hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|GA,"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.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Monroe County Hospital,2024-07-01,2.0.0,Monroe County Hospital,"88 Martin Luther King Jr Dr Forsyth, GA 31029",586010602,TRUE,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
description,code|1,code|1|type,code|2,code|2|type,code|3,code|3|type,setting,drug_unit_of_measurement,drug_type_of_measurement,standard_charge|gross,standard_charge|discounted_cash,modifiers,standard_charge|AETNA|COMMERCIAL|negotiated_dollar,standard_charge|AETNA|COMMERCIAL|negotiated_percentage,standard_charge|AETNA|COMMERCIAL|negotiated_algorithm,estimated_amount|AETNA|COMMERCIAL,standard_charge|AETNA|COMMERCIAL|methodology,additional_payer_notes|AETNA|COMMERCIAL,standard_charge|AMERIGROUP|MEDICAID|negotiated_dollar,standard_charge|AMERIGROUP|MEDICAID|negotiated_percentage,standard_charge|AMERIGROUP|MEDICAID|negotiated_algorithm,estimated_amount|AMERIGROUP|MEDICAID,standard_charge|AMERIGROUP|MEDICAID|methodology,additional_payer_notes|AMERIGROUP|MEDICAID,standard_charge|BCBS_HMO_POS_OPEN_ACCESS_PATHWAYS|MEDICARE|negotiated_dollar,standard_charge|BCBS_HMO_POS_OPEN_ACCESS_PATHWAYS|MEDICARE|negotiated_percentage,standard_charge|BCBS_HMO_POS_OPEN_ACCESS_PATHWAYS|MEDICARE|negotiated_algorithm,estimated_amount|BCBS_HMO_POS_OPEN_ACCESS_PATHWAYS|MEDICARE,standard_charge|BCBS_HMO_POS_OPEN_ACCESS_PATHWAYS|MEDICARE|methodology,additional_payer_notes|BCBS_HMO_POS_OPEN_ACCESS_PATHWAYS|MEDICARE,standard_charge|BCBS_MEDICARE_ADVANTAGE_HMO|MEDICARE|negotiated_dollar,standard_charge|BCBS_MEDICARE_ADVANTAGE_HMO|MEDICARE|negotiated_percentage,standard_charge|BCBS_MEDICARE_ADVANTAGE_HMO|MEDICARE|negotiated_algorithm,estimated_amount|BCBS_MEDICARE_ADVANTAGE_HMO|MEDICARE,standard_charge|BCBS_MEDICARE_ADVANTAGE_HMO|MEDICARE|methodology,additional_payer_notes|BCBS_MEDICARE_ADVANTAGE_HMO|MEDICARE,standard_charge|BCBS_MEDICARE_ADVANTAGE_PPO|MEDICARE|negotiated_dollar,standard_charge|BCBS_MEDICARE_ADVANTAGE_PPO|MEDICARE|negotiated_percentage,standard_charge|BCBS_MEDICARE_ADVANTAGE_PPO|MEDICARE|negotiated_algorithm,estimated_amount|BCBS_MEDICARE_ADVANTAGE_PPO|MEDICARE,standard_charge|BCBS_MEDICARE_ADVANTAGE_PPO|MEDICARE|methodology,additional_payer_notes|BCBS_MEDICARE_ADVANTAGE_PPO|MEDICARE,standard_charge|BCBS_PPO|MEDICARE|negotiated_dollar,standard_charge|BCBS_PPO|MEDICARE|negotiated_percentage,standard_charge|BCBS_PPO|MEDICARE|negotiated_algorithm,estimated_amount|BCBS_PPO|MEDICARE,standard_charge|BCBS_PPO|MEDICARE|methodology,additional_payer_notes|BCBS_PPO|MEDICARE,standard_charge|BCBS_TRADITIONAL|MEDICARE|negotiated_dollar,standard_charge|BCBS_TRADITIONAL|MEDICARE|negotiated_percentage,standard_charge|BCBS_TRADITIONAL|MEDICARE|negotiated_algorithm,estimated_amount|BCBS_TRADITIONAL|MEDICARE,standard_charge|BCBS_TRADITIONAL|MEDICARE|methodology,additional_payer_notes|BCBS_TRADITIONAL|MEDICARE,standard_charge|CARESOURCE|MEDICAID|negotiated_dollar,standard_charge|CARESOURCE|MEDICAID|negotiated_percentage,standard_charge|CARESOURCE|MEDICAID|negotiated_algorithm,estimated_amount|CARESOURCE|MEDICAID,standard_charge|CARESOURCE|MEDICAID|methodology,additional_payer_notes|CARESOURCE|MEDICAID,standard_charge|CIGNA|COMMERCIAL|negotiated_dollar,standard_charge|CIGNA|COMMERCIAL|negotiated_percentage,standard_charge|CIGNA|COMMERCIAL|negotiated_algorithm,estimated_amount|CIGNA|COMMERCIAL,standard_charge|CIGNA|COMMERCIAL|methodology,additional_payer_notes|CIGNA|COMMERCIAL,standard_charge|HUMANA|COMMERCIAL|negotiated_dollar,standard_charge|HUMANA|COMMERCIAL|negotiated_percentage,standard_charge|HUMANA|COMMERCIAL|negotiated_algorithm,estimated_amount|HUMANA|COMMERCIAL,standard_charge|HUMANA|COMMERCIAL|methodology,additional_payer_notes|HUMANA|COMMERCIAL,standard_charge|HUMANA_MEDICARE|MEDICARE|negotiated_dollar,standard_charge|HUMANA_MEDICARE|MEDICARE|negotiated_percentage,standard_charge|HUMANA_MEDICARE|MEDICARE|negotiated_algorithm,estimated_amount|HUMANA_MEDICARE|MEDICARE,standard_charge|HUMANA_MEDICARE|MEDICARE|methodology,additional_payer_notes|HUMANA_MEDICARE|MEDICARE,standard_charge|SECURE_HEALTH|COMMERCIAL|negotiated_dollar,standard_charge|SECURE_HEALTH|COMMERCIAL|negotiated_percentage,standard_charge|SECURE_HEALTH|COMMERCIAL|negotiated_algorithm,estimated_amount|SECURE_HEALTH|COMMERCIAL,standard_charge|SECURE_HEALTH|COMMERCIAL|methodology,additional_payer_notes|SECURE_HEALTH|COMMERCIAL,standard_charge|UHC|COMMERCIAL|negotiated_dollar,standard_charge|UHC|COMMERCIAL|negotiated_percentage,standard_charge|UHC|COMMERCIAL|negotiated_algorithm,estimated_amount|UHC|COMMERCIAL,standard_charge|UHC|COMMERCIAL|methodology,additional_payer_notes|UHC|COMMERCIAL,standard_charge|WELLCARE_MEDICAID|MEDICAID|negotiated_dollar,standard_charge|WELLCARE_MEDICAID|MEDICAID|negotiated_percentage,standard_charge|WELLCARE_MEDICAID|MEDICAID|negotiated_algorithm,estimated_amount|WELLCARE_MEDICAID|MEDICAID,standard_charge|WELLCARE_MEDICAID|MEDICAID|methodology,additional_payer_notes|WELLCARE_MEDICAID|MEDICAID,standard_charge|WELLCARE_MEDICARE|MEDICARE|negotiated_dollar,standard_charge|WELLCARE_MEDICARE|MEDICARE|negotiated_percentage,standard_charge|WELLCARE_MEDICARE|MEDICARE|negotiated_algorithm,estimated_amount|WELLCARE_MEDICARE|MEDICARE,standard_charge|WELLCARE_MEDICARE|MEDICARE|methodology,additional_payer_notes|WELLCARE_MEDICARE|MEDICARE,standard_charge|min,standard_charge|max,additional_generic_notes
SPECIMEN TRAP LUKEN TUBE,3000257,CDM,270,RC,,,Outpatient,,,5.13,3.85,,4,78,,3.2,percent of total billed charges,78% of total billed charges,3.23,63,,2.584,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,1.95,38,,1.56,percent of total billed charges,38% of total billed charges,1.95,38,,1.56,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,4.62,90,,3.696,percent of total billed charges,90% of total billed charges,1.8,35,,1.44,percent of total billed charges,35% of total billed charges,3.45,67.275,,2.76,percent of total billed charges,67.275% of total billed charges,4.1,80,,3.28,percent of total billed charges,80% of total billed charges,1.97,38.38,,1.576,percent of total billed charges,38.38% of total billed charges,4.1,80,,3.28,percent of total billed charges,80% of total billed charges,3.17,61.74,,2.536,percent of total billed charges,61.74% of total billed charges,5.23,102,,4.184,percent of total billed charges,102% of total billed charges,1.95,38,,1.56,percent of total billed charges,38% of total billed charges,1.8,5.23,
ENEMA BAG (ADM SET),3000407,CDM,270,RC,,,Outpatient,,,5.22,3.92,,4.07,78,,3.256,percent of total billed charges,78% of total billed charges,3.29,63,,2.632,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,1.98,38,,1.584,percent of total billed charges,38% of total billed charges,1.98,38,,1.584,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,4.7,90,,3.76,percent of total billed charges,90% of total billed charges,1.83,35,,1.464,percent of total billed charges,35% of total billed charges,3.51,67.275,,2.808,percent of total billed charges,67.275% of total billed charges,4.18,80,,3.344,percent of total billed charges,80% of total billed charges,2,38.38,,1.6,percent of total billed charges,38.38% of total billed charges,4.18,80,,3.344,percent of total billed charges,80% of total billed charges,3.22,61.74,,2.576,percent of total billed charges,61.74% of total billed charges,5.32,102,,4.256,percent of total billed charges,102% of total billed charges,1.98,38,,1.584,percent of total billed charges,38% of total billed charges,1.83,5.32,
CONTOUR BATH SPONGE,3000718,CDM,270,RC,,,Outpatient,,,5.22,3.92,,4.07,78,,3.256,percent of total billed charges,78% of total billed charges,3.29,63,,2.632,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,1.98,38,,1.584,percent of total billed charges,38% of total billed charges,1.98,38,,1.584,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,4.7,90,,3.76,percent of total billed charges,90% of total billed charges,1.83,35,,1.464,percent of total billed charges,35% of total billed charges,3.51,67.275,,2.808,percent of total billed charges,67.275% of total billed charges,4.18,80,,3.344,percent of total billed charges,80% of total billed charges,2,38.38,,1.6,percent of total billed charges,38.38% of total billed charges,4.18,80,,3.344,percent of total billed charges,80% of total billed charges,3.22,61.74,,2.576,percent of total billed charges,61.74% of total billed charges,5.32,102,,4.256,percent of total billed charges,102% of total billed charges,1.98,38,,1.584,percent of total billed charges,38% of total billed charges,1.83,5.32,
IRRIGATION TRAY,3000808,CDM,270,RC,,,Outpatient,,,5.25,3.94,,4.1,78,,3.28,percent of total billed charges,78% of total billed charges,3.31,63,,2.648,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2,38,,1.6,percent of total billed charges,38% of total billed charges,2,38,,1.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,4.73,90,,3.784,percent of total billed charges,90% of total billed charges,1.84,35,,1.472,percent of total billed charges,35% of total billed charges,3.53,67.275,,2.824,percent of total billed charges,67.275% of total billed charges,4.2,80,,3.36,percent of total billed charges,80% of total billed charges,2.01,38.38,,1.608,percent of total billed charges,38.38% of total billed charges,4.2,80,,3.36,percent of total billed charges,80% of total billed charges,3.24,61.74,,2.592,percent of total billed charges,61.74% of total billed charges,5.36,102,,4.288,percent of total billed charges,102% of total billed charges,2,38,,1.6,percent of total billed charges,38% of total billed charges,1.84,5.36,
