPPS fee schedule,$26.59 ,102% CMS Medicare OPPS fee schedule,$26.59 ,102% CMS Medicare OPPS fee schedule,$26.59 ,102% CMS Medicare OPPS fee schedule,$26.59 ,102% CMS Medicare OPPS fee schedule,$151.01 ,80% of total billed charges for outpatient setting,$26.59 ,102% CMS Medicare OPPS fee schedule,$25.56 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$160.45 ,85% of total billed charges for outpatient setting,$26.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$151.01 ,80% of total billed charges for outpatient setting,$160.45 ,85% of total billed charges for outpatient setting,$132.13 ,70% of total billed charges for outpatient setting,$132.13 ,70% of total billed charges for outpatient setting,$145.35 ,77% of total billed charges for outpatient setting,$26.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$160.45 ,85% of total billed charges for outpatient setting,$160.45 ,85% of total billed charges for outpatient setting,$160.45 ,85% of total billed charges for outpatient setting,$160.45 ,85% of total billed charges for outpatient setting,$160.45 ,85% of total billed charges for outpatient setting,$24.83 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$26.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$26.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$26.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$26.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$160.45 ,85% of total billed charges for outpatient setting,$24.34 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$26.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$169.88 ,90% of total billed charges for outpatient setting,$25.07 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$179.32 ,95% of total billed charges for outpatient setting,$160.45 ,85% of total billed charges for outpatient setting,$151.01 ,80% of total billed charges for outpatient setting,$24.83 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$160.45 ,85% of total billed charges for outpatient setting,$160.45 ,85% of total billed charges for outpatient setting,$160.45 ,85% of total billed charges for outpatient setting,$175.55 ,93% of total billed charges for outpatient setting,$141.57 ,75% of total billed charges for outpatient setting,$141.57 ,75% of total billed charges for outpatient setting,$141.57 ,75% of total billed charges for outpatient setting,$37.90 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$160.45 ,85% of total billed charges for outpatient setting,$24.83 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$24.34 ,$179.32 ,$66.07 Outpatient Medical Services,LAB,82947,Glucose Level,301,$49.34 ,$5.18 ,100% Amerigroup fee schedule for outpatient setting,$5.18 ,100% Amerigroup fee schedule for outpatient setting,$24.67 ,75% of total billed charges for outpatient setting,$24.67 ,75% of total billed charges for outpatient setting,$24.67 ,75% of total billed charges for outpatient setting,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$39.47 ,80% of total billed charges for outpatient setting,$4.01 ,102% CMS Medicare OPPS fee schedule,$5.18 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$41.94 ,85% of total billed charges for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$39.47 ,80% of total billed charges for outpatient setting,$41.94 ,85% of total billed charges for outpatient setting,$34.54 ,70% of total billed charges for outpatient setting,$34.54 ,70% of total billed charges for outpatient setting,$37.99 ,77% of total billed charges for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$41.94 ,85% of total billed charges for outpatient setting,$41.94 ,85% of total billed charges for outpatient setting,$41.94 ,85% of total billed charges for outpatient setting,$41.94 ,85% of total billed charges for outpatient setting,$41.94 ,85% of total billed charges for outpatient setting,$5.03 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$41.94 ,85% of total billed charges for outpatient setting,$4.93 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$3.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$44.41 ,90% of total billed charges for outpatient setting,$5.08 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$46.87 ,95% of total billed charges for outpatient setting,$41.94 ,85% of total billed charges for outpatient setting,$39.47 ,80% of total billed charges for outpatient setting,$5.03 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$41.94 ,85% of total billed charges for outpatient setting,$41.94 ,85% of total billed charges for outpatient setting,$41.94 ,85% of total billed charges for outpatient setting,$45.89 ,93% of total billed charges for outpatient setting,$37.01 ,75% of total billed charges for outpatient setting,$37.01 ,75% of total billed charges for outpatient setting,$37.01 ,75% of total billed charges for outpatient setting,$9.91 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$41.94 ,85% of total billed charges for outpatient setting,$5.03 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.93 ,$46.87 ,$17.27 Outpatient Medical Services,LAB,82947,.GTT 1 HR,300,$42.00 ,$5.18 ,100% Amerigroup fee schedule for outpatient setting,$5.18 ,100% Amerigroup fee schedule for outpatient setting,$21.00 ,75% of total billed charges for outpatient setting,$21.00 ,75% of total billed charges for outpatient setting,$21.00 ,75% of total billed charges for outpatient setting,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$33.60 ,80% of total billed charges for outpatient setting,$4.01 ,102% CMS Medicare OPPS fee schedule,$5.18 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$35.70 ,85% of total billed charges for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$33.60 ,80% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$29.40 ,70% of total billed charges for outpatient setting,$29.40 ,70% of total billed charges for outpatient setting,$32.34 ,77% of total billed charges for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$5.03 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$4.93 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$3.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$37.80 ,90% of total billed charges for outpatient setting,$5.08 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$39.90 ,95% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$33.60 ,80% of total billed charges for outpatient setting,$5.03 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$39.06 ,93% of total billed charges for outpatient setting,$31.50 ,75% of total billed charges for outpatient setting,$31.50 ,75% of total billed charges for outpatient setting,$31.50 ,75% of total billed charges for outpatient setting,$8.43 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$35.70 ,85% of total billed charges for outpatient setting,$5.03 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.93 ,$39.90 ,$14.70 Outpatient Medical Services,LAB,82947,.GTT 2 HR,300,$42.00 ,$5.18 ,100% Amerigroup fee schedule for outpatient setting,$5.18 ,100% Amerigroup fee schedule for outpatient setting,$21.00 ,75% of total billed charges for outpatient setting,$21.00 ,75% of total billed charges for outpatient setting,$21.00 ,75% of total billed charges for outpatient setting,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$33.60 ,80% of total billed charges for outpatient setting,$4.01 ,102% CMS Medicare OPPS fee schedule,$5.18 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$35.70 ,85% of total billed charges for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$33.60 ,80% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$29.40 ,70% of total billed charges for outpatient setting,$29.40 ,70% of total billed charges for outpatient setting,$32.34 ,77% of total billed charges for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$5.03 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$4.93 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$3.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$37.80 ,90% of total billed charges for outpatient setting,$5.08 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$39.90 ,95% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$33.60 ,80% of total billed charges for outpatient setting,$5.03 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$39.06 ,93% of total billed charges for outpatient setting,$31.50 ,75% of total billed charges for outpatient setting,$31.50 ,75% of total billed charges for outpatient setting,$31.50 ,75% of total billed charges for outpatient setting,$8.43 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$35.70 ,85% of total billed charges for outpatient setting,$5.03 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.93 ,$39.90 ,$14.70 Outpatient Medical Services,LAB,82947,.GTT 3 HR,300,$42.00 ,$5.18 ,100% Amerigroup fee schedule for outpatient setting,$5.18 ,100% Amerigroup fee schedule for outpatient setting,$21.00 ,75% of total billed charges for outpatient setting,$21.00 ,75% of total billed charges for outpatient setting,$21.00 ,75% of total billed charges for outpatient setting,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$33.60 ,80% of total billed charges for outpatient setting,$4.01 ,102% CMS Medicare OPPS fee schedule,$5.18 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$35.70 ,85% of total billed charges for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$33.60 ,80% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$29.40 ,70% of total billed charges for outpatient setting,$29.40 ,70% of total billed charges for outpatient setting,$32.34 ,77% of total billed charges for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$5.03 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$4.93 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$3.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$37.80 ,90% of total billed charges for outpatient setting,$5.08 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$39.90 ,95% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$33.60 ,80% of total billed charges for outpatient setting,$5.03 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$39.06 ,93% of total billed charges for outpatient setting,$31.50 ,75% of total billed charges for outpatient setting,$31.50 ,75% of total billed charges for outpatient setting,$31.50 ,75% of total billed charges for outpatient setting,$8.43 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$35.70 ,85% of total billed charges for outpatient setting,$5.03 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.93 ,$39.90 ,$14.70 Outpatient Medical Services,LAB,82947,.GTT 4 HR,300,$42.00 ,$5.18 ,100% Amerigroup fee schedule for outpatient setting,$5.18 ,100% Amerigroup fee schedule for outpatient setting,$21.00 ,75% of total billed charges for outpatient setting,$21.00 ,75% of total billed charges for outpatient setting,$21.00 ,75% of total billed charges for outpatient setting,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$33.60 ,80% of total billed charges for outpatient setting,$4.01 ,102% CMS Medicare OPPS fee schedule,$5.18 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$35.70 ,85% of total billed charges for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$33.60 ,80% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$29.40 ,70% of total billed charges for outpatient setting,$29.40 ,70% of total billed charges for outpatient setting,$32.34 ,77% of total billed charges for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$5.03 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$4.93 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$3.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$37.80 ,90% of total billed charges for outpatient setting,$5.08 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$39.90 ,95% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$33.60 ,80% of total billed charges for outpatient setting,$5.03 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$39.06 ,93% of total billed charges for outpatient setting,$31.50 ,75% of total billed charges for outpatient setting,$31.50 ,75% of total billed charges for outpatient setting,$31.50 ,75% of total billed charges for outpatient setting,$8.43 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$35.70 ,85% of total billed charges for outpatient setting,$5.03 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.93 ,$39.90 ,$14.70 Outpatient Medical Services,LAB,82947,.Glucose Fasting,301,$49.34 ,$5.18 ,100% Amerigroup fee schedule for outpatient setting,$5.18 ,100% Amerigroup fee schedule for outpatient setting,$24.67 ,75% of total billed charges for outpatient setting,$24.67 ,75% of total billed charges for outpatient setting,$24.67 ,75% of total billed charges for outpatient setting,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$39.47 ,80% of total billed charges for outpatient setting,$4.01 ,102% CMS Medicare OPPS fee schedule,$5.18 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$41.94 ,85% of total billed charges for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$39.47 ,80% of total billed charges for outpatient setting,$41.94 ,85% of total billed charges for outpatient setting,$34.54 ,70% of total billed charges for outpatient setting,$34.54 ,70% of total billed charges for outpatient setting,$37.99 ,77% of total billed charges for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$41.94 ,85% of total billed charges for outpatient setting,$41.94 ,85% of total billed charges for outpatient setting,$41.94 ,85% of total billed charges for outpatient setting,$41.94 ,85% of total billed charges for outpatient setting,$41.94 ,85% of total billed charges for outpatient setting,$5.03 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$41.94 ,85% of total billed charges for outpatient setting,$4.93 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$3.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$44.41 ,90% of total billed charges for outpatient setting,$5.08 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$46.87 ,95% of total billed charges for outpatient setting,$41.94 ,85% of total billed charges for outpatient setting,$39.47 ,80% of total billed charges for outpatient setting,$5.03 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$41.94 ,85% of total billed charges for outpatient setting,$41.94 ,85% of total billed charges for outpatient setting,$41.94 ,85% of total billed charges for outpatient setting,$45.89 ,93% of total billed charges for outpatient setting,$37.01 ,75% of total billed charges for outpatient setting,$37.01 ,75% of total billed charges for outpatient setting,$37.01 ,75% of total billed charges for outpatient setting,$9.91 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$41.94 ,85% of total billed charges for outpatient setting,$5.03 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.93 ,$46.87 ,$17.27 Outpatient Medical Services,LAB,82947,.GTT 3 HR OB,300,$42.00 ,$5.18 ,100% Amerigroup fee schedule for outpatient setting,$5.18 ,100% Amerigroup fee schedule for outpatient setting,$21.00 ,75% of total billed charges for outpatient setting,$21.00 ,75% of total billed charges for outpatient setting,$21.00 ,75% of total billed charges for outpatient setting,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$33.60 ,80% of total billed charges for outpatient setting,$4.01 ,102% CMS Medicare OPPS fee schedule,$5.18 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$35.70 ,85% of total billed charges for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$33.60 ,80% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$29.40 ,70% of total billed charges for outpatient setting,$29.40 ,70% of total billed charges for outpatient setting,$32.34 ,77% of total billed charges for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$5.03 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$4.93 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$3.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$37.80 ,90% of total billed charges for outpatient setting,$5.08 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$39.90 ,95% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$33.60 ,80% of total billed charges for outpatient setting,$5.03 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$39.06 ,93% of total billed charges for outpatient setting,$31.50 ,75% of total billed charges for outpatient setting,$31.50 ,75% of total billed charges for outpatient setting,$31.50 ,75% of total billed charges for outpatient setting,$8.43 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$35.70 ,85% of total billed charges for outpatient setting,$5.03 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.93 ,$39.90 ,$14.70 Outpatient Medical Services,LAB,82947,Gestational Diabetes Screen,300,$42.00 ,$5.18 ,100% Amerigroup fee schedule for outpatient setting,$5.18 ,100% Amerigroup fee schedule for outpatient setting,$21.00 ,75% of total billed charges for outpatient setting,$21.00 ,75% of total billed charges for outpatient setting,$21.00 ,75% of total billed charges for outpatient setting,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$33.60 ,80% of total billed charges for outpatient setting,$4.01 ,102% CMS Medicare OPPS fee schedule,$5.18 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$35.70 ,85% of total billed charges for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$33.60 ,80% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$29.40 ,70% of total billed charges for outpatient setting,$29.40 ,70% of total billed charges for outpatient setting,$32.34 ,77% of total billed charges for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$5.03 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$4.93 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$3.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$37.80 ,90% of total billed charges for outpatient setting,$5.08 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$39.90 ,95% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$33.60 ,80% of total billed charges for outpatient setting,$5.03 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$39.06 ,93% of total billed charges for outpatient setting,$31.50 ,75% of total billed charges for outpatient setting,$31.50 ,75% of total billed charges for outpatient setting,$31.50 ,75% of total billed charges for outpatient setting,$8.43 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$35.70 ,85% of total billed charges for outpatient setting,$5.03 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.93 ,$39.90 ,$14.70 Outpatient Medical Services,LAB,82947,.GTT 5 HR,300,$42.00 ,$5.18 ,100% Amerigroup fee schedule for outpatient setting,$5.18 ,100% Amerigroup fee schedule for outpatient setting,$21.00 ,75% of total billed charges for outpatient setting,$21.00 ,75% of total billed charges for outpatient setting,$21.00 ,75% of total billed charges for outpatient setting,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$33.60 ,80% of total billed charges for outpatient setting,$4.01 ,102% CMS Medicare OPPS fee schedule,$5.18 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$35.70 ,85% of total billed charges for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$33.60 ,80% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$29.40 ,70% of total billed charges for outpatient setting,$29.40 ,70% of total billed charges for outpatient setting,$32.34 ,77% of total billed charges for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$5.03 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$4.93 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$3.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$37.80 ,90% of total billed charges for outpatient setting,$5.08 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$39.90 ,95% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$33.60 ,80% of total billed charges for outpatient setting,$5.03 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$39.06 ,93% of total billed charges for outpatient setting,$31.50 ,75% of total billed charges for outpatient setting,$31.50 ,75% of total billed charges for outpatient setting,$31.50 ,75% of total billed charges for outpatient setting,$8.43 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$35.70 ,85% of total billed charges for outpatient setting,$5.03 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.93 ,$39.90 ,$14.70 Outpatient Medical Services,LAB,82947,Glucose 2 Hour Post Prandial,300,$42.00 ,$5.18 ,100% Amerigroup fee schedule for outpatient setting,$5.18 ,100% Amerigroup fee schedule for outpatient setting,$21.00 ,75% of total billed charges for outpatient setting,$21.00 ,75% of total billed charges for outpatient setting,$21.00 ,75% of total billed charges for outpatient setting,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$4.01 ,102% CMS Medicare OPPS fee schedule,$33.60 ,80% of total billed charges for outpatient setting,$4.01 ,102% CMS Medicare OPPS fee schedule,$5.18 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$35.70 ,85% of total billed charges for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$33.60 ,80% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$29.40 ,70% of total billed charges for outpatient setting,$29.40 ,70% of total billed charges for outpatient setting,$32.34 ,77% of total billed charges for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$5.03 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$4.93 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$3.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$37.80 ,90% of total billed charges for outpatient setting,$5.08 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$39.90 ,95% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$33.60 ,80% of total billed charges for outpatient setting,$5.03 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$39.06 ,93% of total billed charges for outpatient setting,$31.50 ,75% of total billed charges for outpatient setting,$31.50 ,75% of total billed charges for outpatient setting,$31.50 ,75% of total billed charges for outpatient setting,$8.43 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$35.70 ,85% of total billed charges for outpatient setting,$5.03 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.93 ,$39.90 ,$14.70 Outpatient Medical Services,LAB,82977,Gamma Glutamyl Transferase,300,N/A,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$7.34 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$7.34 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$7.34 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$7.34 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$7.34 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$7.34 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,N/A,Not seperately reimbursable,$7.34 ,102% CMS Medicare OPPS fee schedule,$6.67 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,N/A,Not seperately reimbursable,$7.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$7.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$6.48 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$7.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$7.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$7.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$7.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,N/A,Not seperately reimbursable,$6.35 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$7.20 ,100% CMS Medicare OPPS fee schedule for outpatient setting,N/A,Not seperately reimbursable,$6.54 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$6.48 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,N/A,Not seperately reimbursable,$6.48 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$6.35 ,$7.34 ,N/A Outpatient Medical Services,LAB,82977,GGT LC,300,N/A,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$7.34 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$7.34 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$7.34 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$7.34 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$7.34 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$7.34 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,N/A,Not seperately reimbursable,$7.34 ,102% CMS Medicare OPPS fee schedule,$6.67 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,N/A,Not seperately reimbursable,$7.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$7.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$6.48 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$7.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$7.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$7.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$7.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,N/A,Not seperately reimbursable,$6.35 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$7.20 ,100% CMS Medicare OPPS fee schedule for outpatient setting,N/A,Not seperately reimbursable,$6.54 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$6.48 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,N/A,Not seperately reimbursable,$6.48 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$6.35 ,$7.34 ,N/A Outpatient Medical Services,LAB,83036,Hemoglobin A1c,301,$153.00 ,$12.81 ,100% Amerigroup fee schedule for outpatient setting,$12.81 ,100% Amerigroup fee schedule for outpatient setting,$76.50 ,75% of total billed charges for outpatient setting,$76.50 ,75% of total billed charges for outpatient setting,$76.50 ,75% of total billed charges for outpatient setting,$9.90 ,102% CMS Medicare OPPS fee schedule,$9.90 ,102% CMS Medicare OPPS fee schedule,$9.90 ,102% CMS Medicare OPPS fee schedule,$9.90 ,102% CMS Medicare OPPS fee schedule,$9.90 ,102% CMS Medicare OPPS fee schedule,$9.90 ,102% CMS Medicare OPPS fee schedule,$122.40 ,80% of total billed charges for outpatient setting,$9.90 ,102% CMS Medicare OPPS fee schedule,$12.81 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$130.05 ,85% of total billed charges for outpatient setting,$9.81 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$122.40 ,80% of total billed charges for outpatient setting,$130.05 ,85% of total billed charges for outpatient setting,$107.10 ,70% of total billed charges for outpatient setting,$107.10 ,70% of total billed charges for outpatient setting,$117.81 ,77% of total billed charges for outpatient setting,$9.81 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$130.05 ,85% of total billed charges for outpatient setting,$130.05 ,85% of total billed charges for outpatient setting,$130.05 ,85% of total billed charges for outpatient setting,$130.05 ,85% of total billed charges for outpatient setting,$130.05 ,85% of total billed charges for outpatient setting,$12.44 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$9.81 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.81 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.81 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.81 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$130.05 ,85% of total billed charges for outpatient setting,$12.20 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$9.71 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$137.70 ,90% of total billed charges for outpatient setting,$12.57 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$145.35 ,95% of total billed charges for outpatient setting,$130.05 ,85% of total billed charges for outpatient setting,$122.40 ,80% of total billed charges for outpatient setting,$12.44 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$130.05 ,85% of total billed charges for outpatient setting,$130.05 ,85% of total billed charges for outpatient setting,$130.05 ,85% of total billed charges for outpatient setting,$142.29 ,93% of total billed charges for outpatient setting,$114.75 ,75% of total billed charges for outpatient setting,$114.75 ,75% of total billed charges for outpatient setting,$114.75 ,75% of total billed charges for outpatient setting,$30.72 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$130.05 ,85% of total billed charges for outpatient setting,$12.44 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$9.71 ,$145.35 ,$53.55 Outpatient Medical Services,LAB,83036,Hemoglobin A1c LC,301,$153.00 ,$12.81 ,100% Amerigroup fee schedule for outpatient setting,$12.81 ,100% Amerigroup fee schedule for outpatient setting,$76.50 ,75% of total billed charges for outpatient setting,$76.50 ,75% of total billed charges for outpatient setting,$76.50 ,75% of total billed charges for outpatient setting,$9.90 ,102% CMS Medicare OPPS fee schedule,$9.90 ,102% CMS Medicare OPPS fee schedule,$9.90 ,102% CMS Medicare OPPS fee schedule,$9.90 ,102% CMS Medicare OPPS fee schedule,$9.90 ,102% CMS Medicare OPPS fee schedule,$9.90 ,102% CMS Medicare OPPS fee schedule,$122.40 ,80% of total billed charges for outpatient setting,$9.90 ,102% CMS Medicare OPPS fee schedule,$12.81 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$130.05 ,85% of total billed charges for outpatient setting,$9.81 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$122.40 ,80% of total billed charges for outpatient setting,$130.05 ,85% of total billed charges for outpatient setting,$107.10 ,70% of total billed charges for outpatient setting,$107.10 ,70% of total billed charges for outpatient setting,$117.81 ,77% of total billed charges for outpatient setting,$9.81 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$130.05 ,85% of total billed charges for outpatient setting,$130.05 ,85% of total billed charges for outpatient setting,$130.05 ,85% of total billed charges for outpatient setting,$130.05 ,85% of total billed charges for outpatient setting,$130.05 ,85% of total billed charges for outpatient setting,$12.44 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$9.81 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.81 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.81 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.81 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$130.05 ,85% of total billed charges for outpatient setting,$12.20 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$9.71 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$137.70 ,90% of total billed charges for outpatient setting,$12.57 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$145.35 ,95% of total billed charges for outpatient setting,$130.05 ,85% of total billed charges for outpatient setting,$122.40 ,80% of total billed charges for outpatient setting,$12.44 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$130.05 ,85% of total billed charges for outpatient setting,$130.05 ,85% of total billed charges for outpatient setting,$130.05 ,85% of total billed charges for outpatient setting,$142.29 ,93% of total billed charges for outpatient setting,$114.75 ,75% of total billed charges for outpatient setting,$114.75 ,75% of total billed charges for outpatient setting,$114.75 ,75% of total billed charges for outpatient setting,$30.72 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$130.05 ,85% of total billed charges for outpatient setting,$12.44 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$9.71 ,$145.35 ,$53.55 Outpatient Medical Services,LAB,83540,Iron,300,$71.66 ,$8.56 ,100% Amerigroup fee schedule for outpatient setting,$8.56 ,100% Amerigroup fee schedule for outpatient setting,$35.83 ,75% of total billed charges for outpatient setting,$35.83 ,75% of total billed charges for outpatient setting,$35.83 ,75% of total billed charges for outpatient setting,$6.60 ,102% CMS Medicare OPPS fee schedule,$6.60 ,102% CMS Medicare OPPS fee schedule,$6.60 ,102% CMS Medicare OPPS fee schedule,$6.60 ,102% CMS Medicare OPPS fee schedule,$6.60 ,102% CMS Medicare OPPS fee schedule,$6.60 ,102% CMS Medicare OPPS fee schedule,$57.33 ,80% of total billed charges for outpatient setting,$6.60 ,102% CMS Medicare OPPS fee schedule,$8.56 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$60.91 ,85% of total billed charges for outpatient setting,$6.53 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$57.33 ,80% of total billed charges for outpatient setting,$60.91 ,85% of total billed charges for outpatient setting,$50.16 ,70% of total billed charges for outpatient setting,$50.16 ,70% of total billed charges for outpatient setting,$55.18 ,77% of total billed charges for outpatient setting,$6.53 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$60.91 ,85% of total billed charges for outpatient setting,$60.91 ,85% of total billed charges for outpatient setting,$60.91 ,85% of total billed charges for outpatient setting,$60.91 ,85% of total billed charges for outpatient setting,$60.91 ,85% of total billed charges for outpatient setting,$8.31 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$6.53 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.53 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.53 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.53 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$60.91 ,85% of total billed charges for outpatient setting,$8.15 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$6.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$64.49 ,90% of total billed charges for outpatient setting,$8.39 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$68.08 ,95% of total billed charges for outpatient setting,$60.91 ,85% of total billed charges for outpatient setting,$57.33 ,80% of total billed charges for outpatient setting,$8.31 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$60.91 ,85% of total billed charges for outpatient setting,$60.91 ,85% of total billed charges for outpatient setting,$60.91 ,85% of total billed charges for outpatient setting,$66.64 ,93% of total billed charges for outpatient setting,$53.75 ,75% of total billed charges for outpatient setting,$53.75 ,75% of total billed charges for outpatient setting,$53.75 ,75% of total billed charges for outpatient setting,$14.39 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$60.91 ,85% of total billed charges for outpatient setting,$8.31 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$6.47 ,$68.08 ,$25.08 Outpatient Medical Services,LAB,83550,Iron Level and TIBC,300,$53.63 ,$11.54 ,100% Amerigroup fee schedule for outpatient setting,$11.54 ,100% Amerigroup fee schedule for outpatient setting,$26.82 ,75% of total billed charges for outpatient setting,$26.82 ,75% of total billed charges for outpatient setting,$26.82 ,75% of total billed charges for outpatient setting,$8.91 ,102% CMS Medicare OPPS fee schedule,$8.91 ,102% CMS Medicare OPPS fee schedule,$8.91 ,102% CMS Medicare OPPS fee schedule,$8.91 ,102% CMS Medicare OPPS fee schedule,$8.91 ,102% CMS Medicare OPPS fee schedule,$8.91 ,102% CMS Medicare OPPS fee schedule,$42.90 ,80% of total billed charges for outpatient setting,$8.91 ,102% CMS Medicare OPPS fee schedule,$11.54 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$45.59 ,85% of total billed charges for outpatient setting,$8.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$42.90 ,80% of total billed charges for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$37.54 ,70% of total billed charges for outpatient setting,$37.54 ,70% of total billed charges for outpatient setting,$41.30 ,77% of total billed charges for outpatient setting,$8.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$11.21 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$10.99 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$8.74 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$48.27 ,90% of total billed charges for outpatient setting,$11.32 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$50.95 ,95% of total billed charges for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$42.90 ,80% of total billed charges for outpatient setting,$11.21 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$45.59 ,85% of total billed charges for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$49.88 ,93% of total billed charges for outpatient setting,$40.22 ,75% of total billed charges for outpatient setting,$40.22 ,75% of total billed charges for outpatient setting,$40.22 ,75% of total billed charges for outpatient setting,$10.77 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$45.59 ,85% of total billed charges for outpatient setting,$11.21 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.74 ,$50.95 ,$18.77 Outpatient Medical Services,LAB,83550,Iron Level and TIBC,300,$53.63 ,$11.54 ,100% Amerigroup fee schedule for outpatient setting,$11.54 ,100% Amerigroup fee schedule for outpatient setting,$26.82 ,75% of total billed charges for outpatient setting,$26.82 ,75% of total billed charges for outpatient setting,$26.82 ,75% of total billed charges for outpatient setting,$8.91 ,102% CMS Medicare OPPS fee schedule,$8.91 ,102% CMS Medicare OPPS fee schedule,$8.91 ,102% CMS Medicare OPPS fee schedule,$8.91 ,102% CMS Medicare OPPS fee schedule,$8.91 ,102% CMS Medicare OPPS fee schedule,$8.91 ,102% CMS Medicare OPPS fee schedule,$42.90 ,80% of total billed charges for outpatient setting,$8.91 ,102% CMS Medicare OPPS fee schedule,$11.54 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$45.59 ,85% of total billed charges for outpatient setting,$8.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$42.90 ,80% of total billed charges for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$37.54 ,70% of total billed charges for outpatient setting,$37.54 ,70% of total billed charges for outpatient setting,$41.30 ,77% of total billed charges for outpatient setting,$8.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$11.21 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$10.99 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$8.74 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$48.27 ,90% of total billed charges for outpatient setting,$11.32 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$50.95 ,95% of total billed charges for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$42.90 ,80% of total billed charges for outpatient setting,$11.21 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$45.59 ,85% of total billed charges for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$49.88 ,93% of total billed charges for outpatient setting,$40.22 ,75% of total billed charges for outpatient setting,$40.22 ,75% of total billed charges for outpatient setting,$40.22 ,75% of total billed charges for outpatient setting,$10.77 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$45.59 ,85% of total billed charges for outpatient setting,$11.21 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.74 ,$50.95 ,$18.77 Outpatient Medical Services,LAB,83550,Total Iron Binding Capacity,300,$53.63 ,$11.54 ,100% Amerigroup fee schedule for outpatient setting,$11.54 ,100% Amerigroup fee schedule for outpatient setting,$26.82 ,75% of total billed charges for outpatient setting,$26.82 ,75% of total billed charges for outpatient setting,$26.82 ,75% of total billed charges for outpatient setting,$8.91 ,102% CMS Medicare OPPS fee schedule,$8.91 ,102% CMS Medicare OPPS fee schedule,$8.91 ,102% CMS Medicare OPPS fee schedule,$8.91 ,102% CMS Medicare OPPS fee schedule,$8.91 ,102% CMS Medicare OPPS fee schedule,$8.91 ,102% CMS Medicare OPPS fee schedule,$42.90 ,80% of total billed charges for outpatient setting,$8.91 ,102% CMS Medicare OPPS fee schedule,$11.54 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$45.59 ,85% of total billed charges for outpatient setting,$8.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$42.90 ,80% of total billed charges for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$37.54 ,70% of total billed charges for outpatient setting,$37.54 ,70% of total billed charges for outpatient setting,$41.30 ,77% of total billed charges for outpatient setting,$8.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$11.21 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$10.99 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$8.74 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$48.27 ,90% of total billed charges for outpatient setting,$11.32 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$50.95 ,95% of total billed charges for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$42.90 ,80% of total billed charges for outpatient setting,$11.21 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$45.59 ,85% of total billed charges for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$49.88 ,93% of total billed charges for outpatient setting,$40.22 ,75% of total billed charges for outpatient setting,$40.22 ,75% of total billed charges for outpatient setting,$40.22 ,75% of total billed charges for outpatient setting,$10.77 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$45.59 ,85% of total billed charges for outpatient setting,$11.21 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.74 ,$50.95 ,$18.77 Outpatient Medical Services,LAB,83550,Iron and TIBC LC,300,$53.63 ,$11.54 ,100% Amerigroup fee schedule for outpatient setting,$11.54 ,100% Amerigroup fee schedule for outpatient setting,$26.82 ,75% of total billed charges for outpatient setting,$26.82 ,75% of total billed charges for outpatient setting,$26.82 ,75% of total billed charges for outpatient setting,$8.91 ,102% CMS Medicare OPPS fee schedule,$8.91 ,102% CMS Medicare OPPS fee schedule,$8.91 ,102% CMS Medicare OPPS fee schedule,$8.91 ,102% CMS Medicare OPPS fee schedule,$8.91 ,102% CMS Medicare OPPS fee schedule,$8.91 ,102% CMS Medicare OPPS fee schedule,$42.90 ,80% of total billed charges for outpatient setting,$8.91 ,102% CMS Medicare OPPS fee schedule,$11.54 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$45.59 ,85% of total billed charges for outpatient setting,$8.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$42.90 ,80% of total billed charges for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$37.54 ,70% of total billed charges for outpatient setting,$37.54 ,70% of total billed charges for outpatient setting,$41.30 ,77% of total billed charges for outpatient setting,$8.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$11.21 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.83 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$10.99 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$8.74 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$48.27 ,90% of total billed charges for outpatient setting,$11.32 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$50.95 ,95% of total billed charges for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$42.90 ,80% of total billed charges for outpatient setting,$11.21 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$45.59 ,85% of total billed charges for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$45.59 ,85% of total billed charges for outpatient setting,$49.88 ,93% of total billed charges for outpatient setting,$40.22 ,75% of total billed charges for outpatient setting,$40.22 ,75% of total billed charges for outpatient setting,$40.22 ,75% of total billed charges for outpatient setting,$10.77 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$45.59 ,85% of total billed charges for outpatient setting,$11.21 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.74 ,$50.95 ,$18.77 Outpatient Medical Services,LAB,83605,Lactic Acid,300,$36.47 ,$14.10 ,100% Amerigroup fee schedule for outpatient setting,$14.10 ,100% Amerigroup fee schedule for outpatient setting,$18.24 ,75% of total billed charges for outpatient setting,$18.24 ,75% of total billed charges for outpatient setting,$18.24 ,75% of total billed charges for outpatient setting,$11.80 ,102% CMS Medicare OPPS fee schedule,$11.80 ,102% CMS Medicare OPPS fee schedule,$11.80 ,102% CMS Medicare OPPS fee schedule,$11.80 ,102% CMS Medicare OPPS fee schedule,$11.80 ,102% CMS Medicare OPPS fee schedule,$11.80 ,102% CMS Medicare OPPS fee schedule,$29.18 ,80% of total billed charges for outpatient setting,$11.80 ,102% CMS Medicare OPPS fee schedule,$14.10 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$31.00 ,85% of total billed charges for outpatient setting,$11.69 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$29.18 ,80% of total billed charges for outpatient setting,$31.00 ,85% of total billed charges for outpatient setting,$25.53 ,70% of total billed charges for outpatient setting,$25.53 ,70% of total billed charges for outpatient setting,$28.08 ,77% of total billed charges for outpatient setting,$11.69 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$31.00 ,85% of total billed charges for outpatient setting,$31.00 ,85% of total billed charges for outpatient setting,$31.00 ,85% of total billed charges for outpatient setting,$31.00 ,85% of total billed charges for outpatient setting,$31.00 ,85% of total billed charges for outpatient setting,$13.70 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$11.69 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$11.69 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$11.69 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$11.69 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$31.00 ,85% of total billed charges for outpatient setting,$13.43 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$11.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$32.82 ,90% of total billed charges for outpatient setting,$13.83 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$34.65 ,95% of total billed charges for outpatient setting,$31.00 ,85% of total billed charges for outpatient setting,$29.18 ,80% of total billed charges for outpatient setting,$13.70 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$31.00 ,85% of total billed charges for outpatient setting,$31.00 ,85% of total billed charges for outpatient setting,$31.00 ,85% of total billed charges for outpatient setting,$33.92 ,93% of total billed charges for outpatient setting,$27.35 ,75% of total billed charges for outpatient setting,$27.35 ,75% of total billed charges for outpatient setting,$27.35 ,75% of total billed charges for outpatient setting,$7.32 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$31.00 ,85% of total billed charges for outpatient setting,$13.70 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$7.32 ,$34.65 ,$12.76 Outpatient Medical Services,LAB,83615,Lactate Dehydrogenase,301,$22.88 ,$6.67 ,100% Amerigroup fee schedule for outpatient setting,$6.67 ,100% Amerigroup fee schedule for outpatient setting,$11.44 ,75% of total billed charges for outpatient setting,$11.44 ,75% of total billed charges for outpatient setting,$11.44 ,75% of total billed charges for outpatient setting,$6.16 ,102% CMS Medicare OPPS fee schedule,$6.16 ,102% CMS Medicare OPPS fee schedule,$6.16 ,102% CMS Medicare OPPS fee schedule,$6.16 ,102% CMS Medicare OPPS fee schedule,$6.16 ,102% CMS Medicare OPPS fee schedule,$6.16 ,102% CMS Medicare OPPS fee schedule,$18.30 ,80% of total billed charges for outpatient setting,$6.16 ,102% CMS Medicare OPPS fee schedule,$6.67 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$19.45 ,85% of total billed charges for outpatient setting,$6.10 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$18.30 ,80% of total billed charges for outpatient setting,$19.45 ,85% of total billed charges for outpatient setting,$16.02 ,70% of total billed charges for outpatient setting,$16.02 ,70% of total billed charges for outpatient setting,$17.62 ,77% of total billed charges for outpatient setting,$6.10 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$19.45 ,85% of total billed charges for outpatient setting,$19.45 ,85% of total billed charges for outpatient setting,$19.45 ,85% of total billed charges for outpatient setting,$19.45 ,85% of total billed charges for outpatient setting,$19.45 ,85% of total billed charges for outpatient setting,$6.48 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$6.10 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.10 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.10 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.10 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$19.45 ,85% of total billed charges for outpatient setting,$6.35 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$6.04 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$20.59 ,90% of total billed charges for outpatient setting,$6.54 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$21.74 ,95% of total billed charges for outpatient setting,$19.45 ,85% of total billed charges for outpatient setting,$18.30 ,80% of total billed charges for outpatient setting,$6.48 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$19.45 ,85% of total billed charges for outpatient setting,$19.45 ,85% of total billed charges for outpatient setting,$19.45 ,85% of total billed charges for outpatient setting,$21.28 ,93% of total billed charges for outpatient setting,$17.16 ,75% of total billed charges for outpatient setting,$17.16 ,75% of total billed charges for outpatient setting,$17.16 ,75% of total billed charges for outpatient setting,$4.59 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$19.45 ,85% of total billed charges for outpatient setting,$6.48 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.59 ,$21.74 ,$8.01 Outpatient Medical Services,LAB,83655,"Lead, Blood (Pediatric) LC",300,$78.00 ,$15.98 ,100% Amerigroup fee schedule for outpatient setting,$15.98 ,100% Amerigroup fee schedule for outpatient setting,$39.00 ,75% of total billed charges for outpatient setting,$39.00 ,75% of total billed charges for outpatient setting,$39.00 ,75% of total billed charges for outpatient setting,$12.35 ,102% CMS Medicare OPPS fee schedule,$12.35 ,102% CMS Medicare OPPS fee schedule,$12.35 ,102% CMS Medicare OPPS fee schedule,$12.35 ,102% CMS Medicare OPPS fee schedule,$12.35 ,102% CMS Medicare OPPS fee schedule,$12.35 ,102% CMS Medicare OPPS fee schedule,$62.40 ,80% of total billed charges for outpatient setting,$12.35 ,102% CMS Medicare OPPS fee schedule,$10.50 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$66.30 ,85% of total billed charges for outpatient setting,$12.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.40 ,80% of total billed charges for outpatient setting,$66.30 ,85% of total billed charges for outpatient setting,$54.60 ,70% of total billed charges for outpatient setting,$54.60 ,70% of total billed charges for outpatient setting,$60.06 ,77% of total billed charges for outpatient setting,$12.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$66.30 ,85% of total billed charges for outpatient setting,$66.30 ,85% of total billed charges for outpatient setting,$66.30 ,85% of total billed charges for outpatient setting,$66.30 ,85% of total billed charges for outpatient setting,$66.30 ,85% of total billed charges for outpatient setting,$10.20 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$12.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$66.30 ,85% of total billed charges for outpatient setting,$10.00 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$12.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$70.20 ,90% of total billed charges for outpatient setting,$10.30 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$74.10 ,95% of total billed charges for outpatient setting,$66.30 ,85% of total billed charges for outpatient setting,$62.40 ,80% of total billed charges for outpatient setting,$10.20 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$66.30 ,85% of total billed charges for outpatient setting,$66.30 ,85% of total billed charges for outpatient setting,$66.30 ,85% of total billed charges for outpatient setting,$72.54 ,93% of total billed charges for outpatient setting,$58.50 ,75% of total billed charges for outpatient setting,$58.50 ,75% of total billed charges for outpatient setting,$58.50 ,75% of total billed charges for outpatient setting,$15.66 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$66.30 ,85% of total billed charges for outpatient setting,$10.20 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$10.00 ,$74.10 ,$27.30 Outpatient Medical Services,LAB,83690,Lipase Level,300,$265.98 ,$9.09 ,100% Amerigroup fee schedule for outpatient setting,$9.09 ,100% Amerigroup fee schedule for outpatient setting,$132.99 ,75% of total billed charges for outpatient setting,$132.99 ,75% of total billed charges for outpatient setting,$132.99 ,75% of total billed charges for outpatient setting,$7.03 ,102% CMS Medicare OPPS fee schedule,$7.03 ,102% CMS Medicare OPPS fee schedule,$7.03 ,102% CMS Medicare OPPS fee schedule,$7.03 ,102% CMS Medicare OPPS fee schedule,$7.03 ,102% CMS Medicare OPPS fee schedule,$7.03 ,102% CMS Medicare OPPS fee schedule,$212.78 ,80% of total billed charges for outpatient setting,$7.03 ,102% CMS Medicare OPPS fee schedule,$9.09 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$226.08 ,85% of total billed charges for outpatient setting,$6.96 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$212.78 ,80% of total billed charges for outpatient setting,$226.08 ,85% of total billed charges for outpatient setting,$186.19 ,70% of total billed charges for outpatient setting,$186.19 ,70% of total billed charges for outpatient setting,$204.80 ,77% of total billed charges for outpatient setting,$6.96 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$226.08 ,85% of total billed charges for outpatient setting,$226.08 ,85% of total billed charges for outpatient setting,$226.08 ,85% of total billed charges for outpatient setting,$226.08 ,85% of total billed charges for outpatient setting,$226.08 ,85% of total billed charges for outpatient setting,$8.83 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$6.96 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.96 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.96 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.96 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$226.08 ,85% of total billed charges for outpatient setting,$8.66 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$6.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$239.38 ,90% of total billed charges for outpatient setting,$8.92 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$252.68 ,95% of total billed charges for outpatient setting,$226.08 ,85% of total billed charges for outpatient setting,$212.78 ,80% of total billed charges for outpatient setting,$8.83 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$226.08 ,85% of total billed charges for outpatient setting,$226.08 ,85% of total billed charges for outpatient setting,$226.08 ,85% of total billed charges for outpatient setting,$247.36 ,93% of total billed charges for outpatient setting,$199.49 ,75% of total billed charges for outpatient setting,$199.49 ,75% of total billed charges for outpatient setting,$199.49 ,75% of total billed charges for outpatient setting,$53.41 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$226.08 ,85% of total billed charges for outpatient setting,$8.83 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$6.89 ,$252.68 ,$93.09 Outpatient Medical Services,LAB,83690,Lipase LC,300,$265.98 ,$9.09 ,100% Amerigroup fee schedule for outpatient setting,$9.09 ,100% Amerigroup fee schedule for outpatient setting,$132.99 ,75% of total billed charges for outpatient setting,$132.99 ,75% of total billed charges for outpatient setting,$132.99 ,75% of total billed charges for outpatient setting,$7.03 ,102% CMS Medicare OPPS fee schedule,$7.03 ,102% CMS Medicare OPPS fee schedule,$7.03 ,102% CMS Medicare OPPS fee schedule,$7.03 ,102% CMS Medicare OPPS fee schedule,$7.03 ,102% CMS Medicare OPPS fee schedule,$7.03 ,102% CMS Medicare OPPS fee schedule,$212.78 ,80% of total billed charges for outpatient setting,$7.03 ,102% CMS Medicare OPPS fee schedule,$9.09 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$226.08 ,85% of total billed charges for outpatient setting,$6.96 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$212.78 ,80% of total billed charges for outpatient setting,$226.08 ,85% of total billed charges for outpatient setting,$186.19 ,70% of total billed charges for outpatient setting,$186.19 ,70% of total billed charges for outpatient setting,$204.80 ,77% of total billed charges for outpatient setting,$6.96 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$226.08 ,85% of total billed charges for outpatient setting,$226.08 ,85% of total billed charges for outpatient setting,$226.08 ,85% of total billed charges for outpatient setting,$226.08 ,85% of total billed charges for outpatient setting,$226.08 ,85% of total billed charges for outpatient setting,$8.83 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$6.96 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.96 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.96 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.96 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$226.08 ,85% of total billed charges for outpatient setting,$8.66 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$6.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$239.38 ,90% of total billed charges for outpatient setting,$8.92 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$252.68 ,95% of total billed charges for outpatient setting,$226.08 ,85% of total billed charges for outpatient setting,$212.78 ,80% of total billed charges for outpatient setting,$8.83 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$226.08 ,85% of total billed charges for outpatient setting,$226.08 ,85% of total billed charges for outpatient setting,$226.08 ,85% of total billed charges for outpatient setting,$247.36 ,93% of total billed charges for outpatient setting,$199.49 ,75% of total billed charges for outpatient setting,$199.49 ,75% of total billed charges for outpatient setting,$199.49 ,75% of total billed charges for outpatient setting,$53.41 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$226.08 ,85% of total billed charges for outpatient setting,$8.83 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$6.89 ,$252.68 ,$93.09 Outpatient Medical Services,LAB,83718,HDL,300,$66.00 ,$10.82 ,100% Amerigroup fee schedule for outpatient setting,$10.82 ,100% Amerigroup fee schedule for outpatient setting,$33.00 ,75% of total billed charges for outpatient setting,$33.00 ,75% of total billed charges for outpatient setting,$33.00 ,75% of total billed charges for outpatient setting,$8.35 ,102% CMS Medicare OPPS fee schedule,$8.35 ,102% CMS Medicare OPPS fee schedule,$8.35 ,102% CMS Medicare OPPS fee schedule,$8.35 ,102% CMS Medicare OPPS fee schedule,$8.35 ,102% CMS Medicare OPPS fee schedule,$8.35 ,102% CMS Medicare OPPS fee schedule,$52.80 ,80% of total billed charges for outpatient setting,$8.35 ,102% CMS Medicare OPPS fee schedule,$10.82 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$56.10 ,85% of total billed charges for outpatient setting,$8.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$52.80 ,80% of total billed charges for outpatient setting,$56.10 ,85% of total billed charges for outpatient setting,$46.20 ,70% of total billed charges for outpatient setting,$46.20 ,70% of total billed charges for outpatient setting,$50.82 ,77% of total billed charges for outpatient setting,$8.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$56.10 ,85% of total billed charges for outpatient setting,$56.10 ,85% of total billed charges for outpatient setting,$56.10 ,85% of total billed charges for outpatient setting,$56.10 ,85% of total billed charges for outpatient setting,$56.10 ,85% of total billed charges for outpatient setting,$10.51 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$56.10 ,85% of total billed charges for outpatient setting,$10.30 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$8.19 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$59.40 ,90% of total billed charges for outpatient setting,$10.61 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$62.70 ,95% of total billed charges for outpatient setting,$56.10 ,85% of total billed charges for outpatient setting,$52.80 ,80% of total billed charges for outpatient setting,$10.51 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$56.10 ,85% of total billed charges for outpatient setting,$56.10 ,85% of total billed charges for outpatient setting,$56.10 ,85% of total billed charges for outpatient setting,$61.38 ,93% of total billed charges for outpatient setting,$49.50 ,75% of total billed charges for outpatient setting,$49.50 ,75% of total billed charges for outpatient setting,$49.50 ,75% of total billed charges for outpatient setting,$13.25 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$56.10 ,85% of total billed charges for outpatient setting,$10.51 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.19 ,$62.70 ,$23.10 Outpatient Medical Services,LAB,83735,Magnesium Level,301,$29.32 ,$8.84 ,100% Amerigroup fee schedule for outpatient setting,$8.84 ,100% Amerigroup fee schedule for outpatient setting,$14.66 ,75% of total billed charges for outpatient setting,$14.66 ,75% of total billed charges for outpatient setting,$14.66 ,75% of total billed charges for outpatient setting,$6.83 ,102% CMS Medicare OPPS fee schedule,$6.83 ,102% CMS Medicare OPPS fee schedule,$6.83 ,102% CMS Medicare OPPS fee schedule,$6.83 ,102% CMS Medicare OPPS fee schedule,$6.83 ,102% CMS Medicare OPPS fee schedule,$6.83 ,102% CMS Medicare OPPS fee schedule,$23.46 ,80% of total billed charges for outpatient setting,$6.83 ,102% CMS Medicare OPPS fee schedule,$8.84 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$24.92 ,85% of total billed charges for outpatient setting,$6.77 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$23.46 ,80% of total billed charges for outpatient setting,$24.92 ,85% of total billed charges for outpatient setting,$20.52 ,70% of total billed charges for outpatient setting,$20.52 ,70% of total billed charges for outpatient setting,$22.58 ,77% of total billed charges for outpatient setting,$6.77 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$24.92 ,85% of total billed charges for outpatient setting,$24.92 ,85% of total billed charges for outpatient setting,$24.92 ,85% of total billed charges for outpatient setting,$24.92 ,85% of total billed charges for outpatient setting,$24.92 ,85% of total billed charges for outpatient setting,$8.59 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$6.77 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.77 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.77 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.77 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$24.92 ,85% of total billed charges for outpatient setting,$8.42 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$6.70 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$26.39 ,90% of total billed charges for outpatient setting,$8.67 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$27.85 ,95% of total billed charges for outpatient setting,$24.92 ,85% of total billed charges for outpatient setting,$23.46 ,80% of total billed charges for outpatient setting,$8.59 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$24.92 ,85% of total billed charges for outpatient setting,$24.92 ,85% of total billed charges for outpatient setting,$24.92 ,85% of total billed charges for outpatient setting,$27.27 ,93% of total billed charges for outpatient setting,$21.99 ,75% of total billed charges for outpatient setting,$21.99 ,75% of total billed charges for outpatient setting,$21.99 ,75% of total billed charges for outpatient setting,$5.89 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$24.92 ,85% of total billed charges for outpatient setting,$8.59 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.89 ,$27.85 ,$10.26 Outpatient Medical Services,LAB,83735,Magnesium LC,301,$29.32 ,$8.84 ,100% Amerigroup fee schedule for outpatient setting,$8.84 ,100% Amerigroup fee schedule for outpatient setting,$14.66 ,75% of total billed charges for outpatient setting,$14.66 ,75% of total billed charges for outpatient setting,$14.66 ,75% of total billed charges for outpatient setting,$6.83 ,102% CMS Medicare OPPS fee schedule,$6.83 ,102% CMS Medicare OPPS fee schedule,$6.83 ,102% CMS Medicare OPPS fee schedule,$6.83 ,102% CMS Medicare OPPS fee schedule,$6.83 ,102% CMS Medicare OPPS fee schedule,$6.83 ,102% CMS Medicare OPPS fee schedule,$23.46 ,80% of total billed charges for outpatient setting,$6.83 ,102% CMS Medicare OPPS fee schedule,$8.84 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$24.92 ,85% of total billed charges for outpatient setting,$6.77 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$23.46 ,80% of total billed charges for outpatient setting,$24.92 ,85% of total billed charges for outpatient setting,$20.52 ,70% of total billed charges for outpatient setting,$20.52 ,70% of total billed charges for outpatient setting,$22.58 ,77% of total billed charges for outpatient setting,$6.77 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$24.92 ,85% of total billed charges for outpatient setting,$24.92 ,85% of total billed charges for outpatient setting,$24.92 ,85% of total billed charges for outpatient setting,$24.92 ,85% of total billed charges for outpatient setting,$24.92 ,85% of total billed charges for outpatient setting,$8.59 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$6.77 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.77 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.77 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.77 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$24.92 ,85% of total billed charges for outpatient setting,$8.42 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$6.70 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$26.39 ,90% of total billed charges for outpatient setting,$8.67 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$27.85 ,95% of total billed charges for outpatient setting,$24.92 ,85% of total billed charges for outpatient setting,$23.46 ,80% of total billed charges for outpatient setting,$8.59 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$24.92 ,85% of total billed charges for outpatient setting,$24.92 ,85% of total billed charges for outpatient setting,$24.92 ,85% of total billed charges for outpatient setting,$27.27 ,93% of total billed charges for outpatient setting,$21.99 ,75% of total billed charges for outpatient setting,$21.99 ,75% of total billed charges for outpatient setting,$21.99 ,75% of total billed charges for outpatient setting,$5.89 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$24.92 ,85% of total billed charges for outpatient setting,$8.59 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.89 ,$27.85 ,$10.26 Outpatient Medical Services,LAB,83880,NT-ProBNP II,300,$65.07 ,$44.82 ,100% Amerigroup fee schedule for outpatient setting,$44.82 ,100% Amerigroup fee schedule for outpatient setting,$32.54 ,75% of total billed charges for outpatient setting,$32.54 ,75% of total billed charges for outpatient setting,$32.54 ,75% of total billed charges for outpatient setting,$40.05 ,102% CMS Medicare OPPS fee schedule,$40.05 ,102% CMS Medicare OPPS fee schedule,$40.05 ,102% CMS Medicare OPPS fee schedule,$40.05 ,102% CMS Medicare OPPS fee schedule,$40.05 ,102% CMS Medicare OPPS fee schedule,$40.05 ,102% CMS Medicare OPPS fee schedule,$52.06 ,80% of total billed charges for outpatient setting,$40.05 ,102% CMS Medicare OPPS fee schedule,$44.82 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$55.31 ,85% of total billed charges for outpatient setting,$39.65 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$52.06 ,80% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$45.55 ,70% of total billed charges for outpatient setting,$45.55 ,70% of total billed charges for outpatient setting,$50.10 ,77% of total billed charges for outpatient setting,$39.65 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$43.54 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$39.65 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$39.65 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$39.65 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$39.65 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$42.69 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$39.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$58.56 ,90% of total billed charges for outpatient setting,$43.97 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$61.82 ,95% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$52.06 ,80% of total billed charges for outpatient setting,$43.54 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$60.52 ,93% of total billed charges for outpatient setting,$48.80 ,75% of total billed charges for outpatient setting,$48.80 ,75% of total billed charges for outpatient setting,$48.80 ,75% of total billed charges for outpatient setting,$13.07 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$55.31 ,85% of total billed charges for outpatient setting,$43.54 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$13.07 ,$61.82 ,$22.77 Outpatient Medical Services,LAB,83880,NT-Pro BNP,300,$65.07 ,$44.82 ,100% Amerigroup fee schedule for outpatient setting,$44.82 ,100% Amerigroup fee schedule for outpatient setting,$32.54 ,75% of total billed charges for outpatient setting,$32.54 ,75% of total billed charges for outpatient setting,$32.54 ,75% of total billed charges for outpatient setting,$40.05 ,102% CMS Medicare OPPS fee schedule,$40.05 ,102% CMS Medicare OPPS fee schedule,$40.05 ,102% CMS Medicare OPPS fee schedule,$40.05 ,102% CMS Medicare OPPS fee schedule,$40.05 ,102% CMS Medicare OPPS fee schedule,$40.05 ,102% CMS Medicare OPPS fee schedule,$52.06 ,80% of total billed charges for outpatient setting,$40.05 ,102% CMS Medicare OPPS fee schedule,$44.82 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$55.31 ,85% of total billed charges for outpatient setting,$39.65 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$52.06 ,80% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$45.55 ,70% of total billed charges for outpatient setting,$45.55 ,70% of total billed charges for outpatient setting,$50.10 ,77% of total billed charges for outpatient setting,$39.65 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$43.54 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$39.65 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$39.65 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$39.65 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$39.65 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$42.69 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$39.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$58.56 ,90% of total billed charges for outpatient setting,$43.97 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$61.82 ,95% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$52.06 ,80% of total billed charges for outpatient setting,$43.54 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$60.52 ,93% of total billed charges for outpatient setting,$48.80 ,75% of total billed charges for outpatient setting,$48.80 ,75% of total billed charges for outpatient setting,$48.80 ,75% of total billed charges for outpatient setting,$13.07 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$55.31 ,85% of total billed charges for outpatient setting,$43.54 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$13.07 ,$61.82 ,$22.77 Outpatient Medical Services,LAB,83880,BNP,300,$65.07 ,$44.82 ,100% Amerigroup fee schedule for outpatient setting,$44.82 ,100% Amerigroup fee schedule for outpatient setting,$32.54 ,75% of total billed charges for outpatient setting,$32.54 ,75% of total billed charges for outpatient setting,$32.54 ,75% of total billed charges for outpatient setting,$40.05 ,102% CMS Medicare OPPS fee schedule,$40.05 ,102% CMS Medicare OPPS fee schedule,$40.05 ,102% CMS Medicare OPPS fee schedule,$40.05 ,102% CMS Medicare OPPS fee schedule,$40.05 ,102% CMS Medicare OPPS fee schedule,$40.05 ,102% CMS Medicare OPPS fee schedule,$52.06 ,80% of total billed charges for outpatient setting,$40.05 ,102% CMS Medicare OPPS fee schedule,$44.82 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$55.31 ,85% of total billed charges for outpatient setting,$39.65 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$52.06 ,80% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$45.55 ,70% of total billed charges for outpatient setting,$45.55 ,70% of total billed charges for outpatient setting,$50.10 ,77% of total billed charges for outpatient setting,$39.65 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$43.54 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$39.65 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$39.65 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$39.65 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$39.65 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$42.69 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$39.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$58.56 ,90% of total billed charges for outpatient setting,$43.97 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$61.82 ,95% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$52.06 ,80% of total billed charges for outpatient setting,$43.54 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$60.52 ,93% of total billed charges for outpatient setting,$48.80 ,75% of total billed charges for outpatient setting,$48.80 ,75% of total billed charges for outpatient setting,$48.80 ,75% of total billed charges for outpatient setting,$13.07 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$55.31 ,85% of total billed charges for outpatient setting,$43.54 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$13.07 ,$61.82 ,$22.77 Outpatient Medical Services,LAB,83880,NT-proBNP LC,300,$65.07 ,$44.82 ,100% Amerigroup fee schedule for outpatient setting,$44.82 ,100% Amerigroup fee schedule for outpatient setting,$32.54 ,75% of total billed charges for outpatient setting,$32.54 ,75% of total billed charges for outpatient setting,$32.54 ,75% of total billed charges for outpatient setting,$40.05 ,102% CMS Medicare OPPS fee schedule,$40.05 ,102% CMS Medicare OPPS fee schedule,$40.05 ,102% CMS Medicare OPPS fee schedule,$40.05 ,102% CMS Medicare OPPS fee schedule,$40.05 ,102% CMS Medicare OPPS fee schedule,$40.05 ,102% CMS Medicare OPPS fee schedule,$52.06 ,80% of total billed charges for outpatient setting,$40.05 ,102% CMS Medicare OPPS fee schedule,$44.82 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$55.31 ,85% of total billed charges for outpatient setting,$39.65 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$52.06 ,80% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$45.55 ,70% of total billed charges for outpatient setting,$45.55 ,70% of total billed charges for outpatient setting,$50.10 ,77% of total billed charges for outpatient setting,$39.65 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$43.54 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$39.65 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$39.65 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$39.65 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$39.65 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$42.69 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$39.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$58.56 ,90% of total billed charges for outpatient setting,$43.97 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$61.82 ,95% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$52.06 ,80% of total billed charges for outpatient setting,$43.54 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$60.52 ,93% of total billed charges for outpatient setting,$48.80 ,75% of total billed charges for outpatient setting,$48.80 ,75% of total billed charges for outpatient setting,$48.80 ,75% of total billed charges for outpatient setting,$13.07 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$55.31 ,85% of total billed charges for outpatient setting,$43.54 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$13.07 ,$61.82 ,$22.77 Outpatient Medical Services,LAB,83935,"Osmolality, Urine LC",300,$68.00 ,$9.00 ,100% Amerigroup fee schedule for outpatient setting,$9.00 ,100% Amerigroup fee schedule for outpatient setting,$34.00 ,75% of total billed charges for outpatient setting,$34.00 ,75% of total billed charges for outpatient setting,$34.00 ,75% of total billed charges for outpatient setting,$6.96 ,102% CMS Medicare OPPS fee schedule,$6.96 ,102% CMS Medicare OPPS fee schedule,$6.96 ,102% CMS Medicare OPPS fee schedule,$6.96 ,102% CMS Medicare OPPS fee schedule,$6.96 ,102% CMS Medicare OPPS fee schedule,$6.96 ,102% CMS Medicare OPPS fee schedule,$54.40 ,80% of total billed charges for outpatient setting,$6.96 ,102% CMS Medicare OPPS fee schedule,$9.00 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$57.80 ,85% of total billed charges for outpatient setting,$6.89 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$54.40 ,80% of total billed charges for outpatient setting,$57.80 ,85% of total billed charges for outpatient setting,$47.60 ,70% of total billed charges for outpatient setting,$47.60 ,70% of total billed charges for outpatient setting,$52.36 ,77% of total billed charges for outpatient setting,$6.89 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$57.80 ,85% of total billed charges for outpatient setting,$57.80 ,85% of total billed charges for outpatient setting,$57.80 ,85% of total billed charges for outpatient setting,$57.80 ,85% of total billed charges for outpatient setting,$57.80 ,85% of total billed charges for outpatient setting,$8.74 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$6.89 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.89 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.89 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.89 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$57.80 ,85% of total billed charges for outpatient setting,$8.57 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$6.82 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$61.20 ,90% of total billed charges for outpatient setting,$8.83 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$64.60 ,95% of total billed charges for outpatient setting,$57.80 ,85% of total billed charges for outpatient setting,$54.40 ,80% of total billed charges for outpatient setting,$8.74 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$57.80 ,85% of total billed charges for outpatient setting,$57.80 ,85% of total billed charges for outpatient setting,$57.80 ,85% of total billed charges for outpatient setting,$63.24 ,93% of total billed charges for outpatient setting,$51.00 ,75% of total billed charges for outpatient setting,$51.00 ,75% of total billed charges for outpatient setting,$51.00 ,75% of total billed charges for outpatient setting,$13.65 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$57.80 ,85% of total billed charges for outpatient setting,$8.74 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$6.82 ,$64.60 ,$23.80 Outpatient Medical Services,LAB,84075,Alkaline Phosphatase,300,$32.00 ,$6.67 ,100% Amerigroup fee schedule for outpatient setting,$6.67 ,100% Amerigroup fee schedule for outpatient setting,$16.00 ,75% of total billed charges for outpatient setting,$16.00 ,75% of total billed charges for outpatient setting,$16.00 ,75% of total billed charges for outpatient setting,$5.28 ,102% CMS Medicare OPPS fee schedule,$5.28 ,102% CMS Medicare OPPS fee schedule,$5.28 ,102% CMS Medicare OPPS fee schedule,$5.28 ,102% CMS Medicare OPPS fee schedule,$5.28 ,102% CMS Medicare OPPS fee schedule,$5.28 ,102% CMS Medicare OPPS fee schedule,$25.60 ,80% of total billed charges for outpatient setting,$5.28 ,102% CMS Medicare OPPS fee schedule,$6.67 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$27.20 ,85% of total billed charges for outpatient setting,$5.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$25.60 ,80% of total billed charges for outpatient setting,$27.20 ,85% of total billed charges for outpatient setting,$22.40 ,70% of total billed charges for outpatient setting,$22.40 ,70% of total billed charges for outpatient setting,$24.64 ,77% of total billed charges for outpatient setting,$5.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$27.20 ,85% of total billed charges for outpatient setting,$27.20 ,85% of total billed charges for outpatient setting,$27.20 ,85% of total billed charges for outpatient setting,$27.20 ,85% of total billed charges for outpatient setting,$27.20 ,85% of total billed charges for outpatient setting,$6.48 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$27.20 ,85% of total billed charges for outpatient setting,$6.35 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$5.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$28.80 ,90% of total billed charges for outpatient setting,$6.54 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$30.40 ,95% of total billed charges for outpatient setting,$27.20 ,85% of total billed charges for outpatient setting,$25.60 ,80% of total billed charges for outpatient setting,$6.48 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$27.20 ,85% of total billed charges for outpatient setting,$27.20 ,85% of total billed charges for outpatient setting,$27.20 ,85% of total billed charges for outpatient setting,$29.76 ,93% of total billed charges for outpatient setting,$24.00 ,75% of total billed charges for outpatient setting,$24.00 ,75% of total billed charges for outpatient setting,$24.00 ,75% of total billed charges for outpatient setting,$6.43 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$27.20 ,85% of total billed charges for outpatient setting,$6.48 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.18 ,$30.40 ,$11.20 Outpatient Medical Services,LAB,84100,Phosphorus Level,300,$22.88 ,$6.27 ,100% Amerigroup fee schedule for outpatient setting,$6.27 ,100% Amerigroup fee schedule for outpatient setting,$11.44 ,75% of total billed charges for outpatient setting,$11.44 ,75% of total billed charges for outpatient setting,$11.44 ,75% of total billed charges for outpatient setting,$4.83 ,102% CMS Medicare OPPS fee schedule,$4.83 ,102% CMS Medicare OPPS fee schedule,$4.83 ,102% CMS Medicare OPPS fee schedule,$4.83 ,102% CMS Medicare OPPS fee schedule,$4.83 ,102% CMS Medicare OPPS fee schedule,$4.83 ,102% CMS Medicare OPPS fee schedule,$18.30 ,80% of total billed charges for outpatient setting,$4.83 ,102% CMS Medicare OPPS fee schedule,$6.27 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$19.45 ,85% of total billed charges for outpatient setting,$4.79 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$18.30 ,80% of total billed charges for outpatient setting,$19.45 ,85% of total billed charges for outpatient setting,$16.02 ,70% of total billed charges for outpatient setting,$16.02 ,70% of total billed charges for outpatient setting,$17.62 ,77% of total billed charges for outpatient setting,$4.79 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$19.45 ,85% of total billed charges for outpatient setting,$19.45 ,85% of total billed charges for outpatient setting,$19.45 ,85% of total billed charges for outpatient setting,$19.45 ,85% of total billed charges for outpatient setting,$19.45 ,85% of total billed charges for outpatient setting,$6.09 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.79 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.79 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.79 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.79 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$19.45 ,85% of total billed charges for outpatient setting,$5.97 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$4.74 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$20.59 ,90% of total billed charges for outpatient setting,$6.15 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$21.74 ,95% of total billed charges for outpatient setting,$19.45 ,85% of total billed charges for outpatient setting,$18.30 ,80% of total billed charges for outpatient setting,$6.09 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$19.45 ,85% of total billed charges for outpatient setting,$19.45 ,85% of total billed charges for outpatient setting,$19.45 ,85% of total billed charges for outpatient setting,$21.28 ,93% of total billed charges for outpatient setting,$17.16 ,75% of total billed charges for outpatient setting,$17.16 ,75% of total billed charges for outpatient setting,$17.16 ,75% of total billed charges for outpatient setting,$4.59 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$19.45 ,85% of total billed charges for outpatient setting,$6.09 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.59 ,$21.74 ,$8.01 Outpatient Medical Services,LAB,84100,Phosphorus LC,300,$22.88 ,$6.27 ,100% Amerigroup fee schedule for outpatient setting,$6.27 ,100% Amerigroup fee schedule for outpatient setting,$11.44 ,75% of total billed charges for outpatient setting,$11.44 ,75% of total billed charges for outpatient setting,$11.44 ,75% of total billed charges for outpatient setting,$4.83 ,102% CMS Medicare OPPS fee schedule,$4.83 ,102% CMS Medicare OPPS fee schedule,$4.83 ,102% CMS Medicare OPPS fee schedule,$4.83 ,102% CMS Medicare OPPS fee schedule,$4.83 ,102% CMS Medicare OPPS fee schedule,$4.83 ,102% CMS Medicare OPPS fee schedule,$18.30 ,80% of total billed charges for outpatient setting,$4.83 ,102% CMS Medicare OPPS fee schedule,$6.27 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$19.45 ,85% of total billed charges for outpatient setting,$4.79 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$18.30 ,80% of total billed charges for outpatient setting,$19.45 ,85% of total billed charges for outpatient setting,$16.02 ,70% of total billed charges for outpatient setting,$16.02 ,70% of total billed charges for outpatient setting,$17.62 ,77% of total billed charges for outpatient setting,$4.79 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$19.45 ,85% of total billed charges for outpatient setting,$19.45 ,85% of total billed charges for outpatient setting,$19.45 ,85% of total billed charges for outpatient setting,$19.45 ,85% of total billed charges for outpatient setting,$19.45 ,85% of total billed charges for outpatient setting,$6.09 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.79 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.79 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.79 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.79 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$19.45 ,85% of total billed charges for outpatient setting,$5.97 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$4.74 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$20.59 ,90% of total billed charges for outpatient setting,$6.15 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$21.74 ,95% of total billed charges for outpatient setting,$19.45 ,85% of total billed charges for outpatient setting,$18.30 ,80% of total billed charges for outpatient setting,$6.09 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$19.45 ,85% of total billed charges for outpatient setting,$19.45 ,85% of total billed charges for outpatient setting,$19.45 ,85% of total billed charges for outpatient setting,$21.28 ,93% of total billed charges for outpatient setting,$17.16 ,75% of total billed charges for outpatient setting,$17.16 ,75% of total billed charges for outpatient setting,$17.16 ,75% of total billed charges for outpatient setting,$4.59 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$19.45 ,85% of total billed charges for outpatient setting,$6.09 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.59 ,$21.74 ,$8.01 Outpatient Medical Services,LAB,84132,Potassium Level,301,$23.60 ,$6.07 ,100% Amerigroup fee schedule for outpatient setting,$6.07 ,100% Amerigroup fee schedule for outpatient setting,$11.80 ,75% of total billed charges for outpatient setting,$11.80 ,75% of total billed charges for outpatient setting,$11.80 ,75% of total billed charges for outpatient setting,$4.86 ,102% CMS Medicare OPPS fee schedule,$4.86 ,102% CMS Medicare OPPS fee schedule,$4.86 ,102% CMS Medicare OPPS fee schedule,$4.86 ,102% CMS Medicare OPPS fee schedule,$4.86 ,102% CMS Medicare OPPS fee schedule,$4.86 ,102% CMS Medicare OPPS fee schedule,$18.88 ,80% of total billed charges for outpatient setting,$4.86 ,102% CMS Medicare OPPS fee schedule,$6.07 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$20.06 ,85% of total billed charges for outpatient setting,$4.81 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$18.88 ,80% of total billed charges for outpatient setting,$20.06 ,85% of total billed charges for outpatient setting,$16.52 ,70% of total billed charges for outpatient setting,$16.52 ,70% of total billed charges for outpatient setting,$18.17 ,77% of total billed charges for outpatient setting,$4.81 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$20.06 ,85% of total billed charges for outpatient setting,$20.06 ,85% of total billed charges for outpatient setting,$20.06 ,85% of total billed charges for outpatient setting,$20.06 ,85% of total billed charges for outpatient setting,$20.06 ,85% of total billed charges for outpatient setting,$5.90 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.81 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.81 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.81 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.81 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$20.06 ,85% of total billed charges for outpatient setting,$5.78 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$4.