FLATUS BAG,3000503,CDM,270,RC,,,Outpatient,,,5.27,3.95,,4.11,78,,3.288,percent of total billed charges,78% of total billed charges,3.32,63,,2.656,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2,38,,1.6,percent of total billed charges,38% of total billed charges,2,38,,1.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,4.74,90,,3.792,percent of total billed charges,90% of total billed charges,1.84,35,,1.472,percent of total billed charges,35% of total billed charges,3.55,67.275,,2.84,percent of total billed charges,67.275% of total billed charges,4.22,80,,3.376,percent of total billed charges,80% of total billed charges,2.02,38.38,,1.616,percent of total billed charges,38.38% of total billed charges,4.22,80,,3.376,percent of total billed charges,80% of total billed charges,3.25,61.74,,2.6,percent of total billed charges,61.74% of total billed charges,5.38,102,,4.304,percent of total billed charges,102% of total billed charges,2,38,,1.6,percent of total billed charges,38% of total billed charges,1.84,5.38,
BACTERIAL/VIRAL FILTER - AG Industries,3003027,CDM,270,RC,,,Outpatient,,,5.45,4.09,,4.25,78,,3.4,percent of total billed charges,78% of total billed charges,3.43,63,,2.744,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.07,38,,1.656,percent of total billed charges,38% of total billed charges,2.07,38,,1.656,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,4.91,90,,3.928,percent of total billed charges,90% of total billed charges,1.91,35,,1.528,percent of total billed charges,35% of total billed charges,3.67,67.275,,2.936,percent of total billed charges,67.275% of total billed charges,4.36,80,,3.488,percent of total billed charges,80% of total billed charges,2.09,38.38,,1.672,percent of total billed charges,38.38% of total billed charges,4.36,80,,3.488,percent of total billed charges,80% of total billed charges,3.36,61.74,,2.688,percent of total billed charges,61.74% of total billed charges,5.56,102,,4.448,percent of total billed charges,102% of total billed charges,2.07,38,,1.656,percent of total billed charges,38% of total billed charges,1.91,5.56,
XEROFOAM 5X9,3003040,CDM,270,RC,,,Outpatient,,,5.47,4.1,,4.27,78,,3.416,percent of total billed charges,78% of total billed charges,3.45,63,,2.76,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.08,38,,1.664,percent of total billed charges,38% of total billed charges,2.08,38,,1.664,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,4.92,90,,3.936,percent of total billed charges,90% of total billed charges,1.91,35,,1.528,percent of total billed charges,35% of total billed charges,3.68,67.275,,2.944,percent of total billed charges,67.275% of total billed charges,4.38,80,,3.504,percent of total billed charges,80% of total billed charges,2.1,38.38,,1.68,percent of total billed charges,38.38% of total billed charges,4.38,80,,3.504,percent of total billed charges,80% of total billed charges,3.38,61.74,,2.704,percent of total billed charges,61.74% of total billed charges,5.58,102,,4.464,percent of total billed charges,102% of total billed charges,2.08,38,,1.664,percent of total billed charges,38% of total billed charges,1.91,5.58,
PEDIATRIC NASAL CANNULA,3003012,CDM,270,RC,,,Outpatient,,,5.49,4.12,,4.28,78,,3.424,percent of total billed charges,78% of total billed charges,3.46,63,,2.768,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.09,38,,1.672,percent of total billed charges,38% of total billed charges,2.09,38,,1.672,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,4.94,90,,3.952,percent of total billed charges,90% of total billed charges,1.92,35,,1.536,percent of total billed charges,35% of total billed charges,3.69,67.275,,2.952,percent of total billed charges,67.275% of total billed charges,4.39,80,,3.512,percent of total billed charges,80% of total billed charges,2.11,38.38,,1.688,percent of total billed charges,38.38% of total billed charges,4.39,80,,3.512,percent of total billed charges,80% of total billed charges,3.39,61.74,,2.712,percent of total billed charges,61.74% of total billed charges,5.6,102,,4.48,percent of total billed charges,102% of total billed charges,2.09,38,,1.672,percent of total billed charges,38% of total billed charges,1.92,5.6,
BACTERIAL/VIRAL FILTER - Medtronic,3003030,CDM,270,RC,,,Outpatient,,,5.64,4.23,,4.4,78,,3.52,percent of total billed charges,78% of total billed charges,3.55,63,,2.84,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.14,38,,1.712,percent of total billed charges,38% of total billed charges,2.14,38,,1.712,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,5.08,90,,4.064,percent of total billed charges,90% of total billed charges,1.97,35,,1.576,percent of total billed charges,35% of total billed charges,3.79,67.275,,3.032,percent of total billed charges,67.275% of total billed charges,4.51,80,,3.608,percent of total billed charges,80% of total billed charges,2.16,38.38,,1.728,percent of total billed charges,38.38% of total billed charges,4.51,80,,3.608,percent of total billed charges,80% of total billed charges,3.48,61.74,,2.784,percent of total billed charges,61.74% of total billed charges,5.75,102,,4.6,percent of total billed charges,102% of total billed charges,2.14,38,,1.712,percent of total billed charges,38% of total billed charges,1.97,5.75,
BP CUFF DISP CHILD - GE,3005064,CDM,270,RC,,,Outpatient,,,5.72,4.29,,4.46,78,,3.568,percent of total billed charges,78% of total billed charges,3.6,63,,2.88,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.17,38,,1.736,percent of total billed charges,38% of total billed charges,2.17,38,,1.736,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,5.15,90,,4.12,percent of total billed charges,90% of total billed charges,2,35,,1.6,percent of total billed charges,35% of total billed charges,3.85,67.275,,3.08,percent of total billed charges,67.275% of total billed charges,4.58,80,,3.664,percent of total billed charges,80% of total billed charges,2.2,38.38,,1.76,percent of total billed charges,38.38% of total billed charges,4.58,80,,3.664,percent of total billed charges,80% of total billed charges,3.53,61.74,,2.824,percent of total billed charges,61.74% of total billed charges,5.83,102,,4.664,percent of total billed charges,102% of total billed charges,2.17,38,,1.736,percent of total billed charges,38% of total billed charges,2,5.83,
NASO GASTRIC SALEM SUMP 10FR,3001705,CDM,270,RC,,,Outpatient,,,5.82,4.37,,4.54,78,,3.632,percent of total billed charges,78% of total billed charges,3.67,63,,2.936,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.21,38,,1.768,percent of total billed charges,38% of total billed charges,2.21,38,,1.768,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,5.24,90,,4.192,percent of total billed charges,90% of total billed charges,2.04,35,,1.632,percent of total billed charges,35% of total billed charges,3.92,67.275,,3.136,percent of total billed charges,67.275% of total billed charges,4.66,80,,3.728,percent of total billed charges,80% of total billed charges,2.23,38.38,,1.784,percent of total billed charges,38.38% of total billed charges,4.66,80,,3.728,percent of total billed charges,80% of total billed charges,3.59,61.74,,2.872,percent of total billed charges,61.74% of total billed charges,5.94,102,,4.752,percent of total billed charges,102% of total billed charges,2.21,38,,1.768,percent of total billed charges,38% of total billed charges,2.04,5.94,
VAGINAL SPEC SMALL,3003039,CDM,270,RC,,,Outpatient,,,5.99,4.49,,4.67,78,,3.736,percent of total billed charges,78% of total billed charges,3.77,63,,3.016,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.28,38,,1.824,percent of total billed charges,38% of total billed charges,2.28,38,,1.824,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,5.39,90,,4.312,percent of total billed charges,90% of total billed charges,2.1,35,,1.68,percent of total billed charges,35% of total billed charges,4.03,67.275,,3.224,percent of total billed charges,67.275% of total billed charges,4.79,80,,3.832,percent of total billed charges,80% of total billed charges,2.3,38.38,,1.84,percent of total billed charges,38.38% of total billed charges,4.79,80,,3.832,percent of total billed charges,80% of total billed charges,3.7,61.74,,2.96,percent of total billed charges,61.74% of total billed charges,6.11,102,,4.888,percent of total billed charges,102% of total billed charges,2.28,38,,1.824,percent of total billed charges,38% of total billed charges,2.1,6.11,
HYDROGEL 1 OZ,3000512,CDM,270,RC,,,Outpatient,,,6,4.5,,4.68,78,,3.744,percent of total billed charges,78% of total billed charges,3.78,63,,3.024,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.28,38,,1.824,percent of total billed charges,38% of total billed charges,2.28,38,,1.824,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,2.1,35,,1.68,percent of total billed charges,35% of total billed charges,4.04,67.275,,3.232,percent of total billed charges,67.275% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.3,38.38,,1.84,percent of total billed charges,38.38% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.7,61.74,,2.96,percent of total billed charges,61.74% of total billed charges,6.12,102,,4.896,percent of total billed charges,102% of total billed charges,2.28,38,,1.824,percent of total billed charges,38% of total billed charges,2.1,6.12,