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$21.24 ,90% of total billed charges for outpatient setting,$5.95 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$22.42 ,95% of total billed charges for outpatient setting,$20.06 ,85% of total billed charges for outpatient setting,$18.88 ,80% of total billed charges for outpatient setting,$5.90 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$20.06 ,85% of total billed charges for outpatient setting,$20.06 ,85% of total billed charges for outpatient setting,$20.06 ,85% of total billed charges for outpatient setting,$21.95 ,93% of total billed charges for outpatient setting,$17.70 ,75% of total billed charges for outpatient setting,$17.70 ,75% of total billed charges for outpatient setting,$17.70 ,75% of total billed charges for outpatient setting,$4.74 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$20.06 ,85% of total billed charges for outpatient setting,$5.90 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.74 ,$22.42 ,$8.26 Outpatient Medical Services,LAB,84133,Potassium Level Urine,300,$33.00 ,$5.68 ,100% Amerigroup fee schedule for outpatient setting,$5.68 ,100% Amerigroup fee schedule for outpatient setting,$16.50 ,75% of total billed charges for outpatient setting,$16.50 ,75% of total billed charges for outpatient setting,$16.50 ,75% of total billed charges for outpatient setting,$4.82 ,102% CMS Medicare OPPS fee schedule,$4.82 ,102% CMS Medicare OPPS fee schedule,$4.82 ,102% CMS Medicare OPPS fee schedule,$4.82 ,102% CMS Medicare OPPS fee schedule,$4.82 ,102% CMS Medicare OPPS fee schedule,$4.82 ,102% CMS Medicare OPPS fee schedule,$26.40 ,80% of total billed charges for outpatient setting,$4.82 ,102% CMS Medicare OPPS fee schedule,$5.68 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$28.05 ,85% of total billed charges for outpatient setting,$4.78 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$26.40 ,80% of total billed charges for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$23.10 ,70% of total billed charges for outpatient setting,$23.10 ,70% of total billed charges for outpatient setting,$25.41 ,77% of total billed charges for outpatient setting,$4.78 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$5.52 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.78 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.78 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.78 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.78 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$5.41 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$4.73 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$29.70 ,90% of total billed charges for outpatient setting,$5.57 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$31.35 ,95% of total billed charges for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$26.40 ,80% of total billed charges for outpatient setting,$5.52 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$28.05 ,85% of total billed charges for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$30.69 ,93% of total billed charges for outpatient setting,$24.75 ,75% of total billed charges for outpatient setting,$24.75 ,75% of total billed charges for outpatient setting,$24.75 ,75% of total billed charges for outpatient setting,$6.63 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$28.05 ,85% of total billed charges for outpatient setting,$5.52 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.73 ,$31.35 ,$11.55 Outpatient Medical Services,LAB,84133,Potassium Level 24 Hour Urine,300,$33.00 ,$5.68 ,100% Amerigroup fee schedule for outpatient setting,$5.68 ,100% Amerigroup fee schedule for outpatient setting,$16.50 ,75% of total billed charges for outpatient setting,$16.50 ,75% of total billed charges for outpatient setting,$16.50 ,75% of total billed charges for outpatient setting,$4.82 ,102% CMS Medicare OPPS fee schedule,$4.82 ,102% CMS Medicare OPPS fee schedule,$4.82 ,102% CMS Medicare OPPS fee schedule,$4.82 ,102% CMS Medicare OPPS fee schedule,$4.82 ,102% CMS Medicare OPPS fee schedule,$4.82 ,102% CMS Medicare OPPS fee schedule,$26.40 ,80% of total billed charges for outpatient setting,$4.82 ,102% CMS Medicare OPPS fee schedule,$5.68 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$28.05 ,85% of total billed charges for outpatient setting,$4.78 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$26.40 ,80% of total billed charges for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$23.10 ,70% of total billed charges for outpatient setting,$23.10 ,70% of total billed charges for outpatient setting,$25.41 ,77% of total billed charges for outpatient setting,$4.78 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$5.52 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.78 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.78 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.78 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.78 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$5.41 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$4.73 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$29.70 ,90% of total billed charges for outpatient setting,$5.57 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$31.35 ,95% of total billed charges for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$26.40 ,80% of total billed charges for outpatient setting,$5.52 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$28.05 ,85% of total billed charges for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$30.69 ,93% of total billed charges for outpatient setting,$24.75 ,75% of total billed charges for outpatient setting,$24.75 ,75% of total billed charges for outpatient setting,$24.75 ,75% of total billed charges for outpatient setting,$6.63 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$28.05 ,85% of total billed charges for outpatient setting,$5.52 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.73 ,$31.35 ,$11.55 Outpatient Medical Services,LAB,84153,PSA Diagnostic,301,$36.47 ,$24.29 ,100% Amerigroup fee schedule for outpatient setting,$24.29 ,100% Amerigroup fee schedule for outpatient setting,$18.24 ,75% of total billed charges for outpatient setting,$18.24 ,75% of total billed charges for outpatient setting,$18.24 ,75% of total billed charges for outpatient setting,$18.76 ,102% CMS Medicare OPPS fee schedule,$18.76 ,102% CMS Medicare OPPS fee schedule,$18.76 ,102% CMS Medicare OPPS fee schedule,$18.76 ,102% CMS Medicare OPPS fee schedule,$18.76 ,102% CMS Medicare OPPS fee schedule,$18.76 ,102% CMS Medicare OPPS fee schedule,$29.18 ,80% of total billed charges for outpatient setting,$18.76 ,102% CMS Medicare OPPS fee schedule,$24.29 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$31.00 ,85% of total billed charges for outpatient setting,$18.57 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$29.18 ,80% of total billed charges for outpatient setting,$31.00 ,85% of total billed charges for outpatient setting,$25.53 ,70% of total billed charges for outpatient setting,$25.53 ,70% of total billed charges for outpatient setting,$28.08 ,77% of total billed charges for outpatient setting,$18.57 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$31.00 ,85% of total billed charges for outpatient setting,$31.00 ,85% of total billed charges for outpatient setting,$31.00 ,85% of total billed charges for outpatient setting,$31.00 ,85% of total billed charges for outpatient setting,$31.00 ,85% of total billed charges for outpatient setting,$23.59 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$18.57 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$18.57 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$18.57 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$18.57 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$31.00 ,85% of total billed charges for outpatient setting,$23.13 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$18.39 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$32.82 ,90% of total billed charges for outpatient setting,$23.82 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$34.65 ,95% of total billed charges for outpatient setting,$31.00 ,85% of total billed charges for outpatient setting,$29.18 ,80% of total billed charges for outpatient setting,$23.59 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$31.00 ,85% of total billed charges for outpatient setting,$31.00 ,85% of total billed charges for outpatient setting,$31.00 ,85% of total billed charges for outpatient setting,$33.92 ,93% of total billed charges for outpatient setting,$27.35 ,75% of total billed charges for outpatient setting,$27.35 ,75% of total billed charges for outpatient setting,$27.35 ,75% of total billed charges for outpatient setting,$7.32 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$31.00 ,85% of total billed charges for outpatient setting,$23.59 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$7.32 ,$34.65 ,$12.76 Outpatient Medical Services,LAB,84153,Prostate-Specific Ag LC,301,$36.47 ,$24.29 ,100% Amerigroup fee schedule for outpatient setting,$24.29 ,100% Amerigroup fee schedule for outpatient setting,$18.24 ,75% of total billed charges for outpatient setting,$18.24 ,75% of total billed charges for outpatient setting,$18.24 ,75% of total billed charges for outpatient setting,$18.76 ,102% CMS Medicare OPPS fee schedule,$18.76 ,102% CMS Medicare OPPS fee schedule,$18.76 ,102% CMS Medicare OPPS fee schedule,$18.76 ,102% CMS Medicare OPPS fee schedule,$18.76 ,102% CMS Medicare OPPS fee schedule,$18.76 ,102% CMS Medicare OPPS fee schedule,$29.18 ,80% of total billed charges for outpatient setting,$18.76 ,102% CMS Medicare OPPS fee schedule,$24.29 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$31.00 ,85% of total billed charges for outpatient setting,$18.57 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$29.18 ,80% of total billed charges for outpatient setting,$31.00 ,85% of total billed charges for outpatient setting,$25.53 ,70% of total billed charges for outpatient setting,$25.53 ,70% of total billed charges for outpatient setting,$28.08 ,77% of total billed charges for outpatient setting,$18.57 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$31.00 ,85% of total billed charges for outpatient setting,$31.00 ,85% of total billed charges for outpatient setting,$31.00 ,85% of total billed charges for outpatient setting,$31.00 ,85% of total billed charges for outpatient setting,$31.00 ,85% of total billed charges for outpatient setting,$23.59 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$18.57 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$18.57 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$18.57 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$18.57 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$31.00 ,85% of total billed charges for outpatient setting,$23.13 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$18.39 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$32.82 ,90% of total billed charges for outpatient setting,$23.82 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$34.65 ,95% of total billed charges for outpatient setting,$31.00 ,85% of total billed charges for outpatient setting,$29.18 ,80% of total billed charges for outpatient setting,$23.59 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$31.00 ,85% of total billed charges for outpatient setting,$31.00 ,85% of total billed charges for outpatient setting,$31.00 ,85% of total billed charges for outpatient setting,$33.92 ,93% of total billed charges for outpatient setting,$27.35 ,75% of total billed charges for outpatient setting,$27.35 ,75% of total billed charges for outpatient setting,$27.35 ,75% of total billed charges for outpatient setting,$7.32 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$31.00 ,85% of total billed charges for outpatient setting,$23.59 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$7.32 ,$34.65 ,$12.76 Outpatient Medical Services,LAB,84155,Protein Total,300,$34.00 ,$4.84 ,100% Amerigroup fee schedule for outpatient setting,$4.84 ,100% Amerigroup fee schedule for outpatient setting,$17.00 ,75% of total billed charges for outpatient setting,$17.00 ,75% of total billed charges for outpatient setting,$17.00 ,75% of total billed charges for outpatient setting,$3.74 ,102% CMS Medicare OPPS fee schedule,$3.74 ,102% CMS Medicare OPPS fee schedule,$3.74 ,102% CMS Medicare OPPS fee schedule,$3.74 ,102% CMS Medicare OPPS fee schedule,$3.74 ,102% CMS Medicare OPPS fee schedule,$3.74 ,102% CMS Medicare OPPS fee schedule,$27.20 ,80% of total billed charges for outpatient setting,$3.74 ,102% CMS Medicare OPPS fee schedule,$4.84 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$28.90 ,85% of total billed charges for outpatient setting,$3.71 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$27.20 ,80% of total billed charges for outpatient setting,$28.90 ,85% of total billed charges for outpatient setting,$23.80 ,70% of total billed charges for outpatient setting,$23.80 ,70% of total billed charges for outpatient setting,$26.18 ,77% of total billed charges for outpatient setting,$3.71 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$28.90 ,85% of total billed charges for outpatient setting,$28.90 ,85% of total billed charges for outpatient setting,$28.90 ,85% of total billed charges for outpatient setting,$28.90 ,85% of total billed charges for outpatient setting,$28.90 ,85% of total billed charges for outpatient setting,$4.70 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.71 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.71 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.71 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.71 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$28.90 ,85% of total billed charges for outpatient setting,$4.61 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$3.67 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$30.60 ,90% of total billed charges for outpatient setting,$4.75 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$32.30 ,95% of total billed charges for outpatient setting,$28.90 ,85% of total billed charges for outpatient setting,$27.20 ,80% of total billed charges for outpatient setting,$4.70 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$28.90 ,85% of total billed charges for outpatient setting,$28.90 ,85% of total billed charges for outpatient setting,$28.90 ,85% of total billed charges for outpatient setting,$31.62 ,93% of total billed charges for outpatient setting,$25.50 ,75% of total billed charges for outpatient setting,$25.50 ,75% of total billed charges for outpatient setting,$25.50 ,75% of total billed charges for outpatient setting,$6.83 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$28.90 ,85% of total billed charges for outpatient setting,$4.70 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.67 ,$32.30 ,$11.90 Outpatient Medical Services,LAB,84156,Protein/Creatinine Ratio Urine,300,$47.77 ,$4.84 ,100% Amerigroup fee schedule for outpatient setting,$4.84 ,100% Amerigroup fee schedule for outpatient setting,$23.89 ,75% of total billed charges for outpatient setting,$23.89 ,75% of total billed charges for outpatient setting,$23.89 ,75% of total billed charges for outpatient setting,$3.74 ,102% CMS Medicare OPPS fee schedule,$3.74 ,102% CMS Medicare OPPS fee schedule,$3.74 ,102% CMS Medicare OPPS fee schedule,$3.74 ,102% CMS Medicare OPPS fee schedule,$3.74 ,102% CMS Medicare OPPS fee schedule,$3.74 ,102% CMS Medicare OPPS fee schedule,$38.22 ,80% of total billed charges for outpatient setting,$3.74 ,102% CMS Medicare OPPS fee schedule,$4.84 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$40.60 ,85% of total billed charges for outpatient setting,$3.71 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$38.22 ,80% of total billed charges for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$33.44 ,70% of total billed charges for outpatient setting,$33.44 ,70% of total billed charges for outpatient setting,$36.78 ,77% of total billed charges for outpatient setting,$3.71 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$4.70 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.71 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.71 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.71 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.71 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$4.61 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$3.67 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$42.99 ,90% of total billed charges for outpatient setting,$4.75 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$45.38 ,95% of total billed charges for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$38.22 ,80% of total billed charges for outpatient setting,$4.70 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$40.60 ,85% of total billed charges for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$44.43 ,93% of total billed charges for outpatient setting,$35.83 ,75% of total billed charges for outpatient setting,$35.83 ,75% of total billed charges for outpatient setting,$35.83 ,75% of total billed charges for outpatient setting,$9.59 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$40.60 ,85% of total billed charges for outpatient setting,$4.70 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.67 ,$45.38 ,$16.72 Outpatient Medical Services,LAB,84156,Protein Urine,300,$47.77 ,$4.84 ,100% Amerigroup fee schedule for outpatient setting,$4.84 ,100% Amerigroup fee schedule for outpatient setting,$23.89 ,75% of total billed charges for outpatient setting,$23.89 ,75% of total billed charges for outpatient setting,$23.89 ,75% of total billed charges for outpatient setting,$3.74 ,102% CMS Medicare OPPS fee schedule,$3.74 ,102% CMS Medicare OPPS fee schedule,$3.74 ,102% CMS Medicare OPPS fee schedule,$3.74 ,102% CMS Medicare OPPS fee schedule,$3.74 ,102% CMS Medicare OPPS fee schedule,$3.74 ,102% CMS Medicare OPPS fee schedule,$38.22 ,80% of total billed charges for outpatient setting,$3.74 ,102% CMS Medicare OPPS fee schedule,$4.84 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$40.60 ,85% of total billed charges for outpatient setting,$3.71 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$38.22 ,80% of total billed charges for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$33.44 ,70% of total billed charges for outpatient setting,$33.44 ,70% of total billed charges for outpatient setting,$36.78 ,77% of total billed charges for outpatient setting,$3.71 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$4.70 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.71 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.71 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.71 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.71 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$4.61 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$3.67 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$42.99 ,90% of total billed charges for outpatient setting,$4.75 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$45.38 ,95% of total billed charges for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$38.22 ,80% of total billed charges for outpatient setting,$4.70 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$40.60 ,85% of total billed charges for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$44.43 ,93% of total billed charges for outpatient setting,$35.83 ,75% of total billed charges for outpatient setting,$35.83 ,75% of total billed charges for outpatient setting,$35.83 ,75% of total billed charges for outpatient setting,$9.59 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$40.60 ,85% of total billed charges for outpatient setting,$4.70 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.67 ,$45.38 ,$16.72 Outpatient Medical Services,LAB,84156,Protein Level 24 Hour Urine,300,$47.77 ,$4.84 ,100% Amerigroup fee schedule for outpatient setting,$4.84 ,100% Amerigroup fee schedule for outpatient setting,$23.89 ,75% of total billed charges for outpatient setting,$23.89 ,75% of total billed charges for outpatient setting,$23.89 ,75% of total billed charges for outpatient setting,$3.74 ,102% CMS Medicare OPPS fee schedule,$3.74 ,102% CMS Medicare OPPS fee schedule,$3.74 ,102% CMS Medicare OPPS fee schedule,$3.74 ,102% CMS Medicare OPPS fee schedule,$3.74 ,102% CMS Medicare OPPS fee schedule,$3.74 ,102% CMS Medicare OPPS fee schedule,$38.22 ,80% of total billed charges for outpatient setting,$3.74 ,102% CMS Medicare OPPS fee schedule,$4.84 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$40.60 ,85% of total billed charges for outpatient setting,$3.71 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$38.22 ,80% of total billed charges for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$33.44 ,70% of total billed charges for outpatient setting,$33.44 ,70% of total billed charges for outpatient setting,$36.78 ,77% of total billed charges for outpatient setting,$3.71 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$4.70 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.71 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.71 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.71 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.71 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$4.61 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$3.67 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$42.99 ,90% of total billed charges for outpatient setting,$4.75 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$45.38 ,95% of total billed charges for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$38.22 ,80% of total billed charges for outpatient setting,$4.70 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$40.60 ,85% of total billed charges for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$44.43 ,93% of total billed charges for outpatient setting,$35.83 ,75% of total billed charges for outpatient setting,$35.83 ,75% of total billed charges for outpatient setting,$35.83 ,75% of total billed charges for outpatient setting,$9.59 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$40.60 ,85% of total billed charges for outpatient setting,$4.70 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.67 ,$45.38 ,$16.72 Outpatient Medical Services,LAB,84156,"Protein,Total,Urine LC",300,$47.77 ,$4.84 ,100% Amerigroup fee schedule for outpatient setting,$4.84 ,100% Amerigroup fee schedule for outpatient setting,$23.89 ,75% of total billed charges for outpatient setting,$23.89 ,75% of total billed charges for outpatient setting,$23.89 ,75% of total billed charges for outpatient setting,$3.74 ,102% CMS Medicare OPPS fee schedule,$3.74 ,102% CMS Medicare OPPS fee schedule,$3.74 ,102% CMS Medicare OPPS fee schedule,$3.74 ,102% CMS Medicare OPPS fee schedule,$3.74 ,102% CMS Medicare OPPS fee schedule,$3.74 ,102% CMS Medicare OPPS fee schedule,$38.22 ,80% of total billed charges for outpatient setting,$3.74 ,102% CMS Medicare OPPS fee schedule,$4.84 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$40.60 ,85% of total billed charges for outpatient setting,$3.71 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$38.22 ,80% of total billed charges for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$33.44 ,70% of total billed charges for outpatient setting,$33.44 ,70% of total billed charges for outpatient setting,$36.78 ,77% of total billed charges for outpatient setting,$3.71 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$4.70 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.71 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.71 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.71 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.71 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$4.61 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$3.67 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$42.99 ,90% of total billed charges for outpatient setting,$4.75 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$45.38 ,95% of total billed charges for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$38.22 ,80% of total billed charges for outpatient setting,$4.70 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$40.60 ,85% of total billed charges for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$40.60 ,85% of total billed charges for outpatient setting,$44.43 ,93% of total billed charges for outpatient setting,$35.83 ,75% of total billed charges for outpatient setting,$35.83 ,75% of total billed charges for outpatient setting,$35.83 ,75% of total billed charges for outpatient setting,$9.59 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$40.60 ,85% of total billed charges for outpatient setting,$4.70 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.67 ,$45.38 ,$16.72 Outpatient Medical Services,LAB,84157,Protein Cerebrospinal Fluid,300,$42.00 ,$4.84 ,100% Amerigroup fee schedule for outpatient setting,$4.84 ,100% Amerigroup fee schedule for outpatient setting,$21.00 ,75% of total billed charges for outpatient setting,$21.00 ,75% of total billed charges for outpatient setting,$21.00 ,75% of total billed charges for outpatient setting,$4.08 ,102% CMS Medicare OPPS fee schedule,$4.08 ,102% CMS Medicare OPPS fee schedule,$4.08 ,102% CMS Medicare OPPS fee schedule,$4.08 ,102% CMS Medicare OPPS fee schedule,$4.08 ,102% CMS Medicare OPPS fee schedule,$4.08 ,102% CMS Medicare OPPS fee schedule,$33.60 ,80% of total billed charges for outpatient setting,$4.08 ,102% CMS Medicare OPPS fee schedule,$4.84 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$35.70 ,85% of total billed charges for outpatient setting,$4.04 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$33.60 ,80% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$29.40 ,70% of total billed charges for outpatient setting,$29.40 ,70% of total billed charges for outpatient setting,$32.34 ,77% of total billed charges for outpatient setting,$4.04 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$4.70 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.04 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.04 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.04 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.04 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$4.61 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$4.00 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$37.80 ,90% of total billed charges for outpatient setting,$4.75 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$39.90 ,95% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$33.60 ,80% of total billed charges for outpatient setting,$4.70 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$35.70 ,85% of total billed charges for outpatient setting,$39.06 ,93% of total billed charges for outpatient setting,$31.50 ,75% of total billed charges for outpatient setting,$31.50 ,75% of total billed charges for outpatient setting,$31.50 ,75% of total billed charges for outpatient setting,$8.43 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$35.70 ,85% of total billed charges for outpatient setting,$4.70 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.00 ,$39.90 ,$14.70 Outpatient Medical Services,LAB,84295,Sodium,301,$33.00 ,$6.35 ,100% Amerigroup fee schedule for outpatient setting,$6.35 ,100% Amerigroup fee schedule for outpatient setting,$16.50 ,75% of total billed charges for outpatient setting,$16.50 ,75% of total billed charges for outpatient setting,$16.50 ,75% of total billed charges for outpatient setting,$4.91 ,102% CMS Medicare OPPS fee schedule,$4.91 ,102% CMS Medicare OPPS fee schedule,$4.91 ,102% CMS Medicare OPPS fee schedule,$4.91 ,102% CMS Medicare OPPS fee schedule,$4.91 ,102% CMS Medicare OPPS fee schedule,$4.91 ,102% CMS Medicare OPPS fee schedule,$26.40 ,80% of total billed charges for outpatient setting,$4.91 ,102% CMS Medicare OPPS fee schedule,$6.35 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$28.05 ,85% of total billed charges for outpatient setting,$4.86 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$26.40 ,80% of total billed charges for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$23.10 ,70% of total billed charges for outpatient setting,$23.10 ,70% of total billed charges for outpatient setting,$25.41 ,77% of total billed charges for outpatient setting,$4.86 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$6.17 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.86 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.86 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.86 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.86 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$6.05 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$4.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$29.70 ,90% of total billed charges for outpatient setting,$6.23 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$31.35 ,95% of total billed charges for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$26.40 ,80% of total billed charges for outpatient setting,$6.17 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$28.05 ,85% of total billed charges for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$30.69 ,93% of total billed charges for outpatient setting,$24.75 ,75% of total billed charges for outpatient setting,$24.75 ,75% of total billed charges for outpatient setting,$24.75 ,75% of total billed charges for outpatient setting,$6.63 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$28.05 ,85% of total billed charges for outpatient setting,$6.17 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.81 ,$31.35 ,$11.55 Outpatient Medical Services,LAB,84300,Sodium Level Urine,300,$46.37 ,$4.57 ,100% Amerigroup fee schedule for outpatient setting,$4.57 ,100% Amerigroup fee schedule for outpatient setting,$23.19 ,75% of total billed charges for outpatient setting,$23.19 ,75% of total billed charges for outpatient setting,$23.19 ,75% of total billed charges for outpatient setting,$5.16 ,102% CMS Medicare OPPS fee schedule,$5.16 ,102% CMS Medicare OPPS fee schedule,$5.16 ,102% CMS Medicare OPPS fee schedule,$5.16 ,102% CMS Medicare OPPS fee schedule,$5.16 ,102% CMS Medicare OPPS fee schedule,$5.16 ,102% CMS Medicare OPPS fee schedule,$37.10 ,80% of total billed charges for outpatient setting,$5.16 ,102% CMS Medicare OPPS fee schedule,$4.57 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$39.41 ,85% of total billed charges for outpatient setting,$5.11 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$37.10 ,80% of total billed charges for outpatient setting,$39.41 ,85% of total billed charges for outpatient setting,$32.46 ,70% of total billed charges for outpatient setting,$32.46 ,70% of total billed charges for outpatient setting,$35.70 ,77% of total billed charges for outpatient setting,$5.11 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$39.41 ,85% of total billed charges for outpatient setting,$39.41 ,85% of total billed charges for outpatient setting,$39.41 ,85% of total billed charges for outpatient setting,$39.41 ,85% of total billed charges for outpatient setting,$39.41 ,85% of total billed charges for outpatient setting,$4.44 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.11 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.11 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.11 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.11 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$39.41 ,85% of total billed charges for outpatient setting,$4.35 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$5.06 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$41.73 ,90% of total billed charges for outpatient setting,$4.48 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$44.05 ,95% of total billed charges for outpatient setting,$39.41 ,85% of total billed charges for outpatient setting,$37.10 ,80% of total billed charges for outpatient setting,$4.44 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$39.41 ,85% of total billed charges for outpatient setting,$39.41 ,85% of total billed charges for outpatient setting,$39.41 ,85% of total billed charges for outpatient setting,$43.12 ,93% of total billed charges for outpatient setting,$34.78 ,75% of total billed charges for outpatient setting,$34.78 ,75% of total billed charges for outpatient setting,$34.78 ,75% of total billed charges for outpatient setting,$9.31 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$39.41 ,85% of total billed charges for outpatient setting,$4.44 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.35 ,$44.05 ,$16.23 Outpatient Medical Services,LAB,84300,Sodium Level 24 Hour Urine,300,$46.37 ,$4.57 ,100% Amerigroup fee schedule for outpatient setting,$4.57 ,100% Amerigroup fee schedule for outpatient setting,$23.19 ,75% of total billed charges for outpatient setting,$23.19 ,75% of total billed charges for outpatient setting,$23.19 ,75% of total billed charges for outpatient setting,$5.16 ,102% CMS Medicare OPPS fee schedule,$5.16 ,102% CMS Medicare OPPS fee schedule,$5.16 ,102% CMS Medicare OPPS fee schedule,$5.16 ,102% CMS Medicare OPPS fee schedule,$5.16 ,102% CMS Medicare OPPS fee schedule,$5.16 ,102% CMS Medicare OPPS fee schedule,$37.10 ,80% of total billed charges for outpatient setting,$5.16 ,102% CMS Medicare OPPS fee schedule,$4.57 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$39.41 ,85% of total billed charges for outpatient setting,$5.11 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$37.10 ,80% of total billed charges for outpatient setting,$39.41 ,85% of total billed charges for outpatient setting,$32.46 ,70% of total billed charges for outpatient setting,$32.46 ,70% of total billed charges for outpatient setting,$35.70 ,77% of total billed charges for outpatient setting,$5.11 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$39.41 ,85% of total billed charges for outpatient setting,$39.41 ,85% of total billed charges for outpatient setting,$39.41 ,85% of total billed charges for outpatient setting,$39.41 ,85% of total billed charges for outpatient setting,$39.41 ,85% of total billed charges for outpatient setting,$4.44 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.11 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.11 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.11 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.11 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$39.41 ,85% of total billed charges for outpatient setting,$4.35 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$5.06 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$41.73 ,90% of total billed charges for outpatient setting,$4.48 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$44.05 ,95% of total billed charges for outpatient setting,$39.41 ,85% of total billed charges for outpatient setting,$37.10 ,80% of total billed charges for outpatient setting,$4.44 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$39.41 ,85% of total billed charges for outpatient setting,$39.41 ,85% of total billed charges for outpatient setting,$39.41 ,85% of total billed charges for outpatient setting,$43.12 ,93% of total billed charges for outpatient setting,$34.78 ,75% of total billed charges for outpatient setting,$34.78 ,75% of total billed charges for outpatient setting,$34.78 ,75% of total billed charges for outpatient setting,$9.31 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$39.41 ,85% of total billed charges for outpatient setting,$4.44 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.35 ,$44.05 ,$16.23 Outpatient Medical Services,LAB,84425,"Vitamin B1 (Thiamine), Blood LC",300,N/A,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$21.65 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$21.65 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$21.65 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$21.65 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$21.65 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$21.65 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,N/A,Not seperately reimbursable,$21.65 ,102% CMS Medicare OPPS fee schedule,$28.04 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,N/A,Not seperately reimbursable,$21.44 ,101% CMS Medicare OPPS fee schedule for outpatient setting,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$21.44 ,101% CMS Medicare OPPS fee schedule for outpatient setting,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$27.23 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$21.44 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$21.44 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$21.44 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$21.44 ,101% CMS Medicare OPPS fee schedule for outpatient setting,N/A,Not seperately reimbursable,$26.70 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$21.23 ,100% CMS Medicare OPPS fee schedule for outpatient setting,N/A,Not seperately reimbursable,$27.50 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$27.23 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,N/A,Not seperately reimbursable,$27.23 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$21.23 ,$28.04 ,N/A Outpatient Medical Services,LAB,84436,Total T4 Level,300,$96.00 ,$9.08 ,100% Amerigroup fee schedule for outpatient setting,$9.08 ,100% Amerigroup fee schedule for outpatient setting,$48.00 ,75% of total billed charges for outpatient setting,$48.00 ,75% of total billed charges for outpatient setting,$48.00 ,75% of total billed charges for outpatient setting,$7.01 ,102% CMS Medicare OPPS fee schedule,$7.01 ,102% CMS Medicare OPPS fee schedule,$7.01 ,102% CMS Medicare OPPS fee schedule,$7.01 ,102% CMS Medicare OPPS fee schedule,$7.01 ,102% CMS Medicare OPPS fee schedule,$7.01 ,102% CMS Medicare OPPS fee schedule,$76.80 ,80% of total billed charges for outpatient setting,$7.01 ,102% CMS Medicare OPPS fee schedule,$9.08 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$81.60 ,85% of total billed charges for outpatient setting,$6.94 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$76.80 ,80% of total billed charges for outpatient setting,$81.60 ,85% of total billed charges for outpatient setting,$67.20 ,70% of total billed charges for outpatient setting,$67.20 ,70% of total billed charges for outpatient setting,$73.92 ,77% of total billed charges for outpatient setting,$6.94 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$81.60 ,85% of total billed charges for outpatient setting,$81.60 ,85% of total billed charges for outpatient setting,$81.60 ,85% of total billed charges for outpatient setting,$81.60 ,85% of total billed charges for outpatient setting,$81.60 ,85% of total billed charges for outpatient setting,$8.82 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$6.94 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.94 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.94 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.94 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$81.60 ,85% of total billed charges for outpatient setting,$8.65 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$6.87 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$86.40 ,90% of total billed charges for outpatient setting,$8.91 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$91.20 ,95% of total billed charges for outpatient setting,$81.60 ,85% of total billed charges for outpatient setting,$76.80 ,80% of total billed charges for outpatient setting,$8.82 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$81.60 ,85% of total billed charges for outpatient setting,$81.60 ,85% of total billed charges for outpatient setting,$81.60 ,85% of total billed charges for outpatient setting,$89.28 ,93% of total billed charges for outpatient setting,$72.00 ,75% of total billed charges for outpatient setting,$72.00 ,75% of total billed charges for outpatient setting,$72.00 ,75% of total billed charges for outpatient setting,$19.28 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$81.60 ,85% of total billed charges for outpatient setting,$8.82 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$6.87 ,$91.20 ,$33.60 Outpatient Medical Services,LAB,84436,Thyroxine (T4) LC,300,$96.00 ,$9.08 ,100% Amerigroup fee schedule for outpatient setting,$9.08 ,100% Amerigroup fee schedule for outpatient setting,$48.00 ,75% of total billed charges for outpatient setting,$48.00 ,75% of total billed charges for outpatient setting,$48.00 ,75% of total billed charges for outpatient setting,$7.01 ,102% CMS Medicare OPPS fee schedule,$7.01 ,102% CMS Medicare OPPS fee schedule,$7.01 ,102% CMS Medicare OPPS fee schedule,$7.01 ,102% CMS Medicare OPPS fee schedule,$7.01 ,102% CMS Medicare OPPS fee schedule,$7.01 ,102% CMS Medicare OPPS fee schedule,$76.80 ,80% of total billed charges for outpatient setting,$7.01 ,102% CMS Medicare OPPS fee schedule,$9.08 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$81.60 ,85% of total billed charges for outpatient setting,$6.94 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$76.80 ,80% of total billed charges for outpatient setting,$81.60 ,85% of total billed charges for outpatient setting,$67.20 ,70% of total billed charges for outpatient setting,$67.20 ,70% of total billed charges for outpatient setting,$73.92 ,77% of total billed charges for outpatient setting,$6.94 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$81.60 ,85% of total billed charges for outpatient setting,$81.60 ,85% of total billed charges for outpatient setting,$81.60 ,85% of total billed charges for outpatient setting,$81.60 ,85% of total billed charges for outpatient setting,$81.60 ,85% of total billed charges for outpatient setting,$8.82 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$6.94 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.94 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.94 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.94 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$81.60 ,85% of total billed charges for outpatient setting,$8.65 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$6.87 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$86.40 ,90% of total billed charges for outpatient setting,$8.91 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$91.20 ,95% of total billed charges for outpatient setting,$81.60 ,85% of total billed charges for outpatient setting,$76.80 ,80% of total billed charges for outpatient setting,$8.82 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$81.60 ,85% of total billed charges for outpatient setting,$81.60 ,85% of total billed charges for outpatient setting,$81.60 ,85% of total billed charges for outpatient setting,$89.28 ,93% of total billed charges for outpatient setting,$72.00 ,75% of total billed charges for outpatient setting,$72.00 ,75% of total billed charges for outpatient setting,$72.00 ,75% of total billed charges for outpatient setting,$19.28 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$81.60 ,85% of total billed charges for outpatient setting,$8.82 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$6.87 ,$91.20 ,$33.60 Outpatient Medical Services,LAB,84439,Free T4 Level,300,$104.39 ,$11.91 ,100% Amerigroup fee schedule for outpatient setting,$11.91 ,100% Amerigroup fee schedule for outpatient setting,$52.20 ,75% of total billed charges for outpatient setting,$52.20 ,75% of total billed charges for outpatient setting,$52.20 ,75% of total billed charges for outpatient setting,$9.20 ,102% CMS Medicare OPPS fee schedule,$9.20 ,102% CMS Medicare OPPS fee schedule,$9.20 ,102% CMS Medicare OPPS fee schedule,$9.20 ,102% CMS Medicare OPPS fee schedule,$9.20 ,102% CMS Medicare OPPS fee schedule,$9.20 ,102% CMS Medicare OPPS fee schedule,$83.51 ,80% of total billed charges for outpatient setting,$9.20 ,102% CMS Medicare OPPS fee schedule,$11.91 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$88.73 ,85% of total billed charges for outpatient setting,$9.11 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$83.51 ,80% of total billed charges for outpatient setting,$88.73 ,85% of total billed charges for outpatient setting,$73.07 ,70% of total billed charges for outpatient setting,$73.07 ,70% of total billed charges for outpatient setting,$80.38 ,77% of total billed charges for outpatient setting,$9.11 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$88.73 ,85% of total billed charges for outpatient setting,$88.73 ,85% of total billed charges for outpatient setting,$88.73 ,85% of total billed charges for outpatient setting,$88.73 ,85% of total billed charges for outpatient setting,$88.73 ,85% of total billed charges for outpatient setting,$11.57 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$9.11 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.11 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.11 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.11 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$88.73 ,85% of total billed charges for outpatient setting,$11.34 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$9.02 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$93.95 ,90% of total billed charges for outpatient setting,$11.68 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$99.17 ,95% of total billed charges for outpatient setting,$88.73 ,85% of total billed charges for outpatient setting,$83.51 ,80% of total billed charges for outpatient setting,$11.57 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$88.73 ,85% of total billed charges for outpatient setting,$88.73 ,85% of total billed charges for outpatient setting,$88.73 ,85% of total billed charges for outpatient setting,$97.08 ,93% of total billed charges for outpatient setting,$78.29 ,75% of total billed charges for outpatient setting,$78.29 ,75% of total billed charges for outpatient setting,$78.29 ,75% of total billed charges for outpatient setting,$20.96 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$88.73 ,85% of total billed charges for outpatient setting,$11.57 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$9.02 ,$99.17 ,$36.54 Outpatient Medical Services,LAB,84443,TSH,301,$222.14 ,$22.18 ,100% Amerigroup fee schedule for outpatient setting,$22.18 ,100% Amerigroup fee schedule for outpatient setting,$111.07 ,75% of total billed charges for outpatient setting,$111.07 ,75% of total billed charges for outpatient setting,$111.07 ,75% of total billed charges for outpatient setting,$17.14 ,102% CMS Medicare OPPS fee schedule,$17.14 ,102% CMS Medicare OPPS fee schedule,$17.14 ,102% CMS Medicare OPPS fee schedule,$17.14 ,102% CMS Medicare OPPS fee schedule,$17.14 ,102% CMS Medicare OPPS fee schedule,$17.14 ,102% CMS Medicare OPPS fee schedule,$177.71 ,80% of total billed charges for outpatient setting,$17.14 ,102% CMS Medicare OPPS fee schedule,$22.18 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$188.82 ,85% of total billed charges for outpatient setting,$16.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$177.71 ,80% of total billed charges for outpatient setting,$188.82 ,85% of total billed charges for outpatient setting,$155.50 ,70% of total billed charges for outpatient setting,$155.50 ,70% of total billed charges for outpatient setting,$171.05 ,77% of total billed charges for outpatient setting,$16.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$188.82 ,85% of total billed charges for outpatient setting,$188.82 ,85% of total billed charges for outpatient setting,$188.82 ,85% of total billed charges for outpatient setting,$188.82 ,85% of total billed charges for outpatient setting,$188.82 ,85% of total billed charges for outpatient setting,$21.54 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$16.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$16.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$16.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$16.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$188.82 ,85% of total billed charges for outpatient setting,$21.12 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$16.80 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$199.93 ,90% of total billed charges for outpatient setting,$21.75 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$211.03 ,95% of total billed charges for outpatient setting,$188.82 ,85% of total billed charges for outpatient setting,$177.71 ,80% of total billed charges for outpatient setting,$21.54 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$188.82 ,85% of total billed charges for outpatient setting,$188.82 ,85% of total billed charges for outpatient setting,$188.82 ,85% of total billed charges for outpatient setting,$206.59 ,93% of total billed charges for outpatient setting,$166.61 ,75% of total billed charges for outpatient setting,$166.61 ,75% of total billed charges for outpatient setting,$166.61 ,75% of total billed charges for outpatient setting,$44.61 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$188.82 ,85% of total billed charges for outpatient setting,$21.54 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$16.80 ,$211.03 ,$77.75 Outpatient Medical Services,LAB,84443,TSH LC,301,$222.14 ,$22.18 ,100% Amerigroup fee schedule for outpatient setting,$22.18 ,100% Amerigroup fee schedule for outpatient setting,$111.07 ,75% of total billed charges for outpatient setting,$111.07 ,75% of total billed charges for outpatient setting,$111.07 ,75% of total billed charges for outpatient setting,$17.14 ,102% CMS Medicare OPPS fee schedule,$17.14 ,102% CMS Medicare OPPS fee schedule,$17.14 ,102% CMS Medicare OPPS fee schedule,$17.14 ,102% CMS Medicare OPPS fee schedule,$17.14 ,102% CMS Medicare OPPS fee schedule,$17.14 ,102% CMS Medicare OPPS fee schedule,$177.71 ,80% of total billed charges for outpatient setting,$17.14 ,102% CMS Medicare OPPS fee schedule,$22.18 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$188.82 ,85% of total billed charges for outpatient setting,$16.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$177.71 ,80% of total billed charges for outpatient setting,$188.82 ,85% of total billed charges for outpatient setting,$155.50 ,70% of total billed charges for outpatient setting,$155.50 ,70% of total billed charges for outpatient setting,$171.05 ,77% of total billed charges for outpatient setting,$16.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$188.82 ,85% of total billed charges for outpatient setting,$188.82 ,85% of total billed charges for outpatient setting,$188.82 ,85% of total billed charges for outpatient setting,$188.82 ,85% of total billed charges for outpatient setting,$188.82 ,85% of total billed charges for outpatient setting,$21.54 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$16.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$16.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$16.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$16.97 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$188.82 ,85% of total billed charges for outpatient setting,$21.12 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$16.80 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$199.93 ,90% of total billed charges for outpatient setting,$21.75 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$211.03 ,95% of total billed charges for outpatient setting,$188.82 ,85% of total billed charges for outpatient setting,$177.71 ,80% of total billed charges for outpatient setting,$21.54 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$188.82 ,85% of total billed charges for outpatient setting,$188.82 ,85% of total billed charges for outpatient setting,$188.82 ,85% of total billed charges for outpatient setting,$206.59 ,93% of total billed charges for outpatient setting,$166.61 ,75% of total billed charges for outpatient setting,$166.61 ,75% of total billed charges for outpatient setting,$166.61 ,75% of total billed charges for outpatient setting,$44.61 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$188.82 ,85% of total billed charges for outpatient setting,$21.54 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$16.80 ,$211.03 ,$77.75 Outpatient Medical Services,LAB,84450,Aspartate Aminotransferase,301,$11.00 ,$6.67 ,100% Amerigroup fee schedule for outpatient setting,$6.67 ,100% Amerigroup fee schedule for outpatient setting,$5.50 ,75% of total billed charges for outpatient setting,$5.50 ,75% of total billed charges for outpatient setting,$5.50 ,75% of total billed charges for outpatient setting,$5.28 ,102% CMS Medicare OPPS fee schedule,$5.28 ,102% CMS Medicare OPPS fee schedule,$5.28 ,102% CMS Medicare OPPS fee schedule,$5.28 ,102% CMS Medicare OPPS fee schedule,$5.28 ,102% CMS Medicare OPPS fee schedule,$5.28 ,102% CMS Medicare OPPS fee schedule,$8.80 ,80% of total billed charges for outpatient setting,$5.28 ,102% CMS Medicare OPPS fee schedule,$6.67 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$9.35 ,85% of total billed charges for outpatient setting,$5.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.80 ,80% of total billed charges for outpatient setting,$9.35 ,85% of total billed charges for outpatient setting,$7.70 ,70% of total billed charges for outpatient setting,$7.70 ,70% of total billed charges for outpatient setting,$8.47 ,77% of total billed charges for outpatient setting,$5.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.35 ,85% of total billed charges for outpatient setting,$9.35 ,85% of total billed charges for outpatient setting,$9.35 ,85% of total billed charges for outpatient setting,$9.35 ,85% of total billed charges for outpatient setting,$9.35 ,85% of total billed charges for outpatient setting,$6.48 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.35 ,85% of total billed charges for outpatient setting,$6.35 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$5.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$9.90 ,90% of total billed charges for outpatient setting,$6.54 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$10.45 ,95% of total billed charges for outpatient setting,$9.35 ,85% of total billed charges for outpatient setting,$8.80 ,80% of total billed charges for outpatient setting,$6.48 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$9.35 ,85% of total billed charges for outpatient setting,$9.35 ,85% of total billed charges for outpatient setting,$9.35 ,85% of total billed charges for outpatient setting,$10.23 ,93% of total billed charges for outpatient setting,$8.25 ,75% of total billed charges for outpatient setting,$8.25 ,75% of total billed charges for outpatient setting,$8.25 ,75% of total billed charges for outpatient setting,$2.21 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$9.35 ,85% of total billed charges for outpatient setting,$6.48 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$2.21 ,$10.45 ,$3.85 Outpatient Medical Services,LAB,84460,Alanine Aminotransferase,300,$9.20 ,$6.67 ,100% Amerigroup fee schedule for outpatient setting,$6.67 ,100% Amerigroup fee schedule for outpatient setting,$4.60 ,75% of total billed charges for outpatient setting,$4.60 ,75% of total billed charges for outpatient setting,$4.60 ,75% of total billed charges for outpatient setting,$5.41 ,102% CMS Medicare OPPS fee schedule,$5.41 ,102% CMS Medicare OPPS fee schedule,$5.41 ,102% CMS Medicare OPPS fee schedule,$5.41 ,102% CMS Medicare OPPS fee schedule,$5.41 ,102% CMS Medicare OPPS fee schedule,$5.41 ,102% CMS Medicare OPPS fee schedule,$7.36 ,80% of total billed charges for outpatient setting,$5.41 ,102% CMS Medicare OPPS fee schedule,$6.67 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$7.82 ,85% of total billed charges for outpatient setting,$5.35 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$7.36 ,80% of total billed charges for outpatient setting,$7.82 ,85% of total billed charges for outpatient setting,$6.44 ,70% of total billed charges for outpatient setting,$6.44 ,70% of total billed charges for outpatient setting,$7.08 ,77% of total billed charges for outpatient setting,$5.35 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$7.82 ,85% of total billed charges for outpatient setting,$7.82 ,85% of total billed charges for outpatient setting,$7.82 ,85% of total billed charges for outpatient setting,$7.82 ,85% of total billed charges for outpatient setting,$7.82 ,85% of total billed charges for outpatient setting,$6.48 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.35 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.35 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.35 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.35 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$7.82 ,85% of total billed charges for outpatient setting,$6.35 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$5.30 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.28 ,90% of total billed charges for outpatient setting,$6.54 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$8.74 ,95% of total billed charges for outpatient setting,$7.82 ,85% of total billed charges for outpatient setting,$7.36 ,80% of total billed charges for outpatient setting,$6.48 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$7.82 ,85% of total billed charges for outpatient setting,$7.82 ,85% of total billed charges for outpatient setting,$7.82 ,85% of total billed charges for outpatient setting,$8.56 ,93% of total billed charges for outpatient setting,$6.90 ,75% of total billed charges for outpatient setting,$6.90 ,75% of total billed charges for outpatient setting,$6.90 ,75% of total billed charges for outpatient setting,$1.85 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$7.82 ,85% of total billed charges for outpatient setting,$6.48 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$1.85 ,$8.74 ,$3.22 Outpatient Medical Services,LAB,84466,Transferrin,300,$71.00 ,$16.86 ,100% Amerigroup fee schedule for outpatient setting,$16.86 ,100% Amerigroup fee schedule for outpatient setting,$35.50 ,75% of total billed charges for outpatient setting,$35.50 ,75% of total billed charges for outpatient setting,$35.50 ,75% of total billed charges for outpatient setting,$13.02 ,102% CMS Medicare OPPS fee schedule,$13.02 ,102% CMS Medicare OPPS fee schedule,$13.02 ,102% CMS Medicare OPPS fee schedule,$13.02 ,102% CMS Medicare OPPS fee schedule,$13.02 ,102% CMS Medicare OPPS fee schedule,$13.02 ,102% CMS Medicare OPPS fee schedule,$56.80 ,80% of total billed charges for outpatient setting,$13.02 ,102% CMS Medicare OPPS fee schedule,$16.86 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$60.35 ,85% of total billed charges for outpatient setting,$12.89 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$56.80 ,80% of total billed charges for outpatient setting,$60.35 ,85% of total billed charges for outpatient setting,$49.70 ,70% of total billed charges for outpatient setting,$49.70 ,70% of total billed charges for outpatient setting,$54.67 ,77% of total billed charges for outpatient setting,$12.89 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$60.35 ,85% of total billed charges for outpatient setting,$60.35 ,85% of total billed charges for outpatient setting,$60.35 ,85% of total billed charges for outpatient setting,$60.35 ,85% of total billed charges for outpatient setting,$60.35 ,85% of total billed charges for outpatient setting,$16.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$12.89 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.89 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.89 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.89 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$60.35 ,85% of total billed charges for outpatient setting,$16.06 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$12.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$63.90 ,90% of total billed charges for outpatient setting,$16.54 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$67.45 ,95% of total billed charges for outpatient setting,$60.35 ,85% of total billed charges for outpatient setting,$56.80 ,80% of total billed charges for outpatient setting,$16.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$60.35 ,85% of total billed charges for outpatient setting,$60.35 ,85% of total billed charges for outpatient setting,$60.35 ,85% of total billed charges for outpatient setting,$66.03 ,93% of total billed charges for outpatient setting,$53.25 ,75% of total billed charges for outpatient setting,$53.25 ,75% of total billed charges for outpatient setting,$53.25 ,75% of total billed charges for outpatient setting,$14.26 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$60.35 ,85% of total billed charges for outpatient setting,$16.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$12.76 ,$67.45 ,$24.85 Outpatient Medical Services,LAB,84478,Triglycerides,301,$73.00 ,$6.67 ,100% Amerigroup fee schedule for outpatient setting,$6.67 ,100% Amerigroup fee schedule for outpatient setting,$36.50 ,75% of total billed charges for outpatient setting,$36.50 ,75% of total billed charges for outpatient setting,$36.50 ,75% of total billed charges for outpatient setting,$5.85 ,102% CMS Medicare OPPS fee schedule,$5.85 ,102% CMS Medicare OPPS fee schedule,$5.85 ,102% CMS Medicare OPPS fee schedule,$5.85 ,102% CMS Medicare OPPS fee schedule,$5.85 ,102% CMS Medicare OPPS fee schedule,$5.85 ,102% CMS Medicare OPPS fee schedule,$58.40 ,80% of total billed charges for outpatient setting,$5.85 ,102% CMS Medicare OPPS fee schedule,$6.67 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$62.05 ,85% of total billed charges for outpatient setting,$5.80 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$58.40 ,80% of total billed charges for outpatient setting,$62.05 ,85% of total billed charges for outpatient setting,$51.10 ,70% of total billed charges for outpatient setting,$51.10 ,70% of total billed charges for outpatient setting,$56.21 ,77% of total billed charges for outpatient setting,$5.80 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.05 ,85% of total billed charges for outpatient setting,$62.05 ,85% of total billed charges for outpatient setting,$62.05 ,85% of total billed charges for outpatient setting,$62.05 ,85% of total billed charges for outpatient setting,$62.05 ,85% of total billed charges for outpatient setting,$6.48 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.80 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.80 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.80 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.80 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.05 ,85% of total billed charges for outpatient setting,$6.35 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$5.74 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$65.70 ,90% of total billed charges for outpatient setting,$6.54 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$69.35 ,95% of total billed charges for outpatient setting,$62.05 ,85% of total billed charges for outpatient setting,$58.40 ,80% of total billed charges for outpatient setting,$6.48 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$62.05 ,85% of total billed charges for outpatient setting,$62.05 ,85% of total billed charges for outpatient setting,$62.05 ,85% of total billed charges for outpatient setting,$67.89 ,93% of total billed charges for outpatient setting,$54.75 ,75% of total billed charges for outpatient setting,$54.75 ,75% of total billed charges for outpatient setting,$54.75 ,75% of total billed charges for outpatient setting,$14.66 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$62.05 ,85% of total billed charges for outpatient setting,$6.48 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.74 ,$69.35 ,$25.55 Outpatient Medical Services,LAB,84479,T3 Uptake,300,$89.00 ,$8.55 ,100% Amerigroup fee schedule for outpatient setting,$8.55 ,100% Amerigroup fee schedule for outpatient setting,$44.50 ,75% of total billed charges for outpatient setting,$44.50 ,75% of total billed charges for outpatient setting,$44.50 ,75% of total billed charges for outpatient setting,$6.60 ,102% CMS Medicare OPPS fee schedule,$6.60 ,102% CMS Medicare OPPS fee schedule,$6.60 ,102% CMS Medicare OPPS fee schedule,$6.60 ,102% CMS Medicare OPPS fee schedule,$6.60 ,102% CMS Medicare OPPS fee schedule,$6.60 ,102% CMS Medicare OPPS fee schedule,$71.20 ,80% of total billed charges for outpatient setting,$6.60 ,102% CMS Medicare OPPS fee schedule,$8.55 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$75.65 ,85% of total billed charges for outpatient setting,$6.53 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$71.20 ,80% of total billed charges for outpatient setting,$75.65 ,85% of total billed charges for outpatient setting,$62.30 ,70% of total billed charges for outpatient setting,$62.30 ,70% of total billed charges for outpatient setting,$68.53 ,77% of total billed charges for outpatient setting,$6.53 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$75.65 ,85% of total billed charges for outpatient setting,$75.65 ,85% of total billed charges for outpatient setting,$75.65 ,85% of total billed charges for outpatient setting,$75.65 ,85% of total billed charges for outpatient setting,$75.65 ,85% of total billed charges for outpatient setting,$8.30 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$6.53 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.53 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.53 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.53 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$75.65 ,85% of total billed charges for outpatient setting,$8.14 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$6.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$80.10 ,90% of total billed charges for outpatient setting,$8.38 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$84.55 ,95% of total billed charges for outpatient setting,$75.65 ,85% of total billed charges for outpatient setting,$71.20 ,80% of total billed charges for outpatient setting,$8.30 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$75.65 ,85% of total billed charges for outpatient setting,$75.65 ,85% of total billed charges for outpatient setting,$75.65 ,85% of total billed charges for outpatient setting,$82.77 ,93% of total billed charges for outpatient setting,$66.75 ,75% of total billed charges for outpatient setting,$66.75 ,75% of total billed charges for outpatient setting,$66.75 ,75% of total billed charges for outpatient setting,$17.87 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$75.65 ,85% of total billed charges for outpatient setting,$8.30 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$6.47 ,$84.55 ,$31.15 Outpatient Medical Services,LAB,84481,T3 Free,300,$238.85 ,$22.37 ,100% Amerigroup fee schedule for outpatient setting,$22.37 ,100% Amerigroup fee schedule for outpatient setting,$119.43 ,75% of total billed charges for outpatient setting,$119.43 ,75% of total billed charges for outpatient setting,$119.43 ,75% of total billed charges for outpatient setting,$17.28 ,102% CMS Medicare OPPS fee schedule,$17.28 ,102% CMS Medicare OPPS fee schedule,$17.28 ,102% CMS Medicare OPPS fee schedule,$17.28 ,102% CMS Medicare OPPS fee schedule,$17.28 ,102% CMS Medicare OPPS fee schedule,$17.28 ,102% CMS Medicare OPPS fee schedule,$191.08 ,80% of total billed charges for outpatient setting,$17.28 ,102% CMS Medicare OPPS fee schedule,$22.37 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$203.02 ,85% of total billed charges for outpatient setting,$17.11 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$191.08 ,80% of total billed charges for outpatient setting,$203.02 ,85% of total billed charges for outpatient setting,$167.20 ,70% of total billed charges for outpatient setting,$167.20 ,70% of total billed charges for outpatient setting,$183.91 ,77% of total billed charges for outpatient setting,$17.11 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$203.02 ,85% of total billed charges for outpatient setting,$203.02 ,85% of total billed charges for outpatient setting,$203.02 ,85% of total billed charges for outpatient setting,$203.02 ,85% of total billed charges for outpatient setting,$203.02 ,85% of total billed charges for outpatient setting,$21.73 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$17.11 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$17.11 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$17.11 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$17.11 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$203.02 ,85% of total billed charges for outpatient setting,$21.30 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$16.94 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$214.97 ,90% of total billed charges for outpatient setting,$21.94 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$226.91 ,95% of total billed charges for outpatient setting,$203.02 ,85% of total billed charges for outpatient setting,$191.08 ,80% of total billed charges for outpatient setting,$21.73 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$203.02 ,85% of total billed charges for outpatient setting,$203.02 ,85% of total billed charges for outpatient setting,$203.02 ,85% of total billed charges for outpatient setting,$222.13 ,93% of total billed charges for outpatient setting,$179.14 ,75% of total billed charges for outpatient setting,$179.14 ,75% of total billed charges for outpatient setting,$179.14 ,75% of total billed charges for outpatient setting,$47.96 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$203.02 ,85% of total billed charges for outpatient setting,$21.73 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$16.94 ,$226.91 ,$83.60 Outpatient Medical Services,LAB,84481,"Triiodothyronine (T3), Free LC",300,$238.85 ,$22.37 ,100% Amerigroup fee schedule for outpatient setting,$22.37 ,100% Amerigroup fee schedule for outpatient setting,$119.43 ,75% of total billed charges for outpatient setting,$119.43 ,75% of total billed charges for outpatient setting,$119.43 ,75% of total billed charges for outpatient setting,$17.28 ,102% CMS Medicare OPPS fee schedule,$17.28 ,102% CMS Medicare OPPS fee schedule,$17.28 ,102% CMS Medicare OPPS fee schedule,$17.28 ,102% CMS Medicare OPPS fee schedule,$17.28 ,102% CMS Medicare OPPS fee schedule,$17.28 ,102% CMS Medicare OPPS fee schedule,$191.08 ,80% of total billed charges for outpatient setting,$17.28 ,102% CMS Medicare OPPS fee schedule,$22.37 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$203.02 ,85% of total billed charges for outpatient setting,$17.11 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$191.08 ,80% of total billed charges for outpatient setting,$203.02 ,85% of total billed charges for outpatient setting,$167.20 ,70% of total billed charges for outpatient setting,$167.20 ,70% of total billed charges for outpatient setting,$183.91 ,77% of total billed charges for outpatient setting,$17.11 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$203.02 ,85% of total billed charges for outpatient setting,$203.02 ,85% of total billed charges for outpatient setting,$203.02 ,85% of total billed charges for outpatient setting,$203.02 ,85% of total billed charges for outpatient setting,$203.02 ,85% of total billed charges for outpatient setting,$21.73 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$17.11 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$17.11 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$17.11 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$17.11 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$203.02 ,85% of total billed charges for outpatient setting,$21.30 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$16.94 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$214.97 ,90% of total billed charges for outpatient setting,$21.94 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$226.91 ,95% of total billed charges for outpatient setting,$203.02 ,85% of total billed charges for outpatient setting,$191.08 ,80% of total billed charges for outpatient setting,$21.73 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$203.02 ,85% of total billed charges for outpatient setting,$203.02 ,85% of total billed charges for outpatient setting,$203.02 ,85% of total billed charges for outpatient setting,$222.13 ,93% of total billed charges for outpatient setting,$179.14 ,75% of total billed charges for outpatient setting,$179.14 ,75% of total billed charges for outpatient setting,$179.14 ,75% of total billed charges for outpatient setting,$47.96 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$203.02 ,85% of total billed charges for outpatient setting,$21.73 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$16.94 ,$226.91 ,$83.60 Outpatient Medical Services,LAB,84484,Troponin-I,301,$168.60 ,$13.00 ,100% Amerigroup fee schedule for outpatient setting,$13.00 ,100% Amerigroup fee schedule for outpatient setting,$84.30 ,75% of total billed charges for outpatient setting,$84.30 ,75% of total billed charges for outpatient setting,$84.30 ,75% of total billed charges for outpatient setting,$12.72 ,102% CMS Medicare OPPS fee schedule,$12.72 ,102% CMS Medicare OPPS fee schedule,$12.72 ,102% CMS Medicare OPPS fee schedule,$12.72 ,102% CMS Medicare OPPS fee schedule,$12.72 ,102% CMS Medicare OPPS fee schedule,$12.72 ,102% CMS Medicare OPPS fee schedule,$134.88 ,80% of total billed charges for outpatient setting,$12.72 ,102% CMS Medicare OPPS fee schedule,$13.00 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$143.31 ,85% of total billed charges for outpatient setting,$12.59 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$134.88 ,80% of total billed charges for outpatient setting,$143.31 ,85% of total billed charges for outpatient setting,$118.02 ,70% of total billed charges for outpatient setting,$118.02 ,70% of total billed charges for outpatient setting,$129.82 ,77% of total billed charges for outpatient setting,$12.59 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$143.31 ,85% of total billed charges for outpatient setting,$143.31 ,85% of total billed charges for outpatient setting,$143.31 ,85% of total billed charges for outpatient setting,$143.31 ,85% of total billed charges for outpatient setting,$143.31 ,85% of total billed charges for outpatient setting,$12.63 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$12.59 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.59 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.59 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.59 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$143.31 ,85% of total billed charges for outpatient setting,$12.38 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$12.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$151.74 ,90% of total billed charges for outpatient setting,$12.75 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$160.17 ,95% of total billed charges for outpatient setting,$143.31 ,85% of total billed charges for outpatient setting,$134.88 ,80% of total billed charges for outpatient setting,$12.63 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$143.31 ,85% of total billed charges for outpatient setting,$143.31 ,85% of total billed charges for outpatient setting,$143.31 ,85% of total billed charges for outpatient setting,$156.80 ,93% of total billed charges for outpatient setting,$126.45 ,75% of total billed charges for outpatient setting,$126.45 ,75% of total billed charges for outpatient setting,$126.45 ,75% of total billed charges for outpatient setting,$33.85 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$143.31 ,85% of total billed charges for outpatient setting,$12.63 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$12.38 ,$160.17 ,$59.01 Outpatient Medical Services,LAB,84484,Troponin I,301,$168.60 ,$13.00 ,100% Amerigroup fee schedule for outpatient setting,$13.00 ,100% Amerigroup fee schedule for outpatient setting,$84.30 ,75% of total billed charges for outpatient setting,$84.30 ,75% of total billed charges for outpatient setting,$84.30 ,75% of total billed charges for outpatient setting,$12.72 ,102% CMS Medicare OPPS fee schedule,$12.72 ,102% CMS Medicare OPPS fee schedule,$12.72 ,102% CMS Medicare OPPS fee schedule,$12.72 ,102% CMS Medicare OPPS fee schedule,$12.72 ,102% CMS Medicare OPPS fee schedule,$12.72 ,102% CMS Medicare OPPS fee schedule,$134.88 ,80% of total billed charges for outpatient setting,$12.72 ,102% CMS Medicare OPPS fee schedule,$13.00 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$143.31 ,85% of total billed charges for outpatient setting,$12.59 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$134.88 ,80% of total billed charges for outpatient setting,$143.31 ,85% of total billed charges for outpatient setting,$118.02 ,70% of total billed charges for outpatient setting,$118.02 ,70% of total billed charges for outpatient setting,$129.82 ,77% of total billed charges for outpatient setting,$12.59 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$143.31 ,85% of total billed charges for outpatient setting,$143.31 ,85% of total billed charges for outpatient setting,$143.31 ,85% of total billed charges for outpatient setting,$143.31 ,85% of total billed charges for outpatient setting,$143.31 ,85% of total billed charges for outpatient setting,$12.63 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$12.59 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.59 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.59 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.59 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$143.31 ,85% of total billed charges for outpatient setting,$12.38 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$12.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$151.74 ,90% of total billed charges for outpatient setting,$12.75 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$160.17 ,95% of total billed charges for outpatient setting,$143.31 ,85% of total billed charges for outpatient setting,$134.88 ,80% of total billed charges for outpatient setting,$12.63 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$143.31 ,85% of total billed charges for outpatient setting,$143.31 ,85% of total billed charges for outpatient setting,$143.31 ,85% of total billed charges for outpatient setting,$156.80 ,93% of total billed charges for outpatient setting,$126.45 ,75% of total billed charges for outpatient setting,$126.45 ,75% of total billed charges for outpatient setting,$126.45 ,75% of total billed charges for outpatient setting,$33.85 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$143.31 ,85% of total billed charges for outpatient setting,$12.63 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$12.38 ,$160.17 ,$59.01 Outpatient Medical Services,LAB,84484,Cardiac Profile,300,$162.31 ,$13.00 ,100% Amerigroup fee schedule for outpatient setting,$13.00 ,100% Amerigroup fee schedule for outpatient setting,$81.16 ,75% of total billed charges for outpatient setting,$81.16 ,75% of total billed charges for outpatient setting,$81.16 ,75% of total billed charges for outpatient setting,$12.72 ,102% CMS Medicare OPPS fee schedule,$12.72 ,102% CMS Medicare OPPS fee schedule,$12.72 ,102% CMS Medicare OPPS fee schedule,$12.72 ,102% CMS Medicare OPPS fee schedule,$12.72 ,102% CMS Medicare OPPS fee schedule,$12.72 ,102% CMS Medicare OPPS fee schedule,$129.85 ,80% of total billed charges for outpatient setting,$12.72 ,102% CMS Medicare OPPS fee schedule,$13.00 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$137.96 ,85% of total billed charges for outpatient setting,$12.59 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$129.85 ,80% of total billed charges for outpatient setting,$137.96 ,85% of total billed charges for outpatient setting,$113.62 ,70% of total billed charges for outpatient setting,$113.62 ,70% of total billed charges for outpatient setting,$124.98 ,77% of total billed charges for outpatient setting,$12.59 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$137.96 ,85% of total billed charges for outpatient setting,$137.96 ,85% of total billed charges for outpatient setting,$137.96 ,85% of total billed charges for outpatient setting,$137.96 ,85% of total billed charges for outpatient setting,$137.96 ,85% of total billed charges for outpatient setting,$12.63 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$12.59 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.59 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.59 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.59 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$137.96 ,85% of total billed charges for outpatient setting,$12.38 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$12.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$146.08 ,90% of total billed charges for outpatient setting,$12.75 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$154.19 ,95% of total billed charges for outpatient setting,$137.96 ,85% of total billed charges for outpatient setting,$129.85 ,80% of total billed charges for outpatient setting,$12.63 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$137.96 ,85% of total billed charges for outpatient setting,$137.96 ,85% of total billed charges for outpatient setting,$137.96 ,85% of total billed charges for outpatient setting,$150.95 ,93% of total billed charges for outpatient setting,$121.73 ,75% of total billed charges for outpatient setting,$121.73 ,75% of total billed charges for outpatient setting,$121.73 ,75% of total billed charges for outpatient setting,$32.59 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$137.96 ,85% of total billed charges for outpatient setting,$12.63 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$12.38 ,$154.19 ,$56.81 Outpatient Medical Services,LAB,84484,Troponin T LC,301,$168.60 ,$13.00 ,100% Amerigroup fee schedule for outpatient setting,$13.00 ,100% Amerigroup fee schedule for outpatient setting,$84.30 ,75% of total billed charges for outpatient setting,$84.30 ,75% of total billed charges for outpatient setting,$84.30 ,75% of total billed charges for outpatient setting,$12.72 ,102% CMS Medicare OPPS fee schedule,$12.72 ,102% CMS Medicare OPPS fee schedule,$12.72 ,102% CMS Medicare OPPS fee schedule,$12.72 ,102% CMS Medicare OPPS fee schedule,$12.72 ,102% CMS Medicare OPPS fee schedule,$12.72 ,102% CMS Medicare OPPS fee schedule,$134.88 ,80% of total billed charges for outpatient setting,$12.72 ,102% CMS Medicare OPPS fee schedule,$13.00 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$143.31 ,85% of total billed charges for outpatient setting,$12.59 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$134.88 ,80% of total billed charges for outpatient setting,$143.31 ,85% of total billed charges for outpatient setting,$118.02 ,70% of total billed charges for outpatient setting,$118.02 ,70% of total billed charges for outpatient setting,$129.82 ,77% of total billed charges for outpatient setting,$12.59 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$143.31 ,85% of total billed charges for outpatient setting,$143.31 ,85% of total billed charges for outpatient setting,$143.31 ,85% of total billed charges for outpatient setting,$143.31 ,85% of total billed charges for outpatient setting,$143.31 ,85% of total billed charges for outpatient setting,$12.63 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$12.59 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.59 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.59 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.59 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$143.31 ,85% of total billed charges for outpatient setting,$12.38 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$12.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$151.74 ,90% of total billed charges for outpatient setting,$12.75 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$160.17 ,95% of total billed charges for outpatient setting,$143.31 ,85% of total billed charges for outpatient setting,$134.88 ,80% of total billed charges for outpatient setting,$12.63 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$143.31 ,85% of total billed charges for outpatient setting,$143.31 ,85% of total billed charges for outpatient setting,$143.31 ,85% of total billed charges for outpatient setting,$156.80 ,93% of total billed charges for outpatient setting,$126.45 ,75% of total billed charges for outpatient setting,$126.45 ,75% of total billed charges for outpatient setting,$126.45 ,75% of total billed charges for outpatient setting,$33.85 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$143.31 ,85% of total billed charges for outpatient setting,$12.63 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$12.38 ,$160.17 ,$59.01 Outpatient Medical Services,LAB,84520,Blood Urea Nitrogen,301,$79.00 ,$5.21 ,100% Amerigroup fee schedule for outpatient setting,$5.21 ,100% Amerigroup fee schedule for outpatient setting,$39.50 ,75% of total billed charges for outpatient setting,$39.50 ,75% of total billed charges for outpatient setting,$39.50 ,75% of total billed charges for outpatient setting,$4.03 ,102% CMS Medicare OPPS fee schedule,$4.03 ,102% CMS Medicare OPPS fee schedule,$4.03 ,102% CMS Medicare OPPS fee schedule,$4.03 ,102% CMS Medicare OPPS fee schedule,$4.03 ,102% CMS Medicare OPPS fee schedule,$4.03 ,102% CMS Medicare OPPS fee schedule,$63.20 ,80% of total billed charges for outpatient setting,$4.03 ,102% CMS Medicare OPPS fee schedule,$5.21 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$67.15 ,85% of total billed charges for outpatient setting,$3.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$63.20 ,80% of total billed charges for outpatient setting,$67.15 ,85% of total billed charges for outpatient setting,$55.30 ,70% of total billed charges for outpatient setting,$55.30 ,70% of total billed charges for outpatient setting,$60.83 ,77% of total billed charges for outpatient setting,$3.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$67.15 ,85% of total billed charges for outpatient setting,$67.15 ,85% of total billed charges for outpatient setting,$67.15 ,85% of total billed charges for outpatient setting,$67.15 ,85% of total billed charges for outpatient setting,$67.15 ,85% of total billed charges for outpatient setting,$5.06 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$67.15 ,85% of total billed charges for outpatient setting,$4.96 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$3.95 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$71.10 ,90% of total billed charges for outpatient setting,$5.11 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$75.05 ,95% of total billed charges for outpatient setting,$67.15 ,85% of total billed charges for outpatient setting,$63.20 ,80% of total billed charges for outpatient setting,$5.06 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$67.15 ,85% of total billed charges for outpatient setting,$67.15 ,85% of total billed charges for outpatient setting,$67.15 ,85% of total billed charges for outpatient setting,$73.47 ,93% of total billed charges for outpatient setting,$59.25 ,75% of total billed charges for outpatient setting,$59.25 ,75% of total billed charges for outpatient setting,$59.25 ,75% of total billed charges for outpatient setting,$15.86 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$67.15 ,85% of total billed charges for outpatient setting,$5.06 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.95 ,$75.05 ,$27.65 Outpatient Medical Services,LAB,84540,Urea Nitrogen Urine,300,$35.13 ,$6.28 ,100% Amerigroup fee schedule for outpatient setting,$6.28 ,100% Amerigroup fee schedule for outpatient setting,$17.57 ,75% of total billed charges for outpatient setting,$17.57 ,75% of total billed charges for outpatient setting,$17.57 ,75% of total billed charges for outpatient setting,$5.67 ,102% CMS Medicare OPPS fee schedule,$5.67 ,102% CMS Medicare OPPS fee schedule,$5.67 ,102% CMS Medicare OPPS fee schedule,$5.67 ,102% CMS Medicare OPPS fee schedule,$5.67 ,102% CMS Medicare OPPS fee schedule,$5.67 ,102% CMS Medicare OPPS fee schedule,$28.10 ,80% of total billed charges for outpatient setting,$5.67 ,102% CMS Medicare OPPS fee schedule,$6.28 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$29.86 ,85% of total billed charges for outpatient setting,$5.62 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$28.10 ,80% of total billed charges for outpatient setting,$29.86 ,85% of total billed charges for outpatient setting,$24.59 ,70% of total billed charges for outpatient setting,$24.59 ,70% of total billed charges for outpatient setting,$27.05 ,77% of total billed charges for outpatient setting,$5.62 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$29.86 ,85% of total billed charges for outpatient setting,$29.86 ,85% of total billed charges for outpatient setting,$29.86 ,85% of total billed charges for outpatient setting,$29.86 ,85% of total billed charges for outpatient setting,$29.86 ,85% of total billed charges for outpatient setting,$6.10 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.62 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.62 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.62 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.62 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$29.86 ,85% of total billed charges for outpatient setting,$5.98 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$5.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$31.62 ,90% of total billed charges for outpatient setting,$6.16 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$33.37 ,95% of total billed charges for outpatient setting,$29.86 ,85% of total billed charges for outpatient setting,$28.10 ,80% of total billed charges for outpatient setting,$6.10 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$29.86 ,85% of total billed charges for outpatient setting,$29.86 ,85% of total billed charges for outpatient setting,$29.86 ,85% of total billed charges for outpatient setting,$32.67 ,93% of total billed charges for outpatient setting,$26.35 ,75% of total billed charges for outpatient setting,$26.35 ,75% of total billed charges for outpatient setting,$26.35 ,75% of total billed charges for outpatient setting,$7.05 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$29.86 ,85% of total billed charges for outpatient setting,$6.10 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.56 ,$33.37 ,$12.30 Outpatient Medical Services,LAB,84550,Uric Acid,301,$65.07 ,$5.96 ,100% Amerigroup fee schedule for outpatient setting,$5.96 ,100% Amerigroup fee schedule for outpatient setting,$32.54 ,75% of total billed charges for outpatient setting,$32.54 ,75% of total billed charges for outpatient setting,$32.54 ,75% of total billed charges for outpatient setting,$4.61 ,102% CMS Medicare OPPS fee schedule,$4.61 ,102% CMS Medicare OPPS fee schedule,$4.61 ,102% CMS Medicare OPPS fee schedule,$4.61 ,102% CMS Medicare OPPS fee schedule,$4.61 ,102% CMS Medicare OPPS fee schedule,$4.61 ,102% CMS Medicare OPPS fee schedule,$52.06 ,80% of total billed charges for outpatient setting,$4.61 ,102% CMS Medicare OPPS fee schedule,$5.96 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$55.31 ,85% of total billed charges for outpatient setting,$4.57 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$52.06 ,80% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$45.55 ,70% of total billed charges for outpatient setting,$45.55 ,70% of total billed charges for outpatient setting,$50.10 ,77% of total billed charges for outpatient setting,$4.57 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$5.79 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.57 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.57 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.57 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.57 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$5.68 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$4.52 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$58.56 ,90% of total billed charges for outpatient setting,$5.85 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$61.82 ,95% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$52.06 ,80% of total billed charges for outpatient setting,$5.79 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$60.52 ,93% of total billed charges for outpatient setting,$48.80 ,75% of total billed charges for outpatient setting,$48.80 ,75% of total billed charges for outpatient setting,$48.80 ,75% of total billed charges for outpatient setting,$13.07 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$55.31 ,85% of total billed charges for outpatient setting,$5.79 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.52 ,$61.82 ,$22.77 Outpatient Medical Services,LAB,84550,Uric Acid LC,301,$65.07 ,$5.96 ,100% Amerigroup fee schedule for outpatient setting,$5.96 ,100% Amerigroup fee schedule for outpatient setting,$32.54 ,75% of total billed charges for outpatient setting,$32.54 ,75% of total billed charges for outpatient setting,$32.54 ,75% of total billed charges for outpatient setting,$4.61 ,102% CMS Medicare OPPS fee schedule,$4.61 ,102% CMS Medicare OPPS fee schedule,$4.61 ,102% CMS Medicare OPPS fee schedule,$4.61 ,102% CMS Medicare OPPS fee schedule,$4.61 ,102% CMS Medicare OPPS fee schedule,$4.61 ,102% CMS Medicare OPPS fee schedule,$52.06 ,80% of total billed charges for outpatient setting,$4.61 ,102% CMS Medicare OPPS fee schedule,$5.96 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$55.31 ,85% of total billed charges for outpatient setting,$4.57 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$52.06 ,80% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$45.55 ,70% of total billed charges for outpatient setting,$45.55 ,70% of total billed charges for outpatient setting,$50.10 ,77% of total billed charges for outpatient setting,$4.57 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$5.79 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.57 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.57 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.57 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.57 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$5.68 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$4.52 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$58.56 ,90% of total billed charges for outpatient setting,$5.85 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$61.82 ,95% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$52.06 ,80% of total billed charges for outpatient setting,$5.79 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$60.52 ,93% of total billed charges for outpatient setting,$48.80 ,75% of total billed charges for outpatient setting,$48.80 ,75% of total billed charges for outpatient setting,$48.80 ,75% of total billed charges for outpatient setting,$13.07 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$55.31 ,85% of total billed charges for outpatient setting,$5.79 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.52 ,$61.82 ,$22.77 Outpatient Medical Services,LAB,84702,Beta hCG Quantitative,300,$160.88 ,$8.47 ,100% Amerigroup fee schedule for outpatient setting,$8.47 ,100% Amerigroup fee schedule for outpatient setting,$80.44 ,75% of total billed charges for outpatient setting,$80.44 ,75% of total billed charges for outpatient setting,$80.44 ,75% of total billed charges for outpatient setting,$15.35 ,102% CMS Medicare OPPS fee schedule,$15.35 ,102% CMS Medicare OPPS fee schedule,$15.35 ,102% CMS Medicare OPPS fee schedule,$15.35 ,102% CMS Medicare OPPS fee schedule,$15.35 ,102% CMS Medicare OPPS fee schedule,$15.35 ,102% CMS Medicare OPPS fee schedule,$128.70 ,80% of total billed charges for outpatient setting,$15.35 ,102% CMS Medicare OPPS fee schedule,$8.47 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$136.75 ,85% of total billed charges for outpatient setting,$15.20 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$128.70 ,80% of total billed charges for outpatient setting,$136.75 ,85% of total billed charges for outpatient setting,$112.62 ,70% of total billed charges for outpatient setting,$112.62 ,70% of total billed charges for outpatient setting,$123.88 ,77% of total billed charges for outpatient setting,$15.20 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$136.75 ,85% of total billed charges for outpatient setting,$136.75 ,85% of total billed charges for outpatient setting,$136.75 ,85% of total billed charges for outpatient setting,$136.75 ,85% of total billed charges for outpatient setting,$136.75 ,85% of total billed charges for outpatient setting,$8.23 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$15.20 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$15.20 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$15.20 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$15.20 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$136.75 ,85% of total billed charges for outpatient setting,$8.07 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$15.