PED NON-REBREATH MASK,3003033,CDM,272,RC,,,Outpatient,,,6,4.5,,4.68,78,,3.744,percent of total billed charges,78% of total billed charges,3.78,63,,3.024,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.28,38,,1.824,percent of total billed charges,38% of total billed charges,2.28,38,,1.824,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,2.1,35,,1.68,percent of total billed charges,35% of total billed charges,4.04,67.275,,3.232,percent of total billed charges,67.275% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.3,38.38,,1.84,percent of total billed charges,38.38% of total billed charges,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,3.7,61.74,,2.96,percent of total billed charges,61.74% of total billed charges,6.12,102,,4.896,percent of total billed charges,102% of total billed charges,2.28,38,,1.824,percent of total billed charges,38% of total billed charges,2.1,6.12,
MASK ANESTHESIA MEDIUM,3000011,CDM,270,RC,,,Outpatient,,,6.03,4.52,,4.7,78,,3.76,percent of total billed charges,78% of total billed charges,3.8,63,,3.04,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.29,38,,1.832,percent of total billed charges,38% of total billed charges,2.29,38,,1.832,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,5.43,90,,4.344,percent of total billed charges,90% of total billed charges,2.11,35,,1.688,percent of total billed charges,35% of total billed charges,4.06,67.275,,3.248,percent of total billed charges,67.275% of total billed charges,4.82,80,,3.856,percent of total billed charges,80% of total billed charges,2.31,38.38,,1.848,percent of total billed charges,38.38% of total billed charges,4.82,80,,3.856,percent of total billed charges,80% of total billed charges,3.72,61.74,,2.976,percent of total billed charges,61.74% of total billed charges,6.15,102,,4.92,percent of total billed charges,102% of total billed charges,2.29,38,,1.832,percent of total billed charges,38% of total billed charges,2.11,6.15,
GUEDEL AIRWAY,3003563,CDM,270,RC,,,Outpatient,,,6.12,4.59,,4.77,78,,3.816,percent of total billed charges,78% of total billed charges,3.86,63,,3.088,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.33,38,,1.864,percent of total billed charges,38% of total billed charges,2.33,38,,1.864,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,5.51,90,,4.408,percent of total billed charges,90% of total billed charges,2.14,35,,1.712,percent of total billed charges,35% of total billed charges,4.12,67.275,,3.296,percent of total billed charges,67.275% of total billed charges,4.9,80,,3.92,percent of total billed charges,80% of total billed charges,2.35,38.38,,1.88,percent of total billed charges,38.38% of total billed charges,4.9,80,,3.92,percent of total billed charges,80% of total billed charges,3.78,61.74,,3.024,percent of total billed charges,61.74% of total billed charges,6.24,102,,4.992,percent of total billed charges,102% of total billed charges,2.33,38,,1.864,percent of total billed charges,38% of total billed charges,2.14,6.24,
TUBES ENDO TRACH CUFFED 7.5,3002532,CDM,270,RC,,,Outpatient,,,6.14,4.61,,4.79,78,,3.832,percent of total billed charges,78% of total billed charges,3.87,63,,3.096,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.33,38,,1.864,percent of total billed charges,38% of total billed charges,2.33,38,,1.864,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,5.53,90,,4.424,percent of total billed charges,90% of total billed charges,2.15,35,,1.72,percent of total billed charges,35% of total billed charges,4.13,67.275,,3.304,percent of total billed charges,67.275% of total billed charges,4.91,80,,3.928,percent of total billed charges,80% of total billed charges,2.36,38.38,,1.888,percent of total billed charges,38.38% of total billed charges,4.91,80,,3.928,percent of total billed charges,80% of total billed charges,3.79,61.74,,3.032,percent of total billed charges,61.74% of total billed charges,6.26,102,,5.008,percent of total billed charges,102% of total billed charges,2.33,38,,1.864,percent of total billed charges,38% of total billed charges,2.15,6.26,
BIOPSY PUNCH 4.0MM FR-BP40,3001741,CDM,270,RC,,,Outpatient,,,6.21,4.66,,4.84,78,,3.872,percent of total billed charges,78% of total billed charges,3.91,63,,3.128,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.36,38,,1.888,percent of total billed charges,38% of total billed charges,2.36,38,,1.888,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,5.59,90,,4.472,percent of total billed charges,90% of total billed charges,2.17,35,,1.736,percent of total billed charges,35% of total billed charges,4.18,67.275,,3.344,percent of total billed charges,67.275% of total billed charges,4.97,80,,3.976,percent of total billed charges,80% of total billed charges,2.38,38.38,,1.904,percent of total billed charges,38.38% of total billed charges,4.97,80,,3.976,percent of total billed charges,80% of total billed charges,3.83,61.74,,3.064,percent of total billed charges,61.74% of total billed charges,6.33,102,,5.064,percent of total billed charges,102% of total billed charges,2.36,38,,1.888,percent of total billed charges,38% of total billed charges,2.17,6.33,
BIOPSY PUNCH 6.0MM FR-BP60,3001742,CDM,270,RC,,,Outpatient,,,6.21,4.66,,4.84,78,,3.872,percent of total billed charges,78% of total billed charges,3.91,63,,3.128,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.36,38,,1.888,percent of total billed charges,38% of total billed charges,2.36,38,,1.888,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,5.59,90,,4.472,percent of total billed charges,90% of total billed charges,2.17,35,,1.736,percent of total billed charges,35% of total billed charges,4.18,67.275,,3.344,percent of total billed charges,67.275% of total billed charges,4.97,80,,3.976,percent of total billed charges,80% of total billed charges,2.38,38.38,,1.904,percent of total billed charges,38.38% of total billed charges,4.97,80,,3.976,percent of total billed charges,80% of total billed charges,3.83,61.74,,3.064,percent of total billed charges,61.74% of total billed charges,6.33,102,,5.064,percent of total billed charges,102% of total billed charges,2.36,38,,1.888,percent of total billed charges,38% of total billed charges,2.17,6.33,
BIOPSY PUNCH 8.0MM FR-BP80,3001743,CDM,270,RC,,,Outpatient,,,6.21,4.66,,4.84,78,,3.872,percent of total billed charges,78% of total billed charges,3.91,63,,3.128,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.36,38,,1.888,percent of total billed charges,38% of total billed charges,2.36,38,,1.888,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,5.59,90,,4.472,percent of total billed charges,90% of total billed charges,2.17,35,,1.736,percent of total billed charges,35% of total billed charges,4.18,67.275,,3.344,percent of total billed charges,67.275% of total billed charges,4.97,80,,3.976,percent of total billed charges,80% of total billed charges,2.38,38.38,,1.904,percent of total billed charges,38.38% of total billed charges,4.97,80,,3.976,percent of total billed charges,80% of total billed charges,3.83,61.74,,3.064,percent of total billed charges,61.74% of total billed charges,6.33,102,,5.064,percent of total billed charges,102% of total billed charges,2.36,38,,1.888,percent of total billed charges,38% of total billed charges,2.17,6.33,
BIOPSY PUNCH 2.0MM FR-BP20,3001744,CDM,270,RC,,,Outpatient,,,6.21,4.66,,4.84,78,,3.872,percent of total billed charges,78% of total billed charges,3.91,63,,3.128,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.36,38,,1.888,percent of total billed charges,38% of total billed charges,2.36,38,,1.888,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,5.59,90,,4.472,percent of total billed charges,90% of total billed charges,2.17,35,,1.736,percent of total billed charges,35% of total billed charges,4.18,67.275,,3.344,percent of total billed charges,67.275% of total billed charges,4.97,80,,3.976,percent of total billed charges,80% of total billed charges,2.38,38.38,,1.904,percent of total billed charges,38.38% of total billed charges,4.97,80,,3.976,percent of total billed charges,80% of total billed charges,3.83,61.74,,3.064,percent of total billed charges,61.74% of total billed charges,6.33,102,,5.064,percent of total billed charges,102% of total billed charges,2.36,38,,1.888,percent of total billed charges,38% of total billed charges,2.17,6.33,
TELEMETRY MONITOR POUCH,3001214,CDM,270,RC,,,Outpatient,,,6.35,4.76,,4.95,78,,3.96,percent of total billed charges,78% of total billed charges,4,63,,3.2,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.41,38,,1.928,percent of total billed charges,38% of total billed charges,2.41,38,,1.928,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,5.72,90,,4.576,percent of total billed charges,90% of total billed charges,2.22,35,,1.776,percent of total billed charges,35% of total billed charges,4.27,67.275,,3.416,percent of total billed charges,67.275% of total billed charges,5.08,80,,4.064,percent of total billed charges,80% of total billed charges,2.44,38.38,,1.952,percent of total billed charges,38.38% of total billed charges,5.08,80,,4.064,percent of total billed charges,80% of total billed charges,3.92,61.74,,3.136,percent of total billed charges,61.74% of total billed charges,6.48,102,,5.184,percent of total billed charges,102% of total billed charges,2.41,38,,1.928,percent of total billed charges,38% of total billed charges,2.22,6.48,
UROSTOMY KIT - HOLLISTER,3001512,CDM,270,RC,,,Outpatient,,,6.35,4.76,,4.95,78,,3.96,percent of total billed charges,78% of total billed charges,4,63,,3.2,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.41,38,,1.928,percent of total billed charges,38% of total billed charges,2.41,38,,1.928,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,5.72,90,,4.576,percent of total billed charges,90% of total billed charges,2.22,35,,1.776,percent of total billed charges,35% of total billed charges,4.27,67.275,,3.416,percent of total billed charges,67.275% of total billed charges,5.08,80,,4.064,percent of total billed charges,80% of total billed charges,2.44,38.38,,1.952,percent of total billed charges,38.38% of total billed charges,5.08,80,,4.064,percent of total billed charges,80% of total billed charges,3.92,61.74,,3.136,percent of total billed charges,61.74% of total billed charges,6.48,102,,5.184,percent of total billed charges,102% of total billed charges,2.41,38,,1.928,percent of total billed charges,38% of total billed charges,2.22,6.48,
VICRYL 3-0 J416H,3001556,CDM,270,RC,,,Outpatient,,,6.35,4.76,,4.95,78,,3.96,percent of total billed charges,78% of total billed charges,4,63,,3.2,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.41,38,,1.928,percent of total billed charges,38% of total billed charges,2.41,38,,1.928,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,5.72,90,,4.576,percent of total billed charges,90% of total billed charges,2.22,35,,1.776,percent of total billed charges,35% of total billed charges,4.27,67.275,,3.416,percent of total billed charges,67.275% of total billed charges,5.08,80,,4.064,percent of total billed charges,80% of total billed charges,2.44,38.38,,1.952,percent of total billed charges,38.38% of total billed charges,5.08,80,,4.064,percent of total billed charges,80% of total billed charges,3.92,61.74,,3.136,percent of total billed charges,61.74% of total billed charges,6.48,102,,5.184,percent of total billed charges,102% of total billed charges,2.41,38,,1.928,percent of total billed charges,38% of total billed charges,2.22,6.48,
SUCTION CONNECT TUBING 20',3004182,CDM,270,RC,,,Outpatient,,,6.35,4.76,,4.95,78,,3.96,percent of total billed charges,78% of total billed charges,4,63,,3.2,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.41,38,,1.928,percent of total billed charges,38% of total billed charges,2.41,38,,1.928,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,5.72,90,,4.576,percent of total billed charges,90% of total billed charges,2.22,35,,1.776,percent of total billed charges,35% of total billed charges,4.27,67.275,,3.416,percent of total billed charges,67.275% of total billed charges,5.08,80,,4.064,percent of total billed charges,80% of total billed charges,2.44,38.38,,1.952,percent of total billed charges,38.38% of total billed charges,5.08,80,,4.064,percent of total billed charges,80% of total billed charges,3.92,61.74,,3.136,percent of total billed charges,61.74% of total billed charges,6.48,102,,5.184,percent of total billed charges,102% of total billed charges,2.41,38,,1.928,percent of total billed charges,38% of total billed charges,2.22,6.48,
UNDERCAST PADDING 3,3005042,CDM,270,RC,,,Outpatient,,,6.35,4.76,,4.95,78,,3.96,percent of total billed charges,78% of total billed charges,4,63,,3.2,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.41,38,,1.928,percent of total billed charges,38% of total billed charges,2.41,38,,1.928,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,5.72,90,,4.576,percent of total billed charges,90% of total billed charges,2.22,35,,1.776,percent of total billed charges,35% of total billed charges,4.27,67.275,,3.416,percent of total billed charges,67.275% of total billed charges,5.08,80,,4.064,percent of total billed charges,80% of total billed charges,2.44,38.38,,1.952,percent of total billed charges,38.38% of total billed charges,5.08,80,,4.064,percent of total billed charges,80% of total billed charges,3.92,61.74,,3.136,percent of total billed charges,61.74% of total billed charges,6.48,102,,5.184,percent of total billed charges,102% of total billed charges,2.41,38,,1.928,percent of total billed charges,38% of total billed charges,2.22,6.48,
BERMAN AIRWAY 80MM,3000111,CDM,270,RC,,,Outpatient,,,6.4,4.8,,4.99,78,,3.992,percent of total billed charges,78% of total billed charges,4.03,63,,3.224,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.43,38,,1.944,percent of total billed charges,38% of total billed charges,2.43,38,,1.944,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,5.76,90,,4.608,percent of total billed charges,90% of total billed charges,2.24,35,,1.792,percent of total billed charges,35% of total billed charges,4.31,67.275,,3.448,percent of total billed charges,67.275% of total billed charges,5.12,80,,4.096,percent of total billed charges,80% of total billed charges,2.46,38.38,,1.968,percent of total billed charges,38.38% of total billed charges,5.12,80,,4.096,percent of total billed charges,80% of total billed charges,3.95,61.74,,3.16,percent of total billed charges,61.74% of total billed charges,6.53,102,,5.224,percent of total billed charges,102% of total billed charges,2.43,38,,1.944,percent of total billed charges,38% of total billed charges,2.24,6.53,
FACE MASK ANESTHESIA DISP,3004005,CDM,270,RC,,,Outpatient,,,6.47,4.85,,5.05,78,,4.04,percent of total billed charges,78% of total billed charges,4.08,63,,3.264,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.46,38,,1.968,percent of total billed charges,38% of total billed charges,2.46,38,,1.968,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,5.82,90,,4.656,percent of total billed charges,90% of total billed charges,2.26,35,,1.808,percent of total billed charges,35% of total billed charges,4.35,67.275,,3.48,percent of total billed charges,67.275% of total billed charges,5.18,80,,4.144,percent of total billed charges,80% of total billed charges,2.48,38.38,,1.984,percent of total billed charges,38.38% of total billed charges,5.18,80,,4.144,percent of total billed charges,80% of total billed charges,3.99,61.74,,3.192,percent of total billed charges,61.74% of total billed charges,6.6,102,,5.28,percent of total billed charges,102% of total billed charges,2.46,38,,1.968,percent of total billed charges,38% of total billed charges,2.26,6.6,
BAG DECANTER BD-100,3000128,CDM,270,RC,,,Outpatient,,,6.71,5.03,,5.23,78,,4.184,percent of total billed charges,78% of total billed charges,4.23,63,,3.384,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.55,38,,2.04,percent of total billed charges,38% of total billed charges,2.55,38,,2.04,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,6.04,90,,4.832,percent of total billed charges,90% of total billed charges,2.35,35,,1.88,percent of total billed charges,35% of total billed charges,4.51,67.275,,3.608,percent of total billed charges,67.275% of total billed charges,5.37,80,,4.296,percent of total billed charges,80% of total billed charges,2.58,38.38,,2.064,percent of total billed charges,38.38% of total billed charges,5.37,80,,4.296,percent of total billed charges,80% of total billed charges,4.14,61.74,,3.312,percent of total billed charges,61.74% of total billed charges,6.84,102,,5.472,percent of total billed charges,102% of total billed charges,2.55,38,,2.04,percent of total billed charges,38% of total billed charges,2.35,6.84,
DEBRIDEMENT KIT,3001117,CDM,270,RC,,,Outpatient,,,6.74,5.06,,5.26,78,,4.208,percent of total billed charges,78% of total billed charges,4.25,63,,3.4,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.56,38,,2.048,percent of total billed charges,38% of total billed charges,2.56,38,,2.048,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,6.07,90,,4.856,percent of total billed charges,90% of total billed charges,2.36,35,,1.888,percent of total billed charges,35% of total billed charges,4.53,67.275,,3.624,percent of total billed charges,67.275% of total billed charges,5.39,80,,4.312,percent of total billed charges,80% of total billed charges,2.59,38.38,,2.072,percent of total billed charges,38.38% of total billed charges,5.39,80,,4.312,percent of total billed charges,80% of total billed charges,4.16,61.74,,3.328,percent of total billed charges,61.74% of total billed charges,6.87,102,,5.496,percent of total billed charges,102% of total billed charges,2.56,38,,2.048,percent of total billed charges,38% of total billed charges,2.36,6.87,
BITE BLOCK ADULT,3002546,CDM,270,RC,,,Outpatient,,,6.75,5.06,,5.27,78,,4.216,percent of total billed charges,78% of total billed charges,4.25,63,,3.4,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.57,38,,2.056,percent of total billed charges,38% of total billed charges,2.57,38,,2.056,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,6.08,90,,4.864,percent of total billed charges,90% of total billed charges,2.36,35,,1.888,percent of total billed charges,35% of total billed charges,4.54,67.275,,3.632,percent of total billed charges,67.275% of total billed charges,5.4,80,,4.32,percent of total billed charges,80% of total billed charges,2.59,38.38,,2.072,percent of total billed charges,38.38% of total billed charges,5.4,80,,4.32,percent of total billed charges,80% of total billed charges,4.17,61.74,,3.336,percent of total billed charges,61.74% of total billed charges,6.89,102,,5.512,percent of total billed charges,102% of total billed charges,2.57,38,,2.056,percent of total billed charges,38% of total billed charges,2.36,6.89,
POUCH AUTOLOCK 401442,3001416,CDM,270,RC,,,Outpatient,,,6.81,5.11,,5.31,78,,4.248,percent of total billed charges,78% of total billed charges,4.29,63,,3.432,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.59,38,,2.072,percent of total billed charges,38% of total billed charges,2.59,38,,2.072,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,6.13,90,,4.904,percent of total billed charges,90% of total billed charges,2.38,35,,1.904,percent of total billed charges,35% of total billed charges,4.58,67.275,,3.664,percent of total billed charges,67.275% of total billed charges,5.45,80,,4.36,percent of total billed charges,80% of total billed charges,2.61,38.38,,2.088,percent of total billed charges,38.38% of total billed charges,5.45,80,,4.36,percent of total billed charges,80% of total billed charges,4.2,61.74,,3.36,percent of total billed charges,61.74% of total billed charges,6.95,102,,5.56,percent of total billed charges,102% of total billed charges,2.59,38,,2.072,percent of total billed charges,38% of total billed charges,2.38,6.95,