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$144.79 ,90% of total billed charges for outpatient setting,$8.31 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$152.84 ,95% of total billed charges for outpatient setting,$136.75 ,85% of total billed charges for outpatient setting,$128.70 ,80% of total billed charges for outpatient setting,$8.23 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$136.75 ,85% of total billed charges for outpatient setting,$136.75 ,85% of total billed charges for outpatient setting,$136.75 ,85% of total billed charges for outpatient setting,$149.62 ,93% of total billed charges for outpatient setting,$120.66 ,75% of total billed charges for outpatient setting,$120.66 ,75% of total billed charges for outpatient setting,$120.66 ,75% of total billed charges for outpatient setting,$32.30 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$136.75 ,85% of total billed charges for outpatient setting,$8.23 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.07 ,$152.84 ,$56.31 Outpatient Medical Services,LAB,84703,Pregnancy Test Serum Qual,300,$146.89 ,$8.47 ,100% Amerigroup fee schedule for outpatient setting,$8.47 ,100% Amerigroup fee schedule for outpatient setting,$73.45 ,75% of total billed charges for outpatient setting,$73.45 ,75% of total billed charges for outpatient setting,$73.45 ,75% of total billed charges for outpatient setting,$7.67 ,102% CMS Medicare OPPS fee schedule,$7.67 ,102% CMS Medicare OPPS fee schedule,$7.67 ,102% CMS Medicare OPPS fee schedule,$7.67 ,102% CMS Medicare OPPS fee schedule,$7.67 ,102% CMS Medicare OPPS fee schedule,$7.67 ,102% CMS Medicare OPPS fee schedule,$117.51 ,80% of total billed charges for outpatient setting,$7.67 ,102% CMS Medicare OPPS fee schedule,$8.47 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$124.86 ,85% of total billed charges for outpatient setting,$7.60 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$117.51 ,80% of total billed charges for outpatient setting,$124.86 ,85% of total billed charges for outpatient setting,$102.82 ,70% of total billed charges for outpatient setting,$102.82 ,70% of total billed charges for outpatient setting,$113.11 ,77% of total billed charges for outpatient setting,$7.60 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$124.86 ,85% of total billed charges for outpatient setting,$124.86 ,85% of total billed charges for outpatient setting,$124.86 ,85% of total billed charges for outpatient setting,$124.86 ,85% of total billed charges for outpatient setting,$124.86 ,85% of total billed charges for outpatient setting,$8.23 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$7.60 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$7.60 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$7.60 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$7.60 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$124.86 ,85% of total billed charges for outpatient setting,$8.07 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$7.52 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$132.20 ,90% of total billed charges for outpatient setting,$8.31 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$139.55 ,95% of total billed charges for outpatient setting,$124.86 ,85% of total billed charges for outpatient setting,$117.51 ,80% of total billed charges for outpatient setting,$8.23 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$124.86 ,85% of total billed charges for outpatient setting,$124.86 ,85% of total billed charges for outpatient setting,$124.86 ,85% of total billed charges for outpatient setting,$136.61 ,93% of total billed charges for outpatient setting,$110.17 ,75% of total billed charges for outpatient setting,$110.17 ,75% of total billed charges for outpatient setting,$110.17 ,75% of total billed charges for outpatient setting,$29.50 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$124.86 ,85% of total billed charges for outpatient setting,$8.23 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$7.52 ,$139.55 ,$51.41 Outpatient Medical Services,LAB,85014,Hemoglobin and Hematocrit,305,$30.91 ,$3.13 ,100% Amerigroup fee schedule for outpatient setting,$3.13 ,100% Amerigroup fee schedule for outpatient setting,$15.46 ,75% of total billed charges for outpatient setting,$15.46 ,75% of total billed charges for outpatient setting,$15.46 ,75% of total billed charges for outpatient setting,$2.42 ,102% CMS Medicare OPPS fee schedule,$2.42 ,102% CMS Medicare OPPS fee schedule,$2.42 ,102% CMS Medicare OPPS fee schedule,$2.42 ,102% CMS Medicare OPPS fee schedule,$2.42 ,102% CMS Medicare OPPS fee schedule,$2.42 ,102% CMS Medicare OPPS fee schedule,$24.73 ,80% of total billed charges for outpatient setting,$2.42 ,102% CMS Medicare OPPS fee schedule,$3.13 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$26.27 ,85% of total billed charges for outpatient setting,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$24.73 ,80% of total billed charges for outpatient setting,$26.27 ,85% of total billed charges for outpatient setting,$21.64 ,70% of total billed charges for outpatient setting,$21.64 ,70% of total billed charges for outpatient setting,$23.80 ,77% of total billed charges for outpatient setting,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$26.27 ,85% of total billed charges for outpatient setting,$26.27 ,85% of total billed charges for outpatient setting,$26.27 ,85% of total billed charges for outpatient setting,$26.27 ,85% of total billed charges for outpatient setting,$26.27 ,85% of total billed charges for outpatient setting,$3.04 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$26.27 ,85% of total billed charges for outpatient setting,$2.98 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$2.37 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$27.82 ,90% of total billed charges for outpatient setting,$3.07 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$29.36 ,95% of total billed charges for outpatient setting,$26.27 ,85% of total billed charges for outpatient setting,$24.73 ,80% of total billed charges for outpatient setting,$3.04 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$26.27 ,85% of total billed charges for outpatient setting,$26.27 ,85% of total billed charges for outpatient setting,$26.27 ,85% of total billed charges for outpatient setting,$28.75 ,93% of total billed charges for outpatient setting,$23.18 ,75% of total billed charges for outpatient setting,$23.18 ,75% of total billed charges for outpatient setting,$23.18 ,75% of total billed charges for outpatient setting,$6.21 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$26.27 ,85% of total billed charges for outpatient setting,$3.04 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$2.37 ,$29.36 ,$10.82 Outpatient Medical Services,LAB,85014,85014 HEMATOCRIT CHARGE,305,$30.91 ,$3.13 ,100% Amerigroup fee schedule for outpatient setting,$3.13 ,100% Amerigroup fee schedule for outpatient setting,$15.46 ,75% of total billed charges for outpatient setting,$15.46 ,75% of total billed charges for outpatient setting,$15.46 ,75% of total billed charges for outpatient setting,$2.42 ,102% CMS Medicare OPPS fee schedule,$2.42 ,102% CMS Medicare OPPS fee schedule,$2.42 ,102% CMS Medicare OPPS fee schedule,$2.42 ,102% CMS Medicare OPPS fee schedule,$2.42 ,102% CMS Medicare OPPS fee schedule,$2.42 ,102% CMS Medicare OPPS fee schedule,$24.73 ,80% of total billed charges for outpatient setting,$2.42 ,102% CMS Medicare OPPS fee schedule,$3.13 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$26.27 ,85% of total billed charges for outpatient setting,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$24.73 ,80% of total billed charges for outpatient setting,$26.27 ,85% of total billed charges for outpatient setting,$21.64 ,70% of total billed charges for outpatient setting,$21.64 ,70% of total billed charges for outpatient setting,$23.80 ,77% of total billed charges for outpatient setting,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$26.27 ,85% of total billed charges for outpatient setting,$26.27 ,85% of total billed charges for outpatient setting,$26.27 ,85% of total billed charges for outpatient setting,$26.27 ,85% of total billed charges for outpatient setting,$26.27 ,85% of total billed charges for outpatient setting,$3.04 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$26.27 ,85% of total billed charges for outpatient setting,$2.98 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$2.37 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$27.82 ,90% of total billed charges for outpatient setting,$3.07 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$29.36 ,95% of total billed charges for outpatient setting,$26.27 ,85% of total billed charges for outpatient setting,$24.73 ,80% of total billed charges for outpatient setting,$3.04 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$26.27 ,85% of total billed charges for outpatient setting,$26.27 ,85% of total billed charges for outpatient setting,$26.27 ,85% of total billed charges for outpatient setting,$28.75 ,93% of total billed charges for outpatient setting,$23.18 ,75% of total billed charges for outpatient setting,$23.18 ,75% of total billed charges for outpatient setting,$23.18 ,75% of total billed charges for outpatient setting,$6.21 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$26.27 ,85% of total billed charges for outpatient setting,$3.04 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$2.37 ,$29.36 ,$10.82 Outpatient Medical Services,LAB,85014,Hematocrit LC,305,$30.91 ,$3.13 ,100% Amerigroup fee schedule for outpatient setting,$3.13 ,100% Amerigroup fee schedule for outpatient setting,$15.46 ,75% of total billed charges for outpatient setting,$15.46 ,75% of total billed charges for outpatient setting,$15.46 ,75% of total billed charges for outpatient setting,$2.42 ,102% CMS Medicare OPPS fee schedule,$2.42 ,102% CMS Medicare OPPS fee schedule,$2.42 ,102% CMS Medicare OPPS fee schedule,$2.42 ,102% CMS Medicare OPPS fee schedule,$2.42 ,102% CMS Medicare OPPS fee schedule,$2.42 ,102% CMS Medicare OPPS fee schedule,$24.73 ,80% of total billed charges for outpatient setting,$2.42 ,102% CMS Medicare OPPS fee schedule,$3.13 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$26.27 ,85% of total billed charges for outpatient setting,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$24.73 ,80% of total billed charges for outpatient setting,$26.27 ,85% of total billed charges for outpatient setting,$21.64 ,70% of total billed charges for outpatient setting,$21.64 ,70% of total billed charges for outpatient setting,$23.80 ,77% of total billed charges for outpatient setting,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$26.27 ,85% of total billed charges for outpatient setting,$26.27 ,85% of total billed charges for outpatient setting,$26.27 ,85% of total billed charges for outpatient setting,$26.27 ,85% of total billed charges for outpatient setting,$26.27 ,85% of total billed charges for outpatient setting,$3.04 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$26.27 ,85% of total billed charges for outpatient setting,$2.98 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$2.37 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$27.82 ,90% of total billed charges for outpatient setting,$3.07 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$29.36 ,95% of total billed charges for outpatient setting,$26.27 ,85% of total billed charges for outpatient setting,$24.73 ,80% of total billed charges for outpatient setting,$3.04 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$26.27 ,85% of total billed charges for outpatient setting,$26.27 ,85% of total billed charges for outpatient setting,$26.27 ,85% of total billed charges for outpatient setting,$28.75 ,93% of total billed charges for outpatient setting,$23.18 ,75% of total billed charges for outpatient setting,$23.18 ,75% of total billed charges for outpatient setting,$23.18 ,75% of total billed charges for outpatient setting,$6.21 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$26.27 ,85% of total billed charges for outpatient setting,$3.04 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$2.37 ,$29.36 ,$10.82 Outpatient Medical Services,LAB,85018,Hemoglobin Addon,305,$15.73 ,$3.13 ,100% Amerigroup fee schedule for outpatient setting,$3.13 ,100% Amerigroup fee schedule for outpatient setting,$7.87 ,75% of total billed charges for outpatient setting,$7.87 ,75% of total billed charges for outpatient setting,$7.87 ,75% of total billed charges for outpatient setting,$2.42 ,102% CMS Medicare OPPS fee schedule,$2.42 ,102% CMS Medicare OPPS fee schedule,$2.42 ,102% CMS Medicare OPPS fee schedule,$2.42 ,102% CMS Medicare OPPS fee schedule,$2.42 ,102% CMS Medicare OPPS fee schedule,$2.42 ,102% CMS Medicare OPPS fee schedule,$12.58 ,80% of total billed charges for outpatient setting,$2.42 ,102% CMS Medicare OPPS fee schedule,$3.13 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$13.37 ,85% of total billed charges for outpatient setting,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.58 ,80% of total billed charges for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$11.01 ,70% of total billed charges for outpatient setting,$11.01 ,70% of total billed charges for outpatient setting,$12.11 ,77% of total billed charges for outpatient setting,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$3.04 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$2.98 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$2.37 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$14.16 ,90% of total billed charges for outpatient setting,$3.07 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$14.94 ,95% of total billed charges for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$12.58 ,80% of total billed charges for outpatient setting,$3.04 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$13.37 ,85% of total billed charges for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$14.63 ,93% of total billed charges for outpatient setting,$11.80 ,75% of total billed charges for outpatient setting,$11.80 ,75% of total billed charges for outpatient setting,$11.80 ,75% of total billed charges for outpatient setting,$3.16 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$13.37 ,85% of total billed charges for outpatient setting,$3.04 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$2.37 ,$14.94 ,$5.51 Outpatient Medical Services,LAB,85018,Hemoglobin,305,$15.73 ,$3.13 ,100% Amerigroup fee schedule for outpatient setting,$3.13 ,100% Amerigroup fee schedule for outpatient setting,$7.87 ,75% of total billed charges for outpatient setting,$7.87 ,75% of total billed charges for outpatient setting,$7.87 ,75% of total billed charges for outpatient setting,$2.42 ,102% CMS Medicare OPPS fee schedule,$2.42 ,102% CMS Medicare OPPS fee schedule,$2.42 ,102% CMS Medicare OPPS fee schedule,$2.42 ,102% CMS Medicare OPPS fee schedule,$2.42 ,102% CMS Medicare OPPS fee schedule,$2.42 ,102% CMS Medicare OPPS fee schedule,$12.58 ,80% of total billed charges for outpatient setting,$2.42 ,102% CMS Medicare OPPS fee schedule,$3.13 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$13.37 ,85% of total billed charges for outpatient setting,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.58 ,80% of total billed charges for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$11.01 ,70% of total billed charges for outpatient setting,$11.01 ,70% of total billed charges for outpatient setting,$12.11 ,77% of total billed charges for outpatient setting,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$3.04 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$2.98 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$2.37 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$14.16 ,90% of total billed charges for outpatient setting,$3.07 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$14.94 ,95% of total billed charges for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$12.58 ,80% of total billed charges for outpatient setting,$3.04 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$13.37 ,85% of total billed charges for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$14.63 ,93% of total billed charges for outpatient setting,$11.80 ,75% of total billed charges for outpatient setting,$11.80 ,75% of total billed charges for outpatient setting,$11.80 ,75% of total billed charges for outpatient setting,$3.16 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$13.37 ,85% of total billed charges for outpatient setting,$3.04 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$2.37 ,$14.94 ,$5.51 Outpatient Medical Services,LAB,85018,85018 HEMOGLOBIN CHARGE,305,$15.73 ,$3.13 ,100% Amerigroup fee schedule for outpatient setting,$3.13 ,100% Amerigroup fee schedule for outpatient setting,$7.87 ,75% of total billed charges for outpatient setting,$7.87 ,75% of total billed charges for outpatient setting,$7.87 ,75% of total billed charges for outpatient setting,$2.42 ,102% CMS Medicare OPPS fee schedule,$2.42 ,102% CMS Medicare OPPS fee schedule,$2.42 ,102% CMS Medicare OPPS fee schedule,$2.42 ,102% CMS Medicare OPPS fee schedule,$2.42 ,102% CMS Medicare OPPS fee schedule,$2.42 ,102% CMS Medicare OPPS fee schedule,$12.58 ,80% of total billed charges for outpatient setting,$2.42 ,102% CMS Medicare OPPS fee schedule,$3.13 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$13.37 ,85% of total billed charges for outpatient setting,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.58 ,80% of total billed charges for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$11.01 ,70% of total billed charges for outpatient setting,$11.01 ,70% of total billed charges for outpatient setting,$12.11 ,77% of total billed charges for outpatient setting,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$3.04 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$2.98 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$2.37 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$14.16 ,90% of total billed charges for outpatient setting,$3.07 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$14.94 ,95% of total billed charges for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$12.58 ,80% of total billed charges for outpatient setting,$3.04 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$13.37 ,85% of total billed charges for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$14.63 ,93% of total billed charges for outpatient setting,$11.80 ,75% of total billed charges for outpatient setting,$11.80 ,75% of total billed charges for outpatient setting,$11.80 ,75% of total billed charges for outpatient setting,$3.16 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$13.37 ,85% of total billed charges for outpatient setting,$3.04 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$2.37 ,$14.94 ,$5.51 Outpatient Medical Services,LAB,85018,Hemoglobin LC,305,$15.73 ,$3.13 ,100% Amerigroup fee schedule for outpatient setting,$3.13 ,100% Amerigroup fee schedule for outpatient setting,$7.87 ,75% of total billed charges for outpatient setting,$7.87 ,75% of total billed charges for outpatient setting,$7.87 ,75% of total billed charges for outpatient setting,$2.42 ,102% CMS Medicare OPPS fee schedule,$2.42 ,102% CMS Medicare OPPS fee schedule,$2.42 ,102% CMS Medicare OPPS fee schedule,$2.42 ,102% CMS Medicare OPPS fee schedule,$2.42 ,102% CMS Medicare OPPS fee schedule,$2.42 ,102% CMS Medicare OPPS fee schedule,$12.58 ,80% of total billed charges for outpatient setting,$2.42 ,102% CMS Medicare OPPS fee schedule,$3.13 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$13.37 ,85% of total billed charges for outpatient setting,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.58 ,80% of total billed charges for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$11.01 ,70% of total billed charges for outpatient setting,$11.01 ,70% of total billed charges for outpatient setting,$12.11 ,77% of total billed charges for outpatient setting,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$3.04 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$2.39 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$2.98 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$2.37 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$14.16 ,90% of total billed charges for outpatient setting,$3.07 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$14.94 ,95% of total billed charges for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$12.58 ,80% of total billed charges for outpatient setting,$3.04 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$13.37 ,85% of total billed charges for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$13.37 ,85% of total billed charges for outpatient setting,$14.63 ,93% of total billed charges for outpatient setting,$11.80 ,75% of total billed charges for outpatient setting,$11.80 ,75% of total billed charges for outpatient setting,$11.80 ,75% of total billed charges for outpatient setting,$3.16 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$13.37 ,85% of total billed charges for outpatient setting,$3.04 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$2.37 ,$14.94 ,$5.51 Outpatient Medical Services,LAB,85025,CBC w/ Diff POC,305,$100.21 ,$10.26 ,100% Amerigroup fee schedule for outpatient setting,$10.26 ,100% Amerigroup fee schedule for outpatient setting,$50.11 ,75% of total billed charges for outpatient setting,$50.11 ,75% of total billed charges for outpatient setting,$50.11 ,75% of total billed charges for outpatient setting,$7.93 ,102% CMS Medicare OPPS fee schedule,$7.93 ,102% CMS Medicare OPPS fee schedule,$7.93 ,102% CMS Medicare OPPS fee schedule,$7.93 ,102% CMS Medicare OPPS fee schedule,$7.93 ,102% CMS Medicare OPPS fee schedule,$7.93 ,102% CMS Medicare OPPS fee schedule,$80.17 ,80% of total billed charges for outpatient setting,$7.93 ,102% CMS Medicare OPPS fee schedule,$10.26 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$85.18 ,85% of total billed charges for outpatient setting,$7.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$80.17 ,80% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$70.15 ,70% of total billed charges for outpatient setting,$70.15 ,70% of total billed charges for outpatient setting,$77.16 ,77% of total billed charges for outpatient setting,$7.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$9.97 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$7.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$7.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$7.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$7.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$9.77 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$7.77 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$90.19 ,90% of total billed charges for outpatient setting,$10.06 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$95.20 ,95% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$80.17 ,80% of total billed charges for outpatient setting,$9.97 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$85.18 ,85% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$93.20 ,93% of total billed charges for outpatient setting,$75.16 ,75% of total billed charges for outpatient setting,$75.16 ,75% of total billed charges for outpatient setting,$75.16 ,75% of total billed charges for outpatient setting,$20.12 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$85.18 ,85% of total billed charges for outpatient setting,$9.97 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$7.77 ,$95.20 ,$35.07 Outpatient Medical Services,LAB,85025,CBC w/ Man Diff,305,$100.21 ,$10.26 ,100% Amerigroup fee schedule for outpatient setting,$10.26 ,100% Amerigroup fee schedule for outpatient setting,$50.11 ,75% of total billed charges for outpatient setting,$50.11 ,75% of total billed charges for outpatient setting,$50.11 ,75% of total billed charges for outpatient setting,$7.93 ,102% CMS Medicare OPPS fee schedule,$7.93 ,102% CMS Medicare OPPS fee schedule,$7.93 ,102% CMS Medicare OPPS fee schedule,$7.93 ,102% CMS Medicare OPPS fee schedule,$7.93 ,102% CMS Medicare OPPS fee schedule,$7.93 ,102% CMS Medicare OPPS fee schedule,$80.17 ,80% of total billed charges for outpatient setting,$7.93 ,102% CMS Medicare OPPS fee schedule,$10.26 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$85.18 ,85% of total billed charges for outpatient setting,$7.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$80.17 ,80% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$70.15 ,70% of total billed charges for outpatient setting,$70.15 ,70% of total billed charges for outpatient setting,$77.16 ,77% of total billed charges for outpatient setting,$7.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$9.97 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$7.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$7.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$7.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$7.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$9.77 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$7.77 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$90.19 ,90% of total billed charges for outpatient setting,$10.06 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$95.20 ,95% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$80.17 ,80% of total billed charges for outpatient setting,$9.97 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$85.18 ,85% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$93.20 ,93% of total billed charges for outpatient setting,$75.16 ,75% of total billed charges for outpatient setting,$75.16 ,75% of total billed charges for outpatient setting,$75.16 ,75% of total billed charges for outpatient setting,$20.12 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$85.18 ,85% of total billed charges for outpatient setting,$9.97 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$7.77 ,$95.20 ,$35.07 Outpatient Medical Services,LAB,85025,CBC w/ Auto Diff,305,$100.21 ,$10.26 ,100% Amerigroup fee schedule for outpatient setting,$10.26 ,100% Amerigroup fee schedule for outpatient setting,$50.11 ,75% of total billed charges for outpatient setting,$50.11 ,75% of total billed charges for outpatient setting,$50.11 ,75% of total billed charges for outpatient setting,$7.93 ,102% CMS Medicare OPPS fee schedule,$7.93 ,102% CMS Medicare OPPS fee schedule,$7.93 ,102% CMS Medicare OPPS fee schedule,$7.93 ,102% CMS Medicare OPPS fee schedule,$7.93 ,102% CMS Medicare OPPS fee schedule,$7.93 ,102% CMS Medicare OPPS fee schedule,$80.17 ,80% of total billed charges for outpatient setting,$7.93 ,102% CMS Medicare OPPS fee schedule,$10.26 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$85.18 ,85% of total billed charges for outpatient setting,$7.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$80.17 ,80% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$70.15 ,70% of total billed charges for outpatient setting,$70.15 ,70% of total billed charges for outpatient setting,$77.16 ,77% of total billed charges for outpatient setting,$7.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$9.97 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$7.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$7.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$7.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$7.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$9.77 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$7.77 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$90.19 ,90% of total billed charges for outpatient setting,$10.06 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$95.20 ,95% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$80.17 ,80% of total billed charges for outpatient setting,$9.97 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$85.18 ,85% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$93.20 ,93% of total billed charges for outpatient setting,$75.16 ,75% of total billed charges for outpatient setting,$75.16 ,75% of total billed charges for outpatient setting,$75.16 ,75% of total billed charges for outpatient setting,$20.12 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$85.18 ,85% of total billed charges for outpatient setting,$9.97 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$7.77 ,$95.20 ,$35.07 Outpatient Medical Services,LAB,85025,Auto Diff,305,$100.21 ,$10.26 ,100% Amerigroup fee schedule for outpatient setting,$10.26 ,100% Amerigroup fee schedule for outpatient setting,$50.11 ,75% of total billed charges for outpatient setting,$50.11 ,75% of total billed charges for outpatient setting,$50.11 ,75% of total billed charges for outpatient setting,$7.93 ,102% CMS Medicare OPPS fee schedule,$7.93 ,102% CMS Medicare OPPS fee schedule,$7.93 ,102% CMS Medicare OPPS fee schedule,$7.93 ,102% CMS Medicare OPPS fee schedule,$7.93 ,102% CMS Medicare OPPS fee schedule,$7.93 ,102% CMS Medicare OPPS fee schedule,$80.17 ,80% of total billed charges for outpatient setting,$7.93 ,102% CMS Medicare OPPS fee schedule,$10.26 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$85.18 ,85% of total billed charges for outpatient setting,$7.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$80.17 ,80% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$70.15 ,70% of total billed charges for outpatient setting,$70.15 ,70% of total billed charges for outpatient setting,$77.16 ,77% of total billed charges for outpatient setting,$7.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$9.97 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$7.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$7.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$7.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$7.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$9.77 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$7.77 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$90.19 ,90% of total billed charges for outpatient setting,$10.06 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$95.20 ,95% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$80.17 ,80% of total billed charges for outpatient setting,$9.97 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$85.18 ,85% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$93.20 ,93% of total billed charges for outpatient setting,$75.16 ,75% of total billed charges for outpatient setting,$75.16 ,75% of total billed charges for outpatient setting,$75.16 ,75% of total billed charges for outpatient setting,$20.12 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$85.18 ,85% of total billed charges for outpatient setting,$9.97 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$7.77 ,$95.20 ,$35.07 Outpatient Medical Services,LAB,85025,CBC w/ Differential LC,305,$100.21 ,$10.26 ,100% Amerigroup fee schedule for outpatient setting,$10.26 ,100% Amerigroup fee schedule for outpatient setting,$50.11 ,75% of total billed charges for outpatient setting,$50.11 ,75% of total billed charges for outpatient setting,$50.11 ,75% of total billed charges for outpatient setting,$7.93 ,102% CMS Medicare OPPS fee schedule,$7.93 ,102% CMS Medicare OPPS fee schedule,$7.93 ,102% CMS Medicare OPPS fee schedule,$7.93 ,102% CMS Medicare OPPS fee schedule,$7.93 ,102% CMS Medicare OPPS fee schedule,$7.93 ,102% CMS Medicare OPPS fee schedule,$80.17 ,80% of total billed charges for outpatient setting,$7.93 ,102% CMS Medicare OPPS fee schedule,$10.26 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$85.18 ,85% of total billed charges for outpatient setting,$7.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$80.17 ,80% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$70.15 ,70% of total billed charges for outpatient setting,$70.15 ,70% of total billed charges for outpatient setting,$77.16 ,77% of total billed charges for outpatient setting,$7.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$9.97 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$7.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$7.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$7.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$7.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$9.77 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$7.77 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$90.19 ,90% of total billed charges for outpatient setting,$10.06 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$95.20 ,95% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$80.17 ,80% of total billed charges for outpatient setting,$9.97 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$85.18 ,85% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$85.18 ,85% of total billed charges for outpatient setting,$93.20 ,93% of total billed charges for outpatient setting,$75.16 ,75% of total billed charges for outpatient setting,$75.16 ,75% of total billed charges for outpatient setting,$75.16 ,75% of total billed charges for outpatient setting,$20.12 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$85.18 ,85% of total billed charges for outpatient setting,$9.97 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$7.77 ,$95.20 ,$35.07 Outpatient Medical Services,LAB,85027,CBC w/o Diff,300,$215.32 ,$8.55 ,100% Amerigroup fee schedule for outpatient setting,$8.55 ,100% Amerigroup fee schedule for outpatient setting,$107.66 ,75% of total billed charges for outpatient setting,$107.66 ,75% of total billed charges for outpatient setting,$107.66 ,75% of total billed charges for outpatient setting,$6.60 ,102% CMS Medicare OPPS fee schedule,$6.60 ,102% CMS Medicare OPPS fee schedule,$6.60 ,102% CMS Medicare OPPS fee schedule,$6.60 ,102% CMS Medicare OPPS fee schedule,$6.60 ,102% CMS Medicare OPPS fee schedule,$6.60 ,102% CMS Medicare OPPS fee schedule,$172.26 ,80% of total billed charges for outpatient setting,$6.60 ,102% CMS Medicare OPPS fee schedule,$8.55 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$183.02 ,85% of total billed charges for outpatient setting,$6.53 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$172.26 ,80% of total billed charges for outpatient setting,$183.02 ,85% of total billed charges for outpatient setting,$150.72 ,70% of total billed charges for outpatient setting,$150.72 ,70% of total billed charges for outpatient setting,$165.80 ,77% of total billed charges for outpatient setting,$6.53 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$183.02 ,85% of total billed charges for outpatient setting,$183.02 ,85% of total billed charges for outpatient setting,$183.02 ,85% of total billed charges for outpatient setting,$183.02 ,85% of total billed charges for outpatient setting,$183.02 ,85% of total billed charges for outpatient setting,$8.30 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$6.53 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.53 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.53 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.53 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$183.02 ,85% of total billed charges for outpatient setting,$8.14 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$6.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$193.79 ,90% of total billed charges for outpatient setting,$8.38 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$204.55 ,95% of total billed charges for outpatient setting,$183.02 ,85% of total billed charges for outpatient setting,$172.26 ,80% of total billed charges for outpatient setting,$8.30 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$183.02 ,85% of total billed charges for outpatient setting,$183.02 ,85% of total billed charges for outpatient setting,$183.02 ,85% of total billed charges for outpatient setting,$200.25 ,93% of total billed charges for outpatient setting,$161.49 ,75% of total billed charges for outpatient setting,$161.49 ,75% of total billed charges for outpatient setting,$161.49 ,75% of total billed charges for outpatient setting,$43.24 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$183.02 ,85% of total billed charges for outpatient setting,$8.30 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$6.47 ,$204.55 ,$75.36 Outpatient Medical Services,LAB,85045,Retic Cnt Auto,300,$40.76 ,$5.28 ,100% Amerigroup fee schedule for outpatient setting,$5.28 ,100% Amerigroup fee schedule for outpatient setting,$20.38 ,75% of total billed charges for outpatient setting,$20.38 ,75% of total billed charges for outpatient setting,$20.38 ,75% of total billed charges for outpatient setting,$4.07 ,102% CMS Medicare OPPS fee schedule,$4.07 ,102% CMS Medicare OPPS fee schedule,$4.07 ,102% CMS Medicare OPPS fee schedule,$4.07 ,102% CMS Medicare OPPS fee schedule,$4.07 ,102% CMS Medicare OPPS fee schedule,$4.07 ,102% CMS Medicare OPPS fee schedule,$32.61 ,80% of total billed charges for outpatient setting,$4.07 ,102% CMS Medicare OPPS fee schedule,$5.28 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$34.65 ,85% of total billed charges for outpatient setting,$4.03 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$32.61 ,80% of total billed charges for outpatient setting,$34.65 ,85% of total billed charges for outpatient setting,$28.53 ,70% of total billed charges for outpatient setting,$28.53 ,70% of total billed charges for outpatient setting,$31.39 ,77% of total billed charges for outpatient setting,$4.03 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$34.65 ,85% of total billed charges for outpatient setting,$34.65 ,85% of total billed charges for outpatient setting,$34.65 ,85% of total billed charges for outpatient setting,$34.65 ,85% of total billed charges for outpatient setting,$34.65 ,85% of total billed charges for outpatient setting,$5.13 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.03 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.03 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.03 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.03 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$34.65 ,85% of total billed charges for outpatient setting,$5.03 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$3.99 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$36.68 ,90% of total billed charges for outpatient setting,$5.18 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$38.72 ,95% of total billed charges for outpatient setting,$34.65 ,85% of total billed charges for outpatient setting,$32.61 ,80% of total billed charges for outpatient setting,$5.13 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$34.65 ,85% of total billed charges for outpatient setting,$34.65 ,85% of total billed charges for outpatient setting,$34.65 ,85% of total billed charges for outpatient setting,$37.91 ,93% of total billed charges for outpatient setting,$30.57 ,75% of total billed charges for outpatient setting,$30.57 ,75% of total billed charges for outpatient setting,$30.57 ,75% of total billed charges for outpatient setting,$8.18 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$34.65 ,85% of total billed charges for outpatient setting,$5.13 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.99 ,$38.72 ,$14.27 Outpatient Medical Services,LAB,85048,White Blood Cell Count,305,$33.00 ,$3.36 ,100% Amerigroup fee schedule for outpatient setting,$3.36 ,100% Amerigroup fee schedule for outpatient setting,$16.50 ,75% of total billed charges for outpatient setting,$16.50 ,75% of total billed charges for outpatient setting,$16.50 ,75% of total billed charges for outpatient setting,$2.59 ,102% CMS Medicare OPPS fee schedule,$2.59 ,102% CMS Medicare OPPS fee schedule,$2.59 ,102% CMS Medicare OPPS fee schedule,$2.59 ,102% CMS Medicare OPPS fee schedule,$2.59 ,102% CMS Medicare OPPS fee schedule,$2.59 ,102% CMS Medicare OPPS fee schedule,$26.40 ,80% of total billed charges for outpatient setting,$2.59 ,102% CMS Medicare OPPS fee schedule,$3.36 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$28.05 ,85% of total billed charges for outpatient setting,$2.57 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$26.40 ,80% of total billed charges for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$23.10 ,70% of total billed charges for outpatient setting,$23.10 ,70% of total billed charges for outpatient setting,$25.41 ,77% of total billed charges for outpatient setting,$2.57 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$3.26 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$2.57 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$2.57 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$2.57 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$2.57 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$3.20 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$2.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$29.70 ,90% of total billed charges for outpatient setting,$3.30 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$31.35 ,95% of total billed charges for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$26.40 ,80% of total billed charges for outpatient setting,$3.26 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$28.05 ,85% of total billed charges for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$28.05 ,85% of total billed charges for outpatient setting,$30.69 ,93% of total billed charges for outpatient setting,$24.75 ,75% of total billed charges for outpatient setting,$24.75 ,75% of total billed charges for outpatient setting,$24.75 ,75% of total billed charges for outpatient setting,$6.63 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$28.05 ,85% of total billed charges for outpatient setting,$3.26 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$2.54 ,$31.35 ,$11.55 Outpatient Medical Services,LAB,85049,Platelet Count,305,$36.00 ,$5.91 ,100% Amerigroup fee schedule for outpatient setting,$5.91 ,100% Amerigroup fee schedule for outpatient setting,$18.00 ,75% of total billed charges for outpatient setting,$18.00 ,75% of total billed charges for outpatient setting,$18.00 ,75% of total billed charges for outpatient setting,$4.57 ,102% CMS Medicare OPPS fee schedule,$4.57 ,102% CMS Medicare OPPS fee schedule,$4.57 ,102% CMS Medicare OPPS fee schedule,$4.57 ,102% CMS Medicare OPPS fee schedule,$4.57 ,102% CMS Medicare OPPS fee schedule,$4.57 ,102% CMS Medicare OPPS fee schedule,$28.80 ,80% of total billed charges for outpatient setting,$4.57 ,102% CMS Medicare OPPS fee schedule,$5.91 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$30.60 ,85% of total billed charges for outpatient setting,$4.52 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$28.80 ,80% of total billed charges for outpatient setting,$30.60 ,85% of total billed charges for outpatient setting,$25.20 ,70% of total billed charges for outpatient setting,$25.20 ,70% of total billed charges for outpatient setting,$27.72 ,77% of total billed charges for outpatient setting,$4.52 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$30.60 ,85% of total billed charges for outpatient setting,$30.60 ,85% of total billed charges for outpatient setting,$30.60 ,85% of total billed charges for outpatient setting,$30.60 ,85% of total billed charges for outpatient setting,$30.60 ,85% of total billed charges for outpatient setting,$5.74 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.52 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.52 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.52 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.52 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$30.60 ,85% of total billed charges for outpatient setting,$5.63 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$4.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$32.40 ,90% of total billed charges for outpatient setting,$5.80 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$34.20 ,95% of total billed charges for outpatient setting,$30.60 ,85% of total billed charges for outpatient setting,$28.80 ,80% of total billed charges for outpatient setting,$5.74 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$30.60 ,85% of total billed charges for outpatient setting,$30.60 ,85% of total billed charges for outpatient setting,$30.60 ,85% of total billed charges for outpatient setting,$33.48 ,93% of total billed charges for outpatient setting,$27.00 ,75% of total billed charges for outpatient setting,$27.00 ,75% of total billed charges for outpatient setting,$27.00 ,75% of total billed charges for outpatient setting,$7.23 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$30.60 ,85% of total billed charges for outpatient setting,$5.74 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.48 ,$34.20 ,$12.60 Outpatient Medical Services,LAB,85060,Smear Exam by Pathologist,300,$146.00 ,$27.27 ,100% Amerigroup fee schedule for outpatient setting,$27.27 ,100% Amerigroup fee schedule for outpatient setting,$73.00 ,75% of total billed charges for outpatient setting,$73.00 ,75% of total billed charges for outpatient setting,$73.00 ,75% of total billed charges for outpatient setting,$46.17 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$46.17 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$46.17 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$46.17 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$46.17 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$46.17 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$116.80 ,80% of total billed charges for outpatient setting,$46.17 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$27.27 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$124.10 ,85% of total billed charges for outpatient setting,$45.71 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$116.80 ,80% of total billed charges for outpatient setting,$124.10 ,85% of total billed charges for outpatient setting,$102.20 ,70% of total billed charges for outpatient setting,$102.20 ,70% of total billed charges for outpatient setting,$112.42 ,77% of total billed charges for outpatient setting,$45.71 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$124.10 ,85% of total billed charges for outpatient setting,$124.10 ,85% of total billed charges for outpatient setting,$124.10 ,85% of total billed charges for outpatient setting,$124.10 ,85% of total billed charges for outpatient setting,$124.10 ,85% of total billed charges for outpatient setting,$26.49 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$45.71 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$45.71 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$45.71 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$45.71 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$124.10 ,85% of total billed charges for outpatient setting,$25.97 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$45.26 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$131.40 ,90% of total billed charges for outpatient setting,$26.75 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$138.70 ,95% of total billed charges for outpatient setting,$124.10 ,85% of total billed charges for outpatient setting,$116.80 ,80% of total billed charges for outpatient setting,$26.49 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$124.10 ,85% of total billed charges for outpatient setting,$124.10 ,85% of total billed charges for outpatient setting,$124.10 ,85% of total billed charges for outpatient setting,$135.78 ,93% of total billed charges for outpatient setting,$109.50 ,75% of total billed charges for outpatient setting,$109.50 ,75% of total billed charges for outpatient setting,$109.50 ,75% of total billed charges for outpatient setting,$29.32 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$124.10 ,85% of total billed charges for outpatient setting,$26.49 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$25.97 ,$138.70 ,$51.10 Outpatient Medical Services,LAB,85379,D-Dimer,300,$344.23 ,$13.44 ,100% Amerigroup fee schedule for outpatient setting,$13.44 ,100% Amerigroup fee schedule for outpatient setting,$172.12 ,75% of total billed charges for outpatient setting,$172.12 ,75% of total billed charges for outpatient setting,$172.12 ,75% of total billed charges for outpatient setting,$10.38 ,102% CMS Medicare OPPS fee schedule,$10.38 ,102% CMS Medicare OPPS fee schedule,$10.38 ,102% CMS Medicare OPPS fee schedule,$10.38 ,102% CMS Medicare OPPS fee schedule,$10.38 ,102% CMS Medicare OPPS fee schedule,$10.38 ,102% CMS Medicare OPPS fee schedule,$275.38 ,80% of total billed charges for outpatient setting,$10.38 ,102% CMS Medicare OPPS fee schedule,$13.44 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$292.60 ,85% of total billed charges for outpatient setting,$10.28 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$275.38 ,80% of total billed charges for outpatient setting,$292.60 ,85% of total billed charges for outpatient setting,$240.96 ,70% of total billed charges for outpatient setting,$240.96 ,70% of total billed charges for outpatient setting,$265.06 ,77% of total billed charges for outpatient setting,$10.28 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$292.60 ,85% of total billed charges for outpatient setting,$292.60 ,85% of total billed charges for outpatient setting,$292.60 ,85% of total billed charges for outpatient setting,$292.60 ,85% of total billed charges for outpatient setting,$292.60 ,85% of total billed charges for outpatient setting,$13.06 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$10.28 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$10.28 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$10.28 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$10.28 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$292.60 ,85% of total billed charges for outpatient setting,$12.80 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$10.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$309.81 ,90% of total billed charges for outpatient setting,$13.18 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$327.02 ,95% of total billed charges for outpatient setting,$292.60 ,85% of total billed charges for outpatient setting,$275.38 ,80% of total billed charges for outpatient setting,$13.06 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$292.60 ,85% of total billed charges for outpatient setting,$292.60 ,85% of total billed charges for outpatient setting,$292.60 ,85% of total billed charges for outpatient setting,$320.13 ,93% of total billed charges for outpatient setting,$258.17 ,75% of total billed charges for outpatient setting,$258.17 ,75% of total billed charges for outpatient setting,$258.17 ,75% of total billed charges for outpatient setting,$69.12 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$292.60 ,85% of total billed charges for outpatient setting,$13.06 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$10.18 ,$327.02 ,$120.48 Outpatient Medical Services,LAB,85610,Protime,300,$140.00 ,$5.19 ,100% Amerigroup fee schedule for outpatient setting,$5.19 ,100% Amerigroup fee schedule for outpatient setting,$70.00 ,75% of total billed charges for outpatient setting,$70.00 ,75% of total billed charges for outpatient setting,$70.00 ,75% of total billed charges for outpatient setting,$4.38 ,102% CMS Medicare OPPS fee schedule,$4.38 ,102% CMS Medicare OPPS fee schedule,$4.38 ,102% CMS Medicare OPPS fee schedule,$4.38 ,102% CMS Medicare OPPS fee schedule,$4.38 ,102% CMS Medicare OPPS fee schedule,$4.38 ,102% CMS Medicare OPPS fee schedule,$112.00 ,80% of total billed charges for outpatient setting,$4.38 ,102% CMS Medicare OPPS fee schedule,$5.19 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$119.00 ,85% of total billed charges for outpatient setting,$4.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$112.00 ,80% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$98.00 ,70% of total billed charges for outpatient setting,$98.00 ,70% of total billed charges for outpatient setting,$107.80 ,77% of total billed charges for outpatient setting,$4.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$5.04 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$4.94 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$4.29 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$126.00 ,90% of total billed charges for outpatient setting,$5.09 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$133.00 ,95% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$112.00 ,80% of total billed charges for outpatient setting,$5.04 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$119.00 ,85% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$130.20 ,93% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$28.11 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$119.00 ,85% of total billed charges for outpatient setting,$5.04 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.29 ,$133.00 ,$49.00 Outpatient Medical Services,LAB,85610,Prothrombin Time and INR,305,$42.19 ,$5.19 ,100% Amerigroup fee schedule for outpatient setting,$5.19 ,100% Amerigroup fee schedule for outpatient setting,$21.10 ,75% of total billed charges for outpatient setting,$21.10 ,75% of total billed charges for outpatient setting,$21.10 ,75% of total billed charges for outpatient setting,$4.38 ,102% CMS Medicare OPPS fee schedule,$4.38 ,102% CMS Medicare OPPS fee schedule,$4.38 ,102% CMS Medicare OPPS fee schedule,$4.38 ,102% CMS Medicare OPPS fee schedule,$4.38 ,102% CMS Medicare OPPS fee schedule,$4.38 ,102% CMS Medicare OPPS fee schedule,$33.75 ,80% of total billed charges for outpatient setting,$4.38 ,102% CMS Medicare OPPS fee schedule,$5.19 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$35.86 ,85% of total billed charges for outpatient setting,$4.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$33.75 ,80% of total billed charges for outpatient setting,$35.86 ,85% of total billed charges for outpatient setting,$29.53 ,70% of total billed charges for outpatient setting,$29.53 ,70% of total billed charges for outpatient setting,$32.49 ,77% of total billed charges for outpatient setting,$4.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$35.86 ,85% of total billed charges for outpatient setting,$35.86 ,85% of total billed charges for outpatient setting,$35.86 ,85% of total billed charges for outpatient setting,$35.86 ,85% of total billed charges for outpatient setting,$35.86 ,85% of total billed charges for outpatient setting,$5.04 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$35.86 ,85% of total billed charges for outpatient setting,$4.94 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$4.29 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$37.97 ,90% of total billed charges for outpatient setting,$5.09 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$40.08 ,95% of total billed charges for outpatient setting,$35.86 ,85% of total billed charges for outpatient setting,$33.75 ,80% of total billed charges for outpatient setting,$5.04 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$35.86 ,85% of total billed charges for outpatient setting,$35.86 ,85% of total billed charges for outpatient setting,$35.86 ,85% of total billed charges for outpatient setting,$39.24 ,93% of total billed charges for outpatient setting,$31.64 ,75% of total billed charges for outpatient setting,$31.64 ,75% of total billed charges for outpatient setting,$31.64 ,75% of total billed charges for outpatient setting,$8.47 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$35.86 ,85% of total billed charges for outpatient setting,$5.04 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.29 ,$40.08 ,$14.77 Outpatient Medical Services,LAB,85610,PT/INR,300,$140.00 ,$5.19 ,100% Amerigroup fee schedule for outpatient setting,$5.19 ,100% Amerigroup fee schedule for outpatient setting,$70.00 ,75% of total billed charges for outpatient setting,$70.00 ,75% of total billed charges for outpatient setting,$70.00 ,75% of total billed charges for outpatient setting,$4.38 ,102% CMS Medicare OPPS fee schedule,$4.38 ,102% CMS Medicare OPPS fee schedule,$4.38 ,102% CMS Medicare OPPS fee schedule,$4.38 ,102% CMS Medicare OPPS fee schedule,$4.38 ,102% CMS Medicare OPPS fee schedule,$4.38 ,102% CMS Medicare OPPS fee schedule,$112.00 ,80% of total billed charges for outpatient setting,$4.38 ,102% CMS Medicare OPPS fee schedule,$5.19 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$119.00 ,85% of total billed charges for outpatient setting,$4.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$112.00 ,80% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$98.00 ,70% of total billed charges for outpatient setting,$98.00 ,70% of total billed charges for outpatient setting,$107.80 ,77% of total billed charges for outpatient setting,$4.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$5.04 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$4.94 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$4.29 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$126.00 ,90% of total billed charges for outpatient setting,$5.09 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$133.00 ,95% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$112.00 ,80% of total billed charges for outpatient setting,$5.04 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$119.00 ,85% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$130.20 ,93% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$28.11 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$119.00 ,85% of total billed charges for outpatient setting,$5.04 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.29 ,$133.00 ,$49.00 Outpatient Medical Services,LAB,85610,Prothrombin Time (PT) LC,305,$42.19 ,$5.19 ,100% Amerigroup fee schedule for outpatient setting,$5.19 ,100% Amerigroup fee schedule for outpatient setting,$21.10 ,75% of total billed charges for outpatient setting,$21.10 ,75% of total billed charges for outpatient setting,$21.10 ,75% of total billed charges for outpatient setting,$4.38 ,102% CMS Medicare OPPS fee schedule,$4.38 ,102% CMS Medicare OPPS fee schedule,$4.38 ,102% CMS Medicare OPPS fee schedule,$4.38 ,102% CMS Medicare OPPS fee schedule,$4.38 ,102% CMS Medicare OPPS fee schedule,$4.38 ,102% CMS Medicare OPPS fee schedule,$33.75 ,80% of total billed charges for outpatient setting,$4.38 ,102% CMS Medicare OPPS fee schedule,$5.19 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$35.86 ,85% of total billed charges for outpatient setting,$4.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$33.75 ,80% of total billed charges for outpatient setting,$35.86 ,85% of total billed charges for outpatient setting,$29.53 ,70% of total billed charges for outpatient setting,$29.53 ,70% of total billed charges for outpatient setting,$32.49 ,77% of total billed charges for outpatient setting,$4.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$35.86 ,85% of total billed charges for outpatient setting,$35.86 ,85% of total billed charges for outpatient setting,$35.86 ,85% of total billed charges for outpatient setting,$35.86 ,85% of total billed charges for outpatient setting,$35.86 ,85% of total billed charges for outpatient setting,$5.04 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$35.86 ,85% of total billed charges for outpatient setting,$4.94 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$4.29 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$37.97 ,90% of total billed charges for outpatient setting,$5.09 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$40.08 ,95% of total billed charges for outpatient setting,$35.86 ,85% of total billed charges for outpatient setting,$33.75 ,80% of total billed charges for outpatient setting,$5.04 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$35.86 ,85% of total billed charges for outpatient setting,$35.86 ,85% of total billed charges for outpatient setting,$35.86 ,85% of total billed charges for outpatient setting,$39.24 ,93% of total billed charges for outpatient setting,$31.64 ,75% of total billed charges for outpatient setting,$31.64 ,75% of total billed charges for outpatient setting,$31.64 ,75% of total billed charges for outpatient setting,$8.47 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$35.86 ,85% of total billed charges for outpatient setting,$5.04 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.29 ,$40.08 ,$14.77 Outpatient Medical Services,LAB,85610,PT/INR (Fingerstick),300,$140.00 ,$5.19 ,100% Amerigroup fee schedule for outpatient setting,$5.19 ,100% Amerigroup fee schedule for outpatient setting,$70.00 ,75% of total billed charges for outpatient setting,$70.00 ,75% of total billed charges for outpatient setting,$70.00 ,75% of total billed charges for outpatient setting,$4.38 ,102% CMS Medicare OPPS fee schedule,$4.38 ,102% CMS Medicare OPPS fee schedule,$4.38 ,102% CMS Medicare OPPS fee schedule,$4.38 ,102% CMS Medicare OPPS fee schedule,$4.38 ,102% CMS Medicare OPPS fee schedule,$4.38 ,102% CMS Medicare OPPS fee schedule,$112.00 ,80% of total billed charges for outpatient setting,$4.38 ,102% CMS Medicare OPPS fee schedule,$5.19 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$119.00 ,85% of total billed charges for outpatient setting,$4.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$112.00 ,80% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$98.00 ,70% of total billed charges for outpatient setting,$98.00 ,70% of total billed charges for outpatient setting,$107.80 ,77% of total billed charges for outpatient setting,$4.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$5.04 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.33 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$4.94 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$4.29 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$126.00 ,90% of total billed charges for outpatient setting,$5.09 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$133.00 ,95% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$112.00 ,80% of total billed charges for outpatient setting,$5.04 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$119.00 ,85% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$130.20 ,93% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$28.11 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$119.00 ,85% of total billed charges for outpatient setting,$5.04 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.29 ,$133.00 ,$49.00 Outpatient Medical Services,LAB,85651,ESR,305,$133.48 ,$4.68 ,100% Amerigroup fee schedule for outpatient setting,$4.68 ,100% Amerigroup fee schedule for outpatient setting,$66.74 ,75% of total billed charges for outpatient setting,$66.74 ,75% of total billed charges for outpatient setting,$66.74 ,75% of total billed charges for outpatient setting,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.36 ,102% CMS Medicare OPPS fee schedule,$106.78 ,80% of total billed charges for outpatient setting,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.68 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$113.46 ,85% of total billed charges for outpatient setting,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$106.78 ,80% of total billed charges for outpatient setting,$113.46 ,85% of total billed charges for outpatient setting,$93.44 ,70% of total billed charges for outpatient setting,$93.44 ,70% of total billed charges for outpatient setting,$102.78 ,77% of total billed charges for outpatient setting,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$113.46 ,85% of total billed charges for outpatient setting,$113.46 ,85% of total billed charges for outpatient setting,$113.46 ,85% of total billed charges for outpatient setting,$113.46 ,85% of total billed charges for outpatient setting,$113.46 ,85% of total billed charges for outpatient setting,$4.55 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$113.46 ,85% of total billed charges for outpatient setting,$4.46 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$4.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$120.13 ,90% of total billed charges for outpatient setting,$4.59 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$126.81 ,95% of total billed charges for outpatient setting,$113.46 ,85% of total billed charges for outpatient setting,$106.78 ,80% of total billed charges for outpatient setting,$4.55 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$113.46 ,85% of total billed charges for outpatient setting,$113.46 ,85% of total billed charges for outpatient setting,$113.46 ,85% of total billed charges for outpatient setting,$124.14 ,93% of total billed charges for outpatient setting,$100.11 ,75% of total billed charges for outpatient setting,$100.11 ,75% of total billed charges for outpatient setting,$100.11 ,75% of total billed charges for outpatient setting,$26.80 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$113.46 ,85% of total billed charges for outpatient setting,$4.55 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.27 ,$126.81 ,$46.72 Outpatient Medical Services,LAB,85651,Sedimentation Rate (ESR) LC,305,$133.48 ,$4.68 ,100% Amerigroup fee schedule for outpatient setting,$4.68 ,100% Amerigroup fee schedule for outpatient setting,$66.74 ,75% of total billed charges for outpatient setting,$66.74 ,75% of total billed charges for outpatient setting,$66.74 ,75% of total billed charges for outpatient setting,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.36 ,102% CMS Medicare OPPS fee schedule,$106.78 ,80% of total billed charges for outpatient setting,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.68 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$113.46 ,85% of total billed charges for outpatient setting,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$106.78 ,80% of total billed charges for outpatient setting,$113.46 ,85% of total billed charges for outpatient setting,$93.44 ,70% of total billed charges for outpatient setting,$93.44 ,70% of total billed charges for outpatient setting,$102.78 ,77% of total billed charges for outpatient setting,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$113.46 ,85% of total billed charges for outpatient setting,$113.46 ,85% of total billed charges for outpatient setting,$113.46 ,85% of total billed charges for outpatient setting,$113.46 ,85% of total billed charges for outpatient setting,$113.46 ,85% of total billed charges for outpatient setting,$4.55 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$113.46 ,85% of total billed charges for outpatient setting,$4.46 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$4.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$120.13 ,90% of total billed charges for outpatient setting,$4.59 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$126.81 ,95% of total billed charges for outpatient setting,$113.46 ,85% of total billed charges for outpatient setting,$106.78 ,80% of total billed charges for outpatient setting,$4.55 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$113.46 ,85% of total billed charges for outpatient setting,$113.46 ,85% of total billed charges for outpatient setting,$113.46 ,85% of total billed charges for outpatient setting,$124.14 ,93% of total billed charges for outpatient setting,$100.11 ,75% of total billed charges for outpatient setting,$100.11 ,75% of total billed charges for outpatient setting,$100.11 ,75% of total billed charges for outpatient setting,$26.80 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$113.46 ,85% of total billed charges for outpatient setting,$4.55 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.27 ,$126.81 ,$46.72 Outpatient Medical Services,LAB,85651,"85651 Sedimentation rate, erythrocyte; non-automated",300,$95.00 ,$4.68 ,100% Amerigroup fee schedule for outpatient setting,$4.68 ,100% Amerigroup fee schedule for outpatient setting,$47.50 ,75% of total billed charges for outpatient setting,$47.50 ,75% of total billed charges for outpatient setting,$47.50 ,75% of total billed charges for outpatient setting,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.36 ,102% CMS Medicare OPPS fee schedule,$76.00 ,80% of total billed charges for outpatient setting,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.68 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$80.75 ,85% of total billed charges for outpatient setting,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$76.00 ,80% of total billed charges for outpatient setting,$80.75 ,85% of total billed charges for outpatient setting,$66.50 ,70% of total billed charges for outpatient setting,$66.50 ,70% of total billed charges for outpatient setting,$73.15 ,77% of total billed charges for outpatient setting,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$80.75 ,85% of total billed charges for outpatient setting,$80.75 ,85% of total billed charges for outpatient setting,$80.75 ,85% of total billed charges for outpatient setting,$80.75 ,85% of total billed charges for outpatient setting,$80.75 ,85% of total billed charges for outpatient setting,$4.55 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$80.75 ,85% of total billed charges for outpatient setting,$4.46 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$4.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$85.50 ,90% of total billed charges for outpatient setting,$4.59 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$90.25 ,95% of total billed charges for outpatient setting,$80.75 ,85% of total billed charges for outpatient setting,$76.00 ,80% of total billed charges for outpatient setting,$4.55 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$80.75 ,85% of total billed charges for outpatient setting,$80.75 ,85% of total billed charges for outpatient setting,$80.75 ,85% of total billed charges for outpatient setting,$88.35 ,93% of total billed charges for outpatient setting,$71.25 ,75% of total billed charges for outpatient setting,$71.25 ,75% of total billed charges for outpatient setting,$71.25 ,75% of total billed charges for outpatient setting,$19.08 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$80.75 ,85% of total billed charges for outpatient setting,$4.55 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.27 ,$90.25 ,$33.25 Outpatient Medical Services,LAB,85730,Partial Thromboplastin Time,305,$74.36 ,$7.92 ,100% Amerigroup fee schedule for outpatient setting,$7.92 ,100% Amerigroup fee schedule for outpatient setting,$37.18 ,75% of total billed charges for outpatient setting,$37.18 ,75% of total billed charges for outpatient setting,$37.18 ,75% of total billed charges for outpatient setting,$6.13 ,102% CMS Medicare OPPS fee schedule,$6.13 ,102% CMS Medicare OPPS fee schedule,$6.13 ,102% CMS Medicare OPPS fee schedule,$6.13 ,102% CMS Medicare OPPS fee schedule,$6.13 ,102% CMS Medicare OPPS fee schedule,$6.13 ,102% CMS Medicare OPPS fee schedule,$59.49 ,80% of total billed charges for outpatient setting,$6.13 ,102% CMS Medicare OPPS fee schedule,$7.92 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$63.21 ,85% of total billed charges for outpatient setting,$6.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$59.49 ,80% of total billed charges for outpatient setting,$63.21 ,85% of total billed charges for outpatient setting,$52.05 ,70% of total billed charges for outpatient setting,$52.05 ,70% of total billed charges for outpatient setting,$57.26 ,77% of total billed charges for outpatient setting,$6.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$63.21 ,85% of total billed charges for outpatient setting,$63.21 ,85% of total billed charges for outpatient setting,$63.21 ,85% of total billed charges for outpatient setting,$63.21 ,85% of total billed charges for outpatient setting,$63.21 ,85% of total billed charges for outpatient setting,$7.69 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$6.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$63.21 ,85% of total billed charges for outpatient setting,$7.54 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$6.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$66.92 ,90% of total billed charges for outpatient setting,$7.77 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$70.64 ,95% of total billed charges for outpatient setting,$63.21 ,85% of total billed charges for outpatient setting,$59.49 ,80% of total billed charges for outpatient setting,$7.69 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$63.21 ,85% of total billed charges for outpatient setting,$63.21 ,85% of total billed charges for outpatient setting,$63.21 ,85% of total billed charges for outpatient setting,$69.15 ,93% of total billed charges for outpatient setting,$55.77 ,75% of total billed charges for outpatient setting,$55.77 ,75% of total billed charges for outpatient setting,$55.77 ,75% of total billed charges for outpatient setting,$14.93 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$63.21 ,85% of total billed charges for outpatient setting,$7.69 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$6.01 ,$70.64 ,$26.03 Outpatient Medical Services,LAB,85730,PT/ PTT,305,$74.36 ,$7.92 ,100% Amerigroup fee schedule for outpatient setting,$7.92 ,100% Amerigroup fee schedule for outpatient setting,$37.18 ,75% of total billed charges for outpatient setting,$37.18 ,75% of total billed charges for outpatient setting,$37.18 ,75% of total billed charges for outpatient setting,$6.13 ,102% CMS Medicare OPPS fee schedule,$6.13 ,102% CMS Medicare OPPS fee schedule,$6.13 ,102% CMS Medicare OPPS fee schedule,$6.13 ,102% CMS Medicare OPPS fee schedule,$6.13 ,102% CMS Medicare OPPS fee schedule,$6.13 ,102% CMS Medicare OPPS fee schedule,$59.49 ,80% of total billed charges for outpatient setting,$6.13 ,102% CMS Medicare OPPS fee schedule,$7.92 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$63.21 ,85% of total billed charges for outpatient setting,$6.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$59.49 ,80% of total billed charges for outpatient setting,$63.21 ,85% of total billed charges for outpatient setting,$52.05 ,70% of total billed charges for outpatient setting,$52.05 ,70% of total billed charges for outpatient setting,$57.26 ,77% of total billed charges for outpatient setting,$6.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$63.21 ,85% of total billed charges for outpatient setting,$63.21 ,85% of total billed charges for outpatient setting,$63.21 ,85% of total billed charges for outpatient setting,$63.21 ,85% of total billed charges for outpatient setting,$63.21 ,85% of total billed charges for outpatient setting,$7.69 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$6.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$63.21 ,85% of total billed charges for outpatient setting,$7.54 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$6.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$66.92 ,90% of total billed charges for outpatient setting,$7.77 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$70.64 ,95% of total billed charges for outpatient setting,$63.21 ,85% of total billed charges for outpatient setting,$59.49 ,80% of total billed charges for outpatient setting,$7.69 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$63.21 ,85% of total billed charges for outpatient setting,$63.21 ,85% of total billed charges for outpatient setting,$63.21 ,85% of total billed charges for outpatient setting,$69.15 ,93% of total billed charges for outpatient setting,$55.77 ,75% of total billed charges for outpatient setting,$55.77 ,75% of total billed charges for outpatient setting,$55.77 ,75% of total billed charges for outpatient setting,$14.93 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$63.21 ,85% of total billed charges for outpatient setting,$7.69 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$6.01 ,$70.64 ,$26.03 Outpatient Medical Services,LAB,85730,PT and PTT LC,305,$74.36 ,$7.92 ,100% Amerigroup fee schedule for outpatient setting,$7.92 ,100% Amerigroup fee schedule for outpatient setting,$37.18 ,75% of total billed charges for outpatient setting,$37.18 ,75% of total billed charges for outpatient setting,$37.18 ,75% of total billed charges for outpatient setting,$6.13 ,102% CMS Medicare OPPS fee schedule,$6.13 ,102% CMS Medicare OPPS fee schedule,$6.13 ,102% CMS Medicare OPPS fee schedule,$6.13 ,102% CMS Medicare OPPS fee schedule,$6.13 ,102% CMS Medicare OPPS fee schedule,$6.13 ,102% CMS Medicare OPPS fee schedule,$59.49 ,80% of total billed charges for outpatient setting,$6.13 ,102% CMS Medicare OPPS fee schedule,$7.92 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$63.21 ,85% of total billed charges for outpatient setting,$6.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$59.49 ,80% of total billed charges for outpatient setting,$63.21 ,85% of total billed charges for outpatient setting,$52.05 ,70% of total billed charges for outpatient setting,$52.05 ,70% of total billed charges for outpatient setting,$57.26 ,77% of total billed charges for outpatient setting,$6.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$63.21 ,85% of total billed charges for outpatient setting,$63.21 ,85% of total billed charges for outpatient setting,$63.21 ,85% of total billed charges for outpatient setting,$63.21 ,85% of total billed charges for outpatient setting,$63.21 ,85% of total billed charges for outpatient setting,$7.69 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$6.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.07 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$63.21 ,85% of total billed charges for outpatient setting,$7.54 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$6.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$66.92 ,90% of total billed charges for outpatient setting,$7.77 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$70.64 ,95% of total billed charges for outpatient setting,$63.21 ,85% of total billed charges for outpatient setting,$59.49 ,80% of total billed charges for outpatient setting,$7.69 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$63.21 ,85% of total billed charges for outpatient setting,$63.21 ,85% of total billed charges for outpatient setting,$63.21 ,85% of total billed charges for outpatient setting,$69.15 ,93% of total billed charges for outpatient setting,$55.77 ,75% of total billed charges for outpatient setting,$55.77 ,75% of total billed charges for outpatient setting,$55.77 ,75% of total billed charges for outpatient setting,$14.93 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$63.21 ,85% of total billed charges for outpatient setting,$7.69 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$6.01 ,$70.64 ,$26.03 Outpatient Medical Services,LAB,86038,ANA w/Reflex EIA LC,300,$170.00 ,$15.96 ,100% Amerigroup fee schedule for outpatient setting,$15.96 ,100% Amerigroup fee schedule for outpatient setting,$85.00 ,75% of total billed charges for outpatient setting,$85.00 ,75% of total billed charges for outpatient setting,$85.00 ,75% of total billed charges for outpatient setting,$12.33 ,102% CMS Medicare OPPS fee schedule,$12.33 ,102% CMS Medicare OPPS fee schedule,$12.33 ,102% CMS Medicare OPPS fee schedule,$12.33 ,102% CMS Medicare OPPS fee schedule,$12.33 ,102% CMS Medicare OPPS fee schedule,$12.33 ,102% CMS Medicare OPPS fee schedule,$136.00 ,80% of total billed charges for outpatient setting,$12.33 ,102% CMS Medicare OPPS fee schedule,$15.96 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$144.50 ,85% of total billed charges for outpatient setting,$12.21 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$136.00 ,80% of total billed charges for outpatient setting,$144.50 ,85% of total billed charges for outpatient setting,$119.00 ,70% of total billed charges for outpatient setting,$119.00 ,70% of total billed charges for outpatient setting,$130.90 ,77% of total billed charges for outpatient setting,$12.21 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$144.50 ,85% of total billed charges for outpatient setting,$144.50 ,85% of total billed charges for outpatient setting,$144.50 ,85% of total billed charges for outpatient setting,$144.50 ,85% of total billed charges for outpatient setting,$144.50 ,85% of total billed charges for outpatient setting,$15.50 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$12.21 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.21 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.21 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.21 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$144.50 ,85% of total billed charges for outpatient setting,$15.20 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$12.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$153.00 ,90% of total billed charges for outpatient setting,$15.66 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$161.50 ,95% of total billed charges for outpatient setting,$144.50 ,85% of total billed charges for outpatient setting,$136.00 ,80% of total billed charges for outpatient setting,$15.50 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$144.50 ,85% of total billed charges for outpatient setting,$144.50 ,85% of total billed charges for outpatient setting,$144.50 ,85% of total billed charges for outpatient setting,$158.10 ,93% of total billed charges for outpatient setting,$127.50 ,75% of total billed charges for outpatient setting,$127.50 ,75% of total billed charges for outpatient setting,$127.50 ,75% of total billed charges for outpatient setting,$34.14 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$144.50 ,85% of total billed charges for outpatient setting,$15.50 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$12.09 ,$161.50 ,$59.50 Outpatient Medical Services,LAB,86038,ANA w/ Reflex IFA LC,300,$170.00 ,$15.96 ,100% Amerigroup fee schedule for outpatient setting,$15.96 ,100% Amerigroup fee schedule for outpatient setting,$85.00 ,75% of total billed charges for outpatient setting,$85.00 ,75% of total billed charges for outpatient setting,$85.00 ,75% of total billed charges for outpatient setting,$12.33 ,102% CMS Medicare OPPS fee schedule,$12.33 ,102% CMS Medicare OPPS fee schedule,$12.33 ,102% CMS Medicare OPPS fee schedule,$12.33 ,102% CMS Medicare OPPS fee schedule,$12.33 ,102% CMS Medicare OPPS fee schedule,$12.33 ,102% CMS Medicare OPPS fee schedule,$136.00 ,80% of total billed charges for outpatient setting,$12.33 ,102% CMS Medicare OPPS fee schedule,$15.96 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$144.50 ,85% of total billed charges for outpatient setting,$12.21 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$136.00 ,80% of total billed charges for outpatient setting,$144.50 ,85% of total billed charges for outpatient setting,$119.00 ,70% of total billed charges for outpatient setting,$119.00 ,70% of total billed charges for outpatient setting,$130.90 ,77% of total billed charges for outpatient setting,$12.21 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$144.50 ,85% of total billed charges for outpatient setting,$144.50 ,85% of total billed charges for outpatient setting,$144.50 ,85% of total billed charges for outpatient setting,$144.50 ,85% of total billed charges for outpatient setting,$144.50 ,85% of total billed charges for outpatient setting,$15.50 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$12.21 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.21 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.21 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.21 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$144.50 ,85% of total billed charges for outpatient setting,$15.20 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$12.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$153.00 ,90% of total billed charges for outpatient setting,$15.66 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$161.50 ,95% of total billed charges for outpatient setting,$144.50 ,85% of total billed charges for outpatient setting,$136.00 ,80% of total billed charges for outpatient setting,$15.50 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$144.50 ,85% of total billed charges for outpatient setting,$144.50 ,85% of total billed charges for outpatient setting,$144.50 ,85% of total billed charges for outpatient setting,$158.10 ,93% of total billed charges for outpatient setting,$127.50 ,75% of total billed charges for outpatient setting,$127.50 ,75% of total billed charges for outpatient setting,$127.50 ,75% of total billed charges for outpatient setting,$34.14 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$144.50 ,85% of total billed charges for outpatient setting,$15.50 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$12.09 ,$161.50 ,$59.50 Outpatient Medical Services,LAB,86141,C-Reactive Protein High Sensitivity TC,300,$43.00 ,$17.09 ,100% Amerigroup fee schedule for outpatient setting,$17.09 ,100% Amerigroup fee schedule for outpatient setting,$21.50 ,75% of total billed charges for outpatient setting,$21.50 ,75% of total billed charges for outpatient setting,$21.50 ,75% of total billed charges for outpatient setting,$13.21 ,102% CMS Medicare OPPS fee schedule,$13.21 ,102% CMS Medicare OPPS fee schedule,$13.21 ,102% CMS Medicare OPPS fee schedule,$13.21 ,102% CMS Medicare OPPS fee schedule,$13.21 ,102% CMS Medicare OPPS fee schedule,$13.21 ,102% CMS Medicare OPPS fee schedule,$34.40 ,80% of total billed charges for outpatient setting,$13.21 ,102% CMS Medicare OPPS fee schedule,$17.09 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$36.55 ,85% of total billed charges for outpatient setting,$13.08 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$34.40 ,80% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$30.10 ,70% of total billed charges for outpatient setting,$30.10 ,70% of total billed charges for outpatient setting,$33.11 ,77% of total billed charges for outpatient setting,$13.08 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$16.61 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$13.08 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.08 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.08 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.08 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$16.28 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$12.95 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$38.70 ,90% of total billed charges for outpatient setting,$16.77 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$40.85 ,95% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$34.40 ,80% of total billed charges for outpatient setting,$16.61 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$36.55 ,85% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$39.99 ,93% of total billed charges for outpatient setting,$32.25 ,75% of total billed charges for outpatient setting,$32.25 ,75% of total billed charges for outpatient setting,$32.25 ,75% of total billed charges for outpatient setting,$8.63 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$36.55 ,85% of total billed charges for outpatient setting,$16.61 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.63 ,$40.85 ,$15.05 Outpatient Medical Services,LAB,86141,C-Reactive Protein,300,$43.00 ,$17.09 ,100% Amerigroup fee schedule for outpatient setting,$17.09 ,100% Amerigroup fee schedule for outpatient setting,$21.50 ,75% of total billed charges for outpatient setting,$21.50 ,75% of total billed charges for outpatient setting,$21.50 ,75% of total billed charges for outpatient setting,$13.21 ,102% CMS Medicare OPPS fee schedule,$13.21 ,102% CMS Medicare OPPS fee schedule,$13.21 ,102% CMS Medicare OPPS fee schedule,$13.21 ,102% CMS Medicare OPPS fee schedule,$13.21 ,102% CMS Medicare OPPS fee schedule,$13.21 ,102% CMS Medicare OPPS fee schedule,$34.40 ,80% of total billed charges for outpatient setting,$13.21 ,102% CMS Medicare OPPS fee schedule,$17.09 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$36.55 ,85% of total billed charges for outpatient setting,$13.08 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$34.40 ,80% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$30.10 ,70% of total billed charges for outpatient setting,$30.10 ,70% of total billed charges for outpatient setting,$33.11 ,77% of total billed charges for outpatient setting,$13.08 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$16.61 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$13.08 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.08 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.08 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.08 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$16.28 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$12.95 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$38.70 ,90% of total billed charges for outpatient setting,$16.77 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$40.85 ,95% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$34.40 ,80% of total billed charges for outpatient setting,$16.61 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$36.55 ,85% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$39.99 ,93% of total billed charges for outpatient setting,$32.25 ,75% of total billed charges for outpatient setting,$32.25 ,75% of total billed charges for outpatient setting,$32.25 ,75% of total billed charges for outpatient setting,$8.63 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$36.55 ,85% of total billed charges for outpatient setting,$16.61 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.63 ,$40.85 ,$15.05 Outpatient Medical Services,LAB,86141,CRP LC,300,$43.00 ,$17.09 ,100% Amerigroup fee schedule for outpatient setting,$17.09 ,100% Amerigroup fee schedule for outpatient setting,$21.50 ,75% of total billed charges for outpatient setting,$21.50 ,75% of total billed charges for outpatient setting,$21.50 ,75% of total billed charges for outpatient setting,$13.21 ,102% CMS Medicare OPPS fee schedule,$13.21 ,102% CMS Medicare OPPS fee schedule,$13.21 ,102% CMS Medicare OPPS fee schedule,$13.21 ,102% CMS Medicare OPPS fee schedule,$13.21 ,102% CMS Medicare OPPS fee schedule,$13.21 ,102% CMS Medicare OPPS fee schedule,$34.40 ,80% of total billed charges for outpatient setting,$13.21 ,102% CMS Medicare OPPS fee schedule,$17.09 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$36.55 ,85% of total billed charges for outpatient setting,$13.08 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$34.40 ,80% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$30.10 ,70% of total billed charges for outpatient setting,$30.10 ,70% of total billed charges for outpatient setting,$33.11 ,77% of total billed charges for outpatient setting,$13.08 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$16.61 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$13.08 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.08 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.08 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.08 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$16.28 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$12.95 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$38.70 ,90% of total billed charges for outpatient setting,$16.77 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$40.85 ,95% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$34.40 ,80% of total billed charges for outpatient setting,$16.61 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$36.55 ,85% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$39.99 ,93% of total billed charges for outpatient setting,$32.25 ,75% of total billed charges for outpatient setting,$32.25 ,75% of total billed charges for outpatient setting,$32.25 ,75% of total billed charges for outpatient setting,$8.63 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$36.55 ,85% of total billed charges for outpatient setting,$16.61 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.63 ,$40.85 ,$15.05 Outpatient Medical Services,LAB,86308,Mono Scrn,300,$129.00 ,$6.84 ,100% Amerigroup fee schedule for outpatient setting,$6.84 ,100% Amerigroup fee schedule for outpatient setting,$64.50 ,75% of total billed charges for outpatient setting,$64.50 ,75% of total billed charges for outpatient setting,$64.50 ,75% of total billed charges for outpatient setting,$5.28 ,102% CMS Medicare OPPS fee schedule,$5.28 ,102% CMS Medicare OPPS fee schedule,$5.28 ,102% CMS Medicare OPPS fee schedule,$5.28 ,102% CMS Medicare OPPS fee schedule,$5.28 ,102% CMS Medicare OPPS fee schedule,$5.28 ,102% CMS Medicare OPPS fee schedule,$103.20 ,80% of total billed charges for outpatient setting,$5.28 ,102% CMS Medicare OPPS fee schedule,$6.84 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$109.65 ,85% of total billed charges for outpatient setting,$5.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$103.20 ,80% of total billed charges for outpatient setting,$109.65 ,85% of total billed charges for outpatient setting,$90.30 ,70% of total billed charges for outpatient setting,$90.30 ,70% of total billed charges for outpatient setting,$99.33 ,77% of total billed charges for outpatient setting,$5.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$109.65 ,85% of total billed charges for outpatient setting,$109.65 ,85% of total billed charges for outpatient setting,$109.65 ,85% of total billed charges for outpatient setting,$109.65 ,85% of total billed charges for outpatient setting,$109.65 ,85% of total billed charges for outpatient setting,$6.64 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.23 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$109.65 ,85% of total billed charges for outpatient setting,$6.51 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$5.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$116.10 ,90% of total billed charges for outpatient setting,$6.71 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$122.55 ,95% of total billed charges for outpatient setting,$109.65 ,85% of total billed charges for outpatient setting,$103.20 ,80% of total billed charges for outpatient setting,$6.64 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$109.65 ,85% of total billed charges for outpatient setting,$109.65 ,85% of total billed charges for outpatient setting,$109.65 ,85% of total billed charges for outpatient setting,$119.97 ,93% of total billed charges for outpatient setting,$96.75 ,75% of total billed charges for outpatient setting,$96.75 ,75% of total billed charges for outpatient setting,$96.75 ,75% of total billed charges for outpatient setting,$25.90 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$109.65 ,85% of total billed charges for outpatient setting,$6.64 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.18 ,$122.55 ,$45.15 Outpatient Medical Services,LAB,86430,RF,300,$108.19 ,$7.50 ,100% Amerigroup fee schedule for outpatient setting,$7.50 ,100% Amerigroup fee schedule for outpatient setting,$54.10 ,75% of total billed charges for outpatient setting,$54.10 ,75% of total billed charges for outpatient setting,$54.10 ,75% of total billed charges for outpatient setting,$6.26 ,102% CMS Medicare OPPS fee schedule,$6.26 ,102% CMS Medicare OPPS fee schedule,$6.26 ,102% CMS Medicare OPPS fee schedule,$6.26 ,102% CMS Medicare OPPS fee schedule,$6.26 ,102% CMS Medicare OPPS fee schedule,$6.26 ,102% CMS Medicare OPPS fee schedule,$86.55 ,80% of total billed charges for outpatient setting,$6.26 ,102% CMS Medicare OPPS fee schedule,$7.50 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$91.96 ,85% of total billed charges for outpatient setting,$6.20 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$86.55 ,80% of total billed charges for outpatient setting,$91.96 ,85% of total billed charges for outpatient setting,$75.73 ,70% of total billed charges for outpatient setting,$75.73 ,70% of total billed charges for outpatient setting,$83.31 ,77% of total billed charges for outpatient setting,$6.20 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$91.96 ,85% of total billed charges for outpatient setting,$91.96 ,85% of total billed charges for outpatient setting,$91.96 ,85% of total billed charges for outpatient setting,$91.96 ,85% of total billed charges for outpatient setting,$91.96 ,85% of total billed charges for outpatient setting,$7.28 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$6.20 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.20 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.20 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$6.20 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$91.96 ,85% of total billed charges for outpatient setting,$7.14 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$6.