CATH SECURE TUBE HOLDER    5445-3,3000282,CDM,270,RC,,,Outpatient,,,6.84,5.13,,5.34,78,,4.272,percent of total billed charges,78% of total billed charges,4.31,63,,3.448,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.6,38,,2.08,percent of total billed charges,38% of total billed charges,2.6,38,,2.08,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,6.16,90,,4.928,percent of total billed charges,90% of total billed charges,2.39,35,,1.912,percent of total billed charges,35% of total billed charges,4.6,67.275,,3.68,percent of total billed charges,67.275% of total billed charges,5.47,80,,4.376,percent of total billed charges,80% of total billed charges,2.63,38.38,,2.104,percent of total billed charges,38.38% of total billed charges,5.47,80,,4.376,percent of total billed charges,80% of total billed charges,4.22,61.74,,3.376,percent of total billed charges,61.74% of total billed charges,6.98,102,,5.584,percent of total billed charges,102% of total billed charges,2.6,38,,2.08,percent of total billed charges,38% of total billed charges,2.39,6.98,
SPLINT FINGER 1 X 18,3001736,CDM,270,RC,,,Outpatient,,,6.84,5.13,,5.34,78,,4.272,percent of total billed charges,78% of total billed charges,4.31,63,,3.448,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.6,38,,2.08,percent of total billed charges,38% of total billed charges,2.6,38,,2.08,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,6.16,90,,4.928,percent of total billed charges,90% of total billed charges,2.39,35,,1.912,percent of total billed charges,35% of total billed charges,4.6,67.275,,3.68,percent of total billed charges,67.275% of total billed charges,5.47,80,,4.376,percent of total billed charges,80% of total billed charges,2.63,38.38,,2.104,percent of total billed charges,38.38% of total billed charges,5.47,80,,4.376,percent of total billed charges,80% of total billed charges,4.22,61.74,,3.376,percent of total billed charges,61.74% of total billed charges,6.98,102,,5.584,percent of total billed charges,102% of total billed charges,2.6,38,,2.08,percent of total billed charges,38% of total billed charges,2.39,6.98,
SILK 2-0 K833H,3001577,CDM,270,RC,,,Outpatient,,,6.93,5.2,,5.41,78,,4.328,percent of total billed charges,78% of total billed charges,4.37,63,,3.496,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.63,38,,2.104,percent of total billed charges,38% of total billed charges,2.63,38,,2.104,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,6.24,90,,4.992,percent of total billed charges,90% of total billed charges,2.43,35,,1.944,percent of total billed charges,35% of total billed charges,4.66,67.275,,3.728,percent of total billed charges,67.275% of total billed charges,5.54,80,,4.432,percent of total billed charges,80% of total billed charges,2.66,38.38,,2.128,percent of total billed charges,38.38% of total billed charges,5.54,80,,4.432,percent of total billed charges,80% of total billed charges,4.28,61.74,,3.424,percent of total billed charges,61.74% of total billed charges,7.07,102,,5.656,percent of total billed charges,102% of total billed charges,2.63,38,,2.104,percent of total billed charges,38% of total billed charges,2.43,7.07,
CATHETER SUCTION SINGLE 10FR,3002104,CDM,270,RC,,,Outpatient,,,6.94,5.21,,5.41,78,,4.328,percent of total billed charges,78% of total billed charges,4.37,63,,3.496,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.64,38,,2.112,percent of total billed charges,38% of total billed charges,2.64,38,,2.112,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,6.25,90,,5,percent of total billed charges,90% of total billed charges,2.43,35,,1.944,percent of total billed charges,35% of total billed charges,4.67,67.275,,3.736,percent of total billed charges,67.275% of total billed charges,5.55,80,,4.44,percent of total billed charges,80% of total billed charges,2.66,38.38,,2.128,percent of total billed charges,38.38% of total billed charges,5.55,80,,4.44,percent of total billed charges,80% of total billed charges,4.28,61.74,,3.424,percent of total billed charges,61.74% of total billed charges,7.08,102,,5.664,percent of total billed charges,102% of total billed charges,2.64,38,,2.112,percent of total billed charges,38% of total billed charges,2.43,7.08,
SILK 3-0,3001581,CDM,270,RC,,,Outpatient,,,6.95,5.21,,5.42,78,,4.336,percent of total billed charges,78% of total billed charges,4.38,63,,3.504,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.64,38,,2.112,percent of total billed charges,38% of total billed charges,2.64,38,,2.112,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,6.26,90,,5.008,percent of total billed charges,90% of total billed charges,2.43,35,,1.944,percent of total billed charges,35% of total billed charges,4.68,67.275,,3.744,percent of total billed charges,67.275% of total billed charges,5.56,80,,4.448,percent of total billed charges,80% of total billed charges,2.67,38.38,,2.136,percent of total billed charges,38.38% of total billed charges,5.56,80,,4.448,percent of total billed charges,80% of total billed charges,4.29,61.74,,3.432,percent of total billed charges,61.74% of total billed charges,7.09,102,,5.672,percent of total billed charges,102% of total billed charges,2.64,38,,2.112,percent of total billed charges,38% of total billed charges,2.43,7.09,
INJECTION SC/IM (OBS),2000200,CDM,760,RC,90782,HCPCS,Outpatient,,,7,5.25,,5.46,78,,4.368,percent of total billed charges,78% of total billed charges,4.41,63,,3.528,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.66,38,,2.128,percent of total billed charges,38% of total billed charges,2.66,38,,2.128,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,2.45,35,,1.96,percent of total billed charges,35% of total billed charges,4.71,67.275,,3.768,percent of total billed charges,67.275% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,2.69,38.38,,2.152,percent of total billed charges,38.38% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.32,61.74,,3.456,percent of total billed charges,61.74% of total billed charges,7.14,102,,5.712,percent of total billed charges,102% of total billed charges,2.66,38,,2.128,percent of total billed charges,38% of total billed charges,2.45,7.14,
INJ SC/IM SEPARATE (OBS),2000202,CDM,760,RC,90782,HCPCS,Outpatient,,,7,5.25,,5.46,78,,4.368,percent of total billed charges,78% of total billed charges,4.41,63,,3.528,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.66,38,,2.128,percent of total billed charges,38% of total billed charges,2.66,38,,2.128,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,2.45,35,,1.96,percent of total billed charges,35% of total billed charges,4.71,67.275,,3.768,percent of total billed charges,67.275% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,2.69,38.38,,2.152,percent of total billed charges,38.38% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.32,61.74,,3.456,percent of total billed charges,61.74% of total billed charges,7.14,102,,5.712,percent of total billed charges,102% of total billed charges,2.66,38,,2.128,percent of total billed charges,38% of total billed charges,2.45,7.14,
INJECTION IV (OBS),2000204,CDM,760,RC,90784,HCPCS,Outpatient,,,7,5.25,,5.46,78,,4.368,percent of total billed charges,78% of total billed charges,4.41,63,,3.528,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.66,38,,2.128,percent of total billed charges,38% of total billed charges,2.66,38,,2.128,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,2.45,35,,1.96,percent of total billed charges,35% of total billed charges,4.71,67.275,,3.768,percent of total billed charges,67.275% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,2.69,38.38,,2.152,percent of total billed charges,38.38% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.32,61.74,,3.456,percent of total billed charges,61.74% of total billed charges,7.14,102,,5.712,percent of total billed charges,102% of total billed charges,2.66,38,,2.128,percent of total billed charges,38% of total billed charges,2.45,7.14,
INJ ANTIBIOTIC IM (OBS),2000206,CDM,760,RC,90788,HCPCS,Outpatient,,,7,5.25,,5.46,78,,4.368,percent of total billed charges,78% of total billed charges,4.41,63,,3.528,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.66,38,,2.128,percent of total billed charges,38% of total billed charges,2.66,38,,2.128,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,2.45,35,,1.96,percent of total billed charges,35% of total billed charges,4.71,67.275,,3.768,percent of total billed charges,67.275% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,2.69,38.38,,2.152,percent of total billed charges,38.38% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.32,61.74,,3.456,percent of total billed charges,61.74% of total billed charges,7.14,102,,5.712,percent of total billed charges,102% of total billed charges,2.66,38,,2.128,percent of total billed charges,38% of total billed charges,2.45,7.14,
HEALTH SCREEN -PSA,5000103,CDM,300,RC,,,Outpatient,,,7,5.25,,5.46,78,,4.368,percent of total billed charges,78% of total billed charges,4.41,63,,3.528,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.66,38,,2.128,percent of total billed charges,38% of total billed charges,2.66,38,,2.128,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,2.45,35,,1.96,percent of total billed charges,35% of total billed charges,4.71,67.275,,3.768,percent of total billed charges,67.275% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,2.69,38.38,,2.152,percent of total billed charges,38.38% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.32,61.74,,3.456,percent of total billed charges,61.74% of total billed charges,7.14,102,,5.712,percent of total billed charges,102% of total billed charges,2.66,38,,2.128,percent of total billed charges,38% of total billed charges,2.45,7.14,