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$97.37 ,90% of total billed charges for outpatient setting,$7.35 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$102.78 ,95% of total billed charges for outpatient setting,$91.96 ,85% of total billed charges for outpatient setting,$86.55 ,80% of total billed charges for outpatient setting,$7.28 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$91.96 ,85% of total billed charges for outpatient setting,$91.96 ,85% of total billed charges for outpatient setting,$91.96 ,85% of total billed charges for outpatient setting,$100.62 ,93% of total billed charges for outpatient setting,$81.14 ,75% of total billed charges for outpatient setting,$81.14 ,75% of total billed charges for outpatient setting,$81.14 ,75% of total billed charges for outpatient setting,$21.72 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$91.96 ,85% of total billed charges for outpatient setting,$7.28 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$6.14 ,$102.78 ,$37.87 Outpatient Medical Services,LAB,86592,.RPR LC,300,$28.00 ,$3.76 ,100% Amerigroup fee schedule for outpatient setting,$3.76 ,100% Amerigroup fee schedule for outpatient setting,$14.00 ,75% of total billed charges for outpatient setting,$14.00 ,75% of total billed charges for outpatient setting,$14.00 ,75% of total billed charges for outpatient setting,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.36 ,102% CMS Medicare OPPS fee schedule,$22.40 ,80% of total billed charges for outpatient setting,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.88 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$23.80 ,85% of total billed charges for outpatient setting,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$22.40 ,80% of total billed charges for outpatient setting,$23.80 ,85% of total billed charges for outpatient setting,$19.60 ,70% of total billed charges for outpatient setting,$19.60 ,70% of total billed charges for outpatient setting,$21.56 ,77% of total billed charges for outpatient setting,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$23.80 ,85% of total billed charges for outpatient setting,$23.80 ,85% of total billed charges for outpatient setting,$23.80 ,85% of total billed charges for outpatient setting,$23.80 ,85% of total billed charges for outpatient setting,$23.80 ,85% of total billed charges for outpatient setting,$4.74 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$23.80 ,85% of total billed charges for outpatient setting,$4.65 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$4.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$25.20 ,90% of total billed charges for outpatient setting,$4.79 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$26.60 ,95% of total billed charges for outpatient setting,$23.80 ,85% of total billed charges for outpatient setting,$22.40 ,80% of total billed charges for outpatient setting,$4.74 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$23.80 ,85% of total billed charges for outpatient setting,$23.80 ,85% of total billed charges for outpatient setting,$23.80 ,85% of total billed charges for outpatient setting,$26.04 ,93% of total billed charges for outpatient setting,$21.00 ,75% of total billed charges for outpatient setting,$21.00 ,75% of total billed charges for outpatient setting,$21.00 ,75% of total billed charges for outpatient setting,$5.62 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$23.80 ,85% of total billed charges for outpatient setting,$4.74 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.76 ,$26.60 ,$9.80 Outpatient Medical Services,LAB,86677,H. Pylori Stl Ag,300,$168.00 ,$19.16 ,100% Amerigroup fee schedule for outpatient setting,$19.16 ,100% Amerigroup fee schedule for outpatient setting,$84.00 ,75% of total billed charges for outpatient setting,$84.00 ,75% of total billed charges for outpatient setting,$84.00 ,75% of total billed charges for outpatient setting,$17.19 ,102% CMS Medicare OPPS fee schedule,$17.19 ,102% CMS Medicare OPPS fee schedule,$17.19 ,102% CMS Medicare OPPS fee schedule,$17.19 ,102% CMS Medicare OPPS fee schedule,$17.19 ,102% CMS Medicare OPPS fee schedule,$17.19 ,102% CMS Medicare OPPS fee schedule,$134.40 ,80% of total billed charges for outpatient setting,$17.19 ,102% CMS Medicare OPPS fee schedule,$19.16 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$142.80 ,85% of total billed charges for outpatient setting,$17.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$134.40 ,80% of total billed charges for outpatient setting,$142.80 ,85% of total billed charges for outpatient setting,$117.60 ,70% of total billed charges for outpatient setting,$117.60 ,70% of total billed charges for outpatient setting,$129.36 ,77% of total billed charges for outpatient setting,$17.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$142.80 ,85% of total billed charges for outpatient setting,$142.80 ,85% of total billed charges for outpatient setting,$142.80 ,85% of total billed charges for outpatient setting,$142.80 ,85% of total billed charges for outpatient setting,$142.80 ,85% of total billed charges for outpatient setting,$18.62 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$17.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$17.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$17.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$17.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$142.80 ,85% of total billed charges for outpatient setting,$18.25 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$16.85 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$151.20 ,90% of total billed charges for outpatient setting,$18.80 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$159.60 ,95% of total billed charges for outpatient setting,$142.80 ,85% of total billed charges for outpatient setting,$134.40 ,80% of total billed charges for outpatient setting,$18.62 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$142.80 ,85% of total billed charges for outpatient setting,$142.80 ,85% of total billed charges for outpatient setting,$142.80 ,85% of total billed charges for outpatient setting,$156.24 ,93% of total billed charges for outpatient setting,$126.00 ,75% of total billed charges for outpatient setting,$126.00 ,75% of total billed charges for outpatient setting,$126.00 ,75% of total billed charges for outpatient setting,$33.73 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$142.80 ,85% of total billed charges for outpatient setting,$18.62 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$16.85 ,$159.60 ,$58.80 Outpatient Medical Services,LAB,86703,HIV Ag/Ab w/ Reflex to Conf LC,300,$43.00 ,$12.08 ,100% Amerigroup fee schedule for outpatient setting,$12.08 ,100% Amerigroup fee schedule for outpatient setting,$21.50 ,75% of total billed charges for outpatient setting,$21.50 ,75% of total billed charges for outpatient setting,$21.50 ,75% of total billed charges for outpatient setting,$13.98 ,102% CMS Medicare OPPS fee schedule,$13.98 ,102% CMS Medicare OPPS fee schedule,$13.98 ,102% CMS Medicare OPPS fee schedule,$13.98 ,102% CMS Medicare OPPS fee schedule,$13.98 ,102% CMS Medicare OPPS fee schedule,$13.98 ,102% CMS Medicare OPPS fee schedule,$34.40 ,80% of total billed charges for outpatient setting,$13.98 ,102% CMS Medicare OPPS fee schedule,$15.71 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$36.55 ,85% of total billed charges for outpatient setting,$13.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$34.40 ,80% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$30.10 ,70% of total billed charges for outpatient setting,$30.10 ,70% of total billed charges for outpatient setting,$33.11 ,77% of total billed charges for outpatient setting,$13.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$15.26 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$13.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$13.85 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$14.96 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$13.71 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$38.70 ,90% of total billed charges for outpatient setting,$15.41 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$40.85 ,95% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$34.40 ,80% of total billed charges for outpatient setting,$15.26 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$36.55 ,85% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$36.55 ,85% of total billed charges for outpatient setting,$39.99 ,93% of total billed charges for outpatient setting,$32.25 ,75% of total billed charges for outpatient setting,$32.25 ,75% of total billed charges for outpatient setting,$32.25 ,75% of total billed charges for outpatient setting,$8.63 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$36.55 ,85% of total billed charges for outpatient setting,$15.26 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.63 ,$40.85 ,$15.05 Outpatient Medical Services,LAB,86850,Antibody Screen Tube,300,$154.55 ,$15.99 ,100% Amerigroup fee schedule for outpatient setting,$15.99 ,100% Amerigroup fee schedule for outpatient setting,$77.28 ,75% of total billed charges for outpatient setting,$77.28 ,75% of total billed charges for outpatient setting,$77.28 ,75% of total billed charges for outpatient setting,$9.97 ,102% CMS Medicare OPPS fee schedule,$9.97 ,102% CMS Medicare OPPS fee schedule,$9.97 ,102% CMS Medicare OPPS fee schedule,$9.97 ,102% CMS Medicare OPPS fee schedule,$9.97 ,102% CMS Medicare OPPS fee schedule,$9.97 ,102% CMS Medicare OPPS fee schedule,$123.64 ,80% of total billed charges for outpatient setting,$9.97 ,102% CMS Medicare OPPS fee schedule,$15.99 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$131.37 ,85% of total billed charges for outpatient setting,$9.87 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$123.64 ,80% of total billed charges for outpatient setting,$131.37 ,85% of total billed charges for outpatient setting,$108.19 ,70% of total billed charges for outpatient setting,$108.19 ,70% of total billed charges for outpatient setting,$119.00 ,77% of total billed charges for outpatient setting,$9.87 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$131.37 ,85% of total billed charges for outpatient setting,$131.37 ,85% of total billed charges for outpatient setting,$131.37 ,85% of total billed charges for outpatient setting,$131.37 ,85% of total billed charges for outpatient setting,$131.37 ,85% of total billed charges for outpatient setting,$15.53 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$9.87 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.87 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.87 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.87 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$131.37 ,85% of total billed charges for outpatient setting,$15.23 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$9.77 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$139.10 ,90% of total billed charges for outpatient setting,$15.69 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$146.82 ,95% of total billed charges for outpatient setting,$131.37 ,85% of total billed charges for outpatient setting,$123.64 ,80% of total billed charges for outpatient setting,$15.53 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$131.37 ,85% of total billed charges for outpatient setting,$131.37 ,85% of total billed charges for outpatient setting,$131.37 ,85% of total billed charges for outpatient setting,$143.73 ,93% of total billed charges for outpatient setting,$115.91 ,75% of total billed charges for outpatient setting,$115.91 ,75% of total billed charges for outpatient setting,$115.91 ,75% of total billed charges for outpatient setting,$31.03 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$131.37 ,85% of total billed charges for outpatient setting,$15.53 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$9.77 ,$146.82 ,$54.09 Outpatient Medical Services,LAB,86850,REF Antibody Screen,300,N/A,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$9.97 ,102% CMS Medicare OPPS fee schedule,$9.97 ,102% CMS Medicare OPPS fee schedule,$9.97 ,102% CMS Medicare OPPS fee schedule,$9.97 ,102% CMS Medicare OPPS fee schedule,$9.97 ,102% CMS Medicare OPPS fee schedule,$9.97 ,102% CMS Medicare OPPS fee schedule,N/A,Not seperately reimbursable,$9.97 ,102% CMS Medicare OPPS fee schedule,$15.99 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,N/A,Not seperately reimbursable,$9.87 ,101% CMS Medicare OPPS fee schedule for outpatient setting,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$9.87 ,101% CMS Medicare OPPS fee schedule for outpatient setting,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$15.53 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$9.87 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.87 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.87 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.87 ,101% CMS Medicare OPPS fee schedule for outpatient setting,N/A,Not seperately reimbursable,$15.23 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$9.77 ,100% CMS Medicare OPPS fee schedule for outpatient setting,N/A,Not seperately reimbursable,$15.69 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$15.53 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,N/A,Not seperately reimbursable,$15.53 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$9.77 ,$15.99 ,N/A Outpatient Medical Services,LAB,86850,Antibody Screen Gel 2,300,$154.55 ,$15.99 ,100% Amerigroup fee schedule for outpatient setting,$15.99 ,100% Amerigroup fee schedule for outpatient setting,$77.28 ,75% of total billed charges for outpatient setting,$77.28 ,75% of total billed charges for outpatient setting,$77.28 ,75% of total billed charges for outpatient setting,$9.97 ,102% CMS Medicare OPPS fee schedule,$9.97 ,102% CMS Medicare OPPS fee schedule,$9.97 ,102% CMS Medicare OPPS fee schedule,$9.97 ,102% CMS Medicare OPPS fee schedule,$9.97 ,102% CMS Medicare OPPS fee schedule,$9.97 ,102% CMS Medicare OPPS fee schedule,$123.64 ,80% of total billed charges for outpatient setting,$9.97 ,102% CMS Medicare OPPS fee schedule,$15.99 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$131.37 ,85% of total billed charges for outpatient setting,$9.87 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$123.64 ,80% of total billed charges for outpatient setting,$131.37 ,85% of total billed charges for outpatient setting,$108.19 ,70% of total billed charges for outpatient setting,$108.19 ,70% of total billed charges for outpatient setting,$119.00 ,77% of total billed charges for outpatient setting,$9.87 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$131.37 ,85% of total billed charges for outpatient setting,$131.37 ,85% of total billed charges for outpatient setting,$131.37 ,85% of total billed charges for outpatient setting,$131.37 ,85% of total billed charges for outpatient setting,$131.37 ,85% of total billed charges for outpatient setting,$15.53 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$9.87 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.87 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.87 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.87 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$131.37 ,85% of total billed charges for outpatient setting,$15.23 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$9.77 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$139.10 ,90% of total billed charges for outpatient setting,$15.69 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$146.82 ,95% of total billed charges for outpatient setting,$131.37 ,85% of total billed charges for outpatient setting,$123.64 ,80% of total billed charges for outpatient setting,$15.53 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$131.37 ,85% of total billed charges for outpatient setting,$131.37 ,85% of total billed charges for outpatient setting,$131.37 ,85% of total billed charges for outpatient setting,$143.73 ,93% of total billed charges for outpatient setting,$115.91 ,75% of total billed charges for outpatient setting,$115.91 ,75% of total billed charges for outpatient setting,$115.91 ,75% of total billed charges for outpatient setting,$31.03 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$131.37 ,85% of total billed charges for outpatient setting,$15.53 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$9.77 ,$146.82 ,$54.09 Outpatient Medical Services,LAB,86850,Antibody Screen Gel 2,300,$154.55 ,$15.99 ,100% Amerigroup fee schedule for outpatient setting,$15.99 ,100% Amerigroup fee schedule for outpatient setting,$77.28 ,75% of total billed charges for outpatient setting,$77.28 ,75% of total billed charges for outpatient setting,$77.28 ,75% of total billed charges for outpatient setting,$9.97 ,102% CMS Medicare OPPS fee schedule,$9.97 ,102% CMS Medicare OPPS fee schedule,$9.97 ,102% CMS Medicare OPPS fee schedule,$9.97 ,102% CMS Medicare OPPS fee schedule,$9.97 ,102% CMS Medicare OPPS fee schedule,$9.97 ,102% CMS Medicare OPPS fee schedule,$123.64 ,80% of total billed charges for outpatient setting,$9.97 ,102% CMS Medicare OPPS fee schedule,$15.99 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$131.37 ,85% of total billed charges for outpatient setting,$9.87 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$123.64 ,80% of total billed charges for outpatient setting,$131.37 ,85% of total billed charges for outpatient setting,$108.19 ,70% of total billed charges for outpatient setting,$108.19 ,70% of total billed charges for outpatient setting,$119.00 ,77% of total billed charges for outpatient setting,$9.87 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$131.37 ,85% of total billed charges for outpatient setting,$131.37 ,85% of total billed charges for outpatient setting,$131.37 ,85% of total billed charges for outpatient setting,$131.37 ,85% of total billed charges for outpatient setting,$131.37 ,85% of total billed charges for outpatient setting,$15.53 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$9.87 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.87 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.87 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.87 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$131.37 ,85% of total billed charges for outpatient setting,$15.23 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$9.77 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$139.10 ,90% of total billed charges for outpatient setting,$15.69 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$146.82 ,95% of total billed charges for outpatient setting,$131.37 ,85% of total billed charges for outpatient setting,$123.64 ,80% of total billed charges for outpatient setting,$15.53 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$131.37 ,85% of total billed charges for outpatient setting,$131.37 ,85% of total billed charges for outpatient setting,$131.37 ,85% of total billed charges for outpatient setting,$143.73 ,93% of total billed charges for outpatient setting,$115.91 ,75% of total billed charges for outpatient setting,$115.91 ,75% of total billed charges for outpatient setting,$115.91 ,75% of total billed charges for outpatient setting,$31.03 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$131.37 ,85% of total billed charges for outpatient setting,$15.53 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$9.77 ,$146.82 ,$54.09 Outpatient Medical Services,LAB,86900,ABO/Rh,300,$234.52 ,$3.94 ,100% Amerigroup fee schedule for outpatient setting,$3.94 ,100% Amerigroup fee schedule for outpatient setting,$117.26 ,75% of total billed charges for outpatient setting,$117.26 ,75% of total billed charges for outpatient setting,$117.26 ,75% of total billed charges for outpatient setting,$3.05 ,102% CMS Medicare OPPS fee schedule,$3.05 ,102% CMS Medicare OPPS fee schedule,$3.05 ,102% CMS Medicare OPPS fee schedule,$3.05 ,102% CMS Medicare OPPS fee schedule,$3.05 ,102% CMS Medicare OPPS fee schedule,$3.05 ,102% CMS Medicare OPPS fee schedule,$187.62 ,80% of total billed charges for outpatient setting,$3.05 ,102% CMS Medicare OPPS fee schedule,$3.94 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$199.34 ,85% of total billed charges for outpatient setting,$3.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$187.62 ,80% of total billed charges for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$164.16 ,70% of total billed charges for outpatient setting,$164.16 ,70% of total billed charges for outpatient setting,$180.58 ,77% of total billed charges for outpatient setting,$3.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$3.83 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$3.75 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$2.99 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$211.07 ,90% of total billed charges for outpatient setting,$3.86 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$222.79 ,95% of total billed charges for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$187.62 ,80% of total billed charges for outpatient setting,$3.83 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$199.34 ,85% of total billed charges for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$218.10 ,93% of total billed charges for outpatient setting,$175.89 ,75% of total billed charges for outpatient setting,$175.89 ,75% of total billed charges for outpatient setting,$175.89 ,75% of total billed charges for outpatient setting,$47.09 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$199.34 ,85% of total billed charges for outpatient setting,$3.83 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$2.99 ,$222.79 ,$82.08 Outpatient Medical Services,LAB,86900,ABO Only,300,$234.52 ,$3.94 ,100% Amerigroup fee schedule for outpatient setting,$3.94 ,100% Amerigroup fee schedule for outpatient setting,$117.26 ,75% of total billed charges for outpatient setting,$117.26 ,75% of total billed charges for outpatient setting,$117.26 ,75% of total billed charges for outpatient setting,$3.05 ,102% CMS Medicare OPPS fee schedule,$3.05 ,102% CMS Medicare OPPS fee schedule,$3.05 ,102% CMS Medicare OPPS fee schedule,$3.05 ,102% CMS Medicare OPPS fee schedule,$3.05 ,102% CMS Medicare OPPS fee schedule,$3.05 ,102% CMS Medicare OPPS fee schedule,$187.62 ,80% of total billed charges for outpatient setting,$3.05 ,102% CMS Medicare OPPS fee schedule,$3.94 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$199.34 ,85% of total billed charges for outpatient setting,$3.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$187.62 ,80% of total billed charges for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$164.16 ,70% of total billed charges for outpatient setting,$164.16 ,70% of total billed charges for outpatient setting,$180.58 ,77% of total billed charges for outpatient setting,$3.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$3.83 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$3.75 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$2.99 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$211.07 ,90% of total billed charges for outpatient setting,$3.86 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$222.79 ,95% of total billed charges for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$187.62 ,80% of total billed charges for outpatient setting,$3.83 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$199.34 ,85% of total billed charges for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$218.10 ,93% of total billed charges for outpatient setting,$175.89 ,75% of total billed charges for outpatient setting,$175.89 ,75% of total billed charges for outpatient setting,$175.89 ,75% of total billed charges for outpatient setting,$47.09 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$199.34 ,85% of total billed charges for outpatient setting,$3.83 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$2.99 ,$222.79 ,$82.08 Outpatient Medical Services,LAB,86900,ABO Only 2,300,$234.52 ,$3.94 ,100% Amerigroup fee schedule for outpatient setting,$3.94 ,100% Amerigroup fee schedule for outpatient setting,$117.26 ,75% of total billed charges for outpatient setting,$117.26 ,75% of total billed charges for outpatient setting,$117.26 ,75% of total billed charges for outpatient setting,$3.05 ,102% CMS Medicare OPPS fee schedule,$3.05 ,102% CMS Medicare OPPS fee schedule,$3.05 ,102% CMS Medicare OPPS fee schedule,$3.05 ,102% CMS Medicare OPPS fee schedule,$3.05 ,102% CMS Medicare OPPS fee schedule,$3.05 ,102% CMS Medicare OPPS fee schedule,$187.62 ,80% of total billed charges for outpatient setting,$3.05 ,102% CMS Medicare OPPS fee schedule,$3.94 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$199.34 ,85% of total billed charges for outpatient setting,$3.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$187.62 ,80% of total billed charges for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$164.16 ,70% of total billed charges for outpatient setting,$164.16 ,70% of total billed charges for outpatient setting,$180.58 ,77% of total billed charges for outpatient setting,$3.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$3.83 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$3.75 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$2.99 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$211.07 ,90% of total billed charges for outpatient setting,$3.86 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$222.79 ,95% of total billed charges for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$187.62 ,80% of total billed charges for outpatient setting,$3.83 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$199.34 ,85% of total billed charges for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$218.10 ,93% of total billed charges for outpatient setting,$175.89 ,75% of total billed charges for outpatient setting,$175.89 ,75% of total billed charges for outpatient setting,$175.89 ,75% of total billed charges for outpatient setting,$47.09 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$199.34 ,85% of total billed charges for outpatient setting,$3.83 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$2.99 ,$222.79 ,$82.08 Outpatient Medical Services,LAB,86900,ABO/Rh 2,300,$234.52 ,$3.94 ,100% Amerigroup fee schedule for outpatient setting,$3.94 ,100% Amerigroup fee schedule for outpatient setting,$117.26 ,75% of total billed charges for outpatient setting,$117.26 ,75% of total billed charges for outpatient setting,$117.26 ,75% of total billed charges for outpatient setting,$3.05 ,102% CMS Medicare OPPS fee schedule,$3.05 ,102% CMS Medicare OPPS fee schedule,$3.05 ,102% CMS Medicare OPPS fee schedule,$3.05 ,102% CMS Medicare OPPS fee schedule,$3.05 ,102% CMS Medicare OPPS fee schedule,$3.05 ,102% CMS Medicare OPPS fee schedule,$187.62 ,80% of total billed charges for outpatient setting,$3.05 ,102% CMS Medicare OPPS fee schedule,$3.94 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$199.34 ,85% of total billed charges for outpatient setting,$3.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$187.62 ,80% of total billed charges for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$164.16 ,70% of total billed charges for outpatient setting,$164.16 ,70% of total billed charges for outpatient setting,$180.58 ,77% of total billed charges for outpatient setting,$3.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$3.83 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$3.75 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$2.99 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$211.07 ,90% of total billed charges for outpatient setting,$3.86 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$222.79 ,95% of total billed charges for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$187.62 ,80% of total billed charges for outpatient setting,$3.83 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$199.34 ,85% of total billed charges for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$199.34 ,85% of total billed charges for outpatient setting,$218.10 ,93% of total billed charges for outpatient setting,$175.89 ,75% of total billed charges for outpatient setting,$175.89 ,75% of total billed charges for outpatient setting,$175.89 ,75% of total billed charges for outpatient setting,$47.09 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$199.34 ,85% of total billed charges for outpatient setting,$3.83 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$2.99 ,$222.79 ,$82.08 Outpatient Medical Services,LAB,86901,REF ABO/Rh,300,N/A,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$3.05 ,102% CMS Medicare OPPS fee schedule,$3.05 ,102% CMS Medicare OPPS fee schedule,$3.05 ,102% CMS Medicare OPPS fee schedule,$3.05 ,102% CMS Medicare OPPS fee schedule,$3.05 ,102% CMS Medicare OPPS fee schedule,$3.05 ,102% CMS Medicare OPPS fee schedule,N/A,Not seperately reimbursable,$3.05 ,102% CMS Medicare OPPS fee schedule,$15.24 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,N/A,Not seperately reimbursable,$3.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$3.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$14.80 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,N/A,Not seperately reimbursable,$14.51 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$2.99 ,100% CMS Medicare OPPS fee schedule for outpatient setting,N/A,Not seperately reimbursable,$14.95 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$14.80 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,N/A,Not seperately reimbursable,$14.80 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$2.99 ,$15.24 ,N/A Outpatient Medical Services,LAB,86901,Rh Only,300,$49.00 ,$15.24 ,100% Amerigroup fee schedule for outpatient setting,$15.24 ,100% Amerigroup fee schedule for outpatient setting,$24.50 ,75% of total billed charges for outpatient setting,$24.50 ,75% of total billed charges for outpatient setting,$24.50 ,75% of total billed charges for outpatient setting,$3.05 ,102% CMS Medicare OPPS fee schedule,$3.05 ,102% CMS Medicare OPPS fee schedule,$3.05 ,102% CMS Medicare OPPS fee schedule,$3.05 ,102% CMS Medicare OPPS fee schedule,$3.05 ,102% CMS Medicare OPPS fee schedule,$3.05 ,102% CMS Medicare OPPS fee schedule,$39.20 ,80% of total billed charges for outpatient setting,$3.05 ,102% CMS Medicare OPPS fee schedule,$15.24 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$41.65 ,85% of total billed charges for outpatient setting,$3.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$41.65 ,85% of total billed charges for outpatient setting,$34.30 ,70% of total billed charges for outpatient setting,$34.30 ,70% of total billed charges for outpatient setting,$37.73 ,77% of total billed charges for outpatient setting,$3.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$41.65 ,85% of total billed charges for outpatient setting,$41.65 ,85% of total billed charges for outpatient setting,$41.65 ,85% of total billed charges for outpatient setting,$41.65 ,85% of total billed charges for outpatient setting,$41.65 ,85% of total billed charges for outpatient setting,$14.80 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$3.02 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$41.65 ,85% of total billed charges for outpatient setting,$14.51 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$2.99 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$44.10 ,90% of total billed charges for outpatient setting,$14.95 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$46.55 ,95% of total billed charges for outpatient setting,$41.65 ,85% of total billed charges for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$14.80 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$41.65 ,85% of total billed charges for outpatient setting,$41.65 ,85% of total billed charges for outpatient setting,$41.65 ,85% of total billed charges for outpatient setting,$45.57 ,93% of total billed charges for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$9.84 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$41.65 ,85% of total billed charges for outpatient setting,$14.80 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$2.99 ,$46.55 ,$17.15 Outpatient Medical Services,LAB,86922,Incompatible - XM AHG Tube Interp,300,$272.00 ,$19.19 ,100% Amerigroup fee schedule for outpatient setting,$19.19 ,100% Amerigroup fee schedule for outpatient setting,$136.00 ,75% of total billed charges for outpatient setting,$136.00 ,75% of total billed charges for outpatient setting,$136.00 ,75% of total billed charges for outpatient setting,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$217.60 ,80% of total billed charges for outpatient setting,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$95.20 ,35% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$217.60 ,80% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$190.40 ,70% of total billed charges for outpatient setting,$190.40 ,70% of total billed charges for outpatient setting,$209.44 ,77% of total billed charges for outpatient setting,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$54.10 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$231.20 ,85% of total billed charges for outpatient setting,$53.04 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$84.32 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$244.80 ,90% of total billed charges for outpatient setting,$54.62 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$258.40 ,95% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$217.60 ,80% of total billed charges for outpatient setting,$54.10 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$252.96 ,93% of total billed charges for outpatient setting,$204.00 ,75% of total billed charges for outpatient setting,$204.00 ,75% of total billed charges for outpatient setting,$204.00 ,75% of total billed charges for outpatient setting,$54.62 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$54.10 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$19.19 ,$258.40 ,$95.20 Outpatient Medical Services,LAB,86922,Corrected - XM AHG Tube Interp,300,$272.00 ,$19.19 ,100% Amerigroup fee schedule for outpatient setting,$19.19 ,100% Amerigroup fee schedule for outpatient setting,$136.00 ,75% of total billed charges for outpatient setting,$136.00 ,75% of total billed charges for outpatient setting,$136.00 ,75% of total billed charges for outpatient setting,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$217.60 ,80% of total billed charges for outpatient setting,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$95.20 ,35% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$217.60 ,80% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$190.40 ,70% of total billed charges for outpatient setting,$190.40 ,70% of total billed charges for outpatient setting,$209.44 ,77% of total billed charges for outpatient setting,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$54.10 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$231.20 ,85% of total billed charges for outpatient setting,$53.04 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$84.32 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$244.80 ,90% of total billed charges for outpatient setting,$54.62 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$258.40 ,95% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$217.60 ,80% of total billed charges for outpatient setting,$54.10 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$252.96 ,93% of total billed charges for outpatient setting,$204.00 ,75% of total billed charges for outpatient setting,$204.00 ,75% of total billed charges for outpatient setting,$204.00 ,75% of total billed charges for outpatient setting,$54.62 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$54.10 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$19.19 ,$258.40 ,$95.20 Outpatient Medical Services,LAB,86922,Compatible - XM AHG Tube Interp,300,$272.00 ,$19.19 ,100% Amerigroup fee schedule for outpatient setting,$19.19 ,100% Amerigroup fee schedule for outpatient setting,$136.00 ,75% of total billed charges for outpatient setting,$136.00 ,75% of total billed charges for outpatient setting,$136.00 ,75% of total billed charges for outpatient setting,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$217.60 ,80% of total billed charges for outpatient setting,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$95.20 ,35% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$217.60 ,80% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$190.40 ,70% of total billed charges for outpatient setting,$190.40 ,70% of total billed charges for outpatient setting,$209.44 ,77% of total billed charges for outpatient setting,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$54.10 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$231.20 ,85% of total billed charges for outpatient setting,$53.04 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$84.32 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$244.80 ,90% of total billed charges for outpatient setting,$54.62 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$258.40 ,95% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$217.60 ,80% of total billed charges for outpatient setting,$54.10 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$252.96 ,93% of total billed charges for outpatient setting,$204.00 ,75% of total billed charges for outpatient setting,$204.00 ,75% of total billed charges for outpatient setting,$204.00 ,75% of total billed charges for outpatient setting,$54.62 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$54.10 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$19.19 ,$258.40 ,$95.20 Outpatient Medical Services,LAB,86922,Compatible - Serological Immediate Spin,300,$272.00 ,$19.19 ,100% Amerigroup fee schedule for outpatient setting,$19.19 ,100% Amerigroup fee schedule for outpatient setting,$136.00 ,75% of total billed charges for outpatient setting,$136.00 ,75% of total billed charges for outpatient setting,$136.00 ,75% of total billed charges for outpatient setting,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$217.60 ,80% of total billed charges for outpatient setting,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$95.20 ,35% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$217.60 ,80% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$190.40 ,70% of total billed charges for outpatient setting,$190.40 ,70% of total billed charges for outpatient setting,$209.44 ,77% of total billed charges for outpatient setting,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$54.10 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$231.20 ,85% of total billed charges for outpatient setting,$53.04 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$84.32 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$244.80 ,90% of total billed charges for outpatient setting,$54.62 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$258.40 ,95% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$217.60 ,80% of total billed charges for outpatient setting,$54.10 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$252.96 ,93% of total billed charges for outpatient setting,$204.00 ,75% of total billed charges for outpatient setting,$204.00 ,75% of total billed charges for outpatient setting,$204.00 ,75% of total billed charges for outpatient setting,$54.62 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$54.10 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$19.19 ,$258.40 ,$95.20 Outpatient Medical Services,LAB,86922,Corrected - Serological Immediate Spin,300,$272.00 ,$19.19 ,100% Amerigroup fee schedule for outpatient setting,$19.19 ,100% Amerigroup fee schedule for outpatient setting,$136.00 ,75% of total billed charges for outpatient setting,$136.00 ,75% of total billed charges for outpatient setting,$136.00 ,75% of total billed charges for outpatient setting,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$217.60 ,80% of total billed charges for outpatient setting,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$95.20 ,35% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$217.60 ,80% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$190.40 ,70% of total billed charges for outpatient setting,$190.40 ,70% of total billed charges for outpatient setting,$209.44 ,77% of total billed charges for outpatient setting,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$54.10 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$231.20 ,85% of total billed charges for outpatient setting,$53.04 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$84.32 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$244.80 ,90% of total billed charges for outpatient setting,$54.62 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$258.40 ,95% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$217.60 ,80% of total billed charges for outpatient setting,$54.10 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$252.96 ,93% of total billed charges for outpatient setting,$204.00 ,75% of total billed charges for outpatient setting,$204.00 ,75% of total billed charges for outpatient setting,$204.00 ,75% of total billed charges for outpatient setting,$54.62 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$54.10 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$19.19 ,$258.40 ,$95.20 Outpatient Medical Services,LAB,86922,Incompatible - Serological Immediate Spin,300,$272.00 ,$19.19 ,100% Amerigroup fee schedule for outpatient setting,$19.19 ,100% Amerigroup fee schedule for outpatient setting,$136.00 ,75% of total billed charges for outpatient setting,$136.00 ,75% of total billed charges for outpatient setting,$136.00 ,75% of total billed charges for outpatient setting,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$217.60 ,80% of total billed charges for outpatient setting,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$95.20 ,35% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$217.60 ,80% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$190.40 ,70% of total billed charges for outpatient setting,$190.40 ,70% of total billed charges for outpatient setting,$209.44 ,77% of total billed charges for outpatient setting,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$54.10 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$231.20 ,85% of total billed charges for outpatient setting,$53.04 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$84.32 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$244.80 ,90% of total billed charges for outpatient setting,$54.62 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$258.40 ,95% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$217.60 ,80% of total billed charges for outpatient setting,$54.10 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$252.96 ,93% of total billed charges for outpatient setting,$204.00 ,75% of total billed charges for outpatient setting,$204.00 ,75% of total billed charges for outpatient setting,$204.00 ,75% of total billed charges for outpatient setting,$54.62 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$54.10 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$19.19 ,$258.40 ,$95.20 Outpatient Medical Services,LAB,87040,Blood Culture,306,$77.94 ,$13.63 ,100% Amerigroup fee schedule for outpatient setting,$13.63 ,100% Amerigroup fee schedule for outpatient setting,$38.97 ,75% of total billed charges for outpatient setting,$38.97 ,75% of total billed charges for outpatient setting,$38.97 ,75% of total billed charges for outpatient setting,$10.53 ,102% CMS Medicare OPPS fee schedule,$10.53 ,102% CMS Medicare OPPS fee schedule,$10.53 ,102% CMS Medicare OPPS fee schedule,$10.53 ,102% CMS Medicare OPPS fee schedule,$10.53 ,102% CMS Medicare OPPS fee schedule,$10.53 ,102% CMS Medicare OPPS fee schedule,$62.35 ,80% of total billed charges for outpatient setting,$10.53 ,102% CMS Medicare OPPS fee schedule,$13.63 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$66.25 ,85% of total billed charges for outpatient setting,$10.42 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$62.35 ,80% of total billed charges for outpatient setting,$66.25 ,85% of total billed charges for outpatient setting,$54.56 ,70% of total billed charges for outpatient setting,$54.56 ,70% of total billed charges for outpatient setting,$60.01 ,77% of total billed charges for outpatient setting,$10.42 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$66.25 ,85% of total billed charges for outpatient setting,$66.25 ,85% of total billed charges for outpatient setting,$66.25 ,85% of total billed charges for outpatient setting,$66.25 ,85% of total billed charges for outpatient setting,$66.25 ,85% of total billed charges for outpatient setting,$13.24 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$10.42 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$10.42 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$10.42 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$10.42 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$66.25 ,85% of total billed charges for outpatient setting,$12.98 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$10.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$70.15 ,90% of total billed charges for outpatient setting,$13.37 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$74.04 ,95% of total billed charges for outpatient setting,$66.25 ,85% of total billed charges for outpatient setting,$62.35 ,80% of total billed charges for outpatient setting,$13.24 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$66.25 ,85% of total billed charges for outpatient setting,$66.25 ,85% of total billed charges for outpatient setting,$66.25 ,85% of total billed charges for outpatient setting,$72.48 ,93% of total billed charges for outpatient setting,$58.46 ,75% of total billed charges for outpatient setting,$58.46 ,75% of total billed charges for outpatient setting,$58.46 ,75% of total billed charges for outpatient setting,$15.65 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$66.25 ,85% of total billed charges for outpatient setting,$13.24 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$10.32 ,$74.04 ,$27.28 Outpatient Medical Services,LAB,87045,CULTURE STOOL,306,$214.00 ,$8.31 ,100% Amerigroup fee schedule for outpatient setting,$8.31 ,100% Amerigroup fee schedule for outpatient setting,$107.00 ,75% of total billed charges for outpatient setting,$107.00 ,75% of total billed charges for outpatient setting,$107.00 ,75% of total billed charges for outpatient setting,$9.63 ,102% CMS Medicare OPPS fee schedule,$9.63 ,102% CMS Medicare OPPS fee schedule,$9.63 ,102% CMS Medicare OPPS fee schedule,$9.63 ,102% CMS Medicare OPPS fee schedule,$9.63 ,102% CMS Medicare OPPS fee schedule,$9.63 ,102% CMS Medicare OPPS fee schedule,$171.20 ,80% of total billed charges for outpatient setting,$9.63 ,102% CMS Medicare OPPS fee schedule,$74.90 ,35% of total billed charges for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$9.53 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$171.20 ,80% of total billed charges for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$149.80 ,70% of total billed charges for outpatient setting,$149.80 ,70% of total billed charges for outpatient setting,$164.78 ,77% of total billed charges for outpatient setting,$9.53 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$42.56 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$9.53 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.53 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.53 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.53 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$41.73 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$9.44 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$192.60 ,90% of total billed charges for outpatient setting,$42.97 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$203.30 ,95% of total billed charges for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$171.20 ,80% of total billed charges for outpatient setting,$42.56 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$199.02 ,93% of total billed charges for outpatient setting,$160.50 ,75% of total billed charges for outpatient setting,$160.50 ,75% of total billed charges for outpatient setting,$160.50 ,75% of total billed charges for outpatient setting,$42.97 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$42.56 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$8.31 ,$203.30 ,$74.90 Outpatient Medical Services,LAB,87045,Stool Culture,306,$214.00 ,$8.31 ,100% Amerigroup fee schedule for outpatient setting,$8.31 ,100% Amerigroup fee schedule for outpatient setting,$107.00 ,75% of total billed charges for outpatient setting,$107.00 ,75% of total billed charges for outpatient setting,$107.00 ,75% of total billed charges for outpatient setting,$9.63 ,102% CMS Medicare OPPS fee schedule,$9.63 ,102% CMS Medicare OPPS fee schedule,$9.63 ,102% CMS Medicare OPPS fee schedule,$9.63 ,102% CMS Medicare OPPS fee schedule,$9.63 ,102% CMS Medicare OPPS fee schedule,$9.63 ,102% CMS Medicare OPPS fee schedule,$171.20 ,80% of total billed charges for outpatient setting,$9.63 ,102% CMS Medicare OPPS fee schedule,$74.90 ,35% of total billed charges for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$9.53 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$171.20 ,80% of total billed charges for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$149.80 ,70% of total billed charges for outpatient setting,$149.80 ,70% of total billed charges for outpatient setting,$164.78 ,77% of total billed charges for outpatient setting,$9.53 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$42.56 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$9.53 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.53 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.53 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.53 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$41.73 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$9.44 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$192.60 ,90% of total billed charges for outpatient setting,$42.97 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$203.30 ,95% of total billed charges for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$171.20 ,80% of total billed charges for outpatient setting,$42.56 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$199.02 ,93% of total billed charges for outpatient setting,$160.50 ,75% of total billed charges for outpatient setting,$160.50 ,75% of total billed charges for outpatient setting,$160.50 ,75% of total billed charges for outpatient setting,$42.97 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$42.56 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$8.31 ,$203.30 ,$74.90 Outpatient Medical Services,LAB,87045,Stool Culture LC,306,$214.00 ,$8.31 ,100% Amerigroup fee schedule for outpatient setting,$8.31 ,100% Amerigroup fee schedule for outpatient setting,$107.00 ,75% of total billed charges for outpatient setting,$107.00 ,75% of total billed charges for outpatient setting,$107.00 ,75% of total billed charges for outpatient setting,$9.63 ,102% CMS Medicare OPPS fee schedule,$9.63 ,102% CMS Medicare OPPS fee schedule,$9.63 ,102% CMS Medicare OPPS fee schedule,$9.63 ,102% CMS Medicare OPPS fee schedule,$9.63 ,102% CMS Medicare OPPS fee schedule,$9.63 ,102% CMS Medicare OPPS fee schedule,$171.20 ,80% of total billed charges for outpatient setting,$9.63 ,102% CMS Medicare OPPS fee schedule,$74.90 ,35% of total billed charges for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$9.53 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$171.20 ,80% of total billed charges for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$149.80 ,70% of total billed charges for outpatient setting,$149.80 ,70% of total billed charges for outpatient setting,$164.78 ,77% of total billed charges for outpatient setting,$9.53 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$42.56 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$9.53 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.53 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.53 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.53 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$41.73 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$9.44 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$192.60 ,90% of total billed charges for outpatient setting,$42.97 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$203.30 ,95% of total billed charges for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$171.20 ,80% of total billed charges for outpatient setting,$42.56 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$199.02 ,93% of total billed charges for outpatient setting,$160.50 ,75% of total billed charges for outpatient setting,$160.50 ,75% of total billed charges for outpatient setting,$160.50 ,75% of total billed charges for outpatient setting,$42.97 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$181.90 ,85% of total billed charges for outpatient setting,$42.56 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$8.31 ,$203.30 ,$74.90 Outpatient Medical Services,LAB,87071,Catheter Tip Culture,306,$233.00 ,$6.23 ,100% Amerigroup fee schedule for outpatient setting,$6.23 ,100% Amerigroup fee schedule for outpatient setting,$116.50 ,75% of total billed charges for outpatient setting,$116.50 ,75% of total billed charges for outpatient setting,$116.50 ,75% of total billed charges for outpatient setting,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$186.40 ,80% of total billed charges for outpatient setting,$10.09 ,102% CMS Medicare OPPS fee schedule,$6.23 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$198.05 ,85% of total billed charges for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$186.40 ,80% of total billed charges for outpatient setting,$198.05 ,85% of total billed charges for outpatient setting,$163.10 ,70% of total billed charges for outpatient setting,$163.10 ,70% of total billed charges for outpatient setting,$179.41 ,77% of total billed charges for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$198.05 ,85% of total billed charges for outpatient setting,$198.05 ,85% of total billed charges for outpatient setting,$198.05 ,85% of total billed charges for outpatient setting,$198.05 ,85% of total billed charges for outpatient setting,$198.05 ,85% of total billed charges for outpatient setting,$6.05 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$198.05 ,85% of total billed charges for outpatient setting,$5.93 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$9.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$209.70 ,90% of total billed charges for outpatient setting,$6.11 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$221.35 ,95% of total billed charges for outpatient setting,$198.05 ,85% of total billed charges for outpatient setting,$186.40 ,80% of total billed charges for outpatient setting,$6.05 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$198.05 ,85% of total billed charges for outpatient setting,$198.05 ,85% of total billed charges for outpatient setting,$198.05 ,85% of total billed charges for outpatient setting,$216.69 ,93% of total billed charges for outpatient setting,$174.75 ,75% of total billed charges for outpatient setting,$174.75 ,75% of total billed charges for outpatient setting,$174.75 ,75% of total billed charges for outpatient setting,$46.79 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$198.05 ,85% of total billed charges for outpatient setting,$6.05 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.93 ,$221.35 ,$81.55 Outpatient Medical Services,LAB,87071,Cerebrospinal Fluid Culture,306,$109.00 ,$6.23 ,100% Amerigroup fee schedule for outpatient setting,$6.23 ,100% Amerigroup fee schedule for outpatient setting,$54.50 ,75% of total billed charges for outpatient setting,$54.50 ,75% of total billed charges for outpatient setting,$54.50 ,75% of total billed charges for outpatient setting,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$87.20 ,80% of total billed charges for outpatient setting,$10.09 ,102% CMS Medicare OPPS fee schedule,$6.23 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$92.65 ,85% of total billed charges for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$87.20 ,80% of total billed charges for outpatient setting,$92.65 ,85% of total billed charges for outpatient setting,$76.30 ,70% of total billed charges for outpatient setting,$76.30 ,70% of total billed charges for outpatient setting,$83.93 ,77% of total billed charges for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$92.65 ,85% of total billed charges for outpatient setting,$92.65 ,85% of total billed charges for outpatient setting,$92.65 ,85% of total billed charges for outpatient setting,$92.65 ,85% of total billed charges for outpatient setting,$92.65 ,85% of total billed charges for outpatient setting,$6.05 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$92.65 ,85% of total billed charges for outpatient setting,$5.93 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$9.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$98.10 ,90% of total billed charges for outpatient setting,$6.11 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$103.55 ,95% of total billed charges for outpatient setting,$92.65 ,85% of total billed charges for outpatient setting,$87.20 ,80% of total billed charges for outpatient setting,$6.05 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$92.65 ,85% of total billed charges for outpatient setting,$92.65 ,85% of total billed charges for outpatient setting,$92.65 ,85% of total billed charges for outpatient setting,$101.37 ,93% of total billed charges for outpatient setting,$81.75 ,75% of total billed charges for outpatient setting,$81.75 ,75% of total billed charges for outpatient setting,$81.75 ,75% of total billed charges for outpatient setting,$21.89 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$92.65 ,85% of total billed charges for outpatient setting,$6.05 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.93 ,$103.55 ,$38.15 Outpatient Medical Services,LAB,87071,Body Fluid Culture,306,$223.68 ,$6.23 ,100% Amerigroup fee schedule for outpatient setting,$6.23 ,100% Amerigroup fee schedule for outpatient setting,$111.84 ,75% of total billed charges for outpatient setting,$111.84 ,75% of total billed charges for outpatient setting,$111.84 ,75% of total billed charges for outpatient setting,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$178.94 ,80% of total billed charges for outpatient setting,$10.09 ,102% CMS Medicare OPPS fee schedule,$6.23 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$190.13 ,85% of total billed charges for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$178.94 ,80% of total billed charges for outpatient setting,$190.13 ,85% of total billed charges for outpatient setting,$156.58 ,70% of total billed charges for outpatient setting,$156.58 ,70% of total billed charges for outpatient setting,$172.23 ,77% of total billed charges for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$190.13 ,85% of total billed charges for outpatient setting,$190.13 ,85% of total billed charges for outpatient setting,$190.13 ,85% of total billed charges for outpatient setting,$190.13 ,85% of total billed charges for outpatient setting,$190.13 ,85% of total billed charges for outpatient setting,$6.05 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$190.13 ,85% of total billed charges for outpatient setting,$5.93 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$9.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$201.31 ,90% of total billed charges for outpatient setting,$6.11 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$212.50 ,95% of total billed charges for outpatient setting,$190.13 ,85% of total billed charges for outpatient setting,$178.94 ,80% of total billed charges for outpatient setting,$6.05 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$190.13 ,85% of total billed charges for outpatient setting,$190.13 ,85% of total billed charges for outpatient setting,$190.13 ,85% of total billed charges for outpatient setting,$208.02 ,93% of total billed charges for outpatient setting,$167.76 ,75% of total billed charges for outpatient setting,$167.76 ,75% of total billed charges for outpatient setting,$167.76 ,75% of total billed charges for outpatient setting,$44.91 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$190.13 ,85% of total billed charges for outpatient setting,$6.05 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.93 ,$212.50 ,$78.29 Outpatient Medical Services,LAB,87071,Ear Culture,306,$140.00 ,$6.23 ,100% Amerigroup fee schedule for outpatient setting,$6.23 ,100% Amerigroup fee schedule for outpatient setting,$70.00 ,75% of total billed charges for outpatient setting,$70.00 ,75% of total billed charges for outpatient setting,$70.00 ,75% of total billed charges for outpatient setting,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$112.00 ,80% of total billed charges for outpatient setting,$10.09 ,102% CMS Medicare OPPS fee schedule,$6.23 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$119.00 ,85% of total billed charges for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$112.00 ,80% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$98.00 ,70% of total billed charges for outpatient setting,$98.00 ,70% of total billed charges for outpatient setting,$107.80 ,77% of total billed charges for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$6.05 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$5.93 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$9.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$126.00 ,90% of total billed charges for outpatient setting,$6.11 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$133.00 ,95% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$112.00 ,80% of total billed charges for outpatient setting,$6.05 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$119.00 ,85% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$119.00 ,85% of total billed charges for outpatient setting,$130.20 ,93% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$28.11 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$119.00 ,85% of total billed charges for outpatient setting,$6.05 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.93 ,$133.00 ,$49.00 Outpatient Medical Services,LAB,87071,Eye Culture,306,$453.00 ,$6.23 ,100% Amerigroup fee schedule for outpatient setting,$6.23 ,100% Amerigroup fee schedule for outpatient setting,$226.50 ,75% of total billed charges for outpatient setting,$226.50 ,75% of total billed charges for outpatient setting,$226.50 ,75% of total billed charges for outpatient setting,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$362.40 ,80% of total billed charges for outpatient setting,$10.09 ,102% CMS Medicare OPPS fee schedule,$6.23 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$385.05 ,85% of total billed charges for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$362.40 ,80% of total billed charges for outpatient setting,$385.05 ,85% of total billed charges for outpatient setting,$317.10 ,70% of total billed charges for outpatient setting,$317.10 ,70% of total billed charges for outpatient setting,$348.81 ,77% of total billed charges for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$385.05 ,85% of total billed charges for outpatient setting,$385.05 ,85% of total billed charges for outpatient setting,$385.05 ,85% of total billed charges for outpatient setting,$385.05 ,85% of total billed charges for outpatient setting,$385.05 ,85% of total billed charges for outpatient setting,$6.05 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$385.05 ,85% of total billed charges for outpatient setting,$5.93 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$9.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$407.70 ,90% of total billed charges for outpatient setting,$6.11 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$430.35 ,95% of total billed charges for outpatient setting,$385.05 ,85% of total billed charges for outpatient setting,$362.40 ,80% of total billed charges for outpatient setting,$6.05 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$385.05 ,85% of total billed charges for outpatient setting,$385.05 ,85% of total billed charges for outpatient setting,$385.05 ,85% of total billed charges for outpatient setting,$421.29 ,93% of total billed charges for outpatient setting,$339.75 ,75% of total billed charges for outpatient setting,$339.75 ,75% of total billed charges for outpatient setting,$339.75 ,75% of total billed charges for outpatient setting,$90.96 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$385.05 ,85% of total billed charges for outpatient setting,$6.05 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.93 ,$430.35 ,$158.55 Outpatient Medical Services,LAB,87071,Genital Culture,306,$109.00 ,$6.23 ,100% Amerigroup fee schedule for outpatient setting,$6.23 ,100% Amerigroup fee schedule for outpatient setting,$54.50 ,75% of total billed charges for outpatient setting,$54.50 ,75% of total billed charges for outpatient setting,$54.50 ,75% of total billed charges for outpatient setting,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$87.20 ,80% of total billed charges for outpatient setting,$10.09 ,102% CMS Medicare OPPS fee schedule,$6.23 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$92.65 ,85% of total billed charges for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$87.20 ,80% of total billed charges for outpatient setting,$92.65 ,85% of total billed charges for outpatient setting,$76.30 ,70% of total billed charges for outpatient setting,$76.30 ,70% of total billed charges for outpatient setting,$83.93 ,77% of total billed charges for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$92.65 ,85% of total billed charges for outpatient setting,$92.65 ,85% of total billed charges for outpatient setting,$92.65 ,85% of total billed charges for outpatient setting,$92.65 ,85% of total billed charges for outpatient setting,$92.65 ,85% of total billed charges for outpatient setting,$6.05 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$92.65 ,85% of total billed charges for outpatient setting,$5.93 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$9.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$98.10 ,90% of total billed charges for outpatient setting,$6.11 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$103.55 ,95% of total billed charges for outpatient setting,$92.65 ,85% of total billed charges for outpatient setting,$87.20 ,80% of total billed charges for outpatient setting,$6.05 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$92.65 ,85% of total billed charges for outpatient setting,$92.65 ,85% of total billed charges for outpatient setting,$92.65 ,85% of total billed charges for outpatient setting,$101.37 ,93% of total billed charges for outpatient setting,$81.75 ,75% of total billed charges for outpatient setting,$81.75 ,75% of total billed charges for outpatient setting,$81.75 ,75% of total billed charges for outpatient setting,$21.89 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$92.65 ,85% of total billed charges for outpatient setting,$6.05 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.93 ,$103.55 ,$38.15 Outpatient Medical Services,LAB,87071,Nasal Culture,306,$223.68 ,$6.23 ,100% Amerigroup fee schedule for outpatient setting,$6.23 ,100% Amerigroup fee schedule for outpatient setting,$111.84 ,75% of total billed charges for outpatient setting,$111.84 ,75% of total billed charges for outpatient setting,$111.84 ,75% of total billed charges for outpatient setting,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$178.94 ,80% of total billed charges for outpatient setting,$10.09 ,102% CMS Medicare OPPS fee schedule,$6.23 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$190.13 ,85% of total billed charges for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$178.94 ,80% of total billed charges for outpatient setting,$190.13 ,85% of total billed charges for outpatient setting,$156.58 ,70% of total billed charges for outpatient setting,$156.58 ,70% of total billed charges for outpatient setting,$172.23 ,77% of total billed charges for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$190.13 ,85% of total billed charges for outpatient setting,$190.13 ,85% of total billed charges for outpatient setting,$190.13 ,85% of total billed charges for outpatient setting,$190.13 ,85% of total billed charges for outpatient setting,$190.13 ,85% of total billed charges for outpatient setting,$6.05 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$190.13 ,85% of total billed charges for outpatient setting,$5.93 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$9.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$201.31 ,90% of total billed charges for outpatient setting,$6.11 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$212.50 ,95% of total billed charges for outpatient setting,$190.13 ,85% of total billed charges for outpatient setting,$178.94 ,80% of total billed charges for outpatient setting,$6.05 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$190.13 ,85% of total billed charges for outpatient setting,$190.13 ,85% of total billed charges for outpatient setting,$190.13 ,85% of total billed charges for outpatient setting,$208.02 ,93% of total billed charges for outpatient setting,$167.76 ,75% of total billed charges for outpatient setting,$167.76 ,75% of total billed charges for outpatient setting,$167.76 ,75% of total billed charges for outpatient setting,$44.91 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$190.13 ,85% of total billed charges for outpatient setting,$6.05 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.93 ,$212.50 ,$78.29 Outpatient Medical Services,LAB,87071,Throat Culture,306,$65.07 ,$6.23 ,100% Amerigroup fee schedule for outpatient setting,$6.23 ,100% Amerigroup fee schedule for outpatient setting,$32.54 ,75% of total billed charges for outpatient setting,$32.54 ,75% of total billed charges for outpatient setting,$32.54 ,75% of total billed charges for outpatient setting,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$52.06 ,80% of total billed charges for outpatient setting,$10.09 ,102% CMS Medicare OPPS fee schedule,$6.23 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$55.31 ,85% of total billed charges for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$52.06 ,80% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$45.55 ,70% of total billed charges for outpatient setting,$45.55 ,70% of total billed charges for outpatient setting,$50.10 ,77% of total billed charges for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$6.05 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$5.93 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$9.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$58.56 ,90% of total billed charges for outpatient setting,$6.11 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$61.82 ,95% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$52.06 ,80% of total billed charges for outpatient setting,$6.05 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$60.52 ,93% of total billed charges for outpatient setting,$48.80 ,75% of total billed charges for outpatient setting,$48.80 ,75% of total billed charges for outpatient setting,$48.80 ,75% of total billed charges for outpatient setting,$13.07 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$55.31 ,85% of total billed charges for outpatient setting,$6.05 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.93 ,$61.82 ,$22.77 Outpatient Medical Services,LAB,87071,Tissue Culture,306,$223.68 ,$6.23 ,100% Amerigroup fee schedule for outpatient setting,$6.23 ,100% Amerigroup fee schedule for outpatient setting,$111.84 ,75% of total billed charges for outpatient setting,$111.84 ,75% of total billed charges for outpatient setting,$111.84 ,75% of total billed charges for outpatient setting,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$178.94 ,80% of total billed charges for outpatient setting,$10.09 ,102% CMS Medicare OPPS fee schedule,$6.23 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$190.13 ,85% of total billed charges for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$178.94 ,80% of total billed charges for outpatient setting,$190.13 ,85% of total billed charges for outpatient setting,$156.58 ,70% of total billed charges for outpatient setting,$156.58 ,70% of total billed charges for outpatient setting,$172.23 ,77% of total billed charges for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$190.13 ,85% of total billed charges for outpatient setting,$190.13 ,85% of total billed charges for outpatient setting,$190.13 ,85% of total billed charges for outpatient setting,$190.13 ,85% of total billed charges for outpatient setting,$190.13 ,85% of total billed charges for outpatient setting,$6.05 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$190.13 ,85% of total billed charges for outpatient setting,$5.93 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$9.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$201.31 ,90% of total billed charges for outpatient setting,$6.11 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$212.50 ,95% of total billed charges for outpatient setting,$190.13 ,85% of total billed charges for outpatient setting,$178.94 ,80% of total billed charges for outpatient setting,$6.05 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$190.13 ,85% of total billed charges for outpatient setting,$190.13 ,85% of total billed charges for outpatient setting,$190.13 ,85% of total billed charges for outpatient setting,$208.02 ,93% of total billed charges for outpatient setting,$167.76 ,75% of total billed charges for outpatient setting,$167.76 ,75% of total billed charges for outpatient setting,$167.76 ,75% of total billed charges for outpatient setting,$44.91 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$190.13 ,85% of total billed charges for outpatient setting,$6.05 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.93 ,$212.50 ,$78.29 Outpatient Medical Services,LAB,87071,Wound Culture,306,$153.15 ,$6.23 ,100% Amerigroup fee schedule for outpatient setting,$6.23 ,100% Amerigroup fee schedule for outpatient setting,$76.58 ,75% of total billed charges for outpatient setting,$76.58 ,75% of total billed charges for outpatient setting,$76.58 ,75% of total billed charges for outpatient setting,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$122.52 ,80% of total billed charges for outpatient setting,$10.09 ,102% CMS Medicare OPPS fee schedule,$6.23 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$130.18 ,85% of total billed charges for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$122.52 ,80% of total billed charges for outpatient setting,$130.18 ,85% of total billed charges for outpatient setting,$107.21 ,70% of total billed charges for outpatient setting,$107.21 ,70% of total billed charges for outpatient setting,$117.93 ,77% of total billed charges for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$130.18 ,85% of total billed charges for outpatient setting,$130.18 ,85% of total billed charges for outpatient setting,$130.18 ,85% of total billed charges for outpatient setting,$130.18 ,85% of total billed charges for outpatient setting,$130.18 ,85% of total billed charges for outpatient setting,$6.05 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$130.18 ,85% of total billed charges for outpatient setting,$5.93 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$9.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$137.84 ,90% of total billed charges for outpatient setting,$6.11 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$145.49 ,95% of total billed charges for outpatient setting,$130.18 ,85% of total billed charges for outpatient setting,$122.52 ,80% of total billed charges for outpatient setting,$6.05 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$130.18 ,85% of total billed charges for outpatient setting,$130.18 ,85% of total billed charges for outpatient setting,$130.18 ,85% of total billed charges for outpatient setting,$142.43 ,93% of total billed charges for outpatient setting,$114.86 ,75% of total billed charges for outpatient setting,$114.86 ,75% of total billed charges for outpatient setting,$114.86 ,75% of total billed charges for outpatient setting,$30.75 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$130.18 ,85% of total billed charges for outpatient setting,$6.05 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.93 ,$145.49 ,$53.60 Outpatient Medical Services,LAB,87071,Sputum Culture,306,$314.27 ,$6.23 ,100% Amerigroup fee schedule for outpatient setting,$6.23 ,100% Amerigroup fee schedule for outpatient setting,$157.14 ,75% of total billed charges for outpatient setting,$157.14 ,75% of total billed charges for outpatient setting,$157.14 ,75% of total billed charges for outpatient setting,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$251.42 ,80% of total billed charges for outpatient setting,$10.09 ,102% CMS Medicare OPPS fee schedule,$6.23 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$267.13 ,85% of total billed charges for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$251.42 ,80% of total billed charges for outpatient setting,$267.13 ,85% of total billed charges for outpatient setting,$219.99 ,70% of total billed charges for outpatient setting,$219.99 ,70% of total billed charges for outpatient setting,$241.99 ,77% of total billed charges for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$267.13 ,85% of total billed charges for outpatient setting,$267.13 ,85% of total billed charges for outpatient setting,$267.13 ,85% of total billed charges for outpatient setting,$267.13 ,85% of total billed charges for outpatient setting,$267.13 ,85% of total billed charges for outpatient setting,$6.05 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$267.13 ,85% of total billed charges for outpatient setting,$5.93 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$9.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$282.84 ,90% of total billed charges for outpatient setting,$6.11 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$298.56 ,95% of total billed charges for outpatient setting,$267.13 ,85% of total billed charges for outpatient setting,$251.42 ,80% of total billed charges for outpatient setting,$6.05 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$267.13 ,85% of total billed charges for outpatient setting,$267.13 ,85% of total billed charges for outpatient setting,$267.13 ,85% of total billed charges for outpatient setting,$292.27 ,93% of total billed charges for outpatient setting,$235.70 ,75% of total billed charges for outpatient setting,$235.70 ,75% of total billed charges for outpatient setting,$235.70 ,75% of total billed charges for outpatient setting,$63.11 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$267.13 ,85% of total billed charges for outpatient setting,$6.05 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.93 ,$298.56 ,$109.99 Outpatient Medical Services,LAB,87071,CSF Cell Count w/Diff,306,$109.00 ,$6.23 ,100% Amerigroup fee schedule for outpatient setting,$6.23 ,100% Amerigroup fee schedule for outpatient setting,$54.50 ,75% of total billed charges for outpatient setting,$54.50 ,75% of total billed charges for outpatient setting,$54.50 ,75% of total billed charges for outpatient setting,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$10.09 ,102% CMS Medicare OPPS fee schedule,$87.20 ,80% of total billed charges for outpatient setting,$10.09 ,102% CMS Medicare OPPS fee schedule,$6.23 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$92.65 ,85% of total billed charges for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$87.20 ,80% of total billed charges for outpatient setting,$92.65 ,85% of total billed charges for outpatient setting,$76.30 ,70% of total billed charges for outpatient setting,$76.30 ,70% of total billed charges for outpatient setting,$83.93 ,77% of total billed charges for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$92.65 ,85% of total billed charges for outpatient setting,$92.65 ,85% of total billed charges for outpatient setting,$92.65 ,85% of total billed charges for outpatient setting,$92.65 ,85% of total billed charges for outpatient setting,$92.65 ,85% of total billed charges for outpatient setting,$6.05 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.99 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$92.65 ,85% of total billed charges for outpatient setting,$5.93 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$9.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$98.10 ,90% of total billed charges for outpatient setting,$6.11 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$103.55 ,95% of total billed charges for outpatient setting,$92.65 ,85% of total billed charges for outpatient setting,$87.20 ,80% of total billed charges for outpatient setting,$6.05 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$92.65 ,85% of total billed charges for outpatient setting,$92.65 ,85% of total billed charges for outpatient setting,$92.65 ,85% of total billed charges for outpatient setting,$101.37 ,93% of total billed charges for outpatient setting,$81.75 ,75% of total billed charges for outpatient setting,$81.75 ,75% of total billed charges for outpatient setting,$81.75 ,75% of total billed charges for outpatient setting,$21.89 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$92.65 ,85% of total billed charges for outpatient setting,$6.05 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.93 ,$103.55 ,$38.15 Outpatient Medical Services,LAB,87088,Urine Culture,306,$65.07 ,$10.69 ,100% Amerigroup fee schedule for outpatient setting,$10.69 ,100% Amerigroup fee schedule for outpatient setting,$32.54 ,75% of total billed charges for outpatient setting,$32.54 ,75% of total billed charges for outpatient setting,$32.54 ,75% of total billed charges for outpatient setting,$8.25 ,102% CMS Medicare OPPS fee schedule,$8.25 ,102% CMS Medicare OPPS fee schedule,$8.25 ,102% CMS Medicare OPPS fee schedule,$8.25 ,102% CMS Medicare OPPS fee schedule,$8.25 ,102% CMS Medicare OPPS fee schedule,$8.25 ,102% CMS Medicare OPPS fee schedule,$52.06 ,80% of total billed charges for outpatient setting,$8.25 ,102% CMS Medicare OPPS fee schedule,$10.69 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$55.31 ,85% of total billed charges for outpatient setting,$8.17 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$52.06 ,80% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$45.55 ,70% of total billed charges for outpatient setting,$45.55 ,70% of total billed charges for outpatient setting,$50.10 ,77% of total billed charges for outpatient setting,$8.17 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$10.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.17 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.17 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.17 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.17 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$10.18 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$8.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$58.56 ,90% of total billed charges for outpatient setting,$10.49 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$61.82 ,95% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$52.06 ,80% of total billed charges for outpatient setting,$10.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$60.52 ,93% of total billed charges for outpatient setting,$48.80 ,75% of total billed charges for outpatient setting,$48.80 ,75% of total billed charges for outpatient setting,$48.80 ,75% of total billed charges for outpatient setting,$13.07 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$55.31 ,85% of total billed charges for outpatient setting,$10.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.09 ,$61.82 ,$22.77 Outpatient Medical Services,LAB,87088,"Urine Culture, Routine LC",306,$65.07 ,$10.69 ,100% Amerigroup fee schedule for outpatient setting,$10.69 ,100% Amerigroup fee schedule for outpatient setting,$32.54 ,75% of total billed charges for outpatient setting,$32.54 ,75% of total billed charges for outpatient setting,$32.54 ,75% of total billed charges for outpatient setting,$8.25 ,102% CMS Medicare OPPS fee schedule,$8.25 ,102% CMS Medicare OPPS fee schedule,$8.25 ,102% CMS Medicare OPPS fee schedule,$8.25 ,102% CMS Medicare OPPS fee schedule,$8.25 ,102% CMS Medicare OPPS fee schedule,$8.25 ,102% CMS Medicare OPPS fee schedule,$52.06 ,80% of total billed charges for outpatient setting,$8.25 ,102% CMS Medicare OPPS fee schedule,$10.69 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$55.31 ,85% of total billed charges for outpatient setting,$8.17 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$52.06 ,80% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$45.55 ,70% of total billed charges for outpatient setting,$45.55 ,70% of total billed charges for outpatient setting,$50.10 ,77% of total billed charges for outpatient setting,$8.17 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$10.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.17 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.17 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.17 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$8.17 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$10.18 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$8.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$58.56 ,90% of total billed charges for outpatient setting,$10.49 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$61.82 ,95% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$52.06 ,80% of total billed charges for outpatient setting,$10.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$55.31 ,85% of total billed charges for outpatient setting,$60.52 ,93% of total billed charges for outpatient setting,$48.80 ,75% of total billed charges for outpatient setting,$48.80 ,75% of total billed charges for outpatient setting,$48.80 ,75% of total billed charges for outpatient setting,$13.07 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$55.31 ,85% of total billed charges for outpatient setting,$10.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$8.09 ,$61.82 ,$22.77 Outpatient Medical Services,LAB,87205,Fecal WBC,306,$37.18 ,$3.10 ,100% Amerigroup fee schedule for outpatient setting,$3.10 ,100% Amerigroup fee schedule for outpatient setting,$18.59 ,75% of total billed charges for outpatient setting,$18.59 ,75% of total billed charges for outpatient setting,$18.59 ,75% of total billed charges for outpatient setting,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.36 ,102% CMS Medicare OPPS fee schedule,$29.74 ,80% of total billed charges for outpatient setting,$4.36 ,102% CMS Medicare OPPS fee schedule,$3.10 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$31.60 ,85% of total billed charges for outpatient setting,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$29.74 ,80% of total billed charges for outpatient setting,$31.60 ,85% of total billed charges for outpatient setting,$26.03 ,70% of total billed charges for outpatient setting,$26.03 ,70% of total billed charges for outpatient setting,$28.63 ,77% of total billed charges for outpatient setting,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$31.60 ,85% of total billed charges for outpatient setting,$31.60 ,85% of total billed charges for outpatient setting,$31.60 ,85% of total billed charges for outpatient setting,$31.60 ,85% of total billed charges for outpatient setting,$31.60 ,85% of total billed charges for outpatient setting,$3.01 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$31.60 ,85% of total billed charges for outpatient setting,$2.95 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$4.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$33.46 ,90% of total billed charges for outpatient setting,$3.04 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$35.32 ,95% of total billed charges for outpatient setting,$31.60 ,85% of total billed charges for outpatient setting,$29.74 ,80% of total billed charges for outpatient setting,$3.01 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$31.60 ,85% of total billed charges for outpatient setting,$31.60 ,85% of total billed charges for outpatient setting,$31.60 ,85% of total billed charges for outpatient setting,$34.58 ,93% of total billed charges for outpatient setting,$27.89 ,75% of total billed charges for outpatient setting,$27.89 ,75% of total billed charges for outpatient setting,$27.89 ,75% of total billed charges for outpatient setting,$7.47 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$31.60 ,85% of total billed charges for outpatient setting,$3.01 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$2.95 ,$35.32 ,$13.01 Outpatient Medical Services,LAB,87205,Fecal WBC,306,$37.18 ,$3.10 ,100% Amerigroup fee schedule for outpatient setting,$3.10 ,100% Amerigroup fee schedule for outpatient setting,$18.59 ,75% of total billed charges for outpatient setting,$18.59 ,75% of total billed charges for outpatient setting,$18.59 ,75% of total billed charges for outpatient setting,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.36 ,102% CMS Medicare OPPS fee schedule,$29.74 ,80% of total billed charges for outpatient setting,$4.36 ,102% CMS Medicare OPPS fee schedule,$3.10 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$31.60 ,85% of total billed charges for outpatient setting,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$29.74 ,80% of total billed charges for outpatient setting,$31.60 ,85% of total billed charges for outpatient setting,$26.03 ,70% of total billed charges for outpatient setting,$26.03 ,70% of total billed charges for outpatient setting,$28.63 ,77% of total billed charges for outpatient setting,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$31.60 ,85% of total billed charges for outpatient setting,$31.60 ,85% of total billed charges for outpatient setting,$31.60 ,85% of total billed charges for outpatient setting,$31.60 ,85% of total billed charges for outpatient setting,$31.60 ,85% of total billed charges for outpatient setting,$3.01 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$31.60 ,85% of total billed charges for outpatient setting,$2.95 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$4.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$33.46 ,90% of total billed charges for outpatient setting,$3.04 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$35.32 ,95% of total billed charges for outpatient setting,$31.60 ,85% of total billed charges for outpatient setting,$29.74 ,80% of total billed charges for outpatient setting,$3.01 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$31.60 ,85% of total billed charges for outpatient setting,$31.60 ,85% of total billed charges for outpatient setting,$31.60 ,85% of total billed charges for outpatient setting,$34.58 ,93% of total billed charges for outpatient setting,$27.89 ,75% of total billed charges for outpatient setting,$27.89 ,75% of total billed charges for outpatient setting,$27.89 ,75% of total billed charges for outpatient setting,$7.47 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$31.60 ,85% of total billed charges for outpatient setting,$3.01 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$2.95 ,$35.32 ,$13.01 Outpatient Medical Services,LAB,87205,Gram Stain Report,306,$37.18 ,$3.10 ,100% Amerigroup fee schedule for outpatient setting,$3.10 ,100% Amerigroup fee schedule for outpatient setting,$18.59 ,75% of total billed charges for outpatient setting,$18.59 ,75% of total billed charges for outpatient setting,$18.59 ,75% of total billed charges for outpatient setting,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.36 ,102% CMS Medicare OPPS fee schedule,$4.36 ,102% CMS Medicare OPPS fee schedule,$29.74 ,80% of total billed charges for outpatient setting,$4.36 ,102% CMS Medicare OPPS fee schedule,$3.10 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$31.60 ,85% of total billed charges for outpatient setting,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$29.74 ,80% of total billed charges for outpatient setting,$31.60 ,85% of total billed charges for outpatient setting,$26.03 ,70% of total billed charges for outpatient setting,$26.03 ,70% of total billed charges for outpatient setting,$28.63 ,77% of total billed charges for outpatient setting,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$31.60 ,85% of total billed charges for outpatient setting,$31.60 ,85% of total billed charges for outpatient setting,$31.60 ,85% of total billed charges for outpatient setting,$31.60 ,85% of total billed charges for outpatient setting,$31.60 ,85% of total billed charges for outpatient setting,$3.01 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$4.31 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$31.60 ,85% of total billed charges for outpatient setting,$2.95 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$4.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$33.46 ,90% of total billed charges for outpatient setting,$3.04 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$35.32 ,95% of total billed charges for outpatient setting,$31.60 ,85% of total billed charges for outpatient setting,$29.74 ,80% of total billed charges for outpatient setting,$3.01 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$31.60 ,85% of total billed charges for outpatient setting,$31.60 ,85% of total billed charges for outpatient setting,$31.60 ,85% of total billed charges for outpatient setting,$34.58 ,93% of total billed charges for outpatient setting,$27.89 ,75% of total billed charges for outpatient setting,$27.89 ,75% of total billed charges for outpatient setting,$27.89 ,75% of total billed charges for outpatient setting,$7.47 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$31.60 ,85% of total billed charges for outpatient setting,$3.01 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$2.95 ,$35.32 ,$13.01 Outpatient Medical Services,LAB,87210,Fern Test,306,$12.00 ,$5.63 ,100% Amerigroup fee schedule for outpatient setting,$5.63 ,100% Amerigroup fee schedule for outpatient setting,$6.00 ,75% of total billed charges for outpatient setting,$6.00 ,75% of total billed charges for outpatient setting,$6.00 ,75% of total billed charges for outpatient setting,$5.94 ,102% CMS Medicare OPPS fee schedule,$5.94 ,102% CMS Medicare OPPS fee schedule,$5.94 ,102% CMS Medicare OPPS fee schedule,$5.94 ,102% CMS Medicare OPPS fee schedule,$5.94 ,102% CMS Medicare OPPS fee schedule,$5.94 ,102% CMS Medicare OPPS fee schedule,$9.60 ,80% of total billed charges for outpatient setting,$5.94 ,102% CMS Medicare OPPS fee schedule,$5.63 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$10.20 ,85% of total billed charges for outpatient setting,$5.88 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.60 ,80% of total billed charges for outpatient setting,$10.20 ,85% of total billed charges for outpatient setting,$8.40 ,70% of total billed charges for outpatient setting,$8.40 ,70% of total billed charges for outpatient setting,$9.24 ,77% of total billed charges for outpatient setting,$5.88 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$10.20 ,85% of total billed charges for outpatient setting,$10.20 ,85% of total billed charges for outpatient setting,$10.20 ,85% of total billed charges for outpatient setting,$10.20 ,85% of total billed charges for outpatient setting,$10.20 ,85% of total billed charges for outpatient setting,$5.47 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.88 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.88 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.88 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.88 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$10.20 ,85% of total billed charges for outpatient setting,$5.36 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$5.82 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.80 ,90% of total billed charges for outpatient setting,$5.52 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$11.40 ,95% of total billed charges for outpatient setting,$10.20 ,85% of total billed charges for outpatient setting,$9.60 ,80% of total billed charges for outpatient setting,$5.47 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$10.20 ,85% of total billed charges for outpatient setting,$10.20 ,85% of total billed charges for outpatient setting,$10.20 ,85% of total billed charges for outpatient setting,$11.16 ,93% of total billed charges for outpatient setting,$9.00 ,75% of total billed charges for outpatient setting,$9.00 ,75% of total billed charges for outpatient setting,$9.00 ,75% of total billed charges for outpatient setting,$2.41 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$10.20 ,85% of total billed charges for outpatient setting,$5.47 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$2.41 ,$11.40 ,$4.20 Outpatient Medical Services,LAB,87210,Wet Mount,306,$12.00 ,$5.63 ,100% Amerigroup fee schedule for outpatient setting,$5.63 ,100% Amerigroup fee schedule for outpatient setting,$6.00 ,75% of total billed charges for outpatient setting,$6.00 ,75% of total billed charges for outpatient setting,$6.00 ,75% of total billed charges for outpatient setting,$5.94 ,102% CMS Medicare OPPS fee schedule,$5.94 ,102% CMS Medicare OPPS fee schedule,$5.94 ,102% CMS Medicare OPPS fee schedule,$5.94 ,102% CMS Medicare OPPS fee schedule,$5.94 ,102% CMS Medicare OPPS fee schedule,$5.94 ,102% CMS Medicare OPPS fee schedule,$9.60 ,80% of total billed charges for outpatient setting,$5.94 ,102% CMS Medicare OPPS fee schedule,$5.63 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$10.20 ,85% of total billed charges for outpatient setting,$5.88 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$9.60 ,80% of total billed charges for outpatient setting,$10.20 ,85% of total billed charges for outpatient setting,$8.40 ,70% of total billed charges for outpatient setting,$8.40 ,70% of total billed charges for outpatient setting,$9.24 ,77% of total billed charges for outpatient setting,$5.88 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$10.20 ,85% of total billed charges for outpatient setting,$10.20 ,85% of total billed charges for outpatient setting,$10.20 ,85% of total billed charges for outpatient setting,$10.20 ,85% of total billed charges for outpatient setting,$10.20 ,85% of total billed charges for outpatient setting,$5.47 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.88 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.88 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.88 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.88 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$10.20 ,85% of total billed charges for outpatient setting,$5.36 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$5.82 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.80 ,90% of total billed charges for outpatient setting,$5.52 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$11.40 ,95% of total billed charges for outpatient setting,$10.20 ,85% of total billed charges for outpatient setting,$9.60 ,80% of total billed charges for outpatient setting,$5.47 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$10.20 ,85% of total billed charges for outpatient setting,$10.20 ,85% of total billed charges for outpatient setting,$10.20 ,85% of total billed charges for outpatient setting,$11.16 ,93% of total billed charges for outpatient setting,$9.00 ,75% of total billed charges for outpatient setting,$9.00 ,75% of total billed charges for outpatient setting,$9.00 ,75% of total billed charges for outpatient setting,$2.41 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$10.20 ,85% of total billed charges for outpatient setting,$5.47 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$2.41 ,$11.40 ,$4.20 Outpatient Medical Services,LAB,87329,Giardia/Crypto Ag,300,$120.83 ,$15.83 ,100% Amerigroup fee schedule for outpatient setting,$15.83 ,100% Amerigroup fee schedule for outpatient setting,$60.42 ,75% of total billed charges for outpatient setting,$60.42 ,75% of total billed charges for outpatient setting,$60.42 ,75% of total billed charges for outpatient setting,$12.22 ,102% CMS Medicare OPPS fee schedule,$12.22 ,102% CMS Medicare OPPS fee schedule,$12.22 ,102% CMS Medicare OPPS fee schedule,$12.22 ,102% CMS Medicare OPPS fee schedule,$12.22 ,102% CMS Medicare OPPS fee schedule,$12.22 ,102% CMS Medicare OPPS fee schedule,$96.66 ,80% of total billed charges for outpatient setting,$12.22 ,102% CMS Medicare OPPS fee schedule,$15.83 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$102.71 ,85% of total billed charges for outpatient setting,$12.10 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$96.66 ,80% of total billed charges for outpatient setting,$102.71 ,85% of total billed charges for outpatient setting,$84.58 ,70% of total billed charges for outpatient setting,$84.58 ,70% of total billed charges for outpatient setting,$93.04 ,77% of total billed charges for outpatient setting,$12.10 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$102.71 ,85% of total billed charges for outpatient setting,$102.71 ,85% of total billed charges for outpatient setting,$102.71 ,85% of total billed charges for outpatient setting,$102.71 ,85% of total billed charges for outpatient setting,$102.71 ,85% of total billed charges for outpatient setting,$15.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$12.10 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.10 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.10 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.10 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$102.71 ,85% of total billed charges for outpatient setting,$15.08 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$11.98 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$108.75 ,90% of total billed charges for outpatient setting,$15.53 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$114.79 ,95% of total billed charges for outpatient setting,$102.71 ,85% of total billed charges for outpatient setting,$96.66 ,80% of total billed charges for outpatient setting,$15.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$102.71 ,85% of total billed charges for outpatient setting,$102.71 ,85% of total billed charges for outpatient setting,$102.71 ,85% of total billed charges for outpatient setting,$112.37 ,93% of total billed charges for outpatient setting,$90.62 ,75% of total billed charges for outpatient setting,$90.62 ,75% of total billed charges for outpatient setting,$90.62 ,75% of total billed charges for outpatient setting,$24.26 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$102.71 ,85% of total billed charges for outpatient setting,$15.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$11.98 ,$114.79 ,$42.29 Outpatient Medical Services,LAB,87329,Giardia/Crypto Ag,300,$120.83 ,$15.83 ,100% Amerigroup fee schedule for outpatient setting,$15.83 ,100% Amerigroup fee schedule for outpatient setting,$60.42 ,75% of total billed charges for outpatient setting,$60.42 ,75% of total billed charges for outpatient setting,$60.42 ,75% of total billed charges for outpatient setting,$12.22 ,102% CMS Medicare OPPS fee schedule,$12.22 ,102% CMS Medicare OPPS fee schedule,$12.22 ,102% CMS Medicare OPPS fee schedule,$12.22 ,102% CMS Medicare OPPS fee schedule,$12.22 ,102% CMS Medicare OPPS fee schedule,$12.22 ,102% CMS Medicare OPPS fee schedule,$96.66 ,80% of total billed charges for outpatient setting,$12.22 ,102% CMS Medicare OPPS fee schedule,$15.83 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$102.71 ,85% of total billed charges for outpatient setting,$12.10 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$96.66 ,80% of total billed charges for outpatient setting,$102.71 ,85% of total billed charges for outpatient setting,$84.58 ,70% of total billed charges for outpatient setting,$84.58 ,70% of total billed charges for outpatient setting,$93.04 ,77% of total billed charges for outpatient setting,$12.10 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$102.71 ,85% of total billed charges for outpatient setting,$102.71 ,85% of total billed charges for outpatient setting,$102.71 ,85% of total billed charges for outpatient setting,$102.71 ,85% of total billed charges for outpatient setting,$102.71 ,85% of total billed charges for outpatient setting,$15.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$12.10 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.10 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.10 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.10 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$102.71 ,85% of total billed charges for outpatient setting,$15.08 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$11.98 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$108.75 ,90% of total billed charges for outpatient setting,$15.53 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$114.79 ,95% of total billed charges for outpatient setting,$102.71 ,85% of total billed charges for outpatient setting,$96.66 ,80% of total billed charges for outpatient setting,$15.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$102.71 ,85% of total billed charges for outpatient setting,$102.71 ,85% of total billed charges for outpatient setting,$102.71 ,85% of total billed charges for outpatient setting,$112.37 ,93% of total billed charges for outpatient setting,$90.62 ,75% of total billed charges for outpatient setting,$90.62 ,75% of total billed charges for outpatient setting,$90.62 ,75% of total billed charges for outpatient setting,$24.26 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$102.71 ,85% of total billed charges for outpatient setting,$15.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$11.98 ,$114.79 ,$42.29 Outpatient Medical Services,LAB,87338,H Pylori POC,300,$219.00 ,$18.99 ,100% Amerigroup fee schedule for outpatient setting,$18.99 ,100% Amerigroup fee schedule for outpatient setting,$109.50 ,75% of total billed charges for outpatient setting,$109.50 ,75% of total billed charges for outpatient setting,$109.50 ,75% of total billed charges for outpatient setting,$14.67 ,102% CMS Medicare OPPS fee schedule,$14.67 ,102% CMS Medicare OPPS fee schedule,$14.67 ,102% CMS Medicare OPPS fee schedule,$14.67 ,102% CMS Medicare OPPS fee schedule,$14.67 ,102% CMS Medicare OPPS fee schedule,$14.67 ,102% CMS Medicare OPPS fee schedule,$175.20 ,80% of total billed charges for outpatient setting,$14.67 ,102% CMS Medicare OPPS fee schedule,$18.99 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$186.15 ,85% of total billed charges for outpatient setting,$14.52 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$175.20 ,80% of total billed charges for outpatient setting,$186.15 ,85% of total billed charges for outpatient setting,$153.30 ,70% of total billed charges for outpatient setting,$153.30 ,70% of total billed charges for outpatient setting,$168.63 ,77% of total billed charges for outpatient setting,$14.52 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$186.15 ,85% of total billed charges for outpatient setting,$186.15 ,85% of total billed charges for outpatient setting,$186.15 ,85% of total billed charges for outpatient setting,$186.15 ,85% of total billed charges for outpatient setting,$186.15 ,85% of total billed charges for outpatient setting,$18.45 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$14.52 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$14.52 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$14.52 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$14.52 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$186.15 ,85% of total billed charges for outpatient setting,$18.09 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$14.38 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$197.10 ,90% of total billed charges for outpatient setting,$18.63 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$208.05 ,95% of total billed charges for outpatient setting,$186.15 ,85% of total billed charges for outpatient setting,$175.20 ,80% of total billed charges for outpatient setting,$18.45 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$186.15 ,85% of total billed charges for outpatient setting,$186.15 ,85% of total billed charges for outpatient setting,$186.15 ,85% of total billed charges for outpatient setting,$203.67 ,93% of total billed charges for outpatient setting,$164.25 ,75% of total billed charges for outpatient setting,$164.25 ,75% of total billed charges for outpatient setting,$164.25 ,75% of total billed charges for outpatient setting,$43.98 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$186.15 ,85% of total billed charges for outpatient setting,$18.45 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$14.38 ,$208.05 ,$76.65 Outpatient Medical Services,LAB,87340,HBsAg Screen LC,300,$23.00 ,$13.64 ,100% Amerigroup fee schedule for outpatient setting,$13.64 ,100% Amerigroup fee schedule for outpatient setting,$11.50 ,75% of total billed charges for outpatient setting,$11.50 ,75% of total billed charges for outpatient setting,$11.50 ,75% of total billed charges for outpatient setting,$10.54 ,102% CMS Medicare OPPS fee schedule,$10.54 ,102% CMS Medicare OPPS fee schedule,$10.54 ,102% CMS Medicare OPPS fee schedule,$10.54 ,102% CMS Medicare OPPS fee schedule,$10.54 ,102% CMS Medicare OPPS fee schedule,$10.54 ,102% CMS Medicare OPPS fee schedule,$18.40 ,80% of total billed charges for outpatient setting,$10.54 ,102% CMS Medicare OPPS fee schedule,$13.64 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$19.55 ,85% of total billed charges for outpatient setting,$10.43 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$18.40 ,80% of total billed charges for outpatient setting,$19.55 ,85% of total billed charges for outpatient setting,$16.10 ,70% of total billed charges for outpatient setting,$16.10 ,70% of total billed charges for outpatient setting,$17.71 ,77% of total billed charges for outpatient setting,$10.43 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$19.55 ,85% of total billed charges for outpatient setting,$19.55 ,85% of total billed charges for outpatient setting,$19.55 ,85% of total billed charges for outpatient setting,$19.55 ,85% of total billed charges for outpatient setting,$19.55 ,85% of total billed charges for outpatient setting,$13.25 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$10.43 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$10.43 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$10.43 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$10.43 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$19.55 ,85% of total billed charges for outpatient setting,$12.99 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$10.33 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$20.70 ,90% of total billed charges for outpatient setting,$13.38 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$21.85 ,95% of total billed charges for outpatient setting,$19.55 ,85% of total billed charges for outpatient setting,$18.40 ,80% of total billed charges for outpatient setting,$13.25 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$19.55 ,85% of total billed charges for outpatient setting,$19.55 ,85% of total billed charges for outpatient setting,$19.55 ,85% of total billed charges for outpatient setting,$21.39 ,93% of total billed charges for outpatient setting,$17.25 ,75% of total billed charges for outpatient setting,$17.25 ,75% of total billed charges for outpatient setting,$17.25 ,75% of total billed charges for outpatient setting,$4.62 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$19.55 ,85% of total billed charges for outpatient setting,$13.25 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.62 ,$21.85 ,$8.05 Outpatient Medical Services,LAB,87400,Influenza A,300,$38.61 ,$15.83 ,100% Amerigroup fee schedule for outpatient setting,$15.83 ,100% Amerigroup fee schedule for outpatient setting,$19.31 ,75% of total billed charges for outpatient setting,$19.31 ,75% of total billed charges for outpatient setting,$19.31 ,75% of total billed charges for outpatient setting,$14.41 ,102% CMS Medicare OPPS fee schedule,$14.41 ,102% CMS Medicare OPPS fee schedule,$14.41 ,102% CMS Medicare OPPS fee schedule,$14.41 ,102% CMS Medicare OPPS fee schedule,$14.41 ,102% CMS Medicare OPPS fee schedule,$14.41 ,102% CMS Medicare OPPS fee schedule,$30.89 ,80% of total billed charges for outpatient setting,$14.41 ,102% CMS Medicare OPPS fee schedule,$15.83 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$32.82 ,85% of total billed charges for outpatient setting,$14.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$30.89 ,80% of total billed charges for outpatient setting,$32.82 ,85% of total billed charges for outpatient setting,$27.03 ,70% of total billed charges for outpatient setting,$27.03 ,70% of total billed charges for outpatient setting,$29.73 ,77% of total billed charges for outpatient setting,$14.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$32.82 ,85% of total billed charges for outpatient setting,$32.82 ,85% of total billed charges for outpatient setting,$32.82 ,85% of total billed charges for outpatient setting,$32.82 ,85% of total billed charges for outpatient setting,$32.82 ,85% of total billed charges for outpatient setting,$15.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$14.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$14.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$14.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$14.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$32.82 ,85% of total billed charges for outpatient setting,$15.08 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$14.13 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$34.75 ,90% of total billed charges for outpatient setting,$15.53 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$36.68 ,95% of total billed charges for outpatient setting,$32.82 ,85% of total billed charges for outpatient setting,$30.89 ,80% of total billed charges for outpatient setting,$15.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$32.82 ,85% of total billed charges for outpatient setting,$32.82 ,85% of total billed charges for outpatient setting,$32.82 ,85% of total billed charges for outpatient setting,$35.91 ,93% of total billed charges for outpatient setting,$28.96 ,75% of total billed charges for outpatient setting,$28.96 ,75% of total billed charges for outpatient setting,$28.96 ,75% of total billed charges for outpatient setting,$7.75 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$32.82 ,85% of total billed charges for outpatient setting,$15.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$7.75 ,$36.68 ,$13.51 Outpatient Medical Services,LAB,87400,Influenza B,300,$38.61 ,$15.83 ,100% Amerigroup fee schedule for outpatient setting,$15.83 ,100% Amerigroup fee schedule for outpatient setting,$19.31 ,75% of total billed charges for outpatient setting,$19.31 ,75% of total billed charges for outpatient setting,$19.31 ,75% of total billed charges for outpatient setting,$14.41 ,102% CMS Medicare OPPS fee schedule,$14.41 ,102% CMS Medicare OPPS fee schedule,$14.41 ,102% CMS Medicare OPPS fee schedule,$14.41 ,102% CMS Medicare OPPS fee schedule,$14.41 ,102% CMS Medicare OPPS fee schedule,$14.41 ,102% CMS Medicare OPPS fee schedule,$30.89 ,80% of total billed charges for outpatient setting,$14.41 ,102% CMS Medicare OPPS fee schedule,$15.83 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$32.82 ,85% of total billed charges for outpatient setting,$14.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$30.89 ,80% of total billed charges for outpatient setting,$32.82 ,85% of total billed charges for outpatient setting,$27.03 ,70% of total billed charges for outpatient setting,$27.03 ,70% of total billed charges for outpatient setting,$29.73 ,77% of total billed charges for outpatient setting,$14.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$32.82 ,85% of total billed charges for outpatient setting,$32.82 ,85% of total billed charges for outpatient setting,$32.82 ,85% of total billed charges for outpatient setting,$32.82 ,85% of total billed charges for outpatient setting,$32.82 ,85% of total billed charges for outpatient setting,$15.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$14.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$14.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$14.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$14.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$32.82 ,85% of total billed charges for outpatient setting,$15.08 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$14.13 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$34.75 ,90% of total billed charges for outpatient setting,$15.53 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$36.68 ,95% of total billed charges for outpatient setting,$32.82 ,85% of total billed charges for outpatient setting,$30.89 ,80% of total billed charges for outpatient setting,$15.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$32.82 ,85% of total billed charges for outpatient setting,$32.82 ,85% of total billed charges for outpatient setting,$32.82 ,85% of total billed charges for outpatient setting,$35.91 ,93% of total billed charges for outpatient setting,$28.96 ,75% of total billed charges for outpatient setting,$28.96 ,75% of total billed charges for outpatient setting,$28.96 ,75% of total billed charges for outpatient setting,$7.75 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$32.82 ,85% of total billed charges for outpatient setting,$15.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$7.75 ,$36.68 ,$13.51 Outpatient Medical Services,LAB,87400,Flu A+B,300,$38.61 ,$15.83 ,100% Amerigroup fee schedule for outpatient setting,$15.83 ,100% Amerigroup fee schedule for outpatient setting,$19.31 ,75% of total billed charges for outpatient setting,$19.31 ,75% of total billed charges for outpatient setting,$19.31 ,75% of total billed charges for outpatient setting,$14.41 ,102% CMS Medicare OPPS fee schedule,$14.41 ,102% CMS Medicare OPPS fee schedule,$14.41 ,102% CMS Medicare OPPS fee schedule,$14.41 ,102% CMS Medicare OPPS fee schedule,$14.41 ,102% CMS Medicare OPPS fee schedule,$14.41 ,102% CMS Medicare OPPS fee schedule,$30.89 ,80% of total billed charges for outpatient setting,$14.41 ,102% CMS Medicare OPPS fee schedule,$15.83 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$32.82 ,85% of total billed charges for outpatient setting,$14.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$30.89 ,80% of total billed charges for outpatient setting,$32.82 ,85% of total billed charges for outpatient setting,$27.03 ,70% of total billed charges for outpatient setting,$27.03 ,70% of total billed charges for outpatient setting,$29.73 ,77% of total billed charges for outpatient setting,$14.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$32.82 ,85% of total billed charges for outpatient setting,$32.82 ,85% of total billed charges for outpatient setting,$32.82 ,85% of total billed charges for outpatient setting,$32.82 ,85% of total billed charges for outpatient setting,$32.82 ,85% of total billed charges for outpatient setting,$15.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$14.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$14.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$14.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$14.27 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$32.82 ,85% of total billed charges for outpatient setting,$15.08 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$14.13 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$34.75 ,90% of total billed charges for outpatient setting,$15.53 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$36.68 ,95% of total billed charges for outpatient setting,$32.82 ,85% of total billed charges for outpatient setting,$30.89 ,80% of total billed charges for outpatient setting,$15.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$32.82 ,85% of total billed charges for outpatient setting,$32.82 ,85% of total billed charges for outpatient setting,$32.82 ,85% of total billed charges for outpatient setting,$35.91 ,93% of total billed charges for outpatient setting,$28.96 ,75% of total billed charges for outpatient setting,$28.96 ,75% of total billed charges for outpatient setting,$28.96 ,75% of total billed charges for outpatient setting,$7.75 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$32.82 ,85% of total billed charges for outpatient setting,$15.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$7.75 ,$36.68 ,$13.51 Outpatient Medical Services,LAB,87427,Shiga Toxin 1 and 2,300,$115.21 ,$15.83 ,100% Amerigroup fee schedule for outpatient setting,$15.83 ,100% Amerigroup fee schedule for outpatient setting,$57.61 ,75% of total billed charges for outpatient setting,$57.61 ,75% of total billed charges for outpatient setting,$57.61 ,75% of total billed charges for outpatient setting,$12.22 ,102% CMS Medicare OPPS fee schedule,$12.22 ,102% CMS Medicare OPPS fee schedule,$12.22 ,102% CMS Medicare OPPS fee schedule,$12.22 ,102% CMS Medicare OPPS fee schedule,$12.22 ,102% CMS Medicare OPPS fee schedule,$12.22 ,102% CMS Medicare OPPS fee schedule,$92.17 ,80% of total billed charges for outpatient setting,$12.22 ,102% CMS Medicare OPPS fee schedule,$15.83 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$97.93 ,85% of total billed charges for outpatient setting,$12.10 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$92.17 ,80% of total billed charges for outpatient setting,$97.93 ,85% of total billed charges for outpatient setting,$80.65 ,70% of total billed charges for outpatient setting,$80.65 ,70% of total billed charges for outpatient setting,$88.71 ,77% of total billed charges for outpatient setting,$12.10 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$97.93 ,85% of total billed charges for outpatient setting,$97.93 ,85% of total billed charges for outpatient setting,$97.93 ,85% of total billed charges for outpatient setting,$97.93 ,85% of total billed charges for outpatient setting,$97.93 ,85% of total billed charges for outpatient setting,$15.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$12.10 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.10 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.10 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$12.10 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$97.93 ,85% of total billed charges for outpatient setting,$15.08 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$11.98 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$103.69 ,90% of total billed charges for outpatient setting,$15.53 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$109.45 ,95% of total billed charges for outpatient setting,$97.93 ,85% of total billed charges for outpatient setting,$92.17 ,80% of total billed charges for outpatient setting,$15.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$97.93 ,85% of total billed charges for outpatient setting,$97.93 ,85% of total billed charges for outpatient setting,$97.93 ,85% of total billed charges for outpatient setting,$107.15 ,93% of total billed charges for outpatient setting,$86.41 ,75% of total billed charges for outpatient setting,$86.41 ,75% of total billed charges for outpatient setting,$86.41 ,75% of total billed charges for outpatient setting,$23.13 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$97.93 ,85% of total billed charges for outpatient setting,$15.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$11.98 ,$109.45 ,$40.32 Outpatient Medical Services,LAB,87493,Clostridium Difficile,300,$302.80 ,$162.30 ,53.6% of total biled charges for outpatient setting,$162.30 ,53.6% of total biled charges for outpatient setting,$151.40 ,75% of total billed charges for outpatient setting,$151.40 ,75% of total billed charges for outpatient setting,$151.40 ,75% of total billed charges for outpatient setting,$38.02 ,102% CMS Medicare OPPS fee schedule,$38.02 ,102% CMS Medicare OPPS fee schedule,$38.02 ,102% CMS Medicare OPPS fee schedule,$38.02 ,102% CMS Medicare OPPS fee schedule,$38.02 ,102% CMS Medicare OPPS fee schedule,$38.02 ,102% CMS Medicare OPPS fee schedule,$242.24 ,80% of total billed charges for outpatient setting,$38.02 ,102% CMS Medicare OPPS fee schedule,$105.98 ,35% of total billed charges for outpatient setting,$257.38 ,85% of total billed charges for outpatient setting,$37.64 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$242.24 ,80% of total billed charges for outpatient setting,$257.38 ,85% of total billed charges for outpatient setting,$211.96 ,70% of total billed charges for outpatient setting,$211.96 ,70% of total billed charges for outpatient setting,$233.16 ,77% of total billed charges for outpatient setting,$37.64 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$257.38 ,85% of total billed charges for outpatient setting,$257.38 ,85% of total billed charges for outpatient setting,$257.38 ,85% of total billed charges for outpatient setting,$257.38 ,85% of total billed charges for outpatient setting,$257.38 ,85% of total billed charges for outpatient setting,$60.23 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$37.64 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$37.64 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$37.64 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$37.64 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$257.38 ,85% of total billed charges for outpatient setting,$59.05 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$37.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$272.52 ,90% of total billed charges for outpatient setting,$60.80 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$287.66 ,95% of total billed charges for outpatient setting,$257.38 ,85% of total billed charges for outpatient setting,$242.24 ,80% of total billed charges for outpatient setting,$60.23 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$257.38 ,85% of total billed charges for outpatient setting,$257.38 ,85% of total billed charges for outpatient setting,$257.38 ,85% of total billed charges for outpatient setting,$281.60 ,93% of total billed charges for outpatient setting,$227.10 ,75% of total billed charges for outpatient setting,$227.10 ,75% of total billed charges for outpatient setting,$227.10 ,75% of total billed charges for outpatient setting,$60.80 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$257.38 ,85% of total billed charges for outpatient setting,$60.23 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$37.27 ,$287.66 ,$105.98 Outpatient Medical Services,LAB,87493,C Diff Tox,300,$302.80 ,$162.30 ,53.6% of total biled charges for outpatient setting,$162.30 ,53.6% of total biled charges for outpatient setting,$151.40 ,75% of total billed charges for outpatient setting,$151.40 ,75% of total billed charges for outpatient setting,$151.40 ,75% of total billed charges for outpatient setting,$38.02 ,102% CMS Medicare OPPS fee schedule,$38.02 ,102% CMS Medicare OPPS fee schedule,$38.02 ,102% CMS Medicare OPPS fee schedule,$38.02 ,102% CMS Medicare OPPS fee schedule,$38.02 ,102% CMS Medicare OPPS fee schedule,$38.02 ,102% CMS Medicare OPPS fee schedule,$242.24 ,80% of total billed charges for outpatient setting,$38.02 ,102% CMS Medicare OPPS fee schedule,$105.98 ,35% of total billed charges for outpatient setting,$257.38 ,85% of total billed charges for outpatient setting,$37.64 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$242.24 ,80% of total billed charges for outpatient setting,$257.38 ,85% of total billed charges for outpatient setting,$211.96 ,70% of total billed charges for outpatient setting,$211.96 ,70% of total billed charges for outpatient setting,$233.16 ,77% of total billed charges for outpatient setting,$37.64 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$257.38 ,85% of total billed charges for outpatient setting,$257.38 ,85% of total billed charges for outpatient setting,$257.38 ,85% of total billed charges for outpatient setting,$257.38 ,85% of total billed charges for outpatient setting,$257.38 ,85% of total billed charges for outpatient setting,$60.23 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$37.64 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$37.64 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$37.64 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$37.64 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$257.38 ,85% of total billed charges for outpatient setting,$59.05 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$37.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$272.52 ,90% of total billed charges for outpatient setting,$60.80 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$287.66 ,95% of total billed charges for outpatient setting,$257.38 ,85% of total billed charges for outpatient setting,$242.24 ,80% of total billed charges for outpatient setting,$60.23 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$257.38 ,85% of total billed charges for outpatient setting,$257.38 ,85% of total billed charges for outpatient setting,$257.38 ,85% of total billed charges for outpatient setting,$281.60 ,93% of total billed charges for outpatient setting,$227.10 ,75% of total billed charges for outpatient setting,$227.10 ,75% of total billed charges for outpatient setting,$227.10 ,75% of total billed charges for outpatient setting,$60.80 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$257.38 ,85% of total billed charges for outpatient setting,$60.23 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$37.27 ,$287.66 ,$105.98 Outpatient Medical Services,LAB,87880,Strep A (Revogene),300,$21.45 ,$15.83 ,100% Amerigroup fee schedule for outpatient setting,$15.83 ,100% Amerigroup fee schedule for outpatient setting,$10.73 ,75% of total billed charges for outpatient setting,$10.73 ,75% of total billed charges for outpatient setting,$10.73 ,75% of total billed charges for outpatient setting,$16.86 ,102% CMS Medicare OPPS fee schedule,$16.86 ,102% CMS Medicare OPPS fee schedule,$16.86 ,102% CMS Medicare OPPS fee schedule,$16.86 ,102% CMS Medicare OPPS fee schedule,$16.86 ,102% CMS Medicare OPPS fee schedule,$16.86 ,102% CMS Medicare OPPS fee schedule,$17.16 ,80% of total billed charges for outpatient setting,$16.86 ,102% CMS Medicare OPPS fee schedule,$15.83 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$18.23 ,85% of total billed charges for outpatient setting,$16.70 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$17.16 ,80% of total billed charges for outpatient setting,$18.23 ,85% of total billed charges for outpatient setting,$15.02 ,70% of total billed charges for outpatient setting,$15.02 ,70% of total billed charges for outpatient setting,$16.52 ,77% of total billed charges for outpatient setting,$16.70 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$18.23 ,85% of total billed charges for outpatient setting,$18.23 ,85% of total billed charges for outpatient setting,$18.23 ,85% of total billed charges for outpatient setting,$18.23 ,85% of total billed charges for outpatient setting,$18.23 ,85% of total billed charges for outpatient setting,$15.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$16.70 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$16.70 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$16.70 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$16.70 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$18.23 ,85% of total billed charges for outpatient setting,$15.08 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$16.53 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$19.31 ,90% of total billed charges for outpatient setting,$15.53 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$20.38 ,95% of total billed charges for outpatient setting,$18.23 ,85% of total billed charges for outpatient setting,$17.16 ,80% of total billed charges for outpatient setting,$15.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$18.23 ,85% of total billed charges for outpatient setting,$18.23 ,85% of total billed charges for outpatient setting,$18.23 ,85% of total billed charges for outpatient setting,$19.95 ,93% of total billed charges for outpatient setting,$16.09 ,75% of total billed charges for outpatient setting,$16.09 ,75% of total billed charges for outpatient setting,$16.09 ,75% of total billed charges for outpatient setting,$4.31 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$18.23 ,85% of total billed charges for outpatient setting,$15.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.31 ,$20.38 ,$7.51 Outpatient Medical Services,LAB,87880,Strep A Scrn,300,$21.45 ,$15.83 ,100% Amerigroup fee schedule for outpatient setting,$15.83 ,100% Amerigroup fee schedule for outpatient setting,$10.73 ,75% of total billed charges for outpatient setting,$10.73 ,75% of total billed charges for outpatient setting,$10.73 ,75% of total billed charges for outpatient setting,$16.86 ,102% CMS Medicare OPPS fee schedule,$16.86 ,102% CMS Medicare OPPS fee schedule,$16.86 ,102% CMS Medicare OPPS fee schedule,$16.86 ,102% CMS Medicare OPPS fee schedule,$16.86 ,102% CMS Medicare OPPS fee schedule,$16.86 ,102% CMS Medicare OPPS fee schedule,$17.16 ,80% of total billed charges for outpatient setting,$16.86 ,102% CMS Medicare OPPS fee schedule,$15.83 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$18.23 ,85% of total billed charges for outpatient setting,$16.70 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$17.16 ,80% of total billed charges for outpatient setting,$18.23 ,85% of total billed charges for outpatient setting,$15.02 ,70% of total billed charges for outpatient setting,$15.02 ,70% of total billed charges for outpatient setting,$16.52 ,77% of total billed charges for outpatient setting,$16.70 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$18.23 ,85% of total billed charges for outpatient setting,$18.23 ,85% of total billed charges for outpatient setting,$18.23 ,85% of total billed charges for outpatient setting,$18.23 ,85% of total billed charges for outpatient setting,$18.23 ,85% of total billed charges for outpatient setting,$15.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$16.70 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$16.70 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$16.70 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$16.70 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$18.23 ,85% of total billed charges for outpatient setting,$15.08 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$16.53 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$19.31 ,90% of total billed charges for outpatient setting,$15.53 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$20.38 ,95% of total billed charges for outpatient setting,$18.23 ,85% of total billed charges for outpatient setting,$17.16 ,80% of total billed charges for outpatient setting,$15.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$18.23 ,85% of total billed charges for outpatient setting,$18.23 ,85% of total billed charges for outpatient setting,$18.23 ,85% of total billed charges for outpatient setting,$19.95 ,93% of total billed charges for outpatient setting,$16.09 ,75% of total billed charges for outpatient setting,$16.09 ,75% of total billed charges for outpatient setting,$16.09 ,75% of total billed charges for outpatient setting,$4.31 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$18.23 ,85% of total billed charges for outpatient setting,$15.38 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$4.31 ,$20.38 ,$7.51 Outpatient Medical Services,LAB,88304,88304 Gross & Micro Level III,312,$94.00 ,$31.69 ,100% Amerigroup fee schedule for outpatient setting,$31.69 ,100% Amerigroup fee schedule for outpatient setting,$47.00 ,75% of total billed charges for outpatient setting,$47.00 ,75% of total billed charges for outpatient setting,$47.00 ,75% of total billed charges for outpatient setting,$29.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$29.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$29.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$29.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$29.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$29.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$75.20 ,80% of total billed charges for outpatient setting,$29.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$18.11 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$79.90 ,85% of total billed charges for outpatient setting,$29.43 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$75.20 ,80% of total billed charges for outpatient setting,$79.90 ,85% of total billed charges for outpatient setting,$65.80 ,70% of total billed charges for outpatient setting,$65.80 ,70% of total billed charges for outpatient setting,$72.38 ,77% of total billed charges for outpatient setting,$29.43 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$79.90 ,85% of total billed charges for outpatient setting,$79.90 ,85% of total billed charges for outpatient setting,$79.90 ,85% of total billed charges for outpatient setting,$79.90 ,85% of total billed charges for outpatient setting,$79.90 ,85% of total billed charges for outpatient setting,$17.60 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$29.43 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$29.43 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$29.43 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$29.43 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$79.90 ,85% of total billed charges for outpatient setting,$17.25 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$29.14 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$84.60 ,90% of total billed charges for outpatient setting,$17.77 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$89.30 ,95% of total billed charges for outpatient setting,$79.90 ,85% of total billed charges for outpatient setting,$75.20 ,80% of total billed charges for outpatient setting,$17.60 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$79.90 ,85% of total billed charges for outpatient setting,$79.90 ,85% of total billed charges for outpatient setting,$79.90 ,85% of total billed charges for outpatient setting,$87.42 ,93% of total billed charges for outpatient setting,$70.50 ,75% of total billed charges for outpatient setting,$70.50 ,75% of total billed charges for outpatient setting,$70.50 ,75% of total billed charges for outpatient setting,$18.88 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$79.90 ,85% of total billed charges for outpatient setting,$17.60 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$17.25 ,$89.30 ,$32.90 Outpatient Medical Services,LAB,88304,Gross & Micro III,312,$94.00 ,$31.69 ,100% Amerigroup fee schedule for outpatient setting,$31.69 ,100% Amerigroup fee schedule for outpatient setting,$47.00 ,75% of total billed charges for outpatient setting,$47.00 ,75% of total billed charges for outpatient setting,$47.00 ,75% of total billed charges for outpatient setting,$29.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$29.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$29.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$29.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$29.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$29.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$75.20 ,80% of total billed charges for outpatient setting,$29.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$18.11 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$79.90 ,85% of total billed charges for outpatient setting,$29.43 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$75.20 ,80% of total billed charges for outpatient setting,$79.90 ,85% of total billed charges for outpatient setting,$65.80 ,70% of total billed charges for outpatient setting,$65.80 ,70% of total billed charges for outpatient setting,$72.38 ,77% of total billed charges for outpatient setting,$29.43 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$79.90 ,85% of total billed charges for outpatient setting,$79.90 ,85% of total billed charges for outpatient setting,$79.90 ,85% of total billed charges for outpatient setting,$79.90 ,85% of total billed charges for outpatient setting,$79.90 ,85% of total billed charges for outpatient setting,$17.60 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$29.43 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$29.43 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$29.43 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$29.43 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$79.90 ,85% of total billed charges for outpatient setting,$17.25 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$29.14 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$84.60 ,90% of total billed charges for outpatient setting,$17.77 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$89.30 ,95% of total billed charges for outpatient setting,$79.90 ,85% of total billed charges for outpatient setting,$75.20 ,80% of total billed charges for outpatient setting,$17.60 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$79.90 ,85% of total billed charges for outpatient setting,$79.90 ,85% of total billed charges for outpatient setting,$79.90 ,85% of total billed charges for outpatient setting,$87.42 ,93% of total billed charges for outpatient setting,$70.50 ,75% of total billed charges for outpatient setting,$70.50 ,75% of total billed charges for outpatient setting,$70.50 ,75% of total billed charges for outpatient setting,$18.88 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$79.90 ,85% of total billed charges for outpatient setting,$17.60 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$17.25 ,$89.30 ,$32.90 Outpatient Medical Services,LAB,88305,"88305 Surgical pathology, gross and microscopic examination",312,$212.00 ,$69.17 ,100% Amerigroup fee schedule for outpatient setting,$69.17 ,100% Amerigroup fee schedule for outpatient setting,$106.00 ,75% of total billed charges for outpatient setting,$106.00 ,75% of total billed charges for outpatient setting,$106.00 ,75% of total billed charges for outpatient setting,$67.03 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$67.03 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$67.03 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$67.03 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$67.03 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$67.03 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$169.60 ,80% of total billed charges for outpatient setting,$67.03 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$28.52 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$180.20 ,85% of total billed charges for outpatient setting,$66.38 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$169.60 ,80% of total billed charges for outpatient setting,$180.20 ,85% of total billed charges for outpatient setting,$148.40 ,70% of total billed charges for outpatient setting,$148.40 ,70% of total billed charges for outpatient setting,$163.24 ,77% of total billed charges for outpatient setting,$66.38 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$180.20 ,85% of total billed charges for outpatient setting,$180.20 ,85% of total billed charges for outpatient setting,$180.20 ,85% of total billed charges for outpatient setting,$180.20 ,85% of total billed charges for outpatient setting,$180.20 ,85% of total billed charges for outpatient setting,$27.70 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$66.38 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$66.38 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$66.38 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$66.38 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$180.20 ,85% of total billed charges for outpatient setting,$27.16 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$65.72 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$190.80 ,90% of total billed charges for outpatient setting,$27.97 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$201.40 ,95% of total billed charges for outpatient setting,$180.20 ,85% of total billed charges for outpatient setting,$169.60 ,80% of total billed charges for outpatient setting,$27.70 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$180.20 ,85% of total billed charges for outpatient setting,$180.20 ,85% of total billed charges for outpatient setting,$180.20 ,85% of total billed charges for outpatient setting,$197.16 ,93% of total billed charges for outpatient setting,$159.00 ,75% of total billed charges for outpatient setting,$159.00 ,75% of total billed charges for outpatient setting,$159.00 ,75% of total billed charges for outpatient setting,$42.57 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$180.20 ,85% of total billed charges for outpatient setting,$27.70 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$27.16 ,$201.40 ,$74.20 Outpatient Medical Services,LAB,88305,88305 AP Bill Surg Level IV,312,$212.00 ,$69.17 ,100% Amerigroup fee schedule for outpatient setting,$69.17 ,100% Amerigroup fee schedule for outpatient setting,$106.00 ,75% of total billed charges for outpatient setting,$106.00 ,75% of total billed charges for outpatient setting,$106.00 ,75% of total billed charges for outpatient setting,$67.03 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$67.03 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$67.03 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$67.03 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$67.03 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$67.03 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$169.60 ,80% of total billed charges for outpatient setting,$67.03 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$28.52 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$180.20 ,85% of total billed charges for outpatient setting,$66.38 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$169.60 ,80% of total billed charges for outpatient setting,$180.20 ,85% of total billed charges for outpatient setting,$148.40 ,70% of total billed charges for outpatient setting,$148.40 ,70% of total billed charges for outpatient setting,$163.24 ,77% of total billed charges for outpatient setting,$66.38 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$180.20 ,85% of total billed charges for outpatient setting,$180.20 ,85% of total billed charges for outpatient setting,$180.20 ,85% of total billed charges for outpatient setting,$180.20 ,85% of total billed charges for outpatient setting,$180.20 ,85% of total billed charges for outpatient setting,$27.70 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$66.38 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$66.38 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$66.38 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$66.38 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$180.20 ,85% of total billed charges for outpatient setting,$27.16 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$65.72 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$190.80 ,90% of total billed charges for outpatient setting,$27.97 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$201.40 ,95% of total billed charges for outpatient setting,$180.20 ,85% of total billed charges for outpatient setting,$169.60 ,80% of total billed charges for outpatient setting,$27.70 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$180.20 ,85% of total billed charges for outpatient setting,$180.20 ,85% of total billed charges for outpatient setting,$180.20 ,85% of total billed charges for outpatient setting,$197.16 ,93% of total billed charges for outpatient setting,$159.00 ,75% of total billed charges for outpatient setting,$159.00 ,75% of total billed charges for outpatient setting,$159.00 ,75% of total billed charges for outpatient setting,$42.57 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$180.20 ,85% of total billed charges for outpatient setting,$27.70 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$27.16 ,$201.40 ,$74.20 Outpatient Medical Services,LAB,88311,DECALCIFICATION,312,$38.00 ,$16.22 ,100% Amerigroup fee schedule for outpatient setting,$16.22 ,100% Amerigroup fee schedule for outpatient setting,$19.00 ,75% of total billed charges for outpatient setting,$19.00 ,75% of total billed charges for outpatient setting,$19.00 ,75% of total billed charges for outpatient setting,$12.02 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$12.02 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$12.02 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$12.02 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$12.02 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$12.02 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$30.40 ,80% of total billed charges for outpatient setting,$12.02 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$4.00 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$32.30 ,85% of total billed charges for outpatient setting,$11.90 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$30.40 ,80% of total billed charges for outpatient setting,$32.30 ,85% of total billed charges for outpatient setting,$26.60 ,70% of total billed charges for outpatient setting,$26.60 ,70% of total billed charges for outpatient setting,$29.26 ,77% of total billed charges for outpatient setting,$11.90 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$32.30 ,85% of total billed charges for outpatient setting,$32.30 ,85% of total billed charges for outpatient setting,$32.30 ,85% of total billed charges for outpatient setting,$32.30 ,85% of total billed charges for outpatient setting,$32.30 ,85% of total billed charges for outpatient setting,$3.89 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$11.90 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$11.90 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$11.90 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$11.90 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$32.30 ,85% of total billed charges for outpatient setting,$3.81 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$11.78 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$34.20 ,90% of total billed charges for outpatient setting,$3.92 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$36.10 ,95% of total billed charges for outpatient setting,$32.30 ,85% of total billed charges for outpatient setting,$30.40 ,80% of total billed charges for outpatient setting,$3.89 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$32.30 ,85% of total billed charges for outpatient setting,$32.30 ,85% of total billed charges for outpatient setting,$32.30 ,85% of total billed charges for outpatient setting,$35.34 ,93% of total billed charges for outpatient setting,$28.50 ,75% of total billed charges for outpatient setting,$28.50 ,75% of total billed charges for outpatient setting,$28.50 ,75% of total billed charges for outpatient setting,$7.63 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$32.30 ,85% of total billed charges for outpatient setting,$3.89 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$3.81 ,$36.10 ,$13.30 Outpatient Medical Services,LAB,88342,88342 AP Bill Surg IPX (First Antibody),312,$260.00 ,$75.16 ,100% Amerigroup fee schedule for outpatient setting,$75.16 ,100% Amerigroup fee schedule for outpatient setting,$130.00 ,75% of total billed charges for outpatient setting,$130.00 ,75% of total billed charges for outpatient setting,$130.00 ,75% of total billed charges for outpatient setting,$82.21 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$82.21 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$82.21 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$82.21 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$82.21 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$82.21 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$208.00 ,80% of total billed charges for outpatient setting,$82.21 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$34.27 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$221.00 ,85% of total billed charges for outpatient setting,$81.41 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$208.00 ,80% of total billed charges for outpatient setting,$221.00 ,85% of total billed charges for outpatient setting,$182.00 ,70% of total billed charges for outpatient setting,$182.00 ,70% of total billed charges for outpatient setting,$200.20 ,77% of total billed charges for outpatient setting,$81.41 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$221.00 ,85% of total billed charges for outpatient setting,$221.00 ,85% of total billed charges for outpatient setting,$221.00 ,85% of total billed charges for outpatient setting,$221.00 ,85% of total billed charges for outpatient setting,$221.00 ,85% of total billed charges for outpatient setting,$33.29 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$81.41 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$81.41 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$81.41 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$81.41 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$221.00 ,85% of total billed charges for outpatient setting,$32.64 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$80.60 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$234.00 ,90% of total billed charges for outpatient setting,$33.62 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$247.00 ,95% of total billed charges for outpatient setting,$221.00 ,85% of total billed charges for outpatient setting,$208.00 ,80% of total billed charges for outpatient setting,$33.29 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$221.00 ,85% of total billed charges for outpatient setting,$221.00 ,85% of total billed charges for outpatient setting,$221.00 ,85% of total billed charges for outpatient setting,$241.80 ,93% of total billed charges for outpatient setting,$195.00 ,75% of total billed charges for outpatient setting,$195.00 ,75% of total billed charges for outpatient setting,$195.00 ,75% of total billed charges for outpatient setting,$52.21 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$221.00 ,85% of total billed charges for outpatient setting,$33.29 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$32.64 ,$247.00 ,$91.00 Outpatient Medical Services,LAB,89051,Cell Count w/ Diff CSF,300,$121.00 ,$2.32 ,100% Amerigroup fee schedule for outpatient setting,$2.32 ,100% Amerigroup fee schedule for outpatient setting,$60.50 ,75% of total billed charges for outpatient setting,$60.50 ,75% of total billed charges for outpatient setting,$60.50 ,75% of total billed charges for outpatient setting,$5.71 ,102% CMS Medicare OPPS fee schedule,$5.71 ,102% CMS Medicare OPPS fee schedule,$5.71 ,102% CMS Medicare OPPS fee schedule,$5.71 ,102% CMS Medicare OPPS fee schedule,$5.71 ,102% CMS Medicare OPPS fee schedule,$5.71 ,102% CMS Medicare OPPS fee schedule,$96.80 ,80% of total billed charges for outpatient setting,$5.71 ,102% CMS Medicare OPPS fee schedule,$2.32 ,125.47% of GA Medicaid fee schedule which is 105% of the regular GA Medicaid fee schedule rate,$102.85 ,85% of total billed charges for outpatient setting,$5.66 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$96.80 ,80% of total billed charges for outpatient setting,$102.85 ,85% of total billed charges for outpatient setting,$84.70 ,70% of total billed charges for outpatient setting,$84.70 ,70% of total billed charges for outpatient setting,$93.17 ,77% of total billed charges for outpatient setting,$5.66 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$102.85 ,85% of total billed charges for outpatient setting,$102.85 ,85% of total billed charges for outpatient setting,$102.85 ,85% of total billed charges for outpatient setting,$102.85 ,85% of total billed charges for outpatient setting,$102.85 ,85% of total billed charges for outpatient setting,$2.25 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$5.66 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.66 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.66 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$5.66 ,101% CMS Medicare OPPS fee schedule for outpatient setting,$102.85 ,85% of total billed charges for outpatient setting,$2.21 ,119.5% of GA Medicaid fee schedule which is 100% of the regular GA Medicaid fee schedule rate,$5.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$108.90 ,90% of total billed charges for outpatient setting,$2.28 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$114.95 ,95% of total billed charges for outpatient setting,$102.85 ,85% of total billed charges for outpatient setting,$96.80 ,80% of total billed charges for outpatient setting,$2.25 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$102.85 ,85% of total billed charges for outpatient setting,$102.85 ,85% of total billed charges for outpatient setting,$102.85 ,85% of total billed charges for outpatient setting,$112.53 ,93% of total billed charges for outpatient setting,$90.75 ,75% of total billed charges for outpatient setting,$90.75 ,75% of total billed charges for outpatient setting,$90.75 ,75% of total billed charges for outpatient setting,$24.30 ,123.09% of GA Medicaid fee schedule which is 103% of the regular GA Medicaid fee schedule rate,$102.85 ,85% of total billed charges for outpatient setting,$2.25 ,121.89% of GA Medicaid fee schedule which is 102% of the regular GA Medicaid fee schedule rate,$2.21 ,$114.95 ,$42.35 Outpatient Medical Services,RADIOLOGY,70110,XR Mandible Less Than 4 Views,320,$250.00 ,$134.00 ,53.6% of total biled charges for outpatient setting,$134.00 ,53.6% of total biled charges for outpatient setting,$187.50 ,75% of total billed charges for outpatient setting,$187.50 ,75% of total billed charges for outpatient setting,$187.50 ,75% of total billed charges for outpatient setting,$79.05 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$79.05 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$79.05 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$79.05 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$79.05 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$79.05 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$200.00 ,80% of total billed charges for outpatient setting,$79.05 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$87.50 ,35% of total billed charges for outpatient setting,$212.50 ,85% of total billed charges for outpatient setting,$78.28 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$200.00 ,80% of total billed charges for outpatient setting,$212.50 ,85% of total billed charges for outpatient setting,$175.00 ,70% of total billed charges for outpatient setting,$175.00 ,70% of total billed charges for outpatient setting,$192.50 ,77% of total billed charges for outpatient setting,$78.28 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$212.50 ,85% of total billed charges for outpatient setting,$212.50 ,85% of total billed charges for outpatient setting,$212.50 ,85% of total billed charges for outpatient setting,$212.50 ,85% of total billed charges for outpatient setting,$212.50 ,85% of total billed charges for outpatient setting,$49.73 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$78.28 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$78.28 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$78.28 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$78.28 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$212.50 ,85% of total billed charges for outpatient setting,$48.75 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$77.50 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$225.00 ,90% of total billed charges for outpatient setting,$50.20 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$237.50 ,95% of total billed charges for outpatient setting,$212.50 ,85% of total billed charges for outpatient setting,$200.00 ,80% of total billed charges for outpatient setting,$49.73 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$212.50 ,85% of total billed charges for outpatient setting,$212.50 ,85% of total billed charges for outpatient setting,$212.50 ,85% of total billed charges for outpatient setting,$232.50 ,93% of total billed charges for outpatient setting,$187.50 ,75% of total billed charges for outpatient setting,$187.50 ,75% of total billed charges for outpatient setting,$187.50 ,75% of total billed charges for outpatient setting,$50.20 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$212.50 ,85% of total billed charges for outpatient setting,$49.73 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$48.75 ,$237.50 ,$87.50 Outpatient Medical Services,RADIOLOGY,70150,XR Facial Bones 3+ Views,320,$522.00 ,$279.79 ,53.6% of total biled charges for outpatient setting,$279.79 ,53.6% of total biled charges for outpatient setting,$391.50 ,75% of total billed charges for outpatient setting,$391.50 ,75% of total billed charges for outpatient setting,$391.50 ,75% of total billed charges for outpatient setting,$165.06 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$165.06 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$165.06 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$165.06 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$165.06 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$165.06 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$417.60 ,80% of total billed charges for outpatient setting,$165.06 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$182.70 ,35% of total billed charges for outpatient setting,$443.70 ,85% of total billed charges for outpatient setting,$163.44 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$417.60 ,80% of total billed charges for outpatient setting,$443.70 ,85% of total billed charges for outpatient setting,$365.40 ,70% of total billed charges for outpatient setting,$365.40 ,70% of total billed charges for outpatient setting,$401.94 ,77% of total billed charges for outpatient setting,$163.44 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$443.70 ,85% of total billed charges for outpatient setting,$443.70 ,85% of total billed charges for outpatient setting,$443.70 ,85% of total billed charges for outpatient setting,$443.70 ,85% of total billed charges for outpatient setting,$443.70 ,85% of total billed charges for outpatient setting,$103.83 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$163.44 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$163.44 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$163.44 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$163.44 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$443.70 ,85% of total billed charges for outpatient setting,$101.79 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$161.82 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$469.80 ,90% of total billed charges for outpatient setting,$104.82 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$495.90 ,95% of total billed charges for outpatient setting,$443.70 ,85% of total billed charges for outpatient setting,$417.60 ,80% of total billed charges for outpatient setting,$103.83 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$443.70 ,85% of total billed charges for outpatient setting,$443.70 ,85% of total billed charges for outpatient setting,$443.70 ,85% of total billed charges for outpatient setting,$485.46 ,93% of total billed charges for outpatient setting,$391.50 ,75% of total billed charges for outpatient setting,$391.50 ,75% of total billed charges for outpatient setting,$391.50 ,75% of total billed charges for outpatient setting,$104.82 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$443.70 ,85% of total billed charges for outpatient setting,$103.83 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$101.79 ,$495.90 ,$182.70 Outpatient Medical Services,RADIOLOGY,70160,XR Nasal Bones 3+ Views,320,$147.00 ,$78.79 ,53.6% of total biled charges for outpatient setting,$78.79 ,53.6% of total biled charges for outpatient setting,$110.25 ,75% of total billed charges for outpatient setting,$110.25 ,75% of total billed charges for outpatient setting,$110.25 ,75% of total billed charges for outpatient setting,$46.48 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$46.48 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$46.48 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$46.48 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$46.48 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$46.48 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$117.60 ,80% of total billed charges for outpatient setting,$46.48 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$51.45 ,35% of total billed charges for outpatient setting,$124.95 ,85% of total billed charges for outpatient setting,$46.03 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$117.60 ,80% of total billed charges for outpatient setting,$124.95 ,85% of total billed charges for outpatient setting,$102.90 ,70% of total billed charges for outpatient setting,$102.90 ,70% of total billed charges for outpatient setting,$113.19 ,77% of total billed charges for outpatient setting,$46.03 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$124.95 ,85% of total billed charges for outpatient setting,$124.95 ,85% of total billed charges for outpatient setting,$124.95 ,85% of total billed charges for outpatient setting,$124.95 ,85% of total billed charges for outpatient setting,$124.95 ,85% of total billed charges for outpatient setting,$29.24 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$46.03 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$46.03 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$46.03 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$46.03 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$124.95 ,85% of total billed charges for outpatient setting,$28.67 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$45.57 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$132.30 ,90% of total billed charges for outpatient setting,$29.52 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$139.65 ,95% of total billed charges for outpatient setting,$124.95 ,85% of total billed charges for outpatient setting,$117.60 ,80% of total billed charges for outpatient setting,$29.24 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$124.95 ,85% of total billed charges for outpatient setting,$124.95 ,85% of total billed charges for outpatient setting,$124.95 ,85% of total billed charges for outpatient setting,$136.71 ,93% of total billed charges for outpatient setting,$110.25 ,75% of total billed charges for outpatient setting,$110.25 ,75% of total billed charges for outpatient setting,$110.25 ,75% of total billed charges for outpatient setting,$29.52 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$124.95 ,85% of total billed charges for outpatient setting,$29.24 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$28.67 ,$139.65 ,$51.45 Outpatient Medical Services,RADIOLOGY,70260,XR Skull > 4 views,320,$272.00 ,$145.79 ,53.6% of total biled charges for outpatient setting,$145.79 ,53.6% of total biled charges for outpatient setting,$204.00 ,75% of total billed charges for outpatient setting,$204.00 ,75% of total billed charges for outpatient setting,$204.00 ,75% of total billed charges for outpatient setting,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$217.60 ,80% of total billed charges for outpatient setting,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$95.20 ,35% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$217.60 ,80% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$190.40 ,70% of total billed charges for outpatient setting,$190.40 ,70% of total billed charges for outpatient setting,$209.44 ,77% of total billed charges for outpatient setting,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$54.10 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$231.20 ,85% of total billed charges for outpatient setting,$53.04 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$84.32 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$244.80 ,90% of total billed charges for outpatient setting,$54.62 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$258.40 ,95% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$217.60 ,80% of total billed charges for outpatient setting,$54.10 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$252.96 ,93% of total billed charges for outpatient setting,$204.00 ,75% of total billed charges for outpatient setting,$204.00 ,75% of total billed charges for outpatient setting,$204.00 ,75% of total billed charges for outpatient setting,$54.62 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$54.10 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$53.04 ,$258.40 ,$95.20 Outpatient Medical Services,RADIOLOGY,70360,XR Neck Soft Tissue,320,$288.00 ,$154.37 ,53.6% of total biled charges for outpatient setting,$154.37 ,53.6% of total biled charges for outpatient setting,$216.00 ,75% of total billed charges for outpatient setting,$216.00 ,75% of total billed charges for outpatient setting,$216.00 ,75% of total billed charges for outpatient setting,$91.07 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$91.07 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$91.07 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$91.07 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$91.07 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$91.07 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$230.40 ,80% of total billed charges for outpatient setting,$91.07 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$100.80 ,35% of total billed charges for outpatient setting,$244.80 ,85% of total billed charges for outpatient setting,$90.17 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$230.40 ,80% of total billed charges for outpatient setting,$244.80 ,85% of total billed charges for outpatient setting,$201.60 ,70% of total billed charges for outpatient setting,$201.60 ,70% of total billed charges for outpatient setting,$221.76 ,77% of total billed charges for outpatient setting,$90.17 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$244.80 ,85% of total billed charges for outpatient setting,$244.80 ,85% of total billed charges for outpatient setting,$244.80 ,85% of total billed charges for outpatient setting,$244.80 ,85% of total billed charges for outpatient setting,$244.80 ,85% of total billed charges for outpatient setting,$57.28 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$90.17 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$90.17 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$90.17 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$90.17 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$244.80 ,85% of total billed charges for outpatient setting,$56.16 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$89.28 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$259.20 ,90% of total billed charges for outpatient setting,$57.83 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$273.60 ,95% of total billed charges for outpatient setting,$244.80 ,85% of total billed charges for outpatient setting,$230.40 ,80% of total billed charges for outpatient setting,$57.28 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$244.80 ,85% of total billed charges for outpatient setting,$244.80 ,85% of total billed charges for outpatient setting,$244.80 ,85% of total billed charges for outpatient setting,$267.84 ,93% of total billed charges for outpatient setting,$216.00 ,75% of total billed charges for outpatient setting,$216.00 ,75% of total billed charges for outpatient setting,$216.00 ,75% of total billed charges for outpatient setting,$57.83 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$244.80 ,85% of total billed charges for outpatient setting,$57.28 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$56.16 ,$273.60 ,$100.80 Outpatient Medical Services,RADIOLOGY,71045,XR Chest 1 View,324,$86.88 ,$46.57 ,53.6% of total biled charges for outpatient setting,$46.57 ,53.6% of total biled charges for outpatient setting,$65.16 ,75% of total billed charges for outpatient setting,$65.16 ,75% of total billed charges for outpatient setting,$65.16 ,75% of total billed charges for outpatient setting,$27.47 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$27.47 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$27.47 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$27.47 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$27.47 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$27.47 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$69.50 ,80% of total billed charges for outpatient setting,$27.47 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$30.41 ,35% of total billed charges for outpatient setting,$73.85 ,85% of total billed charges for outpatient setting,$27.20 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$69.50 ,80% of total billed charges for outpatient setting,$73.85 ,85% of total billed charges for outpatient setting,$60.82 ,70% of total billed charges for outpatient setting,$60.82 ,70% of total billed charges for outpatient setting,$66.90 ,77% of total billed charges for outpatient setting,$27.20 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$73.85 ,85% of total billed charges for outpatient setting,$73.85 ,85% of total billed charges for outpatient setting,$73.85 ,85% of total billed charges for outpatient setting,$73.85 ,85% of total billed charges for outpatient setting,$73.85 ,85% of total billed charges for outpatient setting,$17.28 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$27.20 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$27.20 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$27.20 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$27.20 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$73.85 ,85% of total billed charges for outpatient setting,$16.94 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$26.93 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$78.19 ,90% of total billed charges for outpatient setting,$17.45 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$82.54 ,95% of total billed charges for outpatient setting,$73.85 ,85% of total billed charges for outpatient setting,$69.50 ,80% of total billed charges for outpatient setting,$17.28 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$73.85 ,85% of total billed charges for outpatient setting,$73.85 ,85% of total billed charges for outpatient setting,$73.85 ,85% of total billed charges for outpatient setting,$80.80 ,93% of total billed charges for outpatient setting,$65.16 ,75% of total billed charges for outpatient setting,$65.16 ,75% of total billed charges for outpatient setting,$65.16 ,75% of total billed charges for outpatient setting,$17.45 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$73.85 ,85% of total billed charges for outpatient setting,$17.28 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$16.94 ,$82.54 ,$30.41 Outpatient Medical Services,RADIOLOGY,71046,XR Chest 2 Views,324,$442.58 ,$237.22 ,53.6% of total biled charges for outpatient setting,$237.22 ,53.6% of total biled charges for outpatient setting,$331.94 ,75% of total billed charges for outpatient setting,$331.94 ,75% of total billed charges for outpatient setting,$331.94 ,75% of total billed charges for outpatient setting,$139.94 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$139.94 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$139.94 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$139.94 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$139.94 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$139.94 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$354.06 ,80% of total billed charges for outpatient setting,$139.94 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$154.90 ,35% of total billed charges for outpatient setting,$376.19 ,85% of total billed charges for outpatient setting,$138.57 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$354.06 ,80% of total billed charges for outpatient setting,$376.19 ,85% of total billed charges for outpatient setting,$309.81 ,70% of total billed charges for outpatient setting,$309.81 ,70% of total billed charges for outpatient setting,$340.79 ,77% of total billed charges for outpatient setting,$138.57 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$376.19 ,85% of total billed charges for outpatient setting,$376.19 ,85% of total billed charges for outpatient setting,$376.19 ,85% of total billed charges for outpatient setting,$376.19 ,85% of total billed charges for outpatient setting,$376.19 ,85% of total billed charges for outpatient setting,$88.03 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$138.57 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$138.57 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$138.57 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$138.57 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$376.19 ,85% of total billed charges for outpatient setting,$86.30 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$137.20 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$398.32 ,90% of total billed charges for outpatient setting,$88.87 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$420.45 ,95% of total billed charges for outpatient setting,$376.19 ,85% of total billed charges for outpatient setting,$354.06 ,80% of total billed charges for outpatient setting,$88.03 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$376.19 ,85% of total billed charges for outpatient setting,$376.19 ,85% of total billed charges for outpatient setting,$376.19 ,85% of total billed charges for outpatient setting,$411.60 ,93% of total billed charges for outpatient setting,$331.94 ,75% of total billed charges for outpatient setting,$331.94 ,75% of total billed charges for outpatient setting,$331.94 ,75% of total billed charges for outpatient setting,$88.87 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$376.19 ,85% of total billed charges for outpatient setting,$88.03 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$86.30 ,$420.45 ,$154.90 Outpatient Medical Services,RADIOLOGY,71101,XR Ribs w/ PA Chest Left,320,$436.00 ,$233.70 ,53.6% of total biled charges for outpatient setting,$233.70 ,53.6% of total biled charges for outpatient setting,$327.00 ,75% of total billed charges for outpatient setting,$327.00 ,75% of total billed charges for outpatient setting,$327.00 ,75% of total billed charges for outpatient setting,$137.86 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$137.86 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$137.86 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$137.86 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$137.86 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$137.86 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$348.80 ,80% of total billed charges for outpatient setting,$137.86 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$152.60 ,35% of total billed charges for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$136.51 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$348.80 ,80% of total billed charges for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$305.20 ,70% of total billed charges for outpatient setting,$305.20 ,70% of total billed charges for outpatient setting,$335.72 ,77% of total billed charges for outpatient setting,$136.51 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$370.60 ,85% of total billed charges for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$86.72 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$136.51 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$136.51 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$136.51 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$136.51 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$370.60 ,85% of total billed charges for outpatient setting,$85.02 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$135.16 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$392.40 ,90% of total billed charges for outpatient setting,$87.55 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$414.20 ,95% of total billed charges for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$348.80 ,80% of total billed charges for outpatient setting,$86.72 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$405.48 ,93% of total billed charges for outpatient setting,$327.00 ,75% of total billed charges for outpatient setting,$327.00 ,75% of total billed charges for outpatient setting,$327.00 ,75% of total billed charges for outpatient setting,$87.55 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$86.72 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$85.02 ,$414.20 ,$152.60 Outpatient Medical Services,RADIOLOGY,71101,XR Ribs w/ PA Chest Right,320,$436.00 ,$233.70 ,53.6% of total biled charges for outpatient setting,$233.70 ,53.6% of total biled charges for outpatient setting,$327.00 ,75% of total billed charges for outpatient setting,$327.00 ,75% of total billed charges for outpatient setting,$327.00 ,75% of total billed charges for outpatient setting,$137.86 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$137.86 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$137.86 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$137.86 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$137.86 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$137.86 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$348.80 ,80% of total billed charges for outpatient setting,$137.86 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$152.60 ,35% of total billed charges for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$136.51 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$348.80 ,80% of total billed charges for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$305.20 ,70% of total billed charges for outpatient setting,$305.20 ,70% of total billed charges for outpatient setting,$335.72 ,77% of total billed charges for outpatient setting,$136.51 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$370.60 ,85% of total billed charges for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$86.72 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$136.51 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$136.51 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$136.51 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$136.51 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$370.60 ,85% of total billed charges for outpatient setting,$85.02 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$135.16 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$392.40 ,90% of total billed charges for outpatient setting,$87.55 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$414.20 ,95% of total billed charges for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$348.80 ,80% of total billed charges for outpatient setting,$86.72 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$405.48 ,93% of total billed charges for outpatient setting,$327.00 ,75% of total billed charges for outpatient setting,$327.00 ,75% of total billed charges for outpatient setting,$327.00 ,75% of total billed charges for outpatient setting,$87.55 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$86.72 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$85.02 ,$414.20 ,$152.60 Outpatient Medical Services,RADIOLOGY,71101,XR Ribs 3 Views Left,320,$436.00 ,$233.70 ,53.6% of total biled charges for outpatient setting,$233.70 ,53.6% of total biled charges for outpatient setting,$327.00 ,75% of total billed charges for outpatient setting,$327.00 ,75% of total billed charges for outpatient setting,$327.00 ,75% of total billed charges for outpatient setting,$137.86 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$137.86 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$137.86 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$137.86 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$137.86 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$137.86 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$348.80 ,80% of total billed charges for outpatient setting,$137.86 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$152.60 ,35% of total billed charges for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$136.51 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$348.80 ,80% of total billed charges for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$305.20 ,70% of total billed charges for outpatient setting,$305.20 ,70% of total billed charges for outpatient setting,$335.72 ,77% of total billed charges for outpatient setting,$136.51 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$370.60 ,85% of total billed charges for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$86.72 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$136.51 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$136.51 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$136.51 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$136.51 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$370.60 ,85% of total billed charges for outpatient setting,$85.02 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$135.16 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$392.40 ,90% of total billed charges for outpatient setting,$87.55 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$414.20 ,95% of total billed charges for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$348.80 ,80% of total billed charges for outpatient setting,$86.72 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$405.48 ,93% of total billed charges for outpatient setting,$327.00 ,75% of total billed charges for outpatient setting,$327.00 ,75% of total billed charges for outpatient setting,$327.00 ,75% of total billed charges for outpatient setting,$87.55 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$86.72 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$85.02 ,$414.20 ,$152.60 Outpatient Medical Services,RADIOLOGY,71101,XR Ribs 3 Views Right,320,$436.00 ,$233.70 ,53.6% of total biled charges for outpatient setting,$233.70 ,53.6% of total biled charges for outpatient setting,$327.00 ,75% of total billed charges for outpatient setting,$327.00 ,75% of total billed charges for outpatient setting,$327.00 ,75% of total billed charges for outpatient setting,$137.86 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$137.86 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$137.86 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$137.86 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$137.86 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$137.86 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$348.80 ,80% of total billed charges for outpatient setting,$137.86 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$152.60 ,35% of total billed charges for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$136.51 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$348.80 ,80% of total billed charges for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$305.20 ,70% of total billed charges for outpatient setting,$305.20 ,70% of total billed charges for outpatient setting,$335.72 ,77% of total billed charges for outpatient setting,$136.51 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$370.60 ,85% of total billed charges for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$86.72 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$136.51 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$136.51 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$136.51 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$136.51 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$370.60 ,85% of total billed charges for outpatient setting,$85.02 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$135.16 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$392.40 ,90% of total billed charges for outpatient setting,$87.55 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$414.20 ,95% of total billed charges for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$348.80 ,80% of total billed charges for outpatient setting,$86.72 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$405.48 ,93% of total billed charges for outpatient setting,$327.00 ,75% of total billed charges for outpatient setting,$327.00 ,75% of total billed charges for outpatient setting,$327.00 ,75% of total billed charges for outpatient setting,$87.55 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$370.60 ,85% of total billed charges for outpatient setting,$86.72 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$85.02 ,$414.20 ,$152.60 Outpatient Medical Services,RADIOLOGY,71110,XR Ribs 3 Views Bilateral,320,$416.64 ,$223.32 ,53.6% of total biled charges for outpatient setting,$223.32 ,53.6% of total biled charges for outpatient setting,$312.48 ,75% of total billed charges for outpatient setting,$312.48 ,75% of total billed charges for outpatient setting,$312.48 ,75% of total billed charges for outpatient setting,$131.74 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$131.74 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$131.74 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$131.74 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$131.74 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$131.74 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$333.31 ,80% of total billed charges for outpatient setting,$131.74 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$145.82 ,35% of total billed charges for outpatient setting,$354.14 ,85% of total billed charges for outpatient setting,$130.45 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$333.31 ,80% of total billed charges for outpatient setting,$354.14 ,85% of total billed charges for outpatient setting,$291.65 ,70% of total billed charges for outpatient setting,$291.65 ,70% of total billed charges for outpatient setting,$320.81 ,77% of total billed charges for outpatient setting,$130.45 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$354.14 ,85% of total billed charges for outpatient setting,$354.14 ,85% of total billed charges for outpatient setting,$354.14 ,85% of total billed charges for outpatient setting,$354.14 ,85% of total billed charges for outpatient setting,$354.14 ,85% of total billed charges for outpatient setting,$82.87 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$130.45 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$130.45 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$130.45 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$130.45 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$354.14 ,85% of total billed charges for outpatient setting,$81.24 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$129.16 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$374.98 ,90% of total billed charges for outpatient setting,$83.66 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$395.81 ,95% of total billed charges for outpatient setting,$354.14 ,85% of total billed charges for outpatient setting,$333.31 ,80% of total billed charges for outpatient setting,$82.87 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$354.14 ,85% of total billed charges for outpatient setting,$354.14 ,85% of total billed charges for outpatient setting,$354.14 ,85% of total billed charges for outpatient setting,$387.48 ,93% of total billed charges for outpatient setting,$312.48 ,75% of total billed charges for outpatient setting,$312.48 ,75% of total billed charges for outpatient setting,$312.48 ,75% of total billed charges for outpatient setting,$83.66 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$354.14 ,85% of total billed charges for outpatient setting,$82.87 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$81.24 ,$395.81 ,$145.82 Outpatient Medical Services,RADIOLOGY,71111,XR Ribs w/ PA Chest Bilateral,324,$175.00 ,$93.80 ,53.6% of total biled charges for outpatient setting,$93.80 ,53.6% of total biled charges for outpatient setting,$131.25 ,75% of total billed charges for outpatient setting,$131.25 ,75% of total billed charges for outpatient setting,$131.25 ,75% of total billed charges for outpatient setting,$55.34 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$55.34 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$55.34 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$55.34 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$55.34 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$55.34 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$140.00 ,80% of total billed charges for outpatient setting,$55.34 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$61.25 ,35% of total billed charges for outpatient setting,$148.75 ,85% of total billed charges for outpatient setting,$54.79 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$140.00 ,80% of total billed charges for outpatient setting,$148.75 ,85% of total billed charges for outpatient setting,$122.50 ,70% of total billed charges for outpatient setting,$122.50 ,70% of total billed charges for outpatient setting,$134.75 ,77% of total billed charges for outpatient setting,$54.79 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$148.75 ,85% of total billed charges for outpatient setting,$148.75 ,85% of total billed charges for outpatient setting,$148.75 ,85% of total billed charges for outpatient setting,$148.75 ,85% of total billed charges for outpatient setting,$148.75 ,85% of total billed charges for outpatient setting,$34.81 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$54.79 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$54.79 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$54.79 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$54.79 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$148.75 ,85% of total billed charges for outpatient setting,$34.13 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$54.25 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$157.50 ,90% of total billed charges for outpatient setting,$35.14 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$166.25 ,95% of total billed charges for outpatient setting,$148.75 ,85% of total billed charges for outpatient setting,$140.00 ,80% of total billed charges for outpatient setting,$34.81 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$148.75 ,85% of total billed charges for outpatient setting,$148.75 ,85% of total billed charges for outpatient setting,$148.75 ,85% of total billed charges for outpatient setting,$162.75 ,93% of total billed charges for outpatient setting,$131.25 ,75% of total billed charges for outpatient setting,$131.25 ,75% of total billed charges for outpatient setting,$131.25 ,75% of total billed charges for outpatient setting,$35.14 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$148.75 ,85% of total billed charges for outpatient setting,$34.81 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$34.13 ,$166.25 ,$61.25 Outpatient Medical Services,RADIOLOGY,71120,XR Sternum 2+ Views,320,$95.00 ,$50.92 ,53.6% of total biled charges for outpatient setting,$50.92 ,53.6% of total biled charges for outpatient setting,$71.25 ,75% of total billed charges for outpatient setting,$71.25 ,75% of total billed charges for outpatient setting,$71.25 ,75% of total billed charges for outpatient setting,$30.04 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$30.04 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$30.04 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$30.04 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$30.04 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$30.04 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$76.00 ,80% of total billed charges for outpatient setting,$30.04 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$33.25 ,35% of total billed charges for outpatient setting,$80.75 ,85% of total billed charges for outpatient setting,$29.