AMC CHEM SCREEN,5000185,CDM,300,RC,,,Outpatient,,,7,5.25,,5.46,78,,4.368,percent of total billed charges,78% of total billed charges,4.41,63,,3.528,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.66,38,,2.128,percent of total billed charges,38% of total billed charges,2.66,38,,2.128,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,2.45,35,,1.96,percent of total billed charges,35% of total billed charges,4.71,67.275,,3.768,percent of total billed charges,67.275% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,2.69,38.38,,2.152,percent of total billed charges,38.38% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.32,61.74,,3.456,percent of total billed charges,61.74% of total billed charges,7.14,102,,5.712,percent of total billed charges,102% of total billed charges,2.66,38,,2.128,percent of total billed charges,38% of total billed charges,2.45,7.14,
AMC-CBC,5000186,CDM,300,RC,,,Outpatient,,,7,5.25,,5.46,78,,4.368,percent of total billed charges,78% of total billed charges,4.41,63,,3.528,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.66,38,,2.128,percent of total billed charges,38% of total billed charges,2.66,38,,2.128,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,2.45,35,,1.96,percent of total billed charges,35% of total billed charges,4.71,67.275,,3.768,percent of total billed charges,67.275% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,2.69,38.38,,2.152,percent of total billed charges,38.38% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.32,61.74,,3.456,percent of total billed charges,61.74% of total billed charges,7.14,102,,5.712,percent of total billed charges,102% of total billed charges,2.66,38,,2.128,percent of total billed charges,38% of total billed charges,2.45,7.14,
OXYGEN,8000051,CDM,279,RC,,,Outpatient,,,7,5.25,,5.46,78,,4.368,percent of total billed charges,78% of total billed charges,4.41,63,,3.528,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.66,38,,2.128,percent of total billed charges,38% of total billed charges,2.66,38,,2.128,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,2.45,35,,1.96,percent of total billed charges,35% of total billed charges,4.71,67.275,,3.768,percent of total billed charges,67.275% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,2.69,38.38,,2.152,percent of total billed charges,38.38% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.32,61.74,,3.456,percent of total billed charges,61.74% of total billed charges,7.14,102,,5.712,percent of total billed charges,102% of total billed charges,2.66,38,,2.128,percent of total billed charges,38% of total billed charges,2.45,7.14,
"PULSE OXIMETRY, SINGLE 02 SAT (OR EAR)",8000066,CDM,410,RC,94760,HCPCS,Outpatient,,,7,5.25,,5.46,78,,4.368,percent of total billed charges,78% of total billed charges,4.41,63,,3.528,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.66,38,,2.128,percent of total billed charges,38% of total billed charges,2.66,38,,2.128,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,2.45,35,,1.96,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,2.69,38.38,,2.152,percent of total billed charges,38.38% of total billed charges,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,4.32,61.74,,3.456,percent of total billed charges,61.74% of total billed charges,7.14,102,,5.712,percent of total billed charges,102% of total billed charges,2.66,38,,2.128,percent of total billed charges,38% of total billed charges,2.45,145.93,
POPE EAR WICK,3001541,CDM,270,RC,,,Outpatient,,,7.04,5.28,,5.49,78,,4.392,percent of total billed charges,78% of total billed charges,4.44,63,,3.552,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.68,38,,2.144,percent of total billed charges,38% of total billed charges,2.68,38,,2.144,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,6.34,90,,5.072,percent of total billed charges,90% of total billed charges,2.46,35,,1.968,percent of total billed charges,35% of total billed charges,4.74,67.275,,3.792,percent of total billed charges,67.275% of total billed charges,5.63,80,,4.504,percent of total billed charges,80% of total billed charges,2.7,38.38,,2.16,percent of total billed charges,38.38% of total billed charges,5.63,80,,4.504,percent of total billed charges,80% of total billed charges,4.35,61.74,,3.48,percent of total billed charges,61.74% of total billed charges,7.18,102,,5.744,percent of total billed charges,102% of total billed charges,2.68,38,,2.144,percent of total billed charges,38% of total billed charges,2.46,7.18,
TRACH TUBE UNCUFFED 3.0,3001818,CDM,270,RC,,,Outpatient,,,7.09,5.32,,5.53,78,,4.424,percent of total billed charges,78% of total billed charges,4.47,63,,3.576,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.69,38,,2.152,percent of total billed charges,38% of total billed charges,2.69,38,,2.152,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,6.38,90,,5.104,percent of total billed charges,90% of total billed charges,2.48,35,,1.984,percent of total billed charges,35% of total billed charges,4.77,67.275,,3.816,percent of total billed charges,67.275% of total billed charges,5.67,80,,4.536,percent of total billed charges,80% of total billed charges,2.72,38.38,,2.176,percent of total billed charges,38.38% of total billed charges,5.67,80,,4.536,percent of total billed charges,80% of total billed charges,4.38,61.74,,3.504,percent of total billed charges,61.74% of total billed charges,7.23,102,,5.784,percent of total billed charges,102% of total billed charges,2.69,38,,2.152,percent of total billed charges,38% of total billed charges,2.48,7.23,
TRACH TUBE UNCUFFED 4.5,3002520,CDM,270,RC,,,Outpatient,,,7.18,5.39,,5.6,78,,4.48,percent of total billed charges,78% of total billed charges,4.52,63,,3.616,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.73,38,,2.184,percent of total billed charges,38% of total billed charges,2.73,38,,2.184,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,6.46,90,,5.168,percent of total billed charges,90% of total billed charges,2.51,35,,2.008,percent of total billed charges,35% of total billed charges,4.83,67.275,,3.864,percent of total billed charges,67.275% of total billed charges,5.74,80,,4.592,percent of total billed charges,80% of total billed charges,2.76,38.38,,2.208,percent of total billed charges,38.38% of total billed charges,5.74,80,,4.592,percent of total billed charges,80% of total billed charges,4.43,61.74,,3.544,percent of total billed charges,61.74% of total billed charges,7.32,102,,5.856,percent of total billed charges,102% of total billed charges,2.73,38,,2.184,percent of total billed charges,38% of total billed charges,2.51,7.32,
TRACH TUBE UNCUFFED 8.0,3002521,CDM,270,RC,,,Outpatient,,,7.18,5.39,,5.6,78,,4.48,percent of total billed charges,78% of total billed charges,4.52,63,,3.616,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.73,38,,2.184,percent of total billed charges,38% of total billed charges,2.73,38,,2.184,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,6.46,90,,5.168,percent of total billed charges,90% of total billed charges,2.51,35,,2.008,percent of total billed charges,35% of total billed charges,4.83,67.275,,3.864,percent of total billed charges,67.275% of total billed charges,5.74,80,,4.592,percent of total billed charges,80% of total billed charges,2.76,38.38,,2.208,percent of total billed charges,38.38% of total billed charges,5.74,80,,4.592,percent of total billed charges,80% of total billed charges,4.43,61.74,,3.544,percent of total billed charges,61.74% of total billed charges,7.32,102,,5.856,percent of total billed charges,102% of total billed charges,2.73,38,,2.184,percent of total billed charges,38% of total billed charges,2.51,7.32,
TRACH TUBE UNCUFFED 6.0,3002523,CDM,270,RC,,,Outpatient,,,7.18,5.39,,5.6,78,,4.48,percent of total billed charges,78% of total billed charges,4.52,63,,3.616,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.73,38,,2.184,percent of total billed charges,38% of total billed charges,2.73,38,,2.184,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,6.46,90,,5.168,percent of total billed charges,90% of total billed charges,2.51,35,,2.008,percent of total billed charges,35% of total billed charges,4.83,67.275,,3.864,percent of total billed charges,67.275% of total billed charges,5.74,80,,4.592,percent of total billed charges,80% of total billed charges,2.76,38.38,,2.208,percent of total billed charges,38.38% of total billed charges,5.74,80,,4.592,percent of total billed charges,80% of total billed charges,4.43,61.74,,3.544,percent of total billed charges,61.74% of total billed charges,7.32,102,,5.856,percent of total billed charges,102% of total billed charges,2.73,38,,2.184,percent of total billed charges,38% of total billed charges,2.51,7.32,