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$76.00 ,80% of total billed charges for outpatient setting,$80.75 ,85% of total billed charges for outpatient setting,$66.50 ,70% of total billed charges for outpatient setting,$66.50 ,70% of total billed charges for outpatient setting,$73.15 ,77% of total billed charges for outpatient setting,$29.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$80.75 ,85% of total billed charges for outpatient setting,$80.75 ,85% of total billed charges for outpatient setting,$80.75 ,85% of total billed charges for outpatient setting,$80.75 ,85% of total billed charges for outpatient setting,$80.75 ,85% of total billed charges for outpatient setting,$18.90 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$29.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$29.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$29.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$29.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$80.75 ,85% of total billed charges for outpatient setting,$18.53 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$29.45 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$85.50 ,90% of total billed charges for outpatient setting,$19.08 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$90.25 ,95% of total billed charges for outpatient setting,$80.75 ,85% of total billed charges for outpatient setting,$76.00 ,80% of total billed charges for outpatient setting,$18.90 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$80.75 ,85% of total billed charges for outpatient setting,$80.75 ,85% of total billed charges for outpatient setting,$80.75 ,85% of total billed charges for outpatient setting,$88.35 ,93% of total billed charges for outpatient setting,$71.25 ,75% of total billed charges for outpatient setting,$71.25 ,75% of total billed charges for outpatient setting,$71.25 ,75% of total billed charges for outpatient setting,$19.08 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$80.75 ,85% of total billed charges for outpatient setting,$18.90 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$18.53 ,$90.25 ,$33.25 Outpatient Medical Services,RADIOLOGY,72170,XR Pelvis 1 or 2 Views,320,$299.00 ,$160.26 ,53.6% of total biled charges for outpatient setting,$160.26 ,53.6% of total biled charges for outpatient setting,$224.25 ,75% of total billed charges for outpatient setting,$224.25 ,75% of total billed charges for outpatient setting,$224.25 ,75% of total billed charges for outpatient setting,$94.54 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$94.54 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$94.54 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$94.54 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$94.54 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$94.54 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$239.20 ,80% of total billed charges for outpatient setting,$94.54 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$104.65 ,35% of total billed charges for outpatient setting,$254.15 ,85% of total billed charges for outpatient setting,$93.62 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$239.20 ,80% of total billed charges for outpatient setting,$254.15 ,85% of total billed charges for outpatient setting,$209.30 ,70% of total billed charges for outpatient setting,$209.30 ,70% of total billed charges for outpatient setting,$230.23 ,77% of total billed charges for outpatient setting,$93.62 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$254.15 ,85% of total billed charges for outpatient setting,$254.15 ,85% of total billed charges for outpatient setting,$254.15 ,85% of total billed charges for outpatient setting,$254.15 ,85% of total billed charges for outpatient setting,$254.15 ,85% of total billed charges for outpatient setting,$59.47 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$93.62 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$93.62 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$93.62 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$93.62 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$254.15 ,85% of total billed charges for outpatient setting,$58.31 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$92.69 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$269.10 ,90% of total billed charges for outpatient setting,$60.04 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$284.05 ,95% of total billed charges for outpatient setting,$254.15 ,85% of total billed charges for outpatient setting,$239.20 ,80% of total billed charges for outpatient setting,$59.47 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$254.15 ,85% of total billed charges for outpatient setting,$254.15 ,85% of total billed charges for outpatient setting,$254.15 ,85% of total billed charges for outpatient setting,$278.07 ,93% of total billed charges for outpatient setting,$224.25 ,75% of total billed charges for outpatient setting,$224.25 ,75% of total billed charges for outpatient setting,$224.25 ,75% of total billed charges for outpatient setting,$60.04 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$254.15 ,85% of total billed charges for outpatient setting,$59.47 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$58.31 ,$284.05 ,$104.65 Outpatient Medical Services,RADIOLOGY,72202,XR Sacroiliac Joints 1 or 2 Views,320,$434.00 ,$232.62 ,53.6% of total biled charges for outpatient setting,$232.62 ,53.6% of total biled charges for outpatient setting,$325.50 ,75% of total billed charges for outpatient setting,$325.50 ,75% of total billed charges for outpatient setting,$325.50 ,75% of total billed charges for outpatient setting,$137.23 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$137.23 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$137.23 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$137.23 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$137.23 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$137.23 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$347.20 ,80% of total billed charges for outpatient setting,$137.23 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$151.90 ,35% of total billed charges for outpatient setting,$368.90 ,85% of total billed charges for outpatient setting,$135.89 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$347.20 ,80% of total billed charges for outpatient setting,$368.90 ,85% of total billed charges for outpatient setting,$303.80 ,70% of total billed charges for outpatient setting,$303.80 ,70% of total billed charges for outpatient setting,$334.18 ,77% of total billed charges for outpatient setting,$135.89 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$368.90 ,85% of total billed charges for outpatient setting,$368.90 ,85% of total billed charges for outpatient setting,$368.90 ,85% of total billed charges for outpatient setting,$368.90 ,85% of total billed charges for outpatient setting,$368.90 ,85% of total billed charges for outpatient setting,$86.32 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$135.89 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$135.89 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$135.89 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$135.89 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$368.90 ,85% of total billed charges for outpatient setting,$84.63 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$134.54 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$390.60 ,90% of total billed charges for outpatient setting,$87.15 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$412.30 ,95% of total billed charges for outpatient setting,$368.90 ,85% of total billed charges for outpatient setting,$347.20 ,80% of total billed charges for outpatient setting,$86.32 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$368.90 ,85% of total billed charges for outpatient setting,$368.90 ,85% of total billed charges for outpatient setting,$368.90 ,85% of total billed charges for outpatient setting,$403.62 ,93% of total billed charges for outpatient setting,$325.50 ,75% of total billed charges for outpatient setting,$325.50 ,75% of total billed charges for outpatient setting,$325.50 ,75% of total billed charges for outpatient setting,$87.15 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$368.90 ,85% of total billed charges for outpatient setting,$86.32 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$84.63 ,$412.30 ,$151.90 Outpatient Medical Services,RADIOLOGY,73000,XR Clavicle Left,320,$478.00 ,$256.21 ,53.6% of total biled charges for outpatient setting,$256.21 ,53.6% of total biled charges for outpatient setting,$358.50 ,75% of total billed charges for outpatient setting,$358.50 ,75% of total billed charges for outpatient setting,$358.50 ,75% of total billed charges for outpatient setting,$151.14 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$151.14 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$151.14 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$151.14 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$151.14 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$151.14 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$382.40 ,80% of total billed charges for outpatient setting,$151.14 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$167.30 ,35% of total billed charges for outpatient setting,$406.30 ,85% of total billed charges for outpatient setting,$149.66 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$382.40 ,80% of total billed charges for outpatient setting,$406.30 ,85% of total billed charges for outpatient setting,$334.60 ,70% of total billed charges for outpatient setting,$334.60 ,70% of total billed charges for outpatient setting,$368.06 ,77% of total billed charges for outpatient setting,$149.66 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$406.30 ,85% of total billed charges for outpatient setting,$406.30 ,85% of total billed charges for outpatient setting,$406.30 ,85% of total billed charges for outpatient setting,$406.30 ,85% of total billed charges for outpatient setting,$406.30 ,85% of total billed charges for outpatient setting,$95.07 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$149.66 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$149.66 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$149.66 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$149.66 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$406.30 ,85% of total billed charges for outpatient setting,$93.21 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$148.18 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$430.20 ,90% of total billed charges for outpatient setting,$95.98 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$454.10 ,95% of total billed charges for outpatient setting,$406.30 ,85% of total billed charges for outpatient setting,$382.40 ,80% of total billed charges for outpatient setting,$95.07 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$406.30 ,85% of total billed charges for outpatient setting,$406.30 ,85% of total billed charges for outpatient setting,$406.30 ,85% of total billed charges for outpatient setting,$444.54 ,93% of total billed charges for outpatient setting,$358.50 ,75% of total billed charges for outpatient setting,$358.50 ,75% of total billed charges for outpatient setting,$358.50 ,75% of total billed charges for outpatient setting,$95.98 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$406.30 ,85% of total billed charges for outpatient setting,$95.07 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$93.21 ,$454.10 ,$167.30 Outpatient Medical Services,RADIOLOGY,73000,XR Clavicle Right,320,$478.00 ,$256.21 ,53.6% of total biled charges for outpatient setting,$256.21 ,53.6% of total biled charges for outpatient setting,$358.50 ,75% of total billed charges for outpatient setting,$358.50 ,75% of total billed charges for outpatient setting,$358.50 ,75% of total billed charges for outpatient setting,$151.14 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$151.14 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$151.14 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$151.14 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$151.14 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$151.14 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$382.40 ,80% of total billed charges for outpatient setting,$151.14 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$167.30 ,35% of total billed charges for outpatient setting,$406.30 ,85% of total billed charges for outpatient setting,$149.66 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$382.40 ,80% of total billed charges for outpatient setting,$406.30 ,85% of total billed charges for outpatient setting,$334.60 ,70% of total billed charges for outpatient setting,$334.60 ,70% of total billed charges for outpatient setting,$368.06 ,77% of total billed charges for outpatient setting,$149.66 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$406.30 ,85% of total billed charges for outpatient setting,$406.30 ,85% of total billed charges for outpatient setting,$406.30 ,85% of total billed charges for outpatient setting,$406.30 ,85% of total billed charges for outpatient setting,$406.30 ,85% of total billed charges for outpatient setting,$95.07 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$149.66 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$149.66 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$149.66 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$149.66 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$406.30 ,85% of total billed charges for outpatient setting,$93.21 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$148.18 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$430.20 ,90% of total billed charges for outpatient setting,$95.98 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$454.10 ,95% of total billed charges for outpatient setting,$406.30 ,85% of total billed charges for outpatient setting,$382.40 ,80% of total billed charges for outpatient setting,$95.07 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$406.30 ,85% of total billed charges for outpatient setting,$406.30 ,85% of total billed charges for outpatient setting,$406.30 ,85% of total billed charges for outpatient setting,$444.54 ,93% of total billed charges for outpatient setting,$358.50 ,75% of total billed charges for outpatient setting,$358.50 ,75% of total billed charges for outpatient setting,$358.50 ,75% of total billed charges for outpatient setting,$95.98 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$406.30 ,85% of total billed charges for outpatient setting,$95.07 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$93.21 ,$454.10 ,$167.30 Outpatient Medical Services,RADIOLOGY,73020,XR Shoulder 1 View Right,320,$95.00 ,$50.92 ,53.6% of total biled charges for outpatient setting,$50.92 ,53.6% of total biled charges for outpatient setting,$71.25 ,75% of total billed charges for outpatient setting,$71.25 ,75% of total billed charges for outpatient setting,$71.25 ,75% of total billed charges for outpatient setting,$30.04 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$30.04 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$30.04 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$30.04 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$30.04 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$30.04 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$76.00 ,80% of total billed charges for outpatient setting,$30.04 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$33.25 ,35% of total billed charges for outpatient setting,$80.75 ,85% of total billed charges for outpatient setting,$29.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$76.00 ,80% of total billed charges for outpatient setting,$80.75 ,85% of total billed charges for outpatient setting,$66.50 ,70% of total billed charges for outpatient setting,$66.50 ,70% of total billed charges for outpatient setting,$73.15 ,77% of total billed charges for outpatient setting,$29.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$80.75 ,85% of total billed charges for outpatient setting,$80.75 ,85% of total billed charges for outpatient setting,$80.75 ,85% of total billed charges for outpatient setting,$80.75 ,85% of total billed charges for outpatient setting,$80.75 ,85% of total billed charges for outpatient setting,$18.90 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$29.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$29.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$29.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$29.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$80.75 ,85% of total billed charges for outpatient setting,$18.53 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$29.45 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$85.50 ,90% of total billed charges for outpatient setting,$19.08 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$90.25 ,95% of total billed charges for outpatient setting,$80.75 ,85% of total billed charges for outpatient setting,$76.00 ,80% of total billed charges for outpatient setting,$18.90 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$80.75 ,85% of total billed charges for outpatient setting,$80.75 ,85% of total billed charges for outpatient setting,$80.75 ,85% of total billed charges for outpatient setting,$88.35 ,93% of total billed charges for outpatient setting,$71.25 ,75% of total billed charges for outpatient setting,$71.25 ,75% of total billed charges for outpatient setting,$71.25 ,75% of total billed charges for outpatient setting,$19.08 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$80.75 ,85% of total billed charges for outpatient setting,$18.90 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$18.53 ,$90.25 ,$33.25 Outpatient Medical Services,RADIOLOGY,73030,XR Shoulder Complete 2+ Views Left,320,$317.53 ,$170.20 ,53.6% of total biled charges for outpatient setting,$170.20 ,53.6% of total biled charges for outpatient setting,$238.15 ,75% of total billed charges for outpatient setting,$238.15 ,75% of total billed charges for outpatient setting,$238.15 ,75% of total billed charges for outpatient setting,$100.40 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$100.40 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$100.40 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$100.40 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$100.40 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$100.40 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$254.02 ,80% of total billed charges for outpatient setting,$100.40 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$111.14 ,35% of total billed charges for outpatient setting,$269.90 ,85% of total billed charges for outpatient setting,$99.42 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$254.02 ,80% of total billed charges for outpatient setting,$269.90 ,85% of total billed charges for outpatient setting,$222.27 ,70% of total billed charges for outpatient setting,$222.27 ,70% of total billed charges for outpatient setting,$244.50 ,77% of total billed charges for outpatient setting,$99.42 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$269.90 ,85% of total billed charges for outpatient setting,$269.90 ,85% of total billed charges for outpatient setting,$269.90 ,85% of total billed charges for outpatient setting,$269.90 ,85% of total billed charges for outpatient setting,$269.90 ,85% of total billed charges for outpatient setting,$63.16 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$99.42 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$99.42 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$99.42 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$99.42 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$269.90 ,85% of total billed charges for outpatient setting,$61.92 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$98.43 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$285.78 ,90% of total billed charges for outpatient setting,$63.76 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$301.65 ,95% of total billed charges for outpatient setting,$269.90 ,85% of total billed charges for outpatient setting,$254.02 ,80% of total billed charges for outpatient setting,$63.16 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$269.90 ,85% of total billed charges for outpatient setting,$269.90 ,85% of total billed charges for outpatient setting,$269.90 ,85% of total billed charges for outpatient setting,$295.30 ,93% of total billed charges for outpatient setting,$238.15 ,75% of total billed charges for outpatient setting,$238.15 ,75% of total billed charges for outpatient setting,$238.15 ,75% of total billed charges for outpatient setting,$63.76 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$269.90 ,85% of total billed charges for outpatient setting,$63.16 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$61.92 ,$301.65 ,$111.14 Outpatient Medical Services,RADIOLOGY,73030,XR Shoulder Complete 2+ Views Right,320,$317.53 ,$170.20 ,53.6% of total biled charges for outpatient setting,$170.20 ,53.6% of total biled charges for outpatient setting,$238.15 ,75% of total billed charges for outpatient setting,$238.15 ,75% of total billed charges for outpatient setting,$238.15 ,75% of total billed charges for outpatient setting,$100.40 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$100.40 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$100.40 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$100.40 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$100.40 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$100.40 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$254.02 ,80% of total billed charges for outpatient setting,$100.40 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$111.14 ,35% of total billed charges for outpatient setting,$269.90 ,85% of total billed charges for outpatient setting,$99.42 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$254.02 ,80% of total billed charges for outpatient setting,$269.90 ,85% of total billed charges for outpatient setting,$222.27 ,70% of total billed charges for outpatient setting,$222.27 ,70% of total billed charges for outpatient setting,$244.50 ,77% of total billed charges for outpatient setting,$99.42 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$269.90 ,85% of total billed charges for outpatient setting,$269.90 ,85% of total billed charges for outpatient setting,$269.90 ,85% of total billed charges for outpatient setting,$269.90 ,85% of total billed charges for outpatient setting,$269.90 ,85% of total billed charges for outpatient setting,$63.16 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$99.42 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$99.42 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$99.42 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$99.42 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$269.90 ,85% of total billed charges for outpatient setting,$61.92 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$98.43 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$285.78 ,90% of total billed charges for outpatient setting,$63.76 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$301.65 ,95% of total billed charges for outpatient setting,$269.90 ,85% of total billed charges for outpatient setting,$254.02 ,80% of total billed charges for outpatient setting,$63.16 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$269.90 ,85% of total billed charges for outpatient setting,$269.90 ,85% of total billed charges for outpatient setting,$269.90 ,85% of total billed charges for outpatient setting,$295.30 ,93% of total billed charges for outpatient setting,$238.15 ,75% of total billed charges for outpatient setting,$238.15 ,75% of total billed charges for outpatient setting,$238.15 ,75% of total billed charges for outpatient setting,$63.76 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$269.90 ,85% of total billed charges for outpatient setting,$63.16 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$61.92 ,$301.65 ,$111.14 Outpatient Medical Services,RADIOLOGY,73060,XR Humerus Left,320,$331.58 ,$177.73 ,53.6% of total biled charges for outpatient setting,$177.73 ,53.6% of total biled charges for outpatient setting,$248.69 ,75% of total billed charges for outpatient setting,$248.69 ,75% of total billed charges for outpatient setting,$248.69 ,75% of total billed charges for outpatient setting,$104.85 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$104.85 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$104.85 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$104.85 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$104.85 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$104.85 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$265.26 ,80% of total billed charges for outpatient setting,$104.85 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$116.05 ,35% of total billed charges for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$103.82 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$265.26 ,80% of total billed charges for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$232.11 ,70% of total billed charges for outpatient setting,$232.11 ,70% of total billed charges for outpatient setting,$255.32 ,77% of total billed charges for outpatient setting,$103.82 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$281.84 ,85% of total billed charges for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$65.95 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$103.82 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$103.82 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$103.82 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$103.82 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$281.84 ,85% of total billed charges for outpatient setting,$64.66 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$102.79 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$298.42 ,90% of total billed charges for outpatient setting,$66.58 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$315.00 ,95% of total billed charges for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$265.26 ,80% of total billed charges for outpatient setting,$65.95 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$308.37 ,93% of total billed charges for outpatient setting,$248.69 ,75% of total billed charges for outpatient setting,$248.69 ,75% of total billed charges for outpatient setting,$248.69 ,75% of total billed charges for outpatient setting,$66.58 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$65.95 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$64.66 ,$315.00 ,$116.05 Outpatient Medical Services,RADIOLOGY,73060,XR Humerus Right,320,$331.58 ,$177.73 ,53.6% of total biled charges for outpatient setting,$177.73 ,53.6% of total biled charges for outpatient setting,$248.69 ,75% of total billed charges for outpatient setting,$248.69 ,75% of total billed charges for outpatient setting,$248.69 ,75% of total billed charges for outpatient setting,$104.85 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$104.85 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$104.85 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$104.85 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$104.85 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$104.85 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$265.26 ,80% of total billed charges for outpatient setting,$104.85 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$116.05 ,35% of total billed charges for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$103.82 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$265.26 ,80% of total billed charges for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$232.11 ,70% of total billed charges for outpatient setting,$232.11 ,70% of total billed charges for outpatient setting,$255.32 ,77% of total billed charges for outpatient setting,$103.82 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$281.84 ,85% of total billed charges for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$65.95 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$103.82 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$103.82 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$103.82 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$103.82 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$281.84 ,85% of total billed charges for outpatient setting,$64.66 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$102.79 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$298.42 ,90% of total billed charges for outpatient setting,$66.58 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$315.00 ,95% of total billed charges for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$265.26 ,80% of total billed charges for outpatient setting,$65.95 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$308.37 ,93% of total billed charges for outpatient setting,$248.69 ,75% of total billed charges for outpatient setting,$248.69 ,75% of total billed charges for outpatient setting,$248.69 ,75% of total billed charges for outpatient setting,$66.58 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$65.95 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$64.66 ,$315.00 ,$116.05 Outpatient Medical Services,RADIOLOGY,73070,XR Elbow 2 Views Left,320,$450.00 ,$241.20 ,53.6% of total biled charges for outpatient setting,$241.20 ,53.6% of total biled charges for outpatient setting,$337.50 ,75% of total billed charges for outpatient setting,$337.50 ,75% of total billed charges for outpatient setting,$337.50 ,75% of total billed charges for outpatient setting,$142.29 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$142.29 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$142.29 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$142.29 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$142.29 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$142.29 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$360.00 ,80% of total billed charges for outpatient setting,$142.29 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$157.50 ,35% of total billed charges for outpatient setting,$382.50 ,85% of total billed charges for outpatient setting,$140.90 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$360.00 ,80% of total billed charges for outpatient setting,$382.50 ,85% of total billed charges for outpatient setting,$315.00 ,70% of total billed charges for outpatient setting,$315.00 ,70% of total billed charges for outpatient setting,$346.50 ,77% of total billed charges for outpatient setting,$140.90 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$382.50 ,85% of total billed charges for outpatient setting,$382.50 ,85% of total billed charges for outpatient setting,$382.50 ,85% of total billed charges for outpatient setting,$382.50 ,85% of total billed charges for outpatient setting,$382.50 ,85% of total billed charges for outpatient setting,$89.51 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$140.90 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$140.90 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$140.90 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$140.90 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$382.50 ,85% of total billed charges for outpatient setting,$87.75 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$139.50 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$405.00 ,90% of total billed charges for outpatient setting,$90.36 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$427.50 ,95% of total billed charges for outpatient setting,$382.50 ,85% of total billed charges for outpatient setting,$360.00 ,80% of total billed charges for outpatient setting,$89.51 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$382.50 ,85% of total billed charges for outpatient setting,$382.50 ,85% of total billed charges for outpatient setting,$382.50 ,85% of total billed charges for outpatient setting,$418.50 ,93% of total billed charges for outpatient setting,$337.50 ,75% of total billed charges for outpatient setting,$337.50 ,75% of total billed charges for outpatient setting,$337.50 ,75% of total billed charges for outpatient setting,$90.36 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$382.50 ,85% of total billed charges for outpatient setting,$89.51 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$87.75 ,$427.50 ,$157.50 Outpatient Medical Services,RADIOLOGY,73070,XR Elbow 2 Views Right,320,$450.00 ,$241.20 ,53.6% of total biled charges for outpatient setting,$241.20 ,53.6% of total biled charges for outpatient setting,$337.50 ,75% of total billed charges for outpatient setting,$337.50 ,75% of total billed charges for outpatient setting,$337.50 ,75% of total billed charges for outpatient setting,$142.29 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$142.29 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$142.29 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$142.29 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$142.29 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$142.29 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$360.00 ,80% of total billed charges for outpatient setting,$142.29 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$157.50 ,35% of total billed charges for outpatient setting,$382.50 ,85% of total billed charges for outpatient setting,$140.90 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$360.00 ,80% of total billed charges for outpatient setting,$382.50 ,85% of total billed charges for outpatient setting,$315.00 ,70% of total billed charges for outpatient setting,$315.00 ,70% of total billed charges for outpatient setting,$346.50 ,77% of total billed charges for outpatient setting,$140.90 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$382.50 ,85% of total billed charges for outpatient setting,$382.50 ,85% of total billed charges for outpatient setting,$382.50 ,85% of total billed charges for outpatient setting,$382.50 ,85% of total billed charges for outpatient setting,$382.50 ,85% of total billed charges for outpatient setting,$89.51 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$140.90 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$140.90 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$140.90 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$140.90 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$382.50 ,85% of total billed charges for outpatient setting,$87.75 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$139.50 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$405.00 ,90% of total billed charges for outpatient setting,$90.36 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$427.50 ,95% of total billed charges for outpatient setting,$382.50 ,85% of total billed charges for outpatient setting,$360.00 ,80% of total billed charges for outpatient setting,$89.51 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$382.50 ,85% of total billed charges for outpatient setting,$382.50 ,85% of total billed charges for outpatient setting,$382.50 ,85% of total billed charges for outpatient setting,$418.50 ,93% of total billed charges for outpatient setting,$337.50 ,75% of total billed charges for outpatient setting,$337.50 ,75% of total billed charges for outpatient setting,$337.50 ,75% of total billed charges for outpatient setting,$90.36 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$382.50 ,85% of total billed charges for outpatient setting,$89.51 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$87.75 ,$427.50 ,$157.50 Outpatient Medical Services,RADIOLOGY,73080,XR Elbow Complete 3+ Views Left,320,$398.26 ,$213.47 ,53.6% of total biled charges for outpatient setting,$213.47 ,53.6% of total biled charges for outpatient setting,$298.70 ,75% of total billed charges for outpatient setting,$298.70 ,75% of total billed charges for outpatient setting,$298.70 ,75% of total billed charges for outpatient setting,$125.93 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$125.93 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$125.93 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$125.93 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$125.93 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$125.93 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$318.61 ,80% of total billed charges for outpatient setting,$125.93 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$139.39 ,35% of total billed charges for outpatient setting,$338.52 ,85% of total billed charges for outpatient setting,$124.70 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$318.61 ,80% of total billed charges for outpatient setting,$338.52 ,85% of total billed charges for outpatient setting,$278.78 ,70% of total billed charges for outpatient setting,$278.78 ,70% of total billed charges for outpatient setting,$306.66 ,77% of total billed charges for outpatient setting,$124.70 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$338.52 ,85% of total billed charges for outpatient setting,$338.52 ,85% of total billed charges for outpatient setting,$338.52 ,85% of total billed charges for outpatient setting,$338.52 ,85% of total billed charges for outpatient setting,$338.52 ,85% of total billed charges for outpatient setting,$79.21 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$124.70 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$124.70 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$124.70 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$124.70 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$338.52 ,85% of total billed charges for outpatient setting,$77.66 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$123.46 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$358.43 ,90% of total billed charges for outpatient setting,$79.97 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$378.35 ,95% of total billed charges for outpatient setting,$338.52 ,85% of total billed charges for outpatient setting,$318.61 ,80% of total billed charges for outpatient setting,$79.21 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$338.52 ,85% of total billed charges for outpatient setting,$338.52 ,85% of total billed charges for outpatient setting,$338.52 ,85% of total billed charges for outpatient setting,$370.38 ,93% of total billed charges for outpatient setting,$298.70 ,75% of total billed charges for outpatient setting,$298.70 ,75% of total billed charges for outpatient setting,$298.70 ,75% of total billed charges for outpatient setting,$79.97 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$338.52 ,85% of total billed charges for outpatient setting,$79.21 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$77.66 ,$378.35 ,$139.39 Outpatient Medical Services,RADIOLOGY,73080,XR Elbow Complete 3+ Views Right,320,$398.26 ,$213.47 ,53.6% of total biled charges for outpatient setting,$213.47 ,53.6% of total biled charges for outpatient setting,$298.70 ,75% of total billed charges for outpatient setting,$298.70 ,75% of total billed charges for outpatient setting,$298.70 ,75% of total billed charges for outpatient setting,$125.93 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$125.93 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$125.93 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$125.93 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$125.93 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$125.93 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$318.61 ,80% of total billed charges for outpatient setting,$125.93 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$139.39 ,35% of total billed charges for outpatient setting,$338.52 ,85% of total billed charges for outpatient setting,$124.70 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$318.61 ,80% of total billed charges for outpatient setting,$338.52 ,85% of total billed charges for outpatient setting,$278.78 ,70% of total billed charges for outpatient setting,$278.78 ,70% of total billed charges for outpatient setting,$306.66 ,77% of total billed charges for outpatient setting,$124.70 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$338.52 ,85% of total billed charges for outpatient setting,$338.52 ,85% of total billed charges for outpatient setting,$338.52 ,85% of total billed charges for outpatient setting,$338.52 ,85% of total billed charges for outpatient setting,$338.52 ,85% of total billed charges for outpatient setting,$79.21 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$124.70 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$124.70 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$124.70 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$124.70 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$338.52 ,85% of total billed charges for outpatient setting,$77.66 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$123.46 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$358.43 ,90% of total billed charges for outpatient setting,$79.97 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$378.35 ,95% of total billed charges for outpatient setting,$338.52 ,85% of total billed charges for outpatient setting,$318.61 ,80% of total billed charges for outpatient setting,$79.21 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$338.52 ,85% of total billed charges for outpatient setting,$338.52 ,85% of total billed charges for outpatient setting,$338.52 ,85% of total billed charges for outpatient setting,$370.38 ,93% of total billed charges for outpatient setting,$298.70 ,75% of total billed charges for outpatient setting,$298.70 ,75% of total billed charges for outpatient setting,$298.70 ,75% of total billed charges for outpatient setting,$79.97 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$338.52 ,85% of total billed charges for outpatient setting,$79.21 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$77.66 ,$378.35 ,$139.39 Outpatient Medical Services,RADIOLOGY,73100,XR Wrist 2 Views Right,320,$389.00 ,$208.50 ,53.6% of total biled charges for outpatient setting,$208.50 ,53.6% of total biled charges for outpatient setting,$291.75 ,75% of total billed charges for outpatient setting,$291.75 ,75% of total billed charges for outpatient setting,$291.75 ,75% of total billed charges for outpatient setting,$123.00 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$123.00 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$123.00 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$123.00 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$123.00 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$123.00 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$311.20 ,80% of total billed charges for outpatient setting,$123.00 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$136.15 ,35% of total billed charges for outpatient setting,$330.65 ,85% of total billed charges for outpatient setting,$121.80 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$311.20 ,80% of total billed charges for outpatient setting,$330.65 ,85% of total billed charges for outpatient setting,$272.30 ,70% of total billed charges for outpatient setting,$272.30 ,70% of total billed charges for outpatient setting,$299.53 ,77% of total billed charges for outpatient setting,$121.80 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$330.65 ,85% of total billed charges for outpatient setting,$330.65 ,85% of total billed charges for outpatient setting,$330.65 ,85% of total billed charges for outpatient setting,$330.65 ,85% of total billed charges for outpatient setting,$330.65 ,85% of total billed charges for outpatient setting,$77.37 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$121.80 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$121.80 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$121.80 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$121.80 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$330.65 ,85% of total billed charges for outpatient setting,$75.86 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$120.59 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$350.10 ,90% of total billed charges for outpatient setting,$78.11 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$369.55 ,95% of total billed charges for outpatient setting,$330.65 ,85% of total billed charges for outpatient setting,$311.20 ,80% of total billed charges for outpatient setting,$77.37 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$330.65 ,85% of total billed charges for outpatient setting,$330.65 ,85% of total billed charges for outpatient setting,$330.65 ,85% of total billed charges for outpatient setting,$361.77 ,93% of total billed charges for outpatient setting,$291.75 ,75% of total billed charges for outpatient setting,$291.75 ,75% of total billed charges for outpatient setting,$291.75 ,75% of total billed charges for outpatient setting,$78.11 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$330.65 ,85% of total billed charges for outpatient setting,$77.37 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$75.86 ,$369.55 ,$136.15 Outpatient Medical Services,RADIOLOGY,73110,XR Wrist Complete 3+ Views Left,320,$369.66 ,$198.14 ,53.6% of total biled charges for outpatient setting,$198.14 ,53.6% of total biled charges for outpatient setting,$277.25 ,75% of total billed charges for outpatient setting,$277.25 ,75% of total billed charges for outpatient setting,$277.25 ,75% of total billed charges for outpatient setting,$116.89 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$116.89 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$116.89 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$116.89 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$116.89 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$116.89 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$295.73 ,80% of total billed charges for outpatient setting,$116.89 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$129.38 ,35% of total billed charges for outpatient setting,$314.21 ,85% of total billed charges for outpatient setting,$115.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$295.73 ,80% of total billed charges for outpatient setting,$314.21 ,85% of total billed charges for outpatient setting,$258.76 ,70% of total billed charges for outpatient setting,$258.76 ,70% of total billed charges for outpatient setting,$284.64 ,77% of total billed charges for outpatient setting,$115.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$314.21 ,85% of total billed charges for outpatient setting,$314.21 ,85% of total billed charges for outpatient setting,$314.21 ,85% of total billed charges for outpatient setting,$314.21 ,85% of total billed charges for outpatient setting,$314.21 ,85% of total billed charges for outpatient setting,$73.53 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$115.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$115.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$115.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$115.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$314.21 ,85% of total billed charges for outpatient setting,$72.08 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$114.59 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$332.69 ,90% of total billed charges for outpatient setting,$74.23 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$351.18 ,95% of total billed charges for outpatient setting,$314.21 ,85% of total billed charges for outpatient setting,$295.73 ,80% of total billed charges for outpatient setting,$73.53 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$314.21 ,85% of total billed charges for outpatient setting,$314.21 ,85% of total billed charges for outpatient setting,$314.21 ,85% of total billed charges for outpatient setting,$343.78 ,93% of total billed charges for outpatient setting,$277.25 ,75% of total billed charges for outpatient setting,$277.25 ,75% of total billed charges for outpatient setting,$277.25 ,75% of total billed charges for outpatient setting,$74.23 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$314.21 ,85% of total billed charges for outpatient setting,$73.53 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$72.08 ,$351.18 ,$129.38 Outpatient Medical Services,RADIOLOGY,73110,XR Wrist Complete 3+ Views Right,320,$369.66 ,$198.14 ,53.6% of total biled charges for outpatient setting,$198.14 ,53.6% of total biled charges for outpatient setting,$277.25 ,75% of total billed charges for outpatient setting,$277.25 ,75% of total billed charges for outpatient setting,$277.25 ,75% of total billed charges for outpatient setting,$116.89 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$116.89 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$116.89 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$116.89 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$116.89 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$116.89 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$295.73 ,80% of total billed charges for outpatient setting,$116.89 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$129.38 ,35% of total billed charges for outpatient setting,$314.21 ,85% of total billed charges for outpatient setting,$115.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$295.73 ,80% of total billed charges for outpatient setting,$314.21 ,85% of total billed charges for outpatient setting,$258.76 ,70% of total billed charges for outpatient setting,$258.76 ,70% of total billed charges for outpatient setting,$284.64 ,77% of total billed charges for outpatient setting,$115.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$314.21 ,85% of total billed charges for outpatient setting,$314.21 ,85% of total billed charges for outpatient setting,$314.21 ,85% of total billed charges for outpatient setting,$314.21 ,85% of total billed charges for outpatient setting,$314.21 ,85% of total billed charges for outpatient setting,$73.53 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$115.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$115.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$115.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$115.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$314.21 ,85% of total billed charges for outpatient setting,$72.08 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$114.59 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$332.69 ,90% of total billed charges for outpatient setting,$74.23 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$351.18 ,95% of total billed charges for outpatient setting,$314.21 ,85% of total billed charges for outpatient setting,$295.73 ,80% of total billed charges for outpatient setting,$73.53 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$314.21 ,85% of total billed charges for outpatient setting,$314.21 ,85% of total billed charges for outpatient setting,$314.21 ,85% of total billed charges for outpatient setting,$343.78 ,93% of total billed charges for outpatient setting,$277.25 ,75% of total billed charges for outpatient setting,$277.25 ,75% of total billed charges for outpatient setting,$277.25 ,75% of total billed charges for outpatient setting,$74.23 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$314.21 ,85% of total billed charges for outpatient setting,$73.53 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$72.08 ,$351.18 ,$129.38 Outpatient Medical Services,RADIOLOGY,73130,XR Hand Complete 3+ Views Bilateral,320,$264.14 ,$141.58 ,53.6% of total biled charges for outpatient setting,$141.58 ,53.6% of total biled charges for outpatient setting,$198.11 ,75% of total billed charges for outpatient setting,$198.11 ,75% of total billed charges for outpatient setting,$198.11 ,75% of total billed charges for outpatient setting,$83.52 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$83.52 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$83.52 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$83.52 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$83.52 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$83.52 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$211.31 ,80% of total billed charges for outpatient setting,$83.52 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$92.45 ,35% of total billed charges for outpatient setting,$224.52 ,85% of total billed charges for outpatient setting,$82.70 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$211.31 ,80% of total billed charges for outpatient setting,$224.52 ,85% of total billed charges for outpatient setting,$184.90 ,70% of total billed charges for outpatient setting,$184.90 ,70% of total billed charges for outpatient setting,$203.39 ,77% of total billed charges for outpatient setting,$82.70 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$224.52 ,85% of total billed charges for outpatient setting,$224.52 ,85% of total billed charges for outpatient setting,$224.52 ,85% of total billed charges for outpatient setting,$224.52 ,85% of total billed charges for outpatient setting,$224.52 ,85% of total billed charges for outpatient setting,$52.54 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$82.70 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$82.70 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$82.70 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$82.70 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$224.52 ,85% of total billed charges for outpatient setting,$51.51 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$81.88 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$237.73 ,90% of total billed charges for outpatient setting,$53.04 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$250.93 ,95% of total billed charges for outpatient setting,$224.52 ,85% of total billed charges for outpatient setting,$211.31 ,80% of total billed charges for outpatient setting,$52.54 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$224.52 ,85% of total billed charges for outpatient setting,$224.52 ,85% of total billed charges for outpatient setting,$224.52 ,85% of total billed charges for outpatient setting,$245.65 ,93% of total billed charges for outpatient setting,$198.11 ,75% of total billed charges for outpatient setting,$198.11 ,75% of total billed charges for outpatient setting,$198.11 ,75% of total billed charges for outpatient setting,$53.04 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$224.52 ,85% of total billed charges for outpatient setting,$52.54 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$51.51 ,$250.93 ,$92.45 Outpatient Medical Services,RADIOLOGY,73130,XR Hand Complete 3+ Views Left,320,$264.14 ,$141.58 ,53.6% of total biled charges for outpatient setting,$141.58 ,53.6% of total biled charges for outpatient setting,$198.11 ,75% of total billed charges for outpatient setting,$198.11 ,75% of total billed charges for outpatient setting,$198.11 ,75% of total billed charges for outpatient setting,$83.52 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$83.52 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$83.52 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$83.52 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$83.52 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$83.52 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$211.31 ,80% of total billed charges for outpatient setting,$83.52 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$92.45 ,35% of total billed charges for outpatient setting,$224.52 ,85% of total billed charges for outpatient setting,$82.70 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$211.31 ,80% of total billed charges for outpatient setting,$224.52 ,85% of total billed charges for outpatient setting,$184.90 ,70% of total billed charges for outpatient setting,$184.90 ,70% of total billed charges for outpatient setting,$203.39 ,77% of total billed charges for outpatient setting,$82.70 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$224.52 ,85% of total billed charges for outpatient setting,$224.52 ,85% of total billed charges for outpatient setting,$224.52 ,85% of total billed charges for outpatient setting,$224.52 ,85% of total billed charges for outpatient setting,$224.52 ,85% of total billed charges for outpatient setting,$52.54 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$82.70 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$82.70 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$82.70 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$82.70 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$224.52 ,85% of total billed charges for outpatient setting,$51.51 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$81.88 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$237.73 ,90% of total billed charges for outpatient setting,$53.04 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$250.93 ,95% of total billed charges for outpatient setting,$224.52 ,85% of total billed charges for outpatient setting,$211.31 ,80% of total billed charges for outpatient setting,$52.54 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$224.52 ,85% of total billed charges for outpatient setting,$224.52 ,85% of total billed charges for outpatient setting,$224.52 ,85% of total billed charges for outpatient setting,$245.65 ,93% of total billed charges for outpatient setting,$198.11 ,75% of total billed charges for outpatient setting,$198.11 ,75% of total billed charges for outpatient setting,$198.11 ,75% of total billed charges for outpatient setting,$53.04 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$224.52 ,85% of total billed charges for outpatient setting,$52.54 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$51.51 ,$250.93 ,$92.45 Outpatient Medical Services,RADIOLOGY,73130,XR Hand Complete 3+ Views Right,320,$264.14 ,$141.58 ,53.6% of total biled charges for outpatient setting,$141.58 ,53.6% of total biled charges for outpatient setting,$198.11 ,75% of total billed charges for outpatient setting,$198.11 ,75% of total billed charges for outpatient setting,$198.11 ,75% of total billed charges for outpatient setting,$83.52 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$83.52 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$83.52 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$83.52 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$83.52 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$83.52 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$211.31 ,80% of total billed charges for outpatient setting,$83.52 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$92.45 ,35% of total billed charges for outpatient setting,$224.52 ,85% of total billed charges for outpatient setting,$82.70 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$211.31 ,80% of total billed charges for outpatient setting,$224.52 ,85% of total billed charges for outpatient setting,$184.90 ,70% of total billed charges for outpatient setting,$184.90 ,70% of total billed charges for outpatient setting,$203.39 ,77% of total billed charges for outpatient setting,$82.70 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$224.52 ,85% of total billed charges for outpatient setting,$224.52 ,85% of total billed charges for outpatient setting,$224.52 ,85% of total billed charges for outpatient setting,$224.52 ,85% of total billed charges for outpatient setting,$224.52 ,85% of total billed charges for outpatient setting,$52.54 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$82.70 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$82.70 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$82.70 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$82.70 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$224.52 ,85% of total billed charges for outpatient setting,$51.51 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$81.88 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$237.73 ,90% of total billed charges for outpatient setting,$53.04 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$250.93 ,95% of total billed charges for outpatient setting,$224.52 ,85% of total billed charges for outpatient setting,$211.31 ,80% of total billed charges for outpatient setting,$52.54 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$224.52 ,85% of total billed charges for outpatient setting,$224.52 ,85% of total billed charges for outpatient setting,$224.52 ,85% of total billed charges for outpatient setting,$245.65 ,93% of total billed charges for outpatient setting,$198.11 ,75% of total billed charges for outpatient setting,$198.11 ,75% of total billed charges for outpatient setting,$198.11 ,75% of total billed charges for outpatient setting,$53.04 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$224.52 ,85% of total billed charges for outpatient setting,$52.54 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$51.51 ,$250.93 ,$92.45 Outpatient Medical Services,RADIOLOGY,73140,XR Finger(2nd Digit) 2+ Views Left,320,$216.00 ,$115.78 ,53.6% of total biled charges for outpatient setting,$115.78 ,53.6% of total biled charges for outpatient setting,$162.00 ,75% of total billed charges for outpatient setting,$162.00 ,75% of total billed charges for outpatient setting,$162.00 ,75% of total billed charges for outpatient setting,$68.30 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$68.30 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$68.30 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$68.30 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$68.30 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$68.30 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$172.80 ,80% of total billed charges for outpatient setting,$68.30 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$75.60 ,35% of total billed charges for outpatient setting,$183.60 ,85% of total billed charges for outpatient setting,$67.63 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$172.80 ,80% of total billed charges for outpatient setting,$183.60 ,85% of total billed charges for outpatient setting,$151.20 ,70% of total billed charges for outpatient setting,$151.20 ,70% of total billed charges for outpatient setting,$166.32 ,77% of total billed charges for outpatient setting,$67.63 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$183.60 ,85% of total billed charges for outpatient setting,$183.60 ,85% of total billed charges for outpatient setting,$183.60 ,85% of total billed charges for outpatient setting,$183.60 ,85% of total billed charges for outpatient setting,$183.60 ,85% of total billed charges for outpatient setting,$42.96 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$67.63 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$67.63 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$67.63 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$67.63 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$183.60 ,85% of total billed charges for outpatient setting,$42.12 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$66.96 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$194.40 ,90% of total billed charges for outpatient setting,$43.37 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$205.20 ,95% of total billed charges for outpatient setting,$183.60 ,85% of total billed charges for outpatient setting,$172.80 ,80% of total billed charges for outpatient setting,$42.96 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$183.60 ,85% of total billed charges for outpatient setting,$183.60 ,85% of total billed charges for outpatient setting,$183.60 ,85% of total billed charges for outpatient setting,$200.88 ,93% of total billed charges for outpatient setting,$162.00 ,75% of total billed charges for outpatient setting,$162.00 ,75% of total billed charges for outpatient setting,$162.00 ,75% of total billed charges for outpatient setting,$43.37 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$183.60 ,85% of total billed charges for outpatient setting,$42.96 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$42.12 ,$205.20 ,$75.60 Outpatient Medical Services,RADIOLOGY,73140,XR Finger(4th Digit) 2+ Views Left,320,$216.00 ,$115.78 ,53.6% of total biled charges for outpatient setting,$115.78 ,53.6% of total biled charges for outpatient setting,$162.00 ,75% of total billed charges for outpatient setting,$162.00 ,75% of total billed charges for outpatient setting,$162.00 ,75% of total billed charges for outpatient setting,$68.30 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$68.30 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$68.30 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$68.30 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$68.30 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$68.30 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$172.80 ,80% of total billed charges for outpatient setting,$68.30 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$75.60 ,35% of total billed charges for outpatient setting,$183.60 ,85% of total billed charges for outpatient setting,$67.63 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$172.80 ,80% of total billed charges for outpatient setting,$183.60 ,85% of total billed charges for outpatient setting,$151.20 ,70% of total billed charges for outpatient setting,$151.20 ,70% of total billed charges for outpatient setting,$166.32 ,77% of total billed charges for outpatient setting,$67.63 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$183.60 ,85% of total billed charges for outpatient setting,$183.60 ,85% of total billed charges for outpatient setting,$183.60 ,85% of total billed charges for outpatient setting,$183.60 ,85% of total billed charges for outpatient setting,$183.60 ,85% of total billed charges for outpatient setting,$42.96 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$67.63 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$67.63 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$67.63 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$67.63 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$183.60 ,85% of total billed charges for outpatient setting,$42.12 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$66.96 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$194.40 ,90% of total billed charges for outpatient setting,$43.37 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$205.20 ,95% of total billed charges for outpatient setting,$183.60 ,85% of total billed charges for outpatient setting,$172.80 ,80% of total billed charges for outpatient setting,$42.96 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$183.60 ,85% of total billed charges for outpatient setting,$183.60 ,85% of total billed charges for outpatient setting,$183.60 ,85% of total billed charges for outpatient setting,$200.88 ,93% of total billed charges for outpatient setting,$162.00 ,75% of total billed charges for outpatient setting,$162.00 ,75% of total billed charges for outpatient setting,$162.00 ,75% of total billed charges for outpatient setting,$43.37 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$183.60 ,85% of total billed charges for outpatient setting,$42.96 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$42.12 ,$205.20 ,$75.60 Outpatient Medical Services,RADIOLOGY,73502,XR Hip 2-3 Views Left,320,$350.35 ,$187.79 ,53.6% of total biled charges for outpatient setting,$187.79 ,53.6% of total biled charges for outpatient setting,$262.76 ,75% of total billed charges for outpatient setting,$262.76 ,75% of total billed charges for outpatient setting,$262.76 ,75% of total billed charges for outpatient setting,$110.78 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$110.78 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$110.78 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$110.78 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$110.78 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$110.78 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$280.28 ,80% of total billed charges for outpatient setting,$110.78 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$122.62 ,35% of total billed charges for outpatient setting,$297.80 ,85% of total billed charges for outpatient setting,$109.69 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$280.28 ,80% of total billed charges for outpatient setting,$297.80 ,85% of total billed charges for outpatient setting,$245.25 ,70% of total billed charges for outpatient setting,$245.25 ,70% of total billed charges for outpatient setting,$269.77 ,77% of total billed charges for outpatient setting,$109.69 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$297.80 ,85% of total billed charges for outpatient setting,$297.80 ,85% of total billed charges for outpatient setting,$297.80 ,85% of total billed charges for outpatient setting,$297.80 ,85% of total billed charges for outpatient setting,$297.80 ,85% of total billed charges for outpatient setting,$69.68 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$109.69 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$109.69 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$109.69 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$109.69 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$297.80 ,85% of total billed charges for outpatient setting,$68.32 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$108.61 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$315.32 ,90% of total billed charges for outpatient setting,$70.35 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$332.83 ,95% of total billed charges for outpatient setting,$297.80 ,85% of total billed charges for outpatient setting,$280.28 ,80% of total billed charges for outpatient setting,$69.68 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$297.80 ,85% of total billed charges for outpatient setting,$297.80 ,85% of total billed charges for outpatient setting,$297.80 ,85% of total billed charges for outpatient setting,$325.83 ,93% of total billed charges for outpatient setting,$262.76 ,75% of total billed charges for outpatient setting,$262.76 ,75% of total billed charges for outpatient setting,$262.76 ,75% of total billed charges for outpatient setting,$70.35 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$297.80 ,85% of total billed charges for outpatient setting,$69.68 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$68.32 ,$332.83 ,$122.62 Outpatient Medical Services,RADIOLOGY,73502,XR Hip 2-3 Views Right,320,$350.35 ,$187.79 ,53.6% of total biled charges for outpatient setting,$187.79 ,53.6% of total biled charges for outpatient setting,$262.76 ,75% of total billed charges for outpatient setting,$262.76 ,75% of total billed charges for outpatient setting,$262.76 ,75% of total billed charges for outpatient setting,$110.78 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$110.78 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$110.78 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$110.78 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$110.78 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$110.78 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$280.28 ,80% of total billed charges for outpatient setting,$110.78 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$122.62 ,35% of total billed charges for outpatient setting,$297.80 ,85% of total billed charges for outpatient setting,$109.69 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$280.28 ,80% of total billed charges for outpatient setting,$297.80 ,85% of total billed charges for outpatient setting,$245.25 ,70% of total billed charges for outpatient setting,$245.25 ,70% of total billed charges for outpatient setting,$269.77 ,77% of total billed charges for outpatient setting,$109.69 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$297.80 ,85% of total billed charges for outpatient setting,$297.80 ,85% of total billed charges for outpatient setting,$297.80 ,85% of total billed charges for outpatient setting,$297.80 ,85% of total billed charges for outpatient setting,$297.80 ,85% of total billed charges for outpatient setting,$69.68 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$109.69 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$109.69 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$109.69 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$109.69 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$297.80 ,85% of total billed charges for outpatient setting,$68.32 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$108.61 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$315.32 ,90% of total billed charges for outpatient setting,$70.35 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$332.83 ,95% of total billed charges for outpatient setting,$297.80 ,85% of total billed charges for outpatient setting,$280.28 ,80% of total billed charges for outpatient setting,$69.68 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$297.80 ,85% of total billed charges for outpatient setting,$297.80 ,85% of total billed charges for outpatient setting,$297.80 ,85% of total billed charges for outpatient setting,$325.83 ,93% of total billed charges for outpatient setting,$262.76 ,75% of total billed charges for outpatient setting,$262.76 ,75% of total billed charges for outpatient setting,$262.76 ,75% of total billed charges for outpatient setting,$70.35 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$297.80 ,85% of total billed charges for outpatient setting,$69.68 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$68.32 ,$332.83 ,$122.62 Outpatient Medical Services,RADIOLOGY,73522,XR Hips 3-4 Views Bilat,320,$331.58 ,$177.73 ,53.6% of total biled charges for outpatient setting,$177.73 ,53.6% of total biled charges for outpatient setting,$248.69 ,75% of total billed charges for outpatient setting,$248.69 ,75% of total billed charges for outpatient setting,$248.69 ,75% of total billed charges for outpatient setting,$104.85 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$104.85 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$104.85 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$104.85 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$104.85 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$104.85 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$265.26 ,80% of total billed charges for outpatient setting,$104.85 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$116.05 ,35% of total billed charges for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$103.82 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$265.26 ,80% of total billed charges for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$232.11 ,70% of total billed charges for outpatient setting,$232.11 ,70% of total billed charges for outpatient setting,$255.32 ,77% of total billed charges for outpatient setting,$103.82 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$281.84 ,85% of total billed charges for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$65.95 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$103.82 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$103.82 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$103.82 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$103.82 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$281.84 ,85% of total billed charges for outpatient setting,$64.66 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$102.79 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$298.42 ,90% of total billed charges for outpatient setting,$66.58 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$315.00 ,95% of total billed charges for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$265.26 ,80% of total billed charges for outpatient setting,$65.95 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$308.37 ,93% of total billed charges for outpatient setting,$248.69 ,75% of total billed charges for outpatient setting,$248.69 ,75% of total billed charges for outpatient setting,$248.69 ,75% of total billed charges for outpatient setting,$66.58 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$65.95 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$64.66 ,$315.00 ,$116.05 Outpatient Medical Services,RADIOLOGY,73552,XR Femur 2 Views Left,320,$483.00 ,$258.89 ,53.6% of total biled charges for outpatient setting,$258.89 ,53.6% of total biled charges for outpatient setting,$362.25 ,75% of total billed charges for outpatient setting,$362.25 ,75% of total billed charges for outpatient setting,$362.25 ,75% of total billed charges for outpatient setting,$152.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$152.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$152.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$152.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$152.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$152.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$386.40 ,80% of total billed charges for outpatient setting,$152.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$169.05 ,35% of total billed charges for outpatient setting,$410.55 ,85% of total billed charges for outpatient setting,$151.23 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$386.40 ,80% of total billed charges for outpatient setting,$410.55 ,85% of total billed charges for outpatient setting,$338.10 ,70% of total billed charges for outpatient setting,$338.10 ,70% of total billed charges for outpatient setting,$371.91 ,77% of total billed charges for outpatient setting,$151.23 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$410.55 ,85% of total billed charges for outpatient setting,$410.55 ,85% of total billed charges for outpatient setting,$410.55 ,85% of total billed charges for outpatient setting,$410.55 ,85% of total billed charges for outpatient setting,$410.55 ,85% of total billed charges for outpatient setting,$96.07 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$151.23 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$151.23 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$151.23 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$151.23 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$410.55 ,85% of total billed charges for outpatient setting,$94.19 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$149.73 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$434.70 ,90% of total billed charges for outpatient setting,$96.99 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$458.85 ,95% of total billed charges for outpatient setting,$410.55 ,85% of total billed charges for outpatient setting,$386.40 ,80% of total billed charges for outpatient setting,$96.07 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$410.55 ,85% of total billed charges for outpatient setting,$410.55 ,85% of total billed charges for outpatient setting,$410.55 ,85% of total billed charges for outpatient setting,$449.19 ,93% of total billed charges for outpatient setting,$362.25 ,75% of total billed charges for outpatient setting,$362.25 ,75% of total billed charges for outpatient setting,$362.25 ,75% of total billed charges for outpatient setting,$96.99 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$410.55 ,85% of total billed charges for outpatient setting,$96.07 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$94.19 ,$458.85 ,$169.05 Outpatient Medical Services,RADIOLOGY,73552,XR Femur 2 Views Bilat,320,$483.00 ,$258.89 ,53.6% of total biled charges for outpatient setting,$258.89 ,53.6% of total biled charges for outpatient setting,$362.25 ,75% of total billed charges for outpatient setting,$362.25 ,75% of total billed charges for outpatient setting,$362.25 ,75% of total billed charges for outpatient setting,$152.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$152.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$152.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$152.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$152.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$152.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$386.40 ,80% of total billed charges for outpatient setting,$152.