ETHILON 5-0 1865G,3001545,CDM,270,RC,,,Outpatient,,,7.2,5.4,,5.62,78,,4.496,percent of total billed charges,78% of total billed charges,4.54,63,,3.632,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.74,38,,2.192,percent of total billed charges,38% of total billed charges,2.74,38,,2.192,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,6.48,90,,5.184,percent of total billed charges,90% of total billed charges,2.52,35,,2.016,percent of total billed charges,35% of total billed charges,4.84,67.275,,3.872,percent of total billed charges,67.275% of total billed charges,5.76,80,,4.608,percent of total billed charges,80% of total billed charges,2.76,38.38,,2.208,percent of total billed charges,38.38% of total billed charges,5.76,80,,4.608,percent of total billed charges,80% of total billed charges,4.45,61.74,,3.56,percent of total billed charges,61.74% of total billed charges,7.34,102,,5.872,percent of total billed charges,102% of total billed charges,2.74,38,,2.192,percent of total billed charges,38% of total billed charges,2.52,7.34,
"zzzGABITRIL: 4 MG, TABS, 100 EA, BOTTLE",1000279,CDM,259,RC,,,Outpatient,,,7.24,5.43,,5.65,78,,4.52,percent of total billed charges,78% of total billed charges,4.56,63,,3.648,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.75,38,,2.2,percent of total billed charges,38% of total billed charges,2.75,38,,2.2,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,6.52,90,,5.216,percent of total billed charges,90% of total billed charges,2.53,35,,2.024,percent of total billed charges,35% of total billed charges,4.87,67.275,,3.896,percent of total billed charges,67.275% of total billed charges,5.79,80,,4.632,percent of total billed charges,80% of total billed charges,2.78,38.38,,2.224,percent of total billed charges,38.38% of total billed charges,5.79,80,,4.632,percent of total billed charges,80% of total billed charges,4.47,61.74,,3.576,percent of total billed charges,61.74% of total billed charges,7.38,102,,5.904,percent of total billed charges,102% of total billed charges,2.75,38,,2.2,percent of total billed charges,38% of total billed charges,2.53,7.38,
STRATASORB 4X4 MSC3044Z,3000525,CDM,270,RC,,,Outpatient,,,7.33,5.5,,5.72,78,,4.576,percent of total billed charges,78% of total billed charges,4.62,63,,3.696,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.79,38,,2.232,percent of total billed charges,38% of total billed charges,2.79,38,,2.232,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,6.6,90,,5.28,percent of total billed charges,90% of total billed charges,2.57,35,,2.056,percent of total billed charges,35% of total billed charges,4.93,67.275,,3.944,percent of total billed charges,67.275% of total billed charges,5.86,80,,4.688,percent of total billed charges,80% of total billed charges,2.81,38.38,,2.248,percent of total billed charges,38.38% of total billed charges,5.86,80,,4.688,percent of total billed charges,80% of total billed charges,4.53,61.74,,3.624,percent of total billed charges,61.74% of total billed charges,7.48,102,,5.984,percent of total billed charges,102% of total billed charges,2.79,38,,2.232,percent of total billed charges,38% of total billed charges,2.57,7.48,
VICRYL 0 CT NEEDLE J280H,3004184,CDM,270,RC,,,Outpatient,,,7.5,5.63,,5.85,78,,4.68,percent of total billed charges,78% of total billed charges,4.73,63,,3.784,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.85,38,,2.28,percent of total billed charges,38% of total billed charges,2.85,38,,2.28,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,6.75,90,,5.4,percent of total billed charges,90% of total billed charges,2.63,35,,2.104,percent of total billed charges,35% of total billed charges,5.05,67.275,,4.04,percent of total billed charges,67.275% of total billed charges,6,80,,4.8,percent of total billed charges,80% of total billed charges,2.88,38.38,,2.304,percent of total billed charges,38.38% of total billed charges,6,80,,4.8,percent of total billed charges,80% of total billed charges,4.63,61.74,,3.704,percent of total billed charges,61.74% of total billed charges,7.65,102,,6.12,percent of total billed charges,102% of total billed charges,2.85,38,,2.28,percent of total billed charges,38% of total billed charges,2.63,7.65,
SILK 2/0 K873H,3004242,CDM,270,RC,,,Outpatient,,,7.52,5.64,,5.87,78,,4.696,percent of total billed charges,78% of total billed charges,4.74,63,,3.792,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.86,38,,2.288,percent of total billed charges,38% of total billed charges,2.86,38,,2.288,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,6.77,90,,5.416,percent of total billed charges,90% of total billed charges,2.63,35,,2.104,percent of total billed charges,35% of total billed charges,5.06,67.275,,4.048,percent of total billed charges,67.275% of total billed charges,6.02,80,,4.816,percent of total billed charges,80% of total billed charges,2.89,38.38,,2.312,percent of total billed charges,38.38% of total billed charges,6.02,80,,4.816,percent of total billed charges,80% of total billed charges,4.64,61.74,,3.712,percent of total billed charges,61.74% of total billed charges,7.67,102,,6.136,percent of total billed charges,102% of total billed charges,2.86,38,,2.288,percent of total billed charges,38% of total billed charges,2.63,7.67,
CATH SPECIMEN KIT FEMALE,3000251,CDM,270,RC,,,Outpatient,,,7.83,5.87,,6.11,78,,4.888,percent of total billed charges,78% of total billed charges,4.93,63,,3.944,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.98,38,,2.384,percent of total billed charges,38% of total billed charges,2.98,38,,2.384,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,7.05,90,,5.64,percent of total billed charges,90% of total billed charges,2.74,35,,2.192,percent of total billed charges,35% of total billed charges,5.27,67.275,,4.216,percent of total billed charges,67.275% of total billed charges,6.26,80,,5.008,percent of total billed charges,80% of total billed charges,3.01,38.38,,2.408,percent of total billed charges,38.38% of total billed charges,6.26,80,,5.008,percent of total billed charges,80% of total billed charges,4.83,61.74,,3.864,percent of total billed charges,61.74% of total billed charges,7.99,102,,6.392,percent of total billed charges,102% of total billed charges,2.98,38,,2.384,percent of total billed charges,38% of total billed charges,2.74,7.99,
CLORPRES 0.2MG TABS (0.2/15MG),1002719,CDM,259,RC,,,Outpatient,,,7.88,5.91,,6.15,78,,4.92,percent of total billed charges,78% of total billed charges,4.96,63,,3.968,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2.99,38,,2.392,percent of total billed charges,38% of total billed charges,2.99,38,,2.392,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,7.09,90,,5.672,percent of total billed charges,90% of total billed charges,2.76,35,,2.208,percent of total billed charges,35% of total billed charges,5.3,67.275,,4.24,percent of total billed charges,67.275% of total billed charges,6.3,80,,5.04,percent of total billed charges,80% of total billed charges,3.02,38.38,,2.416,percent of total billed charges,38.38% of total billed charges,6.3,80,,5.04,percent of total billed charges,80% of total billed charges,4.87,61.74,,3.896,percent of total billed charges,61.74% of total billed charges,8.04,102,,6.432,percent of total billed charges,102% of total billed charges,2.99,38,,2.392,percent of total billed charges,38% of total billed charges,2.76,8.04,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-same drug add on",1001126,CDM,450,RC,96376,HCPCS,Outpatient,,,8,6,,6.24,78,,4.992,percent of total billed charges,78% of total billed charges,5.04,63,,4.032,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.04,38,,2.432,percent of total billed charges,38% of total billed charges,3.04,38,,2.432,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,2.8,35,,2.24,percent of total billed charges,35% of total billed charges,5.38,67.275,,4.304,percent of total billed charges,67.275% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,3.07,38.38,,2.456,percent of total billed charges,38.38% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,4.94,61.74,,3.952,percent of total billed charges,61.74% of total billed charges,8.16,102,,6.528,percent of total billed charges,102% of total billed charges,3.04,38,,2.432,percent of total billed charges,38% of total billed charges,2.8,8.16,
CATH URETHRAL 18FR RED RUBBER(LATEX)SING,3000195,CDM,270,RC,,,Outpatient,,,8,6,,6.24,78,,4.992,percent of total billed charges,78% of total billed charges,5.04,63,,4.032,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.04,38,,2.432,percent of total billed charges,38% of total billed charges,3.04,38,,2.432,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,2.8,35,,2.24,percent of total billed charges,35% of total billed charges,5.38,67.275,,4.304,percent of total billed charges,67.275% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,3.07,38.38,,2.456,percent of total billed charges,38.38% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,4.94,61.74,,3.952,percent of total billed charges,61.74% of total billed charges,8.16,102,,6.528,percent of total billed charges,102% of total billed charges,3.04,38,,2.432,percent of total billed charges,38% of total billed charges,2.8,8.16,
CATH URETHRAL 12FR RED RUBBER(LATEX)SING,3000198,CDM,270,RC,,,Outpatient,,,8,6,,6.24,78,,4.992,percent of total billed charges,78% of total billed charges,5.04,63,,4.032,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.04,38,,2.432,percent of total billed charges,38% of total billed charges,3.04,38,,2.432,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,2.8,35,,2.24,percent of total billed charges,35% of total billed charges,5.38,67.275,,4.304,percent of total billed charges,67.275% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,3.07,38.38,,2.456,percent of total billed charges,38.38% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,4.94,61.74,,3.952,percent of total billed charges,61.74% of total billed charges,8.16,102,,6.528,percent of total billed charges,102% of total billed charges,3.04,38,,2.432,percent of total billed charges,38% of total billed charges,2.8,8.16,