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$169.05 ,35% of total billed charges for outpatient setting,$410.55 ,85% of total billed charges for outpatient setting,$151.23 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$386.40 ,80% of total billed charges for outpatient setting,$410.55 ,85% of total billed charges for outpatient setting,$338.10 ,70% of total billed charges for outpatient setting,$338.10 ,70% of total billed charges for outpatient setting,$371.91 ,77% of total billed charges for outpatient setting,$151.23 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$410.55 ,85% of total billed charges for outpatient setting,$410.55 ,85% of total billed charges for outpatient setting,$410.55 ,85% of total billed charges for outpatient setting,$410.55 ,85% of total billed charges for outpatient setting,$410.55 ,85% of total billed charges for outpatient setting,$96.07 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$151.23 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$151.23 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$151.23 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$151.23 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$410.55 ,85% of total billed charges for outpatient setting,$94.19 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$149.73 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$434.70 ,90% of total billed charges for outpatient setting,$96.99 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$458.85 ,95% of total billed charges for outpatient setting,$410.55 ,85% of total billed charges for outpatient setting,$386.40 ,80% of total billed charges for outpatient setting,$96.07 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$410.55 ,85% of total billed charges for outpatient setting,$410.55 ,85% of total billed charges for outpatient setting,$410.55 ,85% of total billed charges for outpatient setting,$449.19 ,93% of total billed charges for outpatient setting,$362.25 ,75% of total billed charges for outpatient setting,$362.25 ,75% of total billed charges for outpatient setting,$362.25 ,75% of total billed charges for outpatient setting,$96.99 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$410.55 ,85% of total billed charges for outpatient setting,$96.07 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$94.19 ,$458.85 ,$169.05 Outpatient Medical Services,RADIOLOGY,73560,XR Knee 1 or 2 Views Bilateral,320,$449.00 ,$240.66 ,53.6% of total biled charges for outpatient setting,$240.66 ,53.6% of total biled charges for outpatient setting,$336.75 ,75% of total billed charges for outpatient setting,$336.75 ,75% of total billed charges for outpatient setting,$336.75 ,75% of total billed charges for outpatient setting,$141.97 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$141.97 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$141.97 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$141.97 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$141.97 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$141.97 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$359.20 ,80% of total billed charges for outpatient setting,$141.97 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$157.15 ,35% of total billed charges for outpatient setting,$381.65 ,85% of total billed charges for outpatient setting,$140.58 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$359.20 ,80% of total billed charges for outpatient setting,$381.65 ,85% of total billed charges for outpatient setting,$314.30 ,70% of total billed charges for outpatient setting,$314.30 ,70% of total billed charges for outpatient setting,$345.73 ,77% of total billed charges for outpatient setting,$140.58 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$381.65 ,85% of total billed charges for outpatient setting,$381.65 ,85% of total billed charges for outpatient setting,$381.65 ,85% of total billed charges for outpatient setting,$381.65 ,85% of total billed charges for outpatient setting,$381.65 ,85% of total billed charges for outpatient setting,$89.31 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$140.58 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$140.58 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$140.58 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$140.58 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$381.65 ,85% of total billed charges for outpatient setting,$87.56 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$139.19 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$404.10 ,90% of total billed charges for outpatient setting,$90.16 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$426.55 ,95% of total billed charges for outpatient setting,$381.65 ,85% of total billed charges for outpatient setting,$359.20 ,80% of total billed charges for outpatient setting,$89.31 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$381.65 ,85% of total billed charges for outpatient setting,$381.65 ,85% of total billed charges for outpatient setting,$381.65 ,85% of total billed charges for outpatient setting,$417.57 ,93% of total billed charges for outpatient setting,$336.75 ,75% of total billed charges for outpatient setting,$336.75 ,75% of total billed charges for outpatient setting,$336.75 ,75% of total billed charges for outpatient setting,$90.16 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$381.65 ,85% of total billed charges for outpatient setting,$89.31 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$87.56 ,$426.55 ,$157.15 Outpatient Medical Services,RADIOLOGY,73560,XR Knee 1 or 2 Views Left,320,$449.00 ,$240.66 ,53.6% of total biled charges for outpatient setting,$240.66 ,53.6% of total biled charges for outpatient setting,$336.75 ,75% of total billed charges for outpatient setting,$336.75 ,75% of total billed charges for outpatient setting,$336.75 ,75% of total billed charges for outpatient setting,$141.97 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$141.97 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$141.97 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$141.97 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$141.97 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$141.97 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$359.20 ,80% of total billed charges for outpatient setting,$141.97 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$157.15 ,35% of total billed charges for outpatient setting,$381.65 ,85% of total billed charges for outpatient setting,$140.58 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$359.20 ,80% of total billed charges for outpatient setting,$381.65 ,85% of total billed charges for outpatient setting,$314.30 ,70% of total billed charges for outpatient setting,$314.30 ,70% of total billed charges for outpatient setting,$345.73 ,77% of total billed charges for outpatient setting,$140.58 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$381.65 ,85% of total billed charges for outpatient setting,$381.65 ,85% of total billed charges for outpatient setting,$381.65 ,85% of total billed charges for outpatient setting,$381.65 ,85% of total billed charges for outpatient setting,$381.65 ,85% of total billed charges for outpatient setting,$89.31 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$140.58 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$140.58 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$140.58 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$140.58 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$381.65 ,85% of total billed charges for outpatient setting,$87.56 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$139.19 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$404.10 ,90% of total billed charges for outpatient setting,$90.16 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$426.55 ,95% of total billed charges for outpatient setting,$381.65 ,85% of total billed charges for outpatient setting,$359.20 ,80% of total billed charges for outpatient setting,$89.31 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$381.65 ,85% of total billed charges for outpatient setting,$381.65 ,85% of total billed charges for outpatient setting,$381.65 ,85% of total billed charges for outpatient setting,$417.57 ,93% of total billed charges for outpatient setting,$336.75 ,75% of total billed charges for outpatient setting,$336.75 ,75% of total billed charges for outpatient setting,$336.75 ,75% of total billed charges for outpatient setting,$90.16 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$381.65 ,85% of total billed charges for outpatient setting,$89.31 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$87.56 ,$426.55 ,$157.15 Outpatient Medical Services,RADIOLOGY,73560,XR Knee 1 or 2 Views Right,320,$449.00 ,$240.66 ,53.6% of total biled charges for outpatient setting,$240.66 ,53.6% of total biled charges for outpatient setting,$336.75 ,75% of total billed charges for outpatient setting,$336.75 ,75% of total billed charges for outpatient setting,$336.75 ,75% of total billed charges for outpatient setting,$141.97 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$141.97 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$141.97 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$141.97 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$141.97 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$141.97 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$359.20 ,80% of total billed charges for outpatient setting,$141.97 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$157.15 ,35% of total billed charges for outpatient setting,$381.65 ,85% of total billed charges for outpatient setting,$140.58 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$359.20 ,80% of total billed charges for outpatient setting,$381.65 ,85% of total billed charges for outpatient setting,$314.30 ,70% of total billed charges for outpatient setting,$314.30 ,70% of total billed charges for outpatient setting,$345.73 ,77% of total billed charges for outpatient setting,$140.58 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$381.65 ,85% of total billed charges for outpatient setting,$381.65 ,85% of total billed charges for outpatient setting,$381.65 ,85% of total billed charges for outpatient setting,$381.65 ,85% of total billed charges for outpatient setting,$381.65 ,85% of total billed charges for outpatient setting,$89.31 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$140.58 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$140.58 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$140.58 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$140.58 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$381.65 ,85% of total billed charges for outpatient setting,$87.56 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$139.19 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$404.10 ,90% of total billed charges for outpatient setting,$90.16 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$426.55 ,95% of total billed charges for outpatient setting,$381.65 ,85% of total billed charges for outpatient setting,$359.20 ,80% of total billed charges for outpatient setting,$89.31 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$381.65 ,85% of total billed charges for outpatient setting,$381.65 ,85% of total billed charges for outpatient setting,$381.65 ,85% of total billed charges for outpatient setting,$417.57 ,93% of total billed charges for outpatient setting,$336.75 ,75% of total billed charges for outpatient setting,$336.75 ,75% of total billed charges for outpatient setting,$336.75 ,75% of total billed charges for outpatient setting,$90.16 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$381.65 ,85% of total billed charges for outpatient setting,$89.31 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$87.56 ,$426.55 ,$157.15 Outpatient Medical Services,RADIOLOGY,73562,XR Knee 3 Views Bilateral,320,$421.36 ,$225.85 ,53.6% of total biled charges for outpatient setting,$225.85 ,53.6% of total biled charges for outpatient setting,$316.02 ,75% of total billed charges for outpatient setting,$316.02 ,75% of total billed charges for outpatient setting,$316.02 ,75% of total billed charges for outpatient setting,$133.23 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$133.23 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$133.23 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$133.23 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$133.23 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$133.23 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$337.09 ,80% of total billed charges for outpatient setting,$133.23 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$147.48 ,35% of total billed charges for outpatient setting,$358.16 ,85% of total billed charges for outpatient setting,$131.93 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$337.09 ,80% of total billed charges for outpatient setting,$358.16 ,85% of total billed charges for outpatient setting,$294.95 ,70% of total billed charges for outpatient setting,$294.95 ,70% of total billed charges for outpatient setting,$324.45 ,77% of total billed charges for outpatient setting,$131.93 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$358.16 ,85% of total billed charges for outpatient setting,$358.16 ,85% of total billed charges for outpatient setting,$358.16 ,85% of total billed charges for outpatient setting,$358.16 ,85% of total billed charges for outpatient setting,$358.16 ,85% of total billed charges for outpatient setting,$83.81 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$131.93 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$131.93 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$131.93 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$131.93 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$358.16 ,85% of total billed charges for outpatient setting,$82.17 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$130.62 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$379.22 ,90% of total billed charges for outpatient setting,$84.61 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$400.29 ,95% of total billed charges for outpatient setting,$358.16 ,85% of total billed charges for outpatient setting,$337.09 ,80% of total billed charges for outpatient setting,$83.81 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$358.16 ,85% of total billed charges for outpatient setting,$358.16 ,85% of total billed charges for outpatient setting,$358.16 ,85% of total billed charges for outpatient setting,$391.86 ,93% of total billed charges for outpatient setting,$316.02 ,75% of total billed charges for outpatient setting,$316.02 ,75% of total billed charges for outpatient setting,$316.02 ,75% of total billed charges for outpatient setting,$84.61 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$358.16 ,85% of total billed charges for outpatient setting,$83.81 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$82.17 ,$400.29 ,$147.48 Outpatient Medical Services,RADIOLOGY,73562,XR Knee 3 Views Left,320,$421.36 ,$225.85 ,53.6% of total biled charges for outpatient setting,$225.85 ,53.6% of total biled charges for outpatient setting,$316.02 ,75% of total billed charges for outpatient setting,$316.02 ,75% of total billed charges for outpatient setting,$316.02 ,75% of total billed charges for outpatient setting,$133.23 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$133.23 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$133.23 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$133.23 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$133.23 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$133.23 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$337.09 ,80% of total billed charges for outpatient setting,$133.23 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$147.48 ,35% of total billed charges for outpatient setting,$358.16 ,85% of total billed charges for outpatient setting,$131.93 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$337.09 ,80% of total billed charges for outpatient setting,$358.16 ,85% of total billed charges for outpatient setting,$294.95 ,70% of total billed charges for outpatient setting,$294.95 ,70% of total billed charges for outpatient setting,$324.45 ,77% of total billed charges for outpatient setting,$131.93 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$358.16 ,85% of total billed charges for outpatient setting,$358.16 ,85% of total billed charges for outpatient setting,$358.16 ,85% of total billed charges for outpatient setting,$358.16 ,85% of total billed charges for outpatient setting,$358.16 ,85% of total billed charges for outpatient setting,$83.81 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$131.93 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$131.93 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$131.93 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$131.93 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$358.16 ,85% of total billed charges for outpatient setting,$82.17 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$130.62 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$379.22 ,90% of total billed charges for outpatient setting,$84.61 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$400.29 ,95% of total billed charges for outpatient setting,$358.16 ,85% of total billed charges for outpatient setting,$337.09 ,80% of total billed charges for outpatient setting,$83.81 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$358.16 ,85% of total billed charges for outpatient setting,$358.16 ,85% of total billed charges for outpatient setting,$358.16 ,85% of total billed charges for outpatient setting,$391.86 ,93% of total billed charges for outpatient setting,$316.02 ,75% of total billed charges for outpatient setting,$316.02 ,75% of total billed charges for outpatient setting,$316.02 ,75% of total billed charges for outpatient setting,$84.61 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$358.16 ,85% of total billed charges for outpatient setting,$83.81 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$82.17 ,$400.29 ,$147.48 Outpatient Medical Services,RADIOLOGY,73562,XR Knee 3 Views Right,320,$421.36 ,$225.85 ,53.6% of total biled charges for outpatient setting,$225.85 ,53.6% of total biled charges for outpatient setting,$316.02 ,75% of total billed charges for outpatient setting,$316.02 ,75% of total billed charges for outpatient setting,$316.02 ,75% of total billed charges for outpatient setting,$133.23 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$133.23 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$133.23 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$133.23 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$133.23 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$133.23 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$337.09 ,80% of total billed charges for outpatient setting,$133.23 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$147.48 ,35% of total billed charges for outpatient setting,$358.16 ,85% of total billed charges for outpatient setting,$131.93 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$337.09 ,80% of total billed charges for outpatient setting,$358.16 ,85% of total billed charges for outpatient setting,$294.95 ,70% of total billed charges for outpatient setting,$294.95 ,70% of total billed charges for outpatient setting,$324.45 ,77% of total billed charges for outpatient setting,$131.93 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$358.16 ,85% of total billed charges for outpatient setting,$358.16 ,85% of total billed charges for outpatient setting,$358.16 ,85% of total billed charges for outpatient setting,$358.16 ,85% of total billed charges for outpatient setting,$358.16 ,85% of total billed charges for outpatient setting,$83.81 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$131.93 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$131.93 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$131.93 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$131.93 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$358.16 ,85% of total billed charges for outpatient setting,$82.17 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$130.62 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$379.22 ,90% of total billed charges for outpatient setting,$84.61 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$400.29 ,95% of total billed charges for outpatient setting,$358.16 ,85% of total billed charges for outpatient setting,$337.09 ,80% of total billed charges for outpatient setting,$83.81 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$358.16 ,85% of total billed charges for outpatient setting,$358.16 ,85% of total billed charges for outpatient setting,$358.16 ,85% of total billed charges for outpatient setting,$391.86 ,93% of total billed charges for outpatient setting,$316.02 ,75% of total billed charges for outpatient setting,$316.02 ,75% of total billed charges for outpatient setting,$316.02 ,75% of total billed charges for outpatient setting,$84.61 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$358.16 ,85% of total billed charges for outpatient setting,$83.81 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$82.17 ,$400.29 ,$147.48 Outpatient Medical Services,RADIOLOGY,73564,XR Knee Complete 4+ Views Left,320,$578.00 ,$309.81 ,53.6% of total biled charges for outpatient setting,$309.81 ,53.6% of total biled charges for outpatient setting,$433.50 ,75% of total billed charges for outpatient setting,$433.50 ,75% of total billed charges for outpatient setting,$433.50 ,75% of total billed charges for outpatient setting,$182.76 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$182.76 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$182.76 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$182.76 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$182.76 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$182.76 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$462.40 ,80% of total billed charges for outpatient setting,$182.76 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$202.30 ,35% of total billed charges for outpatient setting,$491.30 ,85% of total billed charges for outpatient setting,$180.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$462.40 ,80% of total billed charges for outpatient setting,$491.30 ,85% of total billed charges for outpatient setting,$404.60 ,70% of total billed charges for outpatient setting,$404.60 ,70% of total billed charges for outpatient setting,$445.06 ,77% of total billed charges for outpatient setting,$180.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$491.30 ,85% of total billed charges for outpatient setting,$491.30 ,85% of total billed charges for outpatient setting,$491.30 ,85% of total billed charges for outpatient setting,$491.30 ,85% of total billed charges for outpatient setting,$491.30 ,85% of total billed charges for outpatient setting,$114.96 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$180.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$180.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$180.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$180.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$491.30 ,85% of total billed charges for outpatient setting,$112.71 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$179.18 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$520.20 ,90% of total billed charges for outpatient setting,$116.06 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$549.10 ,95% of total billed charges for outpatient setting,$491.30 ,85% of total billed charges for outpatient setting,$462.40 ,80% of total billed charges for outpatient setting,$114.96 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$491.30 ,85% of total billed charges for outpatient setting,$491.30 ,85% of total billed charges for outpatient setting,$491.30 ,85% of total billed charges for outpatient setting,$537.54 ,93% of total billed charges for outpatient setting,$433.50 ,75% of total billed charges for outpatient setting,$433.50 ,75% of total billed charges for outpatient setting,$433.50 ,75% of total billed charges for outpatient setting,$116.06 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$491.30 ,85% of total billed charges for outpatient setting,$114.96 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$112.71 ,$549.10 ,$202.30 Outpatient Medical Services,RADIOLOGY,73564,XR Knee Complete 4+ Views Right,320,$578.00 ,$309.81 ,53.6% of total biled charges for outpatient setting,$309.81 ,53.6% of total biled charges for outpatient setting,$433.50 ,75% of total billed charges for outpatient setting,$433.50 ,75% of total billed charges for outpatient setting,$433.50 ,75% of total billed charges for outpatient setting,$182.76 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$182.76 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$182.76 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$182.76 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$182.76 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$182.76 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$462.40 ,80% of total billed charges for outpatient setting,$182.76 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$202.30 ,35% of total billed charges for outpatient setting,$491.30 ,85% of total billed charges for outpatient setting,$180.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$462.40 ,80% of total billed charges for outpatient setting,$491.30 ,85% of total billed charges for outpatient setting,$404.60 ,70% of total billed charges for outpatient setting,$404.60 ,70% of total billed charges for outpatient setting,$445.06 ,77% of total billed charges for outpatient setting,$180.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$491.30 ,85% of total billed charges for outpatient setting,$491.30 ,85% of total billed charges for outpatient setting,$491.30 ,85% of total billed charges for outpatient setting,$491.30 ,85% of total billed charges for outpatient setting,$491.30 ,85% of total billed charges for outpatient setting,$114.96 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$180.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$180.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$180.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$180.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$491.30 ,85% of total billed charges for outpatient setting,$112.71 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$179.18 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$520.20 ,90% of total billed charges for outpatient setting,$116.06 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$549.10 ,95% of total billed charges for outpatient setting,$491.30 ,85% of total billed charges for outpatient setting,$462.40 ,80% of total billed charges for outpatient setting,$114.96 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$491.30 ,85% of total billed charges for outpatient setting,$491.30 ,85% of total billed charges for outpatient setting,$491.30 ,85% of total billed charges for outpatient setting,$537.54 ,93% of total billed charges for outpatient setting,$433.50 ,75% of total billed charges for outpatient setting,$433.50 ,75% of total billed charges for outpatient setting,$433.50 ,75% of total billed charges for outpatient setting,$116.06 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$491.30 ,85% of total billed charges for outpatient setting,$114.96 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$112.71 ,$549.10 ,$202.30 Outpatient Medical Services,RADIOLOGY,73590,XR Tibia/Fibula Left,320,$226.66 ,$121.49 ,53.6% of total biled charges for outpatient setting,$121.49 ,53.6% of total biled charges for outpatient setting,$170.00 ,75% of total billed charges for outpatient setting,$170.00 ,75% of total billed charges for outpatient setting,$170.00 ,75% of total billed charges for outpatient setting,$71.67 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$71.67 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$71.67 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$71.67 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$71.67 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$71.67 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$181.33 ,80% of total billed charges for outpatient setting,$71.67 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$79.33 ,35% of total billed charges for outpatient setting,$192.66 ,85% of total billed charges for outpatient setting,$70.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$181.33 ,80% of total billed charges for outpatient setting,$192.66 ,85% of total billed charges for outpatient setting,$158.66 ,70% of total billed charges for outpatient setting,$158.66 ,70% of total billed charges for outpatient setting,$174.53 ,77% of total billed charges for outpatient setting,$70.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$192.66 ,85% of total billed charges for outpatient setting,$192.66 ,85% of total billed charges for outpatient setting,$192.66 ,85% of total billed charges for outpatient setting,$192.66 ,85% of total billed charges for outpatient setting,$192.66 ,85% of total billed charges for outpatient setting,$45.08 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$70.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$70.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$70.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$70.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$192.66 ,85% of total billed charges for outpatient setting,$44.20 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$70.26 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$203.99 ,90% of total billed charges for outpatient setting,$45.51 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$215.33 ,95% of total billed charges for outpatient setting,$192.66 ,85% of total billed charges for outpatient setting,$181.33 ,80% of total billed charges for outpatient setting,$45.08 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$192.66 ,85% of total billed charges for outpatient setting,$192.66 ,85% of total billed charges for outpatient setting,$192.66 ,85% of total billed charges for outpatient setting,$210.79 ,93% of total billed charges for outpatient setting,$170.00 ,75% of total billed charges for outpatient setting,$170.00 ,75% of total billed charges for outpatient setting,$170.00 ,75% of total billed charges for outpatient setting,$45.51 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$192.66 ,85% of total billed charges for outpatient setting,$45.08 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$44.20 ,$215.33 ,$79.33 Outpatient Medical Services,RADIOLOGY,73590,XR Tibia/Fibula Right,320,$226.66 ,$121.49 ,53.6% of total biled charges for outpatient setting,$121.49 ,53.6% of total biled charges for outpatient setting,$170.00 ,75% of total billed charges for outpatient setting,$170.00 ,75% of total billed charges for outpatient setting,$170.00 ,75% of total billed charges for outpatient setting,$71.67 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$71.67 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$71.67 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$71.67 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$71.67 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$71.67 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$181.33 ,80% of total billed charges for outpatient setting,$71.67 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$79.33 ,35% of total billed charges for outpatient setting,$192.66 ,85% of total billed charges for outpatient setting,$70.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$181.33 ,80% of total billed charges for outpatient setting,$192.66 ,85% of total billed charges for outpatient setting,$158.66 ,70% of total billed charges for outpatient setting,$158.66 ,70% of total billed charges for outpatient setting,$174.53 ,77% of total billed charges for outpatient setting,$70.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$192.66 ,85% of total billed charges for outpatient setting,$192.66 ,85% of total billed charges for outpatient setting,$192.66 ,85% of total billed charges for outpatient setting,$192.66 ,85% of total billed charges for outpatient setting,$192.66 ,85% of total billed charges for outpatient setting,$45.08 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$70.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$70.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$70.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$70.97 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$192.66 ,85% of total billed charges for outpatient setting,$44.20 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$70.26 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$203.99 ,90% of total billed charges for outpatient setting,$45.51 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$215.33 ,95% of total billed charges for outpatient setting,$192.66 ,85% of total billed charges for outpatient setting,$181.33 ,80% of total billed charges for outpatient setting,$45.08 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$192.66 ,85% of total billed charges for outpatient setting,$192.66 ,85% of total billed charges for outpatient setting,$192.66 ,85% of total billed charges for outpatient setting,$210.79 ,93% of total billed charges for outpatient setting,$170.00 ,75% of total billed charges for outpatient setting,$170.00 ,75% of total billed charges for outpatient setting,$170.00 ,75% of total billed charges for outpatient setting,$45.51 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$192.66 ,85% of total billed charges for outpatient setting,$45.08 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$44.20 ,$215.33 ,$79.33 Outpatient Medical Services,RADIOLOGY,73600,XR Ankle 2 Views Left,320,$243.00 ,$130.25 ,53.6% of total biled charges for outpatient setting,$130.25 ,53.6% of total biled charges for outpatient setting,$182.25 ,75% of total billed charges for outpatient setting,$182.25 ,75% of total billed charges for outpatient setting,$182.25 ,75% of total billed charges for outpatient setting,$76.84 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$76.84 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$76.84 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$76.84 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$76.84 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$76.84 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$194.40 ,80% of total billed charges for outpatient setting,$76.84 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$85.05 ,35% of total billed charges for outpatient setting,$206.55 ,85% of total billed charges for outpatient setting,$76.08 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$194.40 ,80% of total billed charges for outpatient setting,$206.55 ,85% of total billed charges for outpatient setting,$170.10 ,70% of total billed charges for outpatient setting,$170.10 ,70% of total billed charges for outpatient setting,$187.11 ,77% of total billed charges for outpatient setting,$76.08 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$206.55 ,85% of total billed charges for outpatient setting,$206.55 ,85% of total billed charges for outpatient setting,$206.55 ,85% of total billed charges for outpatient setting,$206.55 ,85% of total billed charges for outpatient setting,$206.55 ,85% of total billed charges for outpatient setting,$48.33 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$76.08 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$76.08 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$76.08 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$76.08 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$206.55 ,85% of total billed charges for outpatient setting,$47.39 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$75.33 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$218.70 ,90% of total billed charges for outpatient setting,$48.79 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$230.85 ,95% of total billed charges for outpatient setting,$206.55 ,85% of total billed charges for outpatient setting,$194.40 ,80% of total billed charges for outpatient setting,$48.33 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$206.55 ,85% of total billed charges for outpatient setting,$206.55 ,85% of total billed charges for outpatient setting,$206.55 ,85% of total billed charges for outpatient setting,$225.99 ,93% of total billed charges for outpatient setting,$182.25 ,75% of total billed charges for outpatient setting,$182.25 ,75% of total billed charges for outpatient setting,$182.25 ,75% of total billed charges for outpatient setting,$48.79 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$206.55 ,85% of total billed charges for outpatient setting,$48.33 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$47.39 ,$230.85 ,$85.05 Outpatient Medical Services,RADIOLOGY,73600,XR Ankle 2 Views Right,320,$243.00 ,$130.25 ,53.6% of total biled charges for outpatient setting,$130.25 ,53.6% of total biled charges for outpatient setting,$182.25 ,75% of total billed charges for outpatient setting,$182.25 ,75% of total billed charges for outpatient setting,$182.25 ,75% of total billed charges for outpatient setting,$76.84 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$76.84 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$76.84 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$76.84 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$76.84 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$76.84 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$194.40 ,80% of total billed charges for outpatient setting,$76.84 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$85.05 ,35% of total billed charges for outpatient setting,$206.55 ,85% of total billed charges for outpatient setting,$76.08 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$194.40 ,80% of total billed charges for outpatient setting,$206.55 ,85% of total billed charges for outpatient setting,$170.10 ,70% of total billed charges for outpatient setting,$170.10 ,70% of total billed charges for outpatient setting,$187.11 ,77% of total billed charges for outpatient setting,$76.08 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$206.55 ,85% of total billed charges for outpatient setting,$206.55 ,85% of total billed charges for outpatient setting,$206.55 ,85% of total billed charges for outpatient setting,$206.55 ,85% of total billed charges for outpatient setting,$206.55 ,85% of total billed charges for outpatient setting,$48.33 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$76.08 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$76.08 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$76.08 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$76.08 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$206.55 ,85% of total billed charges for outpatient setting,$47.39 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$75.33 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$218.70 ,90% of total billed charges for outpatient setting,$48.79 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$230.85 ,95% of total billed charges for outpatient setting,$206.55 ,85% of total billed charges for outpatient setting,$194.40 ,80% of total billed charges for outpatient setting,$48.33 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$206.55 ,85% of total billed charges for outpatient setting,$206.55 ,85% of total billed charges for outpatient setting,$206.55 ,85% of total billed charges for outpatient setting,$225.99 ,93% of total billed charges for outpatient setting,$182.25 ,75% of total billed charges for outpatient setting,$182.25 ,75% of total billed charges for outpatient setting,$182.25 ,75% of total billed charges for outpatient setting,$48.79 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$206.55 ,85% of total billed charges for outpatient setting,$48.33 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$47.39 ,$230.85 ,$85.05 Outpatient Medical Services,RADIOLOGY,73610,XR Ankle Complete 3+ Views Bilateral,320,$449.60 ,$240.99 ,53.6% of total biled charges for outpatient setting,$240.99 ,53.6% of total biled charges for outpatient setting,$337.20 ,75% of total billed charges for outpatient setting,$337.20 ,75% of total billed charges for outpatient setting,$337.20 ,75% of total billed charges for outpatient setting,$142.16 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$142.16 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$142.16 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$142.16 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$142.16 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$142.16 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$359.68 ,80% of total billed charges for outpatient setting,$142.16 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$157.36 ,35% of total billed charges for outpatient setting,$382.16 ,85% of total billed charges for outpatient setting,$140.77 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$359.68 ,80% of total billed charges for outpatient setting,$382.16 ,85% of total billed charges for outpatient setting,$314.72 ,70% of total billed charges for outpatient setting,$314.72 ,70% of total billed charges for outpatient setting,$346.19 ,77% of total billed charges for outpatient setting,$140.77 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$382.16 ,85% of total billed charges for outpatient setting,$382.16 ,85% of total billed charges for outpatient setting,$382.16 ,85% of total billed charges for outpatient setting,$382.16 ,85% of total billed charges for outpatient setting,$382.16 ,85% of total billed charges for outpatient setting,$89.43 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$140.77 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$140.77 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$140.77 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$140.77 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$382.16 ,85% of total billed charges for outpatient setting,$87.67 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$139.38 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$404.64 ,90% of total billed charges for outpatient setting,$90.28 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$427.12 ,95% of total billed charges for outpatient setting,$382.16 ,85% of total billed charges for outpatient setting,$359.68 ,80% of total billed charges for outpatient setting,$89.43 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$382.16 ,85% of total billed charges for outpatient setting,$382.16 ,85% of total billed charges for outpatient setting,$382.16 ,85% of total billed charges for outpatient setting,$418.13 ,93% of total billed charges for outpatient setting,$337.20 ,75% of total billed charges for outpatient setting,$337.20 ,75% of total billed charges for outpatient setting,$337.20 ,75% of total billed charges for outpatient setting,$90.28 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$382.16 ,85% of total billed charges for outpatient setting,$89.43 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$87.67 ,$427.12 ,$157.36 Outpatient Medical Services,RADIOLOGY,73610,XR Ankle Complete 3+ Views Left,320,$449.60 ,$240.99 ,53.6% of total biled charges for outpatient setting,$240.99 ,53.6% of total biled charges for outpatient setting,$337.20 ,75% of total billed charges for outpatient setting,$337.20 ,75% of total billed charges for outpatient setting,$337.20 ,75% of total billed charges for outpatient setting,$142.16 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$142.16 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$142.16 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$142.16 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$142.16 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$142.16 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$359.68 ,80% of total billed charges for outpatient setting,$142.16 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$157.36 ,35% of total billed charges for outpatient setting,$382.16 ,85% of total billed charges for outpatient setting,$140.77 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$359.68 ,80% of total billed charges for outpatient setting,$382.16 ,85% of total billed charges for outpatient setting,$314.72 ,70% of total billed charges for outpatient setting,$314.72 ,70% of total billed charges for outpatient setting,$346.19 ,77% of total billed charges for outpatient setting,$140.77 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$382.16 ,85% of total billed charges for outpatient setting,$382.16 ,85% of total billed charges for outpatient setting,$382.16 ,85% of total billed charges for outpatient setting,$382.16 ,85% of total billed charges for outpatient setting,$382.16 ,85% of total billed charges for outpatient setting,$89.43 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$140.77 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$140.77 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$140.77 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$140.77 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$382.16 ,85% of total billed charges for outpatient setting,$87.67 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$139.38 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$404.64 ,90% of total billed charges for outpatient setting,$90.28 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$427.12 ,95% of total billed charges for outpatient setting,$382.16 ,85% of total billed charges for outpatient setting,$359.68 ,80% of total billed charges for outpatient setting,$89.43 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$382.16 ,85% of total billed charges for outpatient setting,$382.16 ,85% of total billed charges for outpatient setting,$382.16 ,85% of total billed charges for outpatient setting,$418.13 ,93% of total billed charges for outpatient setting,$337.20 ,75% of total billed charges for outpatient setting,$337.20 ,75% of total billed charges for outpatient setting,$337.20 ,75% of total billed charges for outpatient setting,$90.28 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$382.16 ,85% of total billed charges for outpatient setting,$89.43 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$87.67 ,$427.12 ,$157.36 Outpatient Medical Services,RADIOLOGY,73610,XR Ankle Complete 3+ Views Right,320,$449.60 ,$240.99 ,53.6% of total biled charges for outpatient setting,$240.99 ,53.6% of total biled charges for outpatient setting,$337.20 ,75% of total billed charges for outpatient setting,$337.20 ,75% of total billed charges for outpatient setting,$337.20 ,75% of total billed charges for outpatient setting,$142.16 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$142.16 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$142.16 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$142.16 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$142.16 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$142.16 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$359.68 ,80% of total billed charges for outpatient setting,$142.16 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$157.36 ,35% of total billed charges for outpatient setting,$382.16 ,85% of total billed charges for outpatient setting,$140.77 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$359.68 ,80% of total billed charges for outpatient setting,$382.16 ,85% of total billed charges for outpatient setting,$314.72 ,70% of total billed charges for outpatient setting,$314.72 ,70% of total billed charges for outpatient setting,$346.19 ,77% of total billed charges for outpatient setting,$140.77 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$382.16 ,85% of total billed charges for outpatient setting,$382.16 ,85% of total billed charges for outpatient setting,$382.16 ,85% of total billed charges for outpatient setting,$382.16 ,85% of total billed charges for outpatient setting,$382.16 ,85% of total billed charges for outpatient setting,$89.43 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$140.77 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$140.77 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$140.77 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$140.77 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$382.16 ,85% of total billed charges for outpatient setting,$87.67 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$139.38 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$404.64 ,90% of total billed charges for outpatient setting,$90.28 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$427.12 ,95% of total billed charges for outpatient setting,$382.16 ,85% of total billed charges for outpatient setting,$359.68 ,80% of total billed charges for outpatient setting,$89.43 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$382.16 ,85% of total billed charges for outpatient setting,$382.16 ,85% of total billed charges for outpatient setting,$382.16 ,85% of total billed charges for outpatient setting,$418.13 ,93% of total billed charges for outpatient setting,$337.20 ,75% of total billed charges for outpatient setting,$337.20 ,75% of total billed charges for outpatient setting,$337.20 ,75% of total billed charges for outpatient setting,$90.28 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$382.16 ,85% of total billed charges for outpatient setting,$89.43 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$87.67 ,$427.12 ,$157.36 Outpatient Medical Services,RADIOLOGY,73620,XR Foot 2 Views Left,320,$281.00 ,$150.62 ,53.6% of total biled charges for outpatient setting,$150.62 ,53.6% of total biled charges for outpatient setting,$210.75 ,75% of total billed charges for outpatient setting,$210.75 ,75% of total billed charges for outpatient setting,$210.75 ,75% of total billed charges for outpatient setting,$88.85 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$88.85 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$88.85 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$88.85 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$88.85 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$88.85 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$224.80 ,80% of total billed charges for outpatient setting,$88.85 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$98.35 ,35% of total billed charges for outpatient setting,$238.85 ,85% of total billed charges for outpatient setting,$87.98 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$224.80 ,80% of total billed charges for outpatient setting,$238.85 ,85% of total billed charges for outpatient setting,$196.70 ,70% of total billed charges for outpatient setting,$196.70 ,70% of total billed charges for outpatient setting,$216.37 ,77% of total billed charges for outpatient setting,$87.98 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$238.85 ,85% of total billed charges for outpatient setting,$238.85 ,85% of total billed charges for outpatient setting,$238.85 ,85% of total billed charges for outpatient setting,$238.85 ,85% of total billed charges for outpatient setting,$238.85 ,85% of total billed charges for outpatient setting,$55.89 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$87.98 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$87.98 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$87.98 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$87.98 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$238.85 ,85% of total billed charges for outpatient setting,$54.80 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$87.11 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$252.90 ,90% of total billed charges for outpatient setting,$56.42 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$266.95 ,95% of total billed charges for outpatient setting,$238.85 ,85% of total billed charges for outpatient setting,$224.80 ,80% of total billed charges for outpatient setting,$55.89 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$238.85 ,85% of total billed charges for outpatient setting,$238.85 ,85% of total billed charges for outpatient setting,$238.85 ,85% of total billed charges for outpatient setting,$261.33 ,93% of total billed charges for outpatient setting,$210.75 ,75% of total billed charges for outpatient setting,$210.75 ,75% of total billed charges for outpatient setting,$210.75 ,75% of total billed charges for outpatient setting,$56.42 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$238.85 ,85% of total billed charges for outpatient setting,$55.89 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$54.80 ,$266.95 ,$98.35 Outpatient Medical Services,RADIOLOGY,73630,XR Foot Complete 3+ Views Left,320,$394.81 ,$211.62 ,53.6% of total biled charges for outpatient setting,$211.62 ,53.6% of total biled charges for outpatient setting,$296.11 ,75% of total billed charges for outpatient setting,$296.11 ,75% of total billed charges for outpatient setting,$296.11 ,75% of total billed charges for outpatient setting,$124.84 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$124.84 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$124.84 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$124.84 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$124.84 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$124.84 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$315.85 ,80% of total billed charges for outpatient setting,$124.84 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$138.18 ,35% of total billed charges for outpatient setting,$335.59 ,85% of total billed charges for outpatient setting,$123.62 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$315.85 ,80% of total billed charges for outpatient setting,$335.59 ,85% of total billed charges for outpatient setting,$276.37 ,70% of total billed charges for outpatient setting,$276.37 ,70% of total billed charges for outpatient setting,$304.00 ,77% of total billed charges for outpatient setting,$123.62 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$335.59 ,85% of total billed charges for outpatient setting,$335.59 ,85% of total billed charges for outpatient setting,$335.59 ,85% of total billed charges for outpatient setting,$335.59 ,85% of total billed charges for outpatient setting,$335.59 ,85% of total billed charges for outpatient setting,$78.53 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$123.62 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$123.62 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$123.62 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$123.62 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$335.59 ,85% of total billed charges for outpatient setting,$76.99 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$122.39 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$355.33 ,90% of total billed charges for outpatient setting,$79.28 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$375.07 ,95% of total billed charges for outpatient setting,$335.59 ,85% of total billed charges for outpatient setting,$315.85 ,80% of total billed charges for outpatient setting,$78.53 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$335.59 ,85% of total billed charges for outpatient setting,$335.59 ,85% of total billed charges for outpatient setting,$335.59 ,85% of total billed charges for outpatient setting,$367.17 ,93% of total billed charges for outpatient setting,$296.11 ,75% of total billed charges for outpatient setting,$296.11 ,75% of total billed charges for outpatient setting,$296.11 ,75% of total billed charges for outpatient setting,$79.28 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$335.59 ,85% of total billed charges for outpatient setting,$78.53 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$76.99 ,$375.07 ,$138.18 Outpatient Medical Services,RADIOLOGY,73630,XR Foot Complete 3+ Views Right,320,$394.81 ,$211.62 ,53.6% of total biled charges for outpatient setting,$211.62 ,53.6% of total biled charges for outpatient setting,$296.11 ,75% of total billed charges for outpatient setting,$296.11 ,75% of total billed charges for outpatient setting,$296.11 ,75% of total billed charges for outpatient setting,$124.84 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$124.84 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$124.84 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$124.84 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$124.84 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$124.84 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$315.85 ,80% of total billed charges for outpatient setting,$124.84 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$138.18 ,35% of total billed charges for outpatient setting,$335.59 ,85% of total billed charges for outpatient setting,$123.62 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$315.85 ,80% of total billed charges for outpatient setting,$335.59 ,85% of total billed charges for outpatient setting,$276.37 ,70% of total billed charges for outpatient setting,$276.37 ,70% of total billed charges for outpatient setting,$304.00 ,77% of total billed charges for outpatient setting,$123.62 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$335.59 ,85% of total billed charges for outpatient setting,$335.59 ,85% of total billed charges for outpatient setting,$335.59 ,85% of total billed charges for outpatient setting,$335.59 ,85% of total billed charges for outpatient setting,$335.59 ,85% of total billed charges for outpatient setting,$78.53 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$123.62 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$123.62 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$123.62 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$123.62 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$335.59 ,85% of total billed charges for outpatient setting,$76.99 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$122.39 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$355.33 ,90% of total billed charges for outpatient setting,$79.28 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$375.07 ,95% of total billed charges for outpatient setting,$335.59 ,85% of total billed charges for outpatient setting,$315.85 ,80% of total billed charges for outpatient setting,$78.53 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$335.59 ,85% of total billed charges for outpatient setting,$335.59 ,85% of total billed charges for outpatient setting,$335.59 ,85% of total billed charges for outpatient setting,$367.17 ,93% of total billed charges for outpatient setting,$296.11 ,75% of total billed charges for outpatient setting,$296.11 ,75% of total billed charges for outpatient setting,$296.11 ,75% of total billed charges for outpatient setting,$79.28 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$335.59 ,85% of total billed charges for outpatient setting,$78.53 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$76.99 ,$375.07 ,$138.18 Outpatient Medical Services,RADIOLOGY,73630,73630 XR Foot Complete 3+ Views Right,320,$394.81 ,$211.62 ,53.6% of total biled charges for outpatient setting,$211.62 ,53.6% of total biled charges for outpatient setting,$296.11 ,75% of total billed charges for outpatient setting,$296.11 ,75% of total billed charges for outpatient setting,$296.11 ,75% of total billed charges for outpatient setting,$124.84 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$124.84 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$124.84 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$124.84 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$124.84 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$124.84 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$315.85 ,80% of total billed charges for outpatient setting,$124.84 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$138.18 ,35% of total billed charges for outpatient setting,$335.59 ,85% of total billed charges for outpatient setting,$123.62 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$315.85 ,80% of total billed charges for outpatient setting,$335.59 ,85% of total billed charges for outpatient setting,$276.37 ,70% of total billed charges for outpatient setting,$276.37 ,70% of total billed charges for outpatient setting,$304.00 ,77% of total billed charges for outpatient setting,$123.62 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$335.59 ,85% of total billed charges for outpatient setting,$335.59 ,85% of total billed charges for outpatient setting,$335.59 ,85% of total billed charges for outpatient setting,$335.59 ,85% of total billed charges for outpatient setting,$335.59 ,85% of total billed charges for outpatient setting,$78.53 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$123.62 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$123.62 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$123.62 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$123.62 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$335.59 ,85% of total billed charges for outpatient setting,$76.99 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$122.39 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$355.33 ,90% of total billed charges for outpatient setting,$79.28 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$375.07 ,95% of total billed charges for outpatient setting,$335.59 ,85% of total billed charges for outpatient setting,$315.85 ,80% of total billed charges for outpatient setting,$78.53 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$335.59 ,85% of total billed charges for outpatient setting,$335.59 ,85% of total billed charges for outpatient setting,$335.59 ,85% of total billed charges for outpatient setting,$367.17 ,93% of total billed charges for outpatient setting,$296.11 ,75% of total billed charges for outpatient setting,$296.11 ,75% of total billed charges for outpatient setting,$296.11 ,75% of total billed charges for outpatient setting,$79.28 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$335.59 ,85% of total billed charges for outpatient setting,$78.53 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$76.99 ,$375.07 ,$138.18 Outpatient Medical Services,RADIOLOGY,74018,XR Abdomen 1 View,320,$331.58 ,$177.73 ,53.6% of total biled charges for outpatient setting,$177.73 ,53.6% of total biled charges for outpatient setting,$248.69 ,75% of total billed charges for outpatient setting,$248.69 ,75% of total billed charges for outpatient setting,$248.69 ,75% of total billed charges for outpatient setting,$104.85 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$104.85 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$104.85 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$104.85 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$104.85 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$104.85 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$265.26 ,80% of total billed charges for outpatient setting,$104.85 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$116.05 ,35% of total billed charges for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$103.82 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$265.26 ,80% of total billed charges for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$232.11 ,70% of total billed charges for outpatient setting,$232.11 ,70% of total billed charges for outpatient setting,$255.32 ,77% of total billed charges for outpatient setting,$103.82 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$281.84 ,85% of total billed charges for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$65.95 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$103.82 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$103.82 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$103.82 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$103.82 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$281.84 ,85% of total billed charges for outpatient setting,$64.66 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$102.79 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$298.42 ,90% of total billed charges for outpatient setting,$66.58 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$315.00 ,95% of total billed charges for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$265.26 ,80% of total billed charges for outpatient setting,$65.95 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$308.37 ,93% of total billed charges for outpatient setting,$248.69 ,75% of total billed charges for outpatient setting,$248.69 ,75% of total billed charges for outpatient setting,$248.69 ,75% of total billed charges for outpatient setting,$66.58 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$281.84 ,85% of total billed charges for outpatient setting,$65.95 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$64.66 ,$315.00 ,$116.05 Outpatient Medical Services,RADIOLOGY,74019,XR Abdomen 2 Views,320,$234.00 ,$125.42 ,53.6% of total biled charges for outpatient setting,$125.42 ,53.6% of total biled charges for outpatient setting,$175.50 ,75% of total billed charges for outpatient setting,$175.50 ,75% of total billed charges for outpatient setting,$175.50 ,75% of total billed charges for outpatient setting,$73.99 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$73.99 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$73.99 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$73.99 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$73.99 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$73.99 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$187.20 ,80% of total billed charges for outpatient setting,$73.99 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$81.90 ,35% of total billed charges for outpatient setting,$198.90 ,85% of total billed charges for outpatient setting,$73.27 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$187.20 ,80% of total billed charges for outpatient setting,$198.90 ,85% of total billed charges for outpatient setting,$163.80 ,70% of total billed charges for outpatient setting,$163.80 ,70% of total billed charges for outpatient setting,$180.18 ,77% of total billed charges for outpatient setting,$73.27 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$198.90 ,85% of total billed charges for outpatient setting,$198.90 ,85% of total billed charges for outpatient setting,$198.90 ,85% of total billed charges for outpatient setting,$198.90 ,85% of total billed charges for outpatient setting,$198.90 ,85% of total billed charges for outpatient setting,$46.54 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$73.27 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$73.27 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$73.27 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$73.27 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$198.90 ,85% of total billed charges for outpatient setting,$45.63 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$72.54 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$210.60 ,90% of total billed charges for outpatient setting,$46.99 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$222.30 ,95% of total billed charges for outpatient setting,$198.90 ,85% of total billed charges for outpatient setting,$187.20 ,80% of total billed charges for outpatient setting,$46.54 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$198.90 ,85% of total billed charges for outpatient setting,$198.90 ,85% of total billed charges for outpatient setting,$198.90 ,85% of total billed charges for outpatient setting,$217.62 ,93% of total billed charges for outpatient setting,$175.50 ,75% of total billed charges for outpatient setting,$175.50 ,75% of total billed charges for outpatient setting,$175.50 ,75% of total billed charges for outpatient setting,$46.99 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$198.90 ,85% of total billed charges for outpatient setting,$46.54 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$45.63 ,$222.30 ,$81.90 Outpatient Medical Services,RADIOLOGY,74022,XR Abdomen Series + Chest 1 View,320,$245.88 ,$131.79 ,53.6% of total biled charges for outpatient setting,$131.79 ,53.6% of total biled charges for outpatient setting,$184.41 ,75% of total billed charges for outpatient setting,$184.41 ,75% of total billed charges for outpatient setting,$184.41 ,75% of total billed charges for outpatient setting,$77.75 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$77.75 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$77.75 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$77.75 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$77.75 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$77.75 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$196.70 ,80% of total billed charges for outpatient setting,$77.75 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.06 ,35% of total billed charges for outpatient setting,$209.00 ,85% of total billed charges for outpatient setting,$76.99 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$196.70 ,80% of total billed charges for outpatient setting,$209.00 ,85% of total billed charges for outpatient setting,$172.12 ,70% of total billed charges for outpatient setting,$172.12 ,70% of total billed charges for outpatient setting,$189.33 ,77% of total billed charges for outpatient setting,$76.99 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$209.00 ,85% of total billed charges for outpatient setting,$209.00 ,85% of total billed charges for outpatient setting,$209.00 ,85% of total billed charges for outpatient setting,$209.00 ,85% of total billed charges for outpatient setting,$209.00 ,85% of total billed charges for outpatient setting,$48.91 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$76.99 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$76.99 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$76.99 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$76.99 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$209.00 ,85% of total billed charges for outpatient setting,$47.95 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$76.22 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$221.29 ,90% of total billed charges for outpatient setting,$49.37 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$233.59 ,95% of total billed charges for outpatient setting,$209.00 ,85% of total billed charges for outpatient setting,$196.70 ,80% of total billed charges for outpatient setting,$48.91 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$209.00 ,85% of total billed charges for outpatient setting,$209.00 ,85% of total billed charges for outpatient setting,$209.00 ,85% of total billed charges for outpatient setting,$228.67 ,93% of total billed charges for outpatient setting,$184.41 ,75% of total billed charges for outpatient setting,$184.41 ,75% of total billed charges for outpatient setting,$184.41 ,75% of total billed charges for outpatient setting,$49.37 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$209.00 ,85% of total billed charges for outpatient setting,$48.91 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$47.95 ,$233.59 ,$86.06 Outpatient Medical Services,RADIOLOGY,76010,XR Foreign Body Localization Child 1 Vw,320,$399.90 ,$214.35 ,53.6% of total biled charges for outpatient setting,$214.35 ,53.6% of total biled charges for outpatient setting,$299.93 ,75% of total billed charges for outpatient setting,$299.93 ,75% of total billed charges for outpatient setting,$299.93 ,75% of total billed charges for outpatient setting,$126.45 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$126.45 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$126.45 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$126.45 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$126.45 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$126.45 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$319.92 ,80% of total billed charges for outpatient setting,$126.45 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$139.97 ,35% of total billed charges for outpatient setting,$339.92 ,85% of total billed charges for outpatient setting,$125.21 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$319.92 ,80% of total billed charges for outpatient setting,$339.92 ,85% of total billed charges for outpatient setting,$279.93 ,70% of total billed charges for outpatient setting,$279.93 ,70% of total billed charges for outpatient setting,$307.92 ,77% of total billed charges for outpatient setting,$125.21 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$339.92 ,85% of total billed charges for outpatient setting,$339.92 ,85% of total billed charges for outpatient setting,$339.92 ,85% of total billed charges for outpatient setting,$339.92 ,85% of total billed charges for outpatient setting,$339.92 ,85% of total billed charges for outpatient setting,$79.54 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$125.21 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$125.21 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$125.21 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$125.21 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$339.92 ,85% of total billed charges for outpatient setting,$77.98 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$123.97 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$359.91 ,90% of total billed charges for outpatient setting,$80.30 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$379.91 ,95% of total billed charges for outpatient setting,$339.92 ,85% of total billed charges for outpatient setting,$319.92 ,80% of total billed charges for outpatient setting,$79.54 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$339.92 ,85% of total billed charges for outpatient setting,$339.92 ,85% of total billed charges for outpatient setting,$339.92 ,85% of total billed charges for outpatient setting,$371.91 ,93% of total billed charges for outpatient setting,$299.93 ,75% of total billed charges for outpatient setting,$299.93 ,75% of total billed charges for outpatient setting,$299.93 ,75% of total billed charges for outpatient setting,$80.30 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$339.92 ,85% of total billed charges for outpatient setting,$79.54 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$77.98 ,$379.91 ,$139.97 Outpatient Medical Services,RADIOLOGY,76641,US Breast Complete Right,402,$680.00 ,$364.48 ,53.6% of total biled charges for outpatient setting,$364.48 ,53.6% of total biled charges for outpatient setting,$510.00 ,75% of total billed charges for outpatient setting,$510.00 ,75% of total billed charges for outpatient setting,$510.00 ,75% of total billed charges for outpatient setting,$215.02 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$215.02 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$215.02 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$215.02 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$215.02 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$215.02 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$544.00 ,80% of total billed charges for outpatient setting,$215.02 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$238.00 ,35% of total billed charges for outpatient setting,$578.00 ,85% of total billed charges for outpatient setting,$212.91 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$544.00 ,80% of total billed charges for outpatient setting,$578.00 ,85% of total billed charges for outpatient setting,$476.00 ,70% of total billed charges for outpatient setting,$476.00 ,70% of total billed charges for outpatient setting,$523.60 ,77% of total billed charges for outpatient setting,$212.91 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$578.00 ,85% of total billed charges for outpatient setting,$578.00 ,85% of total billed charges for outpatient setting,$578.00 ,85% of total billed charges for outpatient setting,$578.00 ,85% of total billed charges for outpatient setting,$578.00 ,85% of total billed charges for outpatient setting,$135.25 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$212.91 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$212.91 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$212.91 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$212.91 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$578.00 ,85% of total billed charges for outpatient setting,$132.60 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$210.80 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$612.00 ,90% of total billed charges for outpatient setting,$136.54 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$646.00 ,95% of total billed charges for outpatient setting,$578.00 ,85% of total billed charges for outpatient setting,$544.00 ,80% of total billed charges for outpatient setting,$135.25 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$578.00 ,85% of total billed charges for outpatient setting,$578.00 ,85% of total billed charges for outpatient setting,$578.00 ,85% of total billed charges for outpatient setting,$632.40 ,93% of total billed charges for outpatient setting,$510.00 ,75% of total billed charges for outpatient setting,$510.00 ,75% of total billed charges for outpatient setting,$510.00 ,75% of total billed charges for outpatient setting,$136.54 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$578.00 ,85% of total billed charges for outpatient setting,$135.25 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$132.60 ,$646.00 ,$238.00 Outpatient Medical Services,RADIOLOGY,76705,US Abdomen Limited,402,$907.63 ,$486.49 ,53.6% of total biled charges for outpatient setting,$486.49 ,53.6% of total biled charges for outpatient setting,$680.72 ,75% of total billed charges for outpatient setting,$680.72 ,75% of total billed charges for outpatient setting,$680.72 ,75% of total billed charges for outpatient setting,$286.99 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$286.99 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$286.99 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$286.99 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$286.99 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$286.99 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$726.10 ,80% of total billed charges for outpatient setting,$286.99 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$317.67 ,35% of total billed charges for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$284.18 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$726.10 ,80% of total billed charges for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$635.34 ,70% of total billed charges for outpatient setting,$635.34 ,70% of total billed charges for outpatient setting,$698.88 ,77% of total billed charges for outpatient setting,$284.18 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$771.49 ,85% of total billed charges for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$180.53 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$284.18 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$284.18 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$284.18 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$284.18 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$771.49 ,85% of total billed charges for outpatient setting,$176.99 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$281.37 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$816.87 ,90% of total billed charges for outpatient setting,$182.25 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$862.25 ,95% of total billed charges for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$726.10 ,80% of total billed charges for outpatient setting,$180.53 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$844.10 ,93% of total billed charges for outpatient setting,$680.72 ,75% of total billed charges for outpatient setting,$680.72 ,75% of total billed charges for outpatient setting,$680.72 ,75% of total billed charges for outpatient setting,$182.25 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$180.53 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$176.99 ,$862.25 ,$317.67 Outpatient Medical Services,RADIOLOGY,76705,US Appendix,402,$907.63 ,$486.49 ,53.6% of total biled charges for outpatient setting,$486.49 ,53.6% of total biled charges for outpatient setting,$680.72 ,75% of total billed charges for outpatient setting,$680.72 ,75% of total billed charges for outpatient setting,$680.72 ,75% of total billed charges for outpatient setting,$286.99 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$286.99 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$286.99 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$286.99 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$286.99 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$286.99 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$726.10 ,80% of total billed charges for outpatient setting,$286.99 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$317.67 ,35% of total billed charges for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$284.18 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$726.10 ,80% of total billed charges for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$635.34 ,70% of total billed charges for outpatient setting,$635.34 ,70% of total billed charges for outpatient setting,$698.88 ,77% of total billed charges for outpatient setting,$284.18 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$771.49 ,85% of total billed charges for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$180.53 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$284.18 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$284.18 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$284.18 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$284.18 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$771.49 ,85% of total billed charges for outpatient setting,$176.99 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$281.37 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$816.87 ,90% of total billed charges for outpatient setting,$182.25 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$862.25 ,95% of total billed charges for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$726.10 ,80% of total billed charges for outpatient setting,$180.53 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$844.10 ,93% of total billed charges for outpatient setting,$680.72 ,75% of total billed charges for outpatient setting,$680.72 ,75% of total billed charges for outpatient setting,$680.72 ,75% of total billed charges for outpatient setting,$182.25 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$180.53 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$176.99 ,$862.25 ,$317.67 Outpatient Medical Services,RADIOLOGY,76705,US Soft Tissue,402,$907.63 ,$486.49 ,53.6% of total biled charges for outpatient setting,$486.49 ,53.6% of total biled charges for outpatient setting,$680.72 ,75% of total billed charges for outpatient setting,$680.72 ,75% of total billed charges for outpatient setting,$680.72 ,75% of total billed charges for outpatient setting,$286.99 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$286.99 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$286.99 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$286.99 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$286.99 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$286.99 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$726.10 ,80% of total billed charges for outpatient setting,$286.99 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$317.67 ,35% of total billed charges for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$284.18 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$726.10 ,80% of total billed charges for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$635.34 ,70% of total billed charges for outpatient setting,$635.34 ,70% of total billed charges for outpatient setting,$698.88 ,77% of total billed charges for outpatient setting,$284.18 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$771.49 ,85% of total billed charges for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$180.53 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$284.18 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$284.18 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$284.18 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$284.18 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$771.49 ,85% of total billed charges for outpatient setting,$176.99 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$281.37 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$816.87 ,90% of total billed charges for outpatient setting,$182.25 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$862.25 ,95% of total billed charges for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$726.10 ,80% of total billed charges for outpatient setting,$180.53 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$844.10 ,93% of total billed charges for outpatient setting,$680.72 ,75% of total billed charges for outpatient setting,$680.72 ,75% of total billed charges for outpatient setting,$680.72 ,75% of total billed charges for outpatient setting,$182.25 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$180.53 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$176.99 ,$862.25 ,$317.67 Outpatient Medical Services,RADIOLOGY,76705,US Liver (Hepatic),402,$907.63 ,$486.49 ,53.6% of total biled charges for outpatient setting,$486.49 ,53.6% of total biled charges for outpatient setting,$680.72 ,75% of total billed charges for outpatient setting,$680.72 ,75% of total billed charges for outpatient setting,$680.72 ,75% of total billed charges for outpatient setting,$286.99 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$286.99 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$286.99 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$286.99 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$286.99 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$286.99 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$726.10 ,80% of total billed charges for outpatient setting,$286.99 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$317.67 ,35% of total billed charges for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$284.18 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$726.10 ,80% of total billed charges for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$635.34 ,70% of total billed charges for outpatient setting,$635.34 ,70% of total billed charges for outpatient setting,$698.88 ,77% of total billed charges for outpatient setting,$284.18 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$771.49 ,85% of total billed charges for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$180.53 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$284.18 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$284.18 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$284.18 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$284.18 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$771.49 ,85% of total billed charges for outpatient setting,$176.99 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$281.37 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$816.87 ,90% of total billed charges for outpatient setting,$182.25 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$862.25 ,95% of total billed charges for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$726.10 ,80% of total billed charges for outpatient setting,$180.53 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$844.10 ,93% of total billed charges for outpatient setting,$680.72 ,75% of total billed charges for outpatient setting,$680.72 ,75% of total billed charges for outpatient setting,$680.72 ,75% of total billed charges for outpatient setting,$182.25 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$771.49 ,85% of total billed charges for outpatient setting,$180.53 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$176.99 ,$862.25 ,$317.67 Outpatient Medical Services,RADIOLOGY,76770,US Aorta,402,$414.48 ,$222.16 ,53.6% of total biled charges for outpatient setting,$222.16 ,53.6% of total biled charges for outpatient setting,$310.86 ,75% of total billed charges for outpatient setting,$310.86 ,75% of total billed charges for outpatient setting,$310.86 ,75% of total billed charges for outpatient setting,$131.06 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$131.06 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$131.06 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$131.06 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$131.06 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$131.06 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$331.58 ,80% of total billed charges for outpatient setting,$131.06 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$145.07 ,35% of total billed charges for outpatient setting,$352.31 ,85% of total billed charges for outpatient setting,$129.77 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$331.58 ,80% of total billed charges for outpatient setting,$352.31 ,85% of total billed charges for outpatient setting,$290.14 ,70% of total billed charges for outpatient setting,$290.14 ,70% of total billed charges for outpatient setting,$319.15 ,77% of total billed charges for outpatient setting,$129.77 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$352.31 ,85% of total billed charges for outpatient setting,$352.31 ,85% of total billed charges for outpatient setting,$352.31 ,85% of total billed charges for outpatient setting,$352.31 ,85% of total billed charges for outpatient setting,$352.31 ,85% of total billed charges for outpatient setting,$82.44 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$129.77 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$129.77 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$129.77 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$129.77 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$352.31 ,85% of total billed charges for outpatient setting,$80.82 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$128.49 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$373.03 ,90% of total billed charges for outpatient setting,$83.23 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$393.76 ,95% of total billed charges for outpatient setting,$352.31 ,85% of total billed charges for outpatient setting,$331.58 ,80% of total billed charges for outpatient setting,$82.44 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$352.31 ,85% of total billed charges for outpatient setting,$352.31 ,85% of total billed charges for outpatient setting,$352.31 ,85% of total billed charges for outpatient setting,$385.47 ,93% of total billed charges for outpatient setting,$310.86 ,75% of total billed charges for outpatient setting,$310.86 ,75% of total billed charges for outpatient setting,$310.86 ,75% of total billed charges for outpatient setting,$83.23 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$352.31 ,85% of total billed charges for outpatient setting,$82.44 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$80.82 ,$393.76 ,$145.07 Outpatient Medical Services,RADIOLOGY,76770,US Renal Bilateral,402,$414.48 ,$222.16 ,53.6% of total biled charges for outpatient setting,$222.16 ,53.6% of total biled charges for outpatient setting,$310.86 ,75% of total billed charges for outpatient setting,$310.86 ,75% of total billed charges for outpatient setting,$310.86 ,75% of total billed charges for outpatient setting,$131.06 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$131.06 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$131.06 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$131.06 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$131.06 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$131.06 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$331.58 ,80% of total billed charges for outpatient setting,$131.06 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$145.07 ,35% of total billed charges for outpatient setting,$352.31 ,85% of total billed charges for outpatient setting,$129.77 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$331.58 ,80% of total billed charges for outpatient setting,$352.31 ,85% of total billed charges for outpatient setting,$290.14 ,70% of total billed charges for outpatient setting,$290.14 ,70% of total billed charges for outpatient setting,$319.15 ,77% of total billed charges for outpatient setting,$129.77 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$352.31 ,85% of total billed charges for outpatient setting,$352.31 ,85% of total billed charges for outpatient setting,$352.31 ,85% of total billed charges for outpatient setting,$352.31 ,85% of total billed charges for outpatient setting,$352.31 ,85% of total billed charges for outpatient setting,$82.44 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$129.77 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$129.77 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$129.77 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$129.77 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$352.31 ,85% of total billed charges for outpatient setting,$80.82 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$128.49 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$373.03 ,90% of total billed charges for outpatient setting,$83.23 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$393.76 ,95% of total billed charges for outpatient setting,$352.31 ,85% of total billed charges for outpatient setting,$331.58 ,80% of total billed charges for outpatient setting,$82.44 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$352.31 ,85% of total billed charges for outpatient setting,$352.31 ,85% of total billed charges for outpatient setting,$352.31 ,85% of total billed charges for outpatient setting,$385.47 ,93% of total billed charges for outpatient setting,$310.86 ,75% of total billed charges for outpatient setting,$310.86 ,75% of total billed charges for outpatient setting,$310.86 ,75% of total billed charges for outpatient setting,$83.23 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$352.31 ,85% of total billed charges for outpatient setting,$82.44 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$80.82 ,$393.76 ,$145.07 Outpatient Medical Services,RADIOLOGY,76815,US OB Limited,402,$802.00 ,$429.87 ,53.6% of total biled charges for outpatient setting,$429.87 ,53.6% of total biled charges for outpatient setting,$601.50 ,75% of total billed charges for outpatient setting,$601.50 ,75% of total billed charges for outpatient setting,$601.50 ,75% of total billed charges for outpatient setting,$253.59 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$253.59 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$253.59 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$253.59 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$253.59 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$253.59 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$641.60 ,80% of total billed charges for outpatient setting,$253.59 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$280.70 ,35% of total billed charges for outpatient setting,$681.70 ,85% of total billed charges for outpatient setting,$251.11 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$641.60 ,80% of total billed charges for outpatient setting,$681.70 ,85% of total billed charges for outpatient setting,$561.40 ,70% of total billed charges for outpatient setting,$561.40 ,70% of total billed charges for outpatient setting,$617.54 ,77% of total billed charges for outpatient setting,$251.11 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$681.70 ,85% of total billed charges for outpatient setting,$681.70 ,85% of total billed charges for outpatient setting,$681.70 ,85% of total billed charges for outpatient setting,$681.70 ,85% of total billed charges for outpatient setting,$681.70 ,85% of total billed charges for outpatient setting,$159.52 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$251.11 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$251.11 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$251.11 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$251.11 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$681.70 ,85% of total billed charges for outpatient setting,$156.39 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$248.62 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$721.80 ,90% of total billed charges for outpatient setting,$161.04 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$761.90 ,95% of total billed charges for outpatient setting,$681.70 ,85% of total billed charges for outpatient setting,$641.60 ,80% of total billed charges for outpatient setting,$159.52 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$681.70 ,85% of total billed charges for outpatient setting,$681.70 ,85% of total billed charges for outpatient setting,$681.70 ,85% of total billed charges for outpatient setting,$745.86 ,93% of total billed charges for outpatient setting,$601.50 ,75% of total billed charges for outpatient setting,$601.50 ,75% of total billed charges for outpatient setting,$601.50 ,75% of total billed charges for outpatient setting,$161.04 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$681.70 ,85% of total billed charges for outpatient setting,$159.52 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$156.39 ,$761.90 ,$280.70 Outpatient Medical Services,RADIOLOGY,76830,US Transvaginal Non-OB,402,$995.00 ,$533.32 ,53.6% of total biled charges for outpatient setting,$533.32 ,53.6% of total biled charges for outpatient setting,$746.25 ,75% of total billed charges for outpatient setting,$746.25 ,75% of total billed charges for outpatient setting,$746.25 ,75% of total billed charges for outpatient setting,$314.62 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$314.62 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$314.62 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$314.62 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$314.62 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$314.62 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$796.00 ,80% of total billed charges for outpatient setting,$314.62 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$348.25 ,35% of total billed charges for outpatient setting,$845.75 ,85% of total billed charges for outpatient setting,$311.53 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$796.00 ,80% of total billed charges for outpatient setting,$845.75 ,85% of total billed charges for outpatient setting,$696.50 ,70% of total billed charges for outpatient setting,$696.50 ,70% of total billed charges for outpatient setting,$766.15 ,77% of total billed charges for outpatient setting,$311.53 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$845.75 ,85% of total billed charges for outpatient setting,$845.75 ,85% of total billed charges for outpatient setting,$845.75 ,85% of total billed charges for outpatient setting,$845.75 ,85% of total billed charges for outpatient setting,$845.75 ,85% of total billed charges for outpatient setting,$197.91 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$311.53 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$311.53 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$311.53 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$311.53 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$845.75 ,85% of total billed charges for outpatient setting,$194.03 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$308.45 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$895.50 ,90% of total billed charges for outpatient setting,$199.80 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$945.25 ,95% of total billed charges for outpatient setting,$845.75 ,85% of total billed charges for outpatient setting,$796.00 ,80% of total billed charges for outpatient setting,$197.91 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$845.75 ,85% of total billed charges for outpatient setting,$845.75 ,85% of total billed charges for outpatient setting,$845.75 ,85% of total billed charges for outpatient setting,$925.35 ,93% of total billed charges for outpatient setting,$746.25 ,75% of total billed charges for outpatient setting,$746.25 ,75% of total billed charges for outpatient setting,$746.25 ,75% of total billed charges for outpatient setting,$199.80 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$845.75 ,85% of total billed charges for outpatient setting,$197.91 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$194.03 ,$945.25 ,$348.25 Outpatient Medical Services,RADIOLOGY,76856,US Bladder Scan,402,$841.60 ,$451.10 ,53.6% of total biled charges for outpatient setting,$451.10 ,53.6% of total biled charges for outpatient setting,$631.20 ,75% of total billed charges for outpatient setting,$631.20 ,75% of total billed charges for outpatient setting,$631.20 ,75% of total billed charges for outpatient setting,$266.11 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$266.11 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$266.11 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$266.11 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$266.11 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$266.11 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$673.28 ,80% of total billed charges for outpatient setting,$266.11 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$294.56 ,35% of total billed charges for outpatient setting,$715.36 ,85% of total billed charges for outpatient setting,$263.50 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$673.28 ,80% of total billed charges for outpatient setting,$715.36 ,85% of total billed charges for outpatient setting,$589.12 ,70% of total billed charges for outpatient setting,$589.12 ,70% of total billed charges for outpatient setting,$648.03 ,77% of total billed charges for outpatient setting,$263.50 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$715.36 ,85% of total billed charges for outpatient setting,$715.36 ,85% of total billed charges for outpatient setting,$715.36 ,85% of total billed charges for outpatient setting,$715.36 ,85% of total billed charges for outpatient setting,$715.36 ,85% of total billed charges for outpatient setting,$167.39 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$263.50 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$263.50 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$263.50 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$263.50 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$715.36 ,85% of total billed charges for outpatient setting,$164.11 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$260.90 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$757.44 ,90% of total billed charges for outpatient setting,$168.99 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$799.52 ,95% of total billed charges for outpatient setting,$715.36 ,85% of total billed charges for outpatient setting,$673.28 ,80% of total billed charges for outpatient setting,$167.39 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$715.36 ,85% of total billed charges for outpatient setting,$715.36 ,85% of total billed charges for outpatient setting,$715.36 ,85% of total billed charges for outpatient setting,$782.69 ,93% of total billed charges for outpatient setting,$631.20 ,75% of total billed charges for outpatient setting,$631.20 ,75% of total billed charges for outpatient setting,$631.20 ,75% of total billed charges for outpatient setting,$168.99 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$715.36 ,85% of total billed charges for outpatient setting,$167.39 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$164.11 ,$799.52 ,$294.56 Outpatient Medical Services,RADIOLOGY,76856,US Pelvic Complete,402,$841.60 ,$451.10 ,53.6% of total biled charges for outpatient setting,$451.10 ,53.6% of total biled charges for outpatient setting,$631.20 ,75% of total billed charges for outpatient setting,$631.20 ,75% of total billed charges for outpatient setting,$631.20 ,75% of total billed charges for outpatient setting,$266.11 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$266.11 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$266.11 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$266.11 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$266.11 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$266.11 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$673.28 ,80% of total billed charges for outpatient setting,$266.11 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$294.56 ,35% of total billed charges for outpatient setting,$715.36 ,85% of total billed charges for outpatient setting,$263.50 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$673.28 ,80% of total billed charges for outpatient setting,$715.36 ,85% of total billed charges for outpatient setting,$589.12 ,70% of total billed charges for outpatient setting,$589.12 ,70% of total billed charges for outpatient setting,$648.03 ,77% of total billed charges for outpatient setting,$263.50 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$715.36 ,85% of total billed charges for outpatient setting,$715.36 ,85% of total billed charges for outpatient setting,$715.36 ,85% of total billed charges for outpatient setting,$715.36 ,85% of total billed charges for outpatient setting,$715.36 ,85% of total billed charges for outpatient setting,$167.39 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$263.50 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$263.50 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$263.50 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$263.50 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$715.36 ,85% of total billed charges for outpatient setting,$164.11 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$260.90 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$757.44 ,90% of total billed charges for outpatient setting,$168.99 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$799.52 ,95% of total billed charges for outpatient setting,$715.36 ,85% of total billed charges for outpatient setting,$673.28 ,80% of total billed charges for outpatient setting,$167.39 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$715.36 ,85% of total billed charges for outpatient setting,$715.36 ,85% of total billed charges for outpatient setting,$715.36 ,85% of total billed charges for outpatient setting,$782.69 ,93% of total billed charges for outpatient setting,$631.20 ,75% of total billed charges for outpatient setting,$631.20 ,75% of total billed charges for outpatient setting,$631.20 ,75% of total billed charges for outpatient setting,$168.99 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$715.36 ,85% of total billed charges for outpatient setting,$167.39 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$164.11 ,$799.52 ,$294.56 Outpatient Medical Services,RADIOLOGY,76882,US Extremity Nonvascular Limited Left,402,$431.00 ,$231.02 ,53.6% of total biled charges for outpatient setting,$231.02 ,53.6% of total biled charges for outpatient setting,$323.25 ,75% of total billed charges for outpatient setting,$323.25 ,75% of total billed charges for outpatient setting,$323.25 ,75% of total billed charges for outpatient setting,$136.28 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$136.28 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$136.28 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$136.28 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$136.28 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$136.28 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$344.80 ,80% of total billed charges for outpatient setting,$136.28 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$150.85 ,35% of total billed charges for outpatient setting,$366.35 ,85% of total billed charges for outpatient setting,$134.95 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$344.80 ,80% of total billed charges for outpatient setting,$366.35 ,85% of total billed charges for outpatient setting,$301.70 ,70% of total billed charges for outpatient setting,$301.70 ,70% of total billed charges for outpatient setting,$331.87 ,77% of total billed charges for outpatient setting,$134.95 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$366.35 ,85% of total billed charges for outpatient setting,$366.35 ,85% of total billed charges for outpatient setting,$366.35 ,85% of total billed charges for outpatient setting,$366.35 ,85% of total billed charges for outpatient setting,$366.35 ,85% of total billed charges for outpatient setting,$85.73 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$134.95 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$134.95 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$134.95 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$134.95 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$366.35 ,85% of total billed charges for outpatient setting,$84.05 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$133.61 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$387.90 ,90% of total billed charges for outpatient setting,$86.54 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$409.45 ,95% of total billed charges for outpatient setting,$366.35 ,85% of total billed charges for outpatient setting,$344.80 ,80% of total billed charges for outpatient setting,$85.73 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$366.35 ,85% of total billed charges for outpatient setting,$366.35 ,85% of total billed charges for outpatient setting,$366.35 ,85% of total billed charges for outpatient setting,$400.83 ,93% of total billed charges for outpatient setting,$323.25 ,75% of total billed charges for outpatient setting,$323.25 ,75% of total billed charges for outpatient setting,$323.25 ,75% of total billed charges for outpatient setting,$86.54 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$366.35 ,85% of total billed charges for outpatient setting,$85.73 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$84.05 ,$409.45 ,$150.85 Outpatient Medical Services,RADIOLOGY,76942,76942 Ultrasonic guidance for needle placement,N/A,N/A,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,,,N/A Outpatient Medical Services,RADIOLOGY,77065,MG Mammo Diagnostic Left w/ Tomo,401,$767.60 ,$411.43 ,53.6% of total biled charges for outpatient setting,$411.43 ,53.6% of total biled charges for outpatient setting,$575.70 ,75% of total billed charges for outpatient setting,$575.70 ,75% of total billed charges for outpatient setting,$575.70 ,75% of total billed charges for outpatient setting,$242.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$242.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$242.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$242.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$242.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$242.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$614.08 ,80% of total billed charges for outpatient setting,$242.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$268.66 ,35% of total billed charges for outpatient setting,$652.46 ,85% of total billed charges for outpatient setting,$240.34 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$614.08 ,80% of total billed charges for outpatient setting,$652.46 ,85% of total billed charges for outpatient setting,$537.32 ,70% of total billed charges for outpatient setting,$537.32 ,70% of total billed charges for outpatient setting,$591.05 ,77% of total billed charges for outpatient setting,$240.34 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$652.46 ,85% of total billed charges for outpatient setting,$652.46 ,85% of total billed charges for outpatient setting,$652.46 ,85% of total billed charges for outpatient setting,$652.46 ,85% of total billed charges for outpatient setting,$652.46 ,85% of total billed charges for outpatient setting,$152.68 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$240.34 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$240.34 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$240.34 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$240.34 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$652.46 ,85% of total billed charges for outpatient setting,$149.68 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$237.96 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$690.84 ,90% of total billed charges for outpatient setting,$154.13 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$729.22 ,95% of total billed charges for outpatient setting,$652.46 ,85% of total billed charges for outpatient setting,$614.08 ,80% of total billed charges for outpatient setting,$152.68 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$652.46 ,85% of total billed charges for outpatient setting,$652.46 ,85% of total billed charges for outpatient setting,$652.46 ,85% of total billed charges for outpatient setting,$713.87 ,93% of total billed charges for outpatient setting,$575.70 ,75% of total billed charges for outpatient setting,$575.70 ,75% of total billed charges for outpatient setting,$575.70 ,75% of total billed charges for outpatient setting,$154.13 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$652.46 ,85% of total billed charges for outpatient setting,$152.68 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$149.68 ,$729.22 ,$268.66 Outpatient Medical Services,RADIOLOGY,77065,MG Mammo Diagnostic Right w/ Tomo,401,$767.60 ,$411.43 ,53.6% of total biled charges for outpatient setting,$411.43 ,53.6% of total biled charges for outpatient setting,$575.70 ,75% of total billed charges for outpatient setting,$575.70 ,75% of total billed charges for outpatient setting,$575.70 ,75% of total billed charges for outpatient setting,$242.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$242.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$242.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$242.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$242.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$242.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$614.08 ,80% of total billed charges for outpatient setting,$242.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$268.66 ,35% of total billed charges for outpatient setting,$652.46 ,85% of total billed charges for outpatient setting,$240.34 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$614.08 ,80% of total billed charges for outpatient setting,$652.46 ,85% of total billed charges for outpatient setting,$537.32 ,70% of total billed charges for outpatient setting,$537.32 ,70% of total billed charges for outpatient setting,$591.05 ,77% of total billed charges for outpatient setting,$240.34 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$652.46 ,85% of total billed charges for outpatient setting,$652.46 ,85% of total billed charges for outpatient setting,$652.46 ,85% of total billed charges for outpatient setting,$652.46 ,85% of total billed charges for outpatient setting,$652.46 ,85% of total billed charges for outpatient setting,$152.68 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$240.34 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$240.34 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$240.34 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$240.34 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$652.46 ,85% of total billed charges for outpatient setting,$149.68 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$237.96 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$690.84 ,90% of total billed charges for outpatient setting,$154.13 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$729.22 ,95% of total billed charges for outpatient setting,$652.46 ,85% of total billed charges for outpatient setting,$614.08 ,80% of total billed charges for outpatient setting,$152.68 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$652.46 ,85% of total billed charges for outpatient setting,$652.46 ,85% of total billed charges for outpatient setting,$652.46 ,85% of total billed charges for outpatient setting,$713.87 ,93% of total billed charges for outpatient setting,$575.70 ,75% of total billed charges for outpatient setting,$575.70 ,75% of total billed charges for outpatient setting,$575.70 ,75% of total billed charges for outpatient setting,$154.13 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$652.46 ,85% of total billed charges for outpatient setting,$152.68 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$149.68 ,$729.22 ,$268.66 Outpatient Medical Services,RADIOLOGY,77067,MG Mammo Screening Bilateral w/ Tomo. Rad Charge,403,$880.69 ,$472.05 ,53.6% of total biled charges for outpatient setting,$472.05 ,53.6% of total biled charges for outpatient setting,$660.52 ,75% of total billed charges for outpatient setting,$660.52 ,75% of total billed charges for outpatient setting,$660.52 ,75% of total billed charges for outpatient setting,$278.47 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$278.47 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$278.47 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$278.47 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$278.47 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$278.47 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$704.55 ,80% of total billed charges for outpatient setting,$278.47 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$308.24 ,35% of total billed charges for outpatient setting,$748.59 ,85% of total billed charges for outpatient setting,$275.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$704.55 ,80% of total billed charges for outpatient setting,$748.59 ,85% of total billed charges for outpatient setting,$616.48 ,70% of total billed charges for outpatient setting,$616.48 ,70% of total billed charges for outpatient setting,$678.13 ,77% of total billed charges for outpatient setting,$275.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$748.59 ,85% of total billed charges for outpatient setting,$748.59 ,85% of total billed charges for outpatient setting,$748.59 ,85% of total billed charges for outpatient setting,$748.59 ,85% of total billed charges for outpatient setting,$748.59 ,85% of total billed charges for outpatient setting,$175.17 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$275.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$275.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$275.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$275.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$748.59 ,85% of total billed charges for outpatient setting,$171.73 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$273.01 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$792.62 ,90% of total billed charges for outpatient setting,$176.84 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$836.66 ,95% of total billed charges for outpatient setting,$748.59 ,85% of total billed charges for outpatient setting,$704.55 ,80% of total billed charges for outpatient setting,$175.17 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$748.59 ,85% of total billed charges for outpatient setting,$748.59 ,85% of total billed charges for outpatient setting,$748.59 ,85% of total billed charges for outpatient setting,$819.04 ,93% of total billed charges for outpatient setting,$660.52 ,75% of total billed charges for outpatient setting,$660.52 ,75% of total billed charges for outpatient setting,$660.52 ,75% of total billed charges for outpatient setting,$176.84 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$748.59 ,85% of total billed charges for outpatient setting,$175.17 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$171.73 ,$836.66 ,$308.24 Outpatient Medical Services,RADIOLOGY,77067,MG Mammo Screening Bilateral w/ Tomo,403,$880.69 ,$472.05 ,53.6% of total biled charges for outpatient setting,$472.05 ,53.6% of total biled charges for outpatient setting,$660.52 ,75% of total billed charges for outpatient setting,$660.52 ,75% of total billed charges for outpatient setting,$660.52 ,75% of total billed charges for outpatient setting,$278.47 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$278.47 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$278.47 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$278.47 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$278.47 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$278.47 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$704.55 ,80% of total billed charges for outpatient setting,$278.47 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$308.24 ,35% of total billed charges for outpatient setting,$748.59 ,85% of total billed charges for outpatient setting,$275.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$704.55 ,80% of total billed charges for outpatient setting,$748.59 ,85% of total billed charges for outpatient setting,$616.48 ,70% of total billed charges for outpatient setting,$616.48 ,70% of total billed charges for outpatient setting,$678.13 ,77% of total billed charges for outpatient setting,$275.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$748.59 ,85% of total billed charges for outpatient setting,$748.59 ,85% of total billed charges for outpatient setting,$748.59 ,85% of total billed charges for outpatient setting,$748.59 ,85% of total billed charges for outpatient setting,$748.59 ,85% of total billed charges for outpatient setting,$175.17 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$275.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$275.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$275.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$275.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$748.59 ,85% of total billed charges for outpatient setting,$171.73 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$273.01 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$792.62 ,90% of total billed charges for outpatient setting,$176.84 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$836.66 ,95% of total billed charges for outpatient setting,$748.59 ,85% of total billed charges for outpatient setting,$704.55 ,80% of total billed charges for outpatient setting,$175.17 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$748.59 ,85% of total billed charges for outpatient setting,$748.59 ,85% of total billed charges for outpatient setting,$748.59 ,85% of total billed charges for outpatient setting,$819.04 ,93% of total billed charges for outpatient setting,$660.52 ,75% of total billed charges for outpatient setting,$660.52 ,75% of total billed charges for outpatient setting,$660.52 ,75% of total billed charges for outpatient setting,$176.84 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$748.59 ,85% of total billed charges for outpatient setting,$175.17 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$171.73 ,$836.66 ,$308.24 Outpatient Medical Services,RADIOLOGY,77067,MG Mammo Digital Screening Bilateral,403,$880.69 ,$472.05 ,53.6% of total biled charges for outpatient setting,$472.05 ,53.6% of total biled charges for outpatient setting,$660.52 ,75% of total billed charges for outpatient setting,$660.52 ,75% of total billed charges for outpatient setting,$660.52 ,75% of total billed charges for outpatient setting,$278.47 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$278.47 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$278.47 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$278.47 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$278.47 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$278.47 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$704.55 ,80% of total billed charges for outpatient setting,$278.47 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$308.24 ,35% of total billed charges for outpatient setting,$748.59 ,85% of total billed charges for outpatient setting,$275.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$704.55 ,80% of total billed charges for outpatient setting,$748.59 ,85% of total billed charges for outpatient setting,$616.48 ,70% of total billed charges for outpatient setting,$616.48 ,70% of total billed charges for outpatient setting,$678.13 ,77% of total billed charges for outpatient setting,$275.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$748.59 ,85% of total billed charges for outpatient setting,$748.59 ,85% of total billed charges for outpatient setting,$748.59 ,85% of total billed charges for outpatient setting,$748.59 ,85% of total billed charges for outpatient setting,$748.59 ,85% of total billed charges for outpatient setting,$175.17 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$275.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$275.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$275.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$275.74 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$748.59 ,85% of total billed charges for outpatient setting,$171.73 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$273.01 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$792.62 ,90% of total billed charges for outpatient setting,$176.84 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$836.66 ,95% of total billed charges for outpatient setting,$748.59 ,85% of total billed charges for outpatient setting,$704.55 ,80% of total billed charges for outpatient setting,$175.17 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$748.59 ,85% of total billed charges for outpatient setting,$748.59 ,85% of total billed charges for outpatient setting,$748.59 ,85% of total billed charges for outpatient setting,$819.04 ,93% of total billed charges for outpatient setting,$660.52 ,75% of total billed charges for outpatient setting,$660.52 ,75% of total billed charges for outpatient setting,$660.52 ,75% of total billed charges for outpatient setting,$176.84 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$748.59 ,85% of total billed charges for outpatient setting,$175.17 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$171.73 ,$836.66 ,$308.24 Outpatient Medical Services,RADIOLOGY,77067,MG Mammo Digital Screening Bilateral,401,$758.00 ,$406.29 ,53.6% of total biled charges for outpatient setting,$406.29 ,53.6% of total biled charges for outpatient setting,$568.50 ,75% of total billed charges for outpatient setting,$568.50 ,75% of total billed charges for outpatient setting,$568.50 ,75% of total billed charges for outpatient setting,$239.68 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$239.68 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$239.68 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$239.68 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$239.68 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$239.68 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$606.40 ,80% of total billed charges for outpatient setting,$239.68 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$265.30 ,35% of total billed charges for outpatient setting,$644.30 ,85% of total billed charges for outpatient setting,$237.33 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$606.40 ,80% of total billed charges for outpatient setting,$644.30 ,85% of total billed charges for outpatient setting,$530.60 ,70% of total billed charges for outpatient setting,$530.60 ,70% of total billed charges for outpatient setting,$583.66 ,77% of total billed charges for outpatient setting,$237.33 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$644.30 ,85% of total billed charges for outpatient setting,$644.30 ,85% of total billed charges for outpatient setting,$644.30 ,85% of total billed charges for outpatient setting,$644.30 ,85% of total billed charges for outpatient setting,$644.30 ,85% of total billed charges for outpatient setting,$150.77 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$237.33 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$237.33 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$237.33 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$237.33 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$644.30 ,85% of total billed charges for outpatient setting,$147.81 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$234.98 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$682.20 ,90% of total billed charges for outpatient setting,$152.21 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$720.10 ,95% of total billed charges for outpatient setting,$644.30 ,85% of total billed charges for outpatient setting,$606.40 ,80% of total billed charges for outpatient setting,$150.77 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$644.30 ,85% of total billed charges for outpatient setting,$644.30 ,85% of total billed charges for outpatient setting,$644.30 ,85% of total billed charges for outpatient setting,$704.94 ,93% of total billed charges for outpatient setting,$568.50 ,75% of total billed charges for outpatient setting,$568.50 ,75% of total billed charges for outpatient setting,$568.50 ,75% of total billed charges for outpatient setting,$152.21 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$644.30 ,85% of total billed charges for outpatient setting,$150.77 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$147.81 ,$720.10 ,$265.30 Outpatient Medical Services,RADIOLOGY,77080,BD Bone Density DEXA Axial Skeleton,320,$336.05 ,$180.12 ,53.6% of total biled charges for outpatient setting,$180.12 ,53.6% of total biled charges for outpatient setting,$252.04 ,75% of total billed charges for outpatient setting,$252.04 ,75% of total billed charges for outpatient setting,$252.04 ,75% of total billed charges for outpatient setting,$106.26 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$106.26 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$106.26 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$106.26 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$106.26 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$106.26 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$268.84 ,80% of total billed charges for outpatient setting,$106.26 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$117.62 ,35% of total billed charges for outpatient setting,$285.64 ,85% of total billed charges for outpatient setting,$105.22 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$268.84 ,80% of total billed charges for outpatient setting,$285.64 ,85% of total billed charges for outpatient setting,$235.24 ,70% of total billed charges for outpatient setting,$235.24 ,70% of total billed charges for outpatient setting,$258.76 ,77% of total billed charges for outpatient setting,$105.22 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$285.64 ,85% of total billed charges for outpatient setting,$285.64 ,85% of total billed charges for outpatient setting,$285.64 ,85% of total billed charges for outpatient setting,$285.64 ,85% of total billed charges for outpatient setting,$285.64 ,85% of total billed charges for outpatient setting,$66.84 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$105.22 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$105.22 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$105.22 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$105.22 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$285.64 ,85% of total billed charges for outpatient setting,$65.53 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$104.18 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$302.45 ,90% of total billed charges for outpatient setting,$67.48 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$319.25 ,95% of total billed charges for outpatient setting,$285.64 ,85% of total billed charges for outpatient setting,$268.84 ,80% of total billed charges for outpatient setting,$66.84 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$285.64 ,85% of total billed charges for outpatient setting,$285.64 ,85% of total billed charges for outpatient setting,$285.64 ,85% of total billed charges for outpatient setting,$312.53 ,93% of total billed charges for outpatient setting,$252.04 ,75% of total billed charges for outpatient setting,$252.04 ,75% of total billed charges for outpatient setting,$252.04 ,75% of total billed charges for outpatient setting,$67.48 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$285.64 ,85% of total billed charges for outpatient setting,$66.84 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$65.53 ,$319.25 ,$117.62 Outpatient Medical Services,THERAPY,90832,FAMILY THERAPY W / PATIENT 30 MIN,916,$177.00 ,$94.87 ,53.6% of total biled charges for outpatient setting,$94.87 ,53.6% of total biled charges for outpatient setting,$132.75 ,75% of total billed charges for outpatient setting,$132.75 ,75% of total billed charges for outpatient setting,$132.75 ,75% of total billed charges for outpatient setting,$55.97 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$55.97 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$55.97 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$55.97 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$55.97 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$55.97 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$141.60 ,80% of total billed charges for outpatient setting,$55.97 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$61.95 ,35% of total billed charges for outpatient setting,$150.45 ,85% of total billed charges for outpatient setting,$55.42 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$141.60 ,80% of total billed charges for outpatient setting,$150.45 ,85% of total billed charges for outpatient setting,$123.90 ,70% of total billed charges for outpatient setting,$123.90 ,70% of total billed charges for outpatient setting,$136.29 ,77% of total billed charges for outpatient setting,$55.42 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$150.45 ,85% of total billed charges for outpatient setting,$150.45 ,85% of total billed charges for outpatient setting,$150.45 ,85% of total billed charges for outpatient setting,$150.45 ,85% of total billed charges for outpatient setting,$150.45 ,85% of total billed charges for outpatient setting,$35.21 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$55.42 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$55.42 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$55.42 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$55.42 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$150.45 ,85% of total billed charges for outpatient setting,$34.52 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$54.87 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$159.30 ,90% of total billed charges for outpatient setting,$35.54 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$168.15 ,95% of total billed charges for outpatient setting,$150.45 ,85% of total billed charges for outpatient setting,$141.60 ,80% of total billed charges for outpatient setting,$35.21 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$150.45 ,85% of total billed charges for outpatient setting,$150.45 ,85% of total billed charges for outpatient setting,$150.45 ,85% of total billed charges for outpatient setting,$164.61 ,93% of total billed charges for outpatient setting,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$35.54 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$150.45 ,85% of total billed charges for outpatient setting,$35.21 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$34.52 ,$168.15 ,$61.95 Outpatient Medical Services,THERAPY,90834,INDV PSYCHOTHERAPY 38-52 MIN,914,$299.00 ,$160.26 ,53.6% of total biled charges for outpatient setting,$160.26 ,53.6% of total biled charges for outpatient setting,$224.25 ,75% of total billed charges for outpatient setting,$224.25 ,75% of total billed charges for outpatient setting,$224.25 ,75% of total billed charges for outpatient setting,$94.54 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$94.54 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$94.54 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$94.54 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$94.54 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$94.54 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$239.20 ,80% of total billed charges for outpatient setting,$94.54 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$104.65 ,35% of total billed charges for outpatient setting,$254.15 ,85% of total billed charges for outpatient setting,$93.62 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$239.20 ,80% of total billed charges for outpatient setting,$254.15 ,85% of total billed charges for outpatient setting,$209.30 ,70% of total billed charges for outpatient setting,$209.30 ,70% of total billed charges for outpatient setting,$230.23 ,77% of total billed charges for outpatient setting,$93.62 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$254.15 ,85% of total billed charges for outpatient setting,$254.15 ,85% of total billed charges for outpatient setting,$254.15 ,85% of total billed charges for outpatient setting,$254.15 ,85% of total billed charges for outpatient setting,$254.15 ,85% of total billed charges for outpatient setting,$59.47 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$93.62 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$93.62 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$93.62 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$93.62 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$254.15 ,85% of total billed charges for outpatient setting,$58.31 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$92.69 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$269.10 ,90% of total billed charges for outpatient setting,$60.04 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$284.05 ,95% of total billed charges for outpatient setting,$254.15 ,85% of total billed charges for outpatient setting,$239.20 ,80% of total billed charges for outpatient setting,$59.47 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$254.15 ,85% of total billed charges for outpatient setting,$254.15 ,85% of total billed charges for outpatient setting,$254.15 ,85% of total billed charges for outpatient setting,$278.07 ,93% of total billed charges for outpatient setting,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$60.04 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$254.15 ,85% of total billed charges for outpatient setting,$59.47 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$58.31 ,$284.05 ,$104.65 Outpatient Medical Services,THERAPY,90837,INDIVIDUAL THERAPY 53 - 67 MINS,914,$381.00 ,$204.22 ,53.6% of total biled charges for outpatient setting,$204.22 ,53.6% of total biled charges for outpatient setting,$285.75 ,75% of total billed charges for outpatient setting,$285.75 ,75% of total billed charges for outpatient setting,$285.75 ,75% of total billed charges for outpatient setting,$120.47 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$120.47 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$120.47 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$120.47 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$120.47 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$120.47 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$304.80 ,80% of total billed charges for outpatient setting,$120.47 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$133.35 ,35% of total billed charges for outpatient setting,$323.85 ,85% of total billed charges for outpatient setting,$119.29 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$304.80 ,80% of total billed charges for outpatient setting,$323.85 ,85% of total billed charges for outpatient setting,$266.70 ,70% of total billed charges for outpatient setting,$266.70 ,70% of total billed charges for outpatient setting,$293.37 ,77% of total billed charges for outpatient setting,$119.29 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$323.85 ,85% of total billed charges for outpatient setting,$323.85 ,85% of total billed charges for outpatient setting,$323.85 ,85% of total billed charges for outpatient setting,$323.85 ,85% of total billed charges for outpatient setting,$323.85 ,85% of total billed charges for outpatient setting,$75.78 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$119.29 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$119.29 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$119.29 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$119.29 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$323.85 ,85% of total billed charges for outpatient setting,$74.30 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$118.11 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$342.90 ,90% of total billed charges for outpatient setting,$76.50 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$361.95 ,95% of total billed charges for outpatient setting,$323.85 ,85% of total billed charges for outpatient setting,$304.80 ,80% of total billed charges for outpatient setting,$75.78 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$323.85 ,85% of total billed charges for outpatient setting,$323.85 ,85% of total billed charges for outpatient setting,$323.85 ,85% of total billed charges for outpatient setting,$354.33 ,93% of total billed charges for outpatient setting,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$76.50 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$323.85 ,85% of total billed charges for outpatient setting,$75.78 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$74.30 ,$361.95 ,$133.35 Outpatient Medical Services,THERAPY,90846,FAMILY PSYCHOTHERAPY W/OUT PATIENT PRESENT,916,$272.00 ,$145.79 ,53.6% of total biled charges for outpatient setting,$145.79 ,53.6% of total biled charges for outpatient setting,$204.00 ,75% of total billed charges for outpatient setting,$204.00 ,75% of total billed charges for outpatient setting,$204.00 ,75% of total billed charges for outpatient setting,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$217.60 ,80% of total billed charges for outpatient setting,$86.01 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$95.20 ,35% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$217.60 ,80% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$190.40 ,70% of total billed charges for outpatient setting,$190.40 ,70% of total billed charges for outpatient setting,$209.44 ,77% of total billed charges for outpatient setting,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$54.10 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$85.16 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$231.20 ,85% of total billed charges for outpatient setting,$53.04 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$84.32 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$244.80 ,90% of total billed charges for outpatient setting,$54.62 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$258.40 ,95% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$217.60 ,80% of total billed charges for outpatient setting,$54.10 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$252.96 ,93% of total billed charges for outpatient setting,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$54.62 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$231.20 ,85% of total billed charges for outpatient setting,$54.10 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$53.04 ,$258.40 ,$95.20 Outpatient Medical Services,THERAPY,90847,FAMILY THERAPY W / PATIENT 1HR,916,$353.00 ,$189.21 ,53.6% of total biled charges for outpatient setting,$189.21 ,53.6% of total biled charges for outpatient setting,$264.75 ,75% of total billed charges for outpatient setting,$264.75 ,75% of total billed charges for outpatient setting,$264.75 ,75% of total billed charges for outpatient setting,$111.62 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$111.62 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$111.62 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$111.62 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$111.62 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$111.62 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$282.40 ,80% of total billed charges for outpatient setting,$111.62 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$123.55 ,35% of total billed charges for outpatient setting,$300.05 ,85% of total billed charges for outpatient setting,$110.52 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$282.40 ,80% of total billed charges for outpatient setting,$300.05 ,85% of total billed charges for outpatient setting,$247.10 ,70% of total billed charges for outpatient setting,$247.10 ,70% of total billed charges for outpatient setting,$271.81 ,77% of total billed charges for outpatient setting,$110.52 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$300.05 ,85% of total billed charges for outpatient setting,$300.05 ,85% of total billed charges for outpatient setting,$300.05 ,85% of total billed charges for outpatient setting,$300.05 ,85% of total billed charges for outpatient setting,$300.05 ,85% of total billed charges for outpatient setting,$70.21 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$110.52 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$110.52 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$110.52 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$110.52 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$300.05 ,85% of total billed charges for outpatient setting,$68.84 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$109.43 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$317.70 ,90% of total billed charges for outpatient setting,$70.88 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$335.35 ,95% of total billed charges for outpatient setting,$300.05 ,85% of total billed charges for outpatient setting,$282.40 ,80% of total billed charges for outpatient setting,$70.21 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$300.05 ,85% of total billed charges for outpatient setting,$300.05 ,85% of total billed charges for outpatient setting,$300.05 ,85% of total billed charges for outpatient setting,$328.29 ,93% of total billed charges for outpatient setting,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$70.88 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$300.05 ,85% of total billed charges for outpatient setting,$70.21 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$68.84 ,$335.35 ,$123.55 Outpatient Medical Services,THERAPY,90847,FAMILY PSYCHOTHERAPY W/ PATIENT PRESENT,916,$353.00 ,$189.21 ,53.6% of total biled charges for outpatient setting,$189.21 ,53.6% of total biled charges for outpatient setting,$264.75 ,75% of total billed charges for outpatient setting,$264.75 ,75% of total billed charges for outpatient setting,$264.75 ,75% of total billed charges for outpatient setting,$111.62 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$111.62 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$111.62 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$111.62 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$111.62 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$111.62 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$282.40 ,80% of total billed charges for outpatient setting,$111.62 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$123.55 ,35% of total billed charges for outpatient setting,$300.05 ,85% of total billed charges for outpatient setting,$110.52 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$282.40 ,80% of total billed charges for outpatient setting,$300.05 ,85% of total billed charges for outpatient setting,$247.10 ,70% of total billed charges for outpatient setting,$247.10 ,70% of total billed charges for outpatient setting,$271.81 ,77% of total billed charges for outpatient setting,$110.52 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$300.05 ,85% of total billed charges for outpatient setting,$300.05 ,85% of total billed charges for outpatient setting,$300.05 ,85% of total billed charges for outpatient setting,$300.05 ,85% of total billed charges for outpatient setting,$300.05 ,85% of total billed charges for outpatient setting,$70.21 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$110.52 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$110.52 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$110.52 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$110.52 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$300.05 ,85% of total billed charges for outpatient setting,$68.84 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$109.43 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$317.70 ,90% of total billed charges for outpatient setting,$70.88 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$335.35 ,95% of total billed charges for outpatient setting,$300.05 ,85% of total billed charges for outpatient setting,$282.40 ,80% of total billed charges for outpatient setting,$70.21 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$300.05 ,85% of total billed charges for outpatient setting,$300.05 ,85% of total billed charges for outpatient setting,$300.05 ,85% of total billed charges for outpatient setting,$328.29 ,93% of total billed charges for outpatient setting,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$70.88 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$300.05 ,85% of total billed charges for outpatient setting,$70.21 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$68.84 ,$335.35 ,$123.55 Outpatient Medical Services,THERAPY,90853,GROUP PSYCHOTHERAPY,915,$326.00 ,$174.74 ,53.6% of total biled charges for outpatient setting,$174.74 ,53.6% of total biled charges for outpatient setting,$244.50 ,75% of total billed charges for outpatient setting,$244.50 ,75% of total billed charges for outpatient setting,$244.50 ,75% of total billed charges for outpatient setting,$103.08 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$103.08 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$103.08 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$103.08 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$103.08 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$103.08 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$260.80 ,80% of total billed charges for outpatient setting,$103.08 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$114.10 ,35% of total billed charges for outpatient setting,$277.10 ,85% of total billed charges for outpatient setting,$102.07 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$260.80 ,80% of total billed charges for outpatient setting,$277.10 ,85% of total billed charges for outpatient setting,$228.20 ,70% of total billed charges for outpatient setting,$228.20 ,70% of total billed charges for outpatient setting,$251.02 ,77% of total billed charges for outpatient setting,$102.07 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$277.10 ,85% of total billed charges for outpatient setting,$277.10 ,85% of total billed charges for outpatient setting,$277.10 ,85% of total billed charges for outpatient setting,$277.10 ,85% of total billed charges for outpatient setting,$277.10 ,85% of total billed charges for outpatient setting,$64.84 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$102.07 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$102.07 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$102.07 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$102.07 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$277.10 ,85% of total billed charges for outpatient setting,$63.57 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$101.06 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$293.40 ,90% of total billed charges for outpatient setting,$65.46 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$309.70 ,95% of total billed charges for outpatient setting,$277.10 ,85% of total billed charges for outpatient setting,$260.80 ,80% of total billed charges for outpatient setting,$64.84 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$277.10 ,85% of total billed charges for outpatient setting,$277.10 ,85% of total billed charges for outpatient setting,$277.10 ,85% of total billed charges for outpatient setting,$303.18 ,93% of total billed charges for outpatient setting,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$65.46 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$277.10 ,85% of total billed charges for outpatient setting,$64.84 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$63.57 ,$309.70 ,$114.10 Outpatient Medical Services,VISIT,90832,PSYC TX 30 MIN IND OP (16-27 MIN),914,$217.00 ,$116.31 ,53.6% of total biled charges for outpatient setting,$116.31 ,53.6% of total biled charges for outpatient setting,$162.75 ,75% of total billed charges for outpatient setting,$162.75 ,75% of total billed charges for outpatient setting,$162.75 ,75% of total billed charges for outpatient setting,$68.62 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$68.62 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$68.62 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$68.62 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$68.62 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$68.62 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$173.60 ,80% of total billed charges for outpatient setting,$68.62 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$75.95 ,35% of total billed charges for outpatient setting,$184.45 ,85% of total billed charges for outpatient setting,$67.94 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$173.60 ,80% of total billed charges for outpatient setting,$184.45 ,85% of total billed charges for outpatient setting,$151.90 ,70% of total billed charges for outpatient setting,$151.90 ,70% of total billed charges for outpatient setting,$167.09 ,77% of total billed charges for outpatient setting,$67.94 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$184.45 ,85% of total billed charges for outpatient setting,$184.45 ,85% of total billed charges for outpatient setting,$184.45 ,85% of total billed charges for outpatient setting,$184.45 ,85% of total billed charges for outpatient setting,$184.45 ,85% of total billed charges for outpatient setting,$43.16 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$67.94 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$67.94 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$67.94 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$67.94 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$184.45 ,85% of total billed charges for outpatient setting,$42.32 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$67.27 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$195.30 ,90% of total billed charges for outpatient setting,$43.57 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$206.15 ,95% of total billed charges for outpatient setting,$184.45 ,85% of total billed charges for outpatient setting,$173.60 ,80% of total billed charges for outpatient setting,$43.16 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$184.45 ,85% of total billed charges for outpatient setting,$184.45 ,85% of total billed charges for outpatient setting,$184.45 ,85% of total billed charges for outpatient setting,$201.81 ,93% of total billed charges for outpatient setting,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$43.57 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$184.45 ,85% of total billed charges for outpatient setting,$43.16 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$42.32 ,$206.15 ,$75.95 Outpatient Medical Services,VISIT,99203,OFFICE/OP VISIT NEW-3 CHARGE,510,$308.00 ,$165.09 ,53.6% of total biled charges for outpatient setting,$165.09 ,53.6% of total biled charges for outpatient setting,$231.00 ,75% of total billed charges for outpatient setting,$231.00 ,75% of total billed charges for outpatient setting,$231.00 ,75% of total billed charges for outpatient setting,$97.39 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$97.39 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$97.39 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$97.39 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$97.39 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$97.39 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$246.40 ,80% of total billed charges for outpatient setting,$97.39 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$107.80 ,35% of total billed charges for outpatient setting,$261.80 ,85% of total billed charges for outpatient setting,$96.43 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$246.40 ,80% of total billed charges for outpatient setting,$261.80 ,85% of total billed charges for outpatient setting,$215.60 ,70% of total billed charges for outpatient setting,$215.60 ,70% of total billed charges for outpatient setting,$237.16 ,77% of total billed charges for outpatient setting,$96.43 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$261.80 ,85% of total billed charges for outpatient setting,$261.80 ,85% of total billed charges for outpatient setting,$261.80 ,85% of total billed charges for outpatient setting,$261.80 ,85% of total billed charges for outpatient setting,$261.80 ,85% of total billed charges for outpatient setting,$61.26 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$96.43 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$96.43 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$96.43 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$96.43 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$261.80 ,85% of total billed charges for outpatient setting,$60.06 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$95.48 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$277.20 ,90% of total billed charges for outpatient setting,$61.85 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$292.60 ,95% of total billed charges for outpatient setting,$261.80 ,85% of total billed charges for outpatient setting,$246.40 ,80% of total billed charges for outpatient setting,$61.26 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$261.80 ,85% of total billed charges for outpatient setting,$261.80 ,85% of total billed charges for outpatient setting,$261.80 ,85% of total billed charges for outpatient setting,$286.44 ,93% of total billed charges for outpatient setting,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$61.85 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$261.80 ,85% of total billed charges for outpatient setting,$61.26 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$60.06 ,$292.60 ,$107.80 Outpatient Medical Services,VISIT,99204,OFFICE/OP VISIT NEW-4 CHARGE,510,$475.00 ,$254.60 ,53.6% of total biled charges for outpatient setting,$254.60 ,53.6% of total biled charges for outpatient setting,$356.25 ,75% of total billed charges for outpatient setting,$356.25 ,75% of total billed charges for outpatient setting,$356.25 ,75% of total billed charges for outpatient setting,$150.20 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$150.20 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$150.20 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$150.20 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$150.20 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$150.20 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$380.00 ,80% of total billed charges for outpatient setting,$150.20 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$166.25 ,35% of total billed charges for outpatient setting,$403.75 ,85% of total billed charges for outpatient setting,$148.72 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$380.00 ,80% of total billed charges for outpatient setting,$403.75 ,85% of total billed charges for outpatient setting,$332.50 ,70% of total billed charges for outpatient setting,$332.50 ,70% of total billed charges for outpatient setting,$365.75 ,77% of total billed charges for outpatient setting,$148.72 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$403.75 ,85% of total billed charges for outpatient setting,$403.75 ,85% of total billed charges for outpatient setting,$403.75 ,85% of total billed charges for outpatient setting,$403.75 ,85% of total billed charges for outpatient setting,$403.75 ,85% of total billed charges for outpatient setting,$94.48 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$148.72 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$148.72 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$148.72 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$148.72 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$403.75 ,85% of total billed charges for outpatient setting,$92.63 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$147.25 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$427.50 ,90% of total billed charges for outpatient setting,$95.38 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$451.25 ,95% of total billed charges for outpatient setting,$403.75 ,85% of total billed charges for outpatient setting,$380.00 ,80% of total billed charges for outpatient setting,$94.48 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$403.75 ,85% of total billed charges for outpatient setting,$403.75 ,85% of total billed charges for outpatient setting,$403.75 ,85% of total billed charges for outpatient setting,$441.75 ,93% of total billed charges for outpatient setting,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$95.38 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$403.75 ,85% of total billed charges for outpatient setting,$94.48 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$92.63 ,$451.25 ,$166.25 Outpatient Medical Services,VISIT,99205,Level Five New Visit,510,$600.00 ,$321.60 ,53.6% of total biled charges for outpatient setting,$321.60 ,53.6% of total biled charges for outpatient setting,$450.00 ,75% of total billed charges for outpatient setting,$450.00 ,75% of total billed charges for outpatient setting,$450.00 ,75% of total billed charges for outpatient setting,$189.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$189.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$189.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$189.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$189.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$189.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$480.00 ,80% of total billed charges for outpatient setting,$189.72 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$210.00 ,35% of total billed charges for outpatient setting,$510.00 ,85% of total billed charges for outpatient setting,$187.86 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$480.00 ,80% of total billed charges for outpatient setting,$510.00 ,85% of total billed charges for outpatient setting,$420.00 ,70% of total billed charges for outpatient setting,$420.00 ,70% of total billed charges for outpatient setting,$462.00 ,77% of total billed charges for outpatient setting,$187.86 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$510.00 ,85% of total billed charges for outpatient setting,$510.00 ,85% of total billed charges for outpatient setting,$510.00 ,85% of total billed charges for outpatient setting,$510.00 ,85% of total billed charges for outpatient setting,$510.00 ,85% of total billed charges for outpatient setting,$119.34 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$187.86 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$187.86 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$187.86 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$187.86 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$510.00 ,85% of total billed charges for outpatient setting,$117.00 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$186.00 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$540.00 ,90% of total billed charges for outpatient setting,$120.48 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$570.00 ,95% of total billed charges for outpatient setting,$510.00 ,85% of total billed charges for outpatient setting,$480.00 ,80% of total billed charges for outpatient setting,$119.34 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$510.00 ,85% of total billed charges for outpatient setting,$510.00 ,85% of total billed charges for outpatient setting,$510.00 ,85% of total billed charges for outpatient setting,$558.00 ,93% of total billed charges for outpatient setting,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$120.48 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$510.00 ,85% of total billed charges for outpatient setting,$119.34 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$117.00 ,$570.00 ,$210.00 Outpatient Medical Services,VISIT,99211,OFFICE/OP VISIT EST-1 CHARGE,510,$122.00 ,$65.39 ,53.6% of total biled charges for outpatient setting,$65.39 ,53.6% of total biled charges for outpatient setting,$91.50 ,75% of total billed charges for outpatient setting,$91.50 ,75% of total billed charges for outpatient setting,$91.50 ,75% of total billed charges for outpatient setting,$38.58 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$38.58 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$38.58 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$38.58 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$38.58 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$38.58 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$97.60 ,80% of total billed charges for outpatient setting,$38.58 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$42.70 ,35% of total billed charges for outpatient setting,$103.70 ,85% of total billed charges for outpatient setting,$38.20 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$97.60 ,80% of total billed charges for outpatient setting,$103.70 ,85% of total billed charges for outpatient setting,$85.40 ,70% of total billed charges for outpatient setting,$85.40 ,70% of total billed charges for outpatient setting,$93.94 ,77% of total billed charges for outpatient setting,$38.20 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$103.70 ,85% of total billed charges for outpatient setting,$103.70 ,85% of total billed charges for outpatient setting,$103.70 ,85% of total billed charges for outpatient setting,$103.70 ,85% of total billed charges for outpatient setting,$103.70 ,85% of total billed charges for outpatient setting,$24.27 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$38.20 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$38.20 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$38.20 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$38.20 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$103.70 ,85% of total billed charges for outpatient setting,$23.79 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$37.82 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$109.80 ,90% of total billed charges for outpatient setting,$24.50 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$115.90 ,95% of total billed charges for outpatient setting,$103.70 ,85% of total billed charges for outpatient setting,$97.60 ,80% of total billed charges for outpatient setting,$24.27 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$103.70 ,85% of total billed charges for outpatient setting,$103.70 ,85% of total billed charges for outpatient setting,$103.70 ,85% of total billed charges for outpatient setting,$113.46 ,93% of total billed charges for outpatient setting,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$24.50 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$103.70 ,85% of total billed charges for outpatient setting,$24.27 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$23.79 ,$115.90 ,$42.70 Outpatient Medical Services,VISIT,99211,TREATMENT ROOM,761,$77.94 ,$41.78 ,53.6% of total biled charges for outpatient setting,$41.78 ,53.6% of total biled charges for outpatient setting,$58.46 ,75% of total billed charges for outpatient setting,$58.46 ,75% of total billed charges for outpatient setting,$58.46 ,75% of total billed charges for outpatient setting,$24.64 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$24.64 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$24.64 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$24.64 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$24.64 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$24.64 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$62.35 ,80% of total billed charges for outpatient setting,$24.64 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$27.28 ,35% of total billed charges for outpatient setting,$66.25 ,85% of total billed charges for outpatient setting,$24.40 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$62.35 ,80% of total billed charges for outpatient setting,$66.25 ,85% of total billed charges for outpatient setting,$54.56 ,70% of total billed charges for outpatient setting,$54.56 ,70% of total billed charges for outpatient setting,$60.01 ,77% of total billed charges for outpatient setting,$24.40 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$66.25 ,85% of total billed charges for outpatient setting,$66.25 ,85% of total billed charges for outpatient setting,$66.25 ,85% of total billed charges for outpatient setting,$66.25 ,85% of total billed charges for outpatient setting,$66.25 ,85% of total billed charges for outpatient setting,$15.50 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$24.40 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$24.40 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$24.40 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$24.40 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$66.25 ,85% of total billed charges for outpatient setting,$15.20 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$24.16 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$70.15 ,90% of total billed charges for outpatient setting,$15.65 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$74.04 ,95% of total billed charges for outpatient setting,$66.25 ,85% of total billed charges for outpatient setting,$62.35 ,80% of total billed charges for outpatient setting,$15.50 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$66.25 ,85% of total billed charges for outpatient setting,$66.25 ,85% of total billed charges for outpatient setting,$66.25 ,85% of total billed charges for outpatient setting,$72.48 ,93% of total billed charges for outpatient setting,$58.46 ,75% of total billed charges for outpatient setting,$58.46 ,75% of total billed charges for outpatient setting,$58.46 ,75% of total billed charges for outpatient setting,$15.65 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$66.25 ,85% of total billed charges for outpatient setting,$15.50 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$15.20 ,$74.04 ,$27.28 Outpatient Medical Services,VISIT,99212,OFFICE/OP VISIT EST-2 CHARGE,510,$175.18 ,$93.90 ,53.6% of total biled charges for outpatient setting,$93.90 ,53.6% of total biled charges for outpatient setting,$131.39 ,75% of total billed charges for outpatient setting,$131.39 ,75% of total billed charges for outpatient setting,$131.39 ,75% of total billed charges for outpatient setting,$55.39 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$55.39 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$55.39 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$55.39 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$55.39 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$55.39 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$140.14 ,80% of total billed charges for outpatient setting,$55.39 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$61.31 ,35% of total billed charges for outpatient setting,$148.90 ,85% of total billed charges for outpatient setting,$54.85 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$140.14 ,80% of total billed charges for outpatient setting,$148.90 ,85% of total billed charges for outpatient setting,$122.63 ,70% of total billed charges for outpatient setting,$122.63 ,70% of total billed charges for outpatient setting,$134.89 ,77% of total billed charges for outpatient setting,$54.85 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$148.90 ,85% of total billed charges for outpatient setting,$148.90 ,85% of total billed charges for outpatient setting,$148.90 ,85% of total billed charges for outpatient setting,$148.90 ,85% of total billed charges for outpatient setting,$148.90 ,85% of total billed charges for outpatient setting,$34.84 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$54.85 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$54.85 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$54.85 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$54.85 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$148.90 ,85% of total billed charges for outpatient setting,$34.16 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$54.31 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$157.66 ,90% of total billed charges for outpatient setting,$35.18 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$166.42 ,95% of total billed charges for outpatient setting,$148.90 ,85% of total billed charges for outpatient setting,$140.14 ,80% of total billed charges for outpatient setting,$34.84 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$148.90 ,85% of total billed charges for outpatient setting,$148.90 ,85% of total billed charges for outpatient setting,$148.90 ,85% of total billed charges for outpatient setting,$162.92 ,93% of total billed charges for outpatient setting,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$35.18 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$148.90 ,85% of total billed charges for outpatient setting,$34.84 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$34.16 ,$166.42 ,$61.31 Outpatient Medical Services,VISIT,99213,OFFICE/OP VISIT EST-3 CHARGE,510,$302.08 ,$161.91 ,53.6% of total biled charges for outpatient setting,$161.91 ,53.6% of total biled charges for outpatient setting,$226.56 ,75% of total billed charges for outpatient setting,$226.56 ,75% of total billed charges for outpatient setting,$226.56 ,75% of total billed charges for outpatient setting,$95.52 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$95.52 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$95.52 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$95.52 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$95.52 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$95.52 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$241.66 ,80% of total billed charges for outpatient setting,$95.52 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$105.73 ,35% of total billed charges for outpatient setting,$256.77 ,85% of total billed charges for outpatient setting,$94.58 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$241.66 ,80% of total billed charges for outpatient setting,$256.77 ,85% of total billed charges for outpatient setting,$211.46 ,70% of total billed charges for outpatient setting,$211.46 ,70% of total billed charges for outpatient setting,$232.60 ,77% of total billed charges for outpatient setting,$94.58 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$256.77 ,85% of total billed charges for outpatient setting,$256.77 ,85% of total billed charges for outpatient setting,$256.77 ,85% of total billed charges for outpatient setting,$256.77 ,85% of total billed charges for outpatient setting,$256.77 ,85% of total billed charges for outpatient setting,$60.08 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$94.58 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$94.58 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$94.58 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$94.58 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$256.77 ,85% of total billed charges for outpatient setting,$58.91 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$93.64 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$271.87 ,90% of total billed charges for outpatient setting,$60.66 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$286.98 ,95% of total billed charges for outpatient setting,$256.77 ,85% of total billed charges for outpatient setting,$241.66 ,80% of total billed charges for outpatient setting,$60.08 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$256.77 ,85% of total billed charges for outpatient setting,$256.77 ,85% of total billed charges for outpatient setting,$256.77 ,85% of total billed charges for outpatient setting,$280.93 ,93% of total billed charges for outpatient setting,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$60.66 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$256.77 ,85% of total billed charges for outpatient setting,$60.08 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$58.91 ,$286.98 ,$105.73 Outpatient Medical Services,VISIT,99213,"Office/Outpatient - Established Patient, Low (20-29 mins)",510,$302.08 ,$161.91 ,53.6% of total biled charges for outpatient setting,$161.91 ,53.6% of total biled charges for outpatient setting,$226.56 ,75% of total billed charges for outpatient setting,$226.56 ,75% of total billed charges for outpatient setting,$226.56 ,75% of total billed charges for outpatient setting,$95.52 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$95.52 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$95.52 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$95.52 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$95.52 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$95.52 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$241.66 ,80% of total billed charges for outpatient setting,$95.52 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$105.73 ,35% of total billed charges for outpatient setting,$256.77 ,85% of total billed charges for outpatient setting,$94.58 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$241.66 ,80% of total billed charges for outpatient setting,$256.77 ,85% of total billed charges for outpatient setting,$211.46 ,70% of total billed charges for outpatient setting,$211.46 ,70% of total billed charges for outpatient setting,$232.60 ,77% of total billed charges for outpatient setting,$94.58 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$256.77 ,85% of total billed charges for outpatient setting,$256.77 ,85% of total billed charges for outpatient setting,$256.77 ,85% of total billed charges for outpatient setting,$256.77 ,85% of total billed charges for outpatient setting,$256.77 ,85% of total billed charges for outpatient setting,$60.08 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$94.58 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$94.58 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$94.58 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$94.58 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$256.77 ,85% of total billed charges for outpatient setting,$58.91 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$93.64 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$271.87 ,90% of total billed charges for outpatient setting,$60.66 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$286.98 ,95% of total billed charges for outpatient setting,$256.77 ,85% of total billed charges for outpatient setting,$241.66 ,80% of total billed charges for outpatient setting,$60.08 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$256.77 ,85% of total billed charges for outpatient setting,$256.77 ,85% of total billed charges for outpatient setting,$256.77 ,85% of total billed charges for outpatient setting,$280.93 ,93% of total billed charges for outpatient setting,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$60.66 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$256.77 ,85% of total billed charges for outpatient setting,$60.08 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$58.91 ,$286.98 ,$105.73 Outpatient Medical Services,VISIT,99214,OFFICE/OP VISIT EST-4 CHARGE,761,$223.08 ,$119.57 ,53.6% of total biled charges for outpatient setting,$119.57 ,53.6% of total biled charges for outpatient setting,$167.31 ,75% of total billed charges for outpatient setting,$167.31 ,75% of total billed charges for outpatient setting,$167.31 ,75% of total billed charges for outpatient setting,$70.54 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$70.54 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$70.54 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$70.54 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$70.54 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$70.54 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$178.46 ,80% of total billed charges for outpatient setting,$70.54 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$78.08 ,35% of total billed charges for outpatient setting,$189.62 ,85% of total billed charges for outpatient setting,$69.85 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$178.46 ,80% of total billed charges for outpatient setting,$189.62 ,85% of total billed charges for outpatient setting,$156.16 ,70% of total billed charges for outpatient setting,$156.16 ,70% of total billed charges for outpatient setting,$171.77 ,77% of total billed charges for outpatient setting,$69.85 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$189.62 ,85% of total billed charges for outpatient setting,$189.62 ,85% of total billed charges for outpatient setting,$189.62 ,85% of total billed charges for outpatient setting,$189.62 ,85% of total billed charges for outpatient setting,$189.62 ,85% of total billed charges for outpatient setting,$44.37 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$69.85 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$69.85 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$69.85 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$69.85 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$189.62 ,85% of total billed charges for outpatient setting,$43.50 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$69.15 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$200.77 ,90% of total billed charges for outpatient setting,$44.79 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$211.93 ,95% of total billed charges for outpatient setting,$189.62 ,85% of total billed charges for outpatient setting,$178.46 ,80% of total billed charges for outpatient setting,$44.37 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$189.62 ,85% of total billed charges for outpatient setting,$189.62 ,85% of total billed charges for outpatient setting,$189.62 ,85% of total billed charges for outpatient setting,$207.46 ,93% of total billed charges for outpatient setting,$167.31 ,75% of total billed charges for outpatient setting,$167.31 ,75% of total billed charges for outpatient setting,$167.31 ,75% of total billed charges for outpatient setting,$44.79 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$189.62 ,85% of total billed charges for outpatient setting,$44.37 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$43.50 ,$211.93 ,$78.08 Outpatient Medical Services,VISIT,99215,Level Five Follow-Up,510,$420.00 ,$225.12 ,53.6% of total biled charges for outpatient setting,$225.12 ,53.6% of total biled charges for outpatient setting,$315.00 ,75% of total billed charges for outpatient setting,$315.00 ,75% of total billed charges for outpatient setting,$315.00 ,75% of total billed charges for outpatient setting,$132.80 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$132.80 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$132.80 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$132.80 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$132.80 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$132.80 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$336.00 ,80% of total billed charges for outpatient setting,$132.80 ,31.62% of total billed charges which is 102% of the Medicare outpatient rate,$147.00 ,35% of total billed charges for outpatient setting,$357.00 ,85% of total billed charges for outpatient setting,$131.50 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$336.00 ,80% of total billed charges for outpatient setting,$357.00 ,85% of total billed charges for outpatient setting,$294.00 ,70% of total billed charges for outpatient setting,$294.00 ,70% of total billed charges for outpatient setting,$323.40 ,77% of total billed charges for outpatient setting,$131.50 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$357.00 ,85% of total billed charges for outpatient setting,$357.00 ,85% of total billed charges for outpatient setting,$357.00 ,85% of total billed charges for outpatient setting,$357.00 ,85% of total billed charges for outpatient setting,$357.00 ,85% of total billed charges for outpatient setting,$83.54 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$131.50 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$131.50 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$131.50 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$131.50 ,31.31% of total billed charges which is 101% of the Medicare outpatient rate,$357.00 ,85% of total billed charges for outpatient setting,$81.90 ,19.5% of total billed charges which is 100% of the GA Medicaid rate for outpatient setting,$130.20 ,31% of total billed charges for outpatient setting which is 100% of the CMS Medicare outpatient rate,$378.00 ,90% of total billed charges for outpatient setting,$84.34 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$399.00 ,95% of total billed charges for outpatient setting,$357.00 ,85% of total billed charges for outpatient setting,$336.00 ,80% of total billed charges for outpatient setting,$83.54 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$357.00 ,85% of total billed charges for outpatient setting,$357.00 ,85% of total billed charges for outpatient setting,$357.00 ,85% of total billed charges for outpatient setting,$390.60 ,93% of total billed charges for outpatient setting,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,$84.34 ,20.08% of total billed charges which is 103% of the GA Medicaid rate for outpatient setting,$357.00 ,85% of total billed charges for outpatient setting,$83.54 ,19.89% of total billed charges which is 102% of the GA Medicaid rate for outpatient setting,$81.90 ,$399.00 ,$147.00 Outpatient Medical Services,OFFICE VISIT,99243,"Patient office consultation, typically 40 min",761,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,OFFICE VISIT,99244,"Patient office consultation, typically 60 min",761,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,OFFICE VISIT,99385,"Initial new patient preventive medicine evaluation, for those ages 18 to 39",761,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,OFFICE VISIT,99386,"Initial new patient preventive medicine evaluation, for those ages 40 to 64",761,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,LAB,80055,Obstetric blood test panel,300,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,LAB,81001,Manual urinalysis test with examination using microscope,300,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,LAB,81003,Prostate specific antigen,300,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,RADIOLOGY,70450,"CT scan, head or brain, without contrast",350,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,RADIOLOGY,70553,MRI scan of brain before and after contrast,610,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,RADIOLOGY,72110,"X-Ray, lower back, minimum four views",320,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,RADIOLOGY,72148,MRI scan of lower spinal canal ,610,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,RADIOLOGY,72193,"CT scan, pelvis, with contrast",350,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,RADIOLOGY,73721,MRI scan of leg joint,610,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,RADIOLOGY,74177,CT scan of abdomen and pelvis with contrast,320,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,RADIOLOGY,76700,Ultrasound of abdomen,402,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,RADIOLOGY,76805,"Abdominal ultrasound of pregnant uterus, greater or equal to 14 weeks 0 days, single or first fetus",402,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,RADIOLOGY,77066,Mammography of both breasts,403,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,RADIOLOGY,19120,"Removal of 1 or more breast growth, open procedure",360,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,29826,Shaving of shoulder bone using an endoscope,360,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,29881,Removal of one knee cartilage using an endoscope,360,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,42820,Removal of tonsils and adenoid glands patient younger than age 12,360,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscop",360,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,43239,"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",360,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,45378,Diagnostic examination of large bowel using an endoscope,360,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,45380,Biopsy of large bowel using an endoscope,360,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,45385,Removal of polyps or growths of large bowel using an endoscope,360,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,45391,Ultrasound examination of lower large bowel using an endoscope,360,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,47562,Removal of gallbladder using an endoscope,360,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,49505,Repair of groin hernia patient age 5 or older,360,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,55700,Biopsy of prostate gland,360,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,360,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,59400,"Routine obstetric care for vaginal delivery, including pre-and post-delivery care",720,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,59510,"Routine obstetric care for cesarean delivery, including pre-and post-delivery care",720,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,59610,Routine obstetric care for vaginal delivery after prior cesarean delivery including pre-and post-delivery care,720,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidanc,360,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,62322,Injection of substance into spinal canal of lower back or sacrum using imaging guidanc,360,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,360,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,66821,Removal of recurring cataract in lens capsule using laser,360,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,66984,Removal of cataract with insertion of lens,360,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,ECCG,93000,"Electrocardiogram, routine, with interpretation and report",730,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,CARDIOLOGY,93452,Insertion of catheter into left heart for diagnosis,480,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,SLEEP STUDY,95810,Sleep study,920,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Outpatient Medical Services,PHYSICAL THERAPY,97110,"Physical therapy, therapeutic exercise",420,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Inpatient Medical Services,INPATIENT PROCEDURES,216,Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications or comorbidities,100,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Inpatient Medical Services,INPATIENT PROCEDURES,460,Spinal fusion except cervical without major comorbid conditions or complications,100,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Inpatient Medical Services,INPATIENT PROCEDURES,470,Major joint replacement or reattachment of lower extremity without major comorbid conditions or complications,100,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Inpatient Medical Services,INPATIENT PROCEDURES,473,Cervical spinal fusion without comorbid conditions or major comorbid conditions or complications,100,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A Inpatient Medical Services,INPATIENT PROCEDURES,743,Uterine and adnexa procedures for non-malignancy without comorbid conditions or major comorbid conditions or complications,100,SERVICE NOT OFFERED,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,Not seperately reimbursable,N/A,N/A,N/A