CATH URETHRAL 10FR RED RUBBER(LATEX)SING,3000199,CDM,270,RC,,,Outpatient,,,8,6,,6.24,78,,4.992,percent of total billed charges,78% of total billed charges,5.04,63,,4.032,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.04,38,,2.432,percent of total billed charges,38% of total billed charges,3.04,38,,2.432,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,2.8,35,,2.24,percent of total billed charges,35% of total billed charges,5.38,67.275,,4.304,percent of total billed charges,67.275% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,3.07,38.38,,2.456,percent of total billed charges,38.38% of total billed charges,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,4.94,61.74,,3.952,percent of total billed charges,61.74% of total billed charges,8.16,102,,6.528,percent of total billed charges,102% of total billed charges,3.04,38,,2.432,percent of total billed charges,38% of total billed charges,2.8,8.16,
VICRYL 2-0 SH,3001560,CDM,270,RC,,,Outpatient,,,8.01,6.01,,6.25,78,,5,percent of total billed charges,78% of total billed charges,5.05,63,,4.04,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.04,38,,2.432,percent of total billed charges,38% of total billed charges,3.04,38,,2.432,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,7.21,90,,5.768,percent of total billed charges,90% of total billed charges,2.8,35,,2.24,percent of total billed charges,35% of total billed charges,5.39,67.275,,4.312,percent of total billed charges,67.275% of total billed charges,6.41,80,,5.128,percent of total billed charges,80% of total billed charges,3.07,38.38,,2.456,percent of total billed charges,38.38% of total billed charges,6.41,80,,5.128,percent of total billed charges,80% of total billed charges,4.95,61.74,,3.96,percent of total billed charges,61.74% of total billed charges,8.17,102,,6.536,percent of total billed charges,102% of total billed charges,3.04,38,,2.432,percent of total billed charges,38% of total billed charges,2.8,8.17,
URINARY LEG BAG - 19 oz,3000307,CDM,270,RC,,,Outpatient,,,8.05,6.04,,6.28,78,,5.024,percent of total billed charges,78% of total billed charges,5.07,63,,4.056,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.06,38,,2.448,percent of total billed charges,38% of total billed charges,3.06,38,,2.448,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,7.25,90,,5.8,percent of total billed charges,90% of total billed charges,2.82,35,,2.256,percent of total billed charges,35% of total billed charges,5.42,67.275,,4.336,percent of total billed charges,67.275% of total billed charges,6.44,80,,5.152,percent of total billed charges,80% of total billed charges,3.09,38.38,,2.472,percent of total billed charges,38.38% of total billed charges,6.44,80,,5.152,percent of total billed charges,80% of total billed charges,4.97,61.74,,3.976,percent of total billed charges,61.74% of total billed charges,8.21,102,,6.568,percent of total billed charges,102% of total billed charges,3.06,38,,2.448,percent of total billed charges,38% of total billed charges,2.82,8.21,
BP CUFF DISP REG ADULT - GE,3005066,CDM,270,RC,,,Outpatient,,,8.05,6.04,,6.28,78,,5.024,percent of total billed charges,78% of total billed charges,5.07,63,,4.056,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.06,38,,2.448,percent of total billed charges,38% of total billed charges,3.06,38,,2.448,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,7.25,90,,5.8,percent of total billed charges,90% of total billed charges,2.82,35,,2.256,percent of total billed charges,35% of total billed charges,5.42,67.275,,4.336,percent of total billed charges,67.275% of total billed charges,6.44,80,,5.152,percent of total billed charges,80% of total billed charges,3.09,38.38,,2.472,percent of total billed charges,38.38% of total billed charges,6.44,80,,5.152,percent of total billed charges,80% of total billed charges,4.97,61.74,,3.976,percent of total billed charges,61.74% of total billed charges,8.21,102,,6.568,percent of total billed charges,102% of total billed charges,3.06,38,,2.448,percent of total billed charges,38% of total billed charges,2.82,8.21,
TEGADERM FOAM ADHESIVE DRESSING 3.5X3.5,3000521,CDM,270,RC,,,Outpatient,,,8.13,6.1,,6.34,78,,5.072,percent of total billed charges,78% of total billed charges,5.12,63,,4.096,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.09,38,,2.472,percent of total billed charges,38% of total billed charges,3.09,38,,2.472,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,7.32,90,,5.856,percent of total billed charges,90% of total billed charges,2.85,35,,2.28,percent of total billed charges,35% of total billed charges,5.47,67.275,,4.376,percent of total billed charges,67.275% of total billed charges,6.5,80,,5.2,percent of total billed charges,80% of total billed charges,3.12,38.38,,2.496,percent of total billed charges,38.38% of total billed charges,6.5,80,,5.2,percent of total billed charges,80% of total billed charges,5.02,61.74,,4.016,percent of total billed charges,61.74% of total billed charges,8.29,102,,6.632,percent of total billed charges,102% of total billed charges,3.09,38,,2.472,percent of total billed charges,38% of total billed charges,2.85,8.29,
NASO GASTRIC SALEM SUMP 18 FR,3001612,CDM,270,RC,,,Outpatient,,,8.15,6.11,,6.36,78,,5.088,percent of total billed charges,78% of total billed charges,5.13,63,,4.104,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.1,38,,2.48,percent of total billed charges,38% of total billed charges,3.1,38,,2.48,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,7.34,90,,5.872,percent of total billed charges,90% of total billed charges,2.85,35,,2.28,percent of total billed charges,35% of total billed charges,5.48,67.275,,4.384,percent of total billed charges,67.275% of total billed charges,6.52,80,,5.216,percent of total billed charges,80% of total billed charges,3.13,38.38,,2.504,percent of total billed charges,38.38% of total billed charges,6.52,80,,5.216,percent of total billed charges,80% of total billed charges,5.03,61.74,,4.024,percent of total billed charges,61.74% of total billed charges,8.31,102,,6.648,percent of total billed charges,102% of total billed charges,3.1,38,,2.48,percent of total billed charges,38% of total billed charges,2.85,8.31,
ASTRA GUARD FILTER W/NOSE CLIP,3004290,CDM,270,RC,,,Outpatient,,,8.16,6.12,,6.36,78,,5.088,percent of total billed charges,78% of total billed charges,5.14,63,,4.112,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.1,38,,2.48,percent of total billed charges,38% of total billed charges,3.1,38,,2.48,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,7.34,90,,5.872,percent of total billed charges,90% of total billed charges,2.86,35,,2.288,percent of total billed charges,35% of total billed charges,5.49,67.275,,4.392,percent of total billed charges,67.275% of total billed charges,6.53,80,,5.224,percent of total billed charges,80% of total billed charges,3.13,38.38,,2.504,percent of total billed charges,38.38% of total billed charges,6.53,80,,5.224,percent of total billed charges,80% of total billed charges,5.04,61.74,,4.032,percent of total billed charges,61.74% of total billed charges,8.32,102,,6.656,percent of total billed charges,102% of total billed charges,3.1,38,,2.48,percent of total billed charges,38% of total billed charges,2.86,8.32,
FENESTRATED SHEET LARGE,3000711,CDM,270,RC,,,Outpatient,,,8.19,6.14,,6.39,78,,5.112,percent of total billed charges,78% of total billed charges,5.16,63,,4.128,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.11,38,,2.488,percent of total billed charges,38% of total billed charges,3.11,38,,2.488,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,7.37,90,,5.896,percent of total billed charges,90% of total billed charges,2.87,35,,2.296,percent of total billed charges,35% of total billed charges,5.51,67.275,,4.408,percent of total billed charges,67.275% of total billed charges,6.55,80,,5.24,percent of total billed charges,80% of total billed charges,3.14,38.38,,2.512,percent of total billed charges,38.38% of total billed charges,6.55,80,,5.24,percent of total billed charges,80% of total billed charges,5.06,61.74,,4.048,percent of total billed charges,61.74% of total billed charges,8.35,102,,6.68,percent of total billed charges,102% of total billed charges,3.11,38,,2.488,percent of total billed charges,38% of total billed charges,2.87,8.35,
VICRYL 2-0  CT-1  J259H,3004241,CDM,270,RC,,,Outpatient,,,8.21,6.16,,6.4,78,,5.12,percent of total billed charges,78% of total billed charges,5.17,63,,4.136,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.12,38,,2.496,percent of total billed charges,38% of total billed charges,3.12,38,,2.496,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,7.39,90,,5.912,percent of total billed charges,90% of total billed charges,2.87,35,,2.296,percent of total billed charges,35% of total billed charges,5.52,67.275,,4.416,percent of total billed charges,67.275% of total billed charges,6.57,80,,5.256,percent of total billed charges,80% of total billed charges,3.15,38.38,,2.52,percent of total billed charges,38.38% of total billed charges,6.57,80,,5.256,percent of total billed charges,80% of total billed charges,5.07,61.74,,4.056,percent of total billed charges,61.74% of total billed charges,8.37,102,,6.696,percent of total billed charges,102% of total billed charges,3.12,38,,2.496,percent of total billed charges,38% of total billed charges,2.87,8.37,
VICRYL 3-0 CT-1 J338H,3002336,CDM,270,RC,,,Outpatient,,,8.44,6.33,,6.58,78,,5.264,percent of total billed charges,78% of total billed charges,5.32,63,,4.256,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.21,38,,2.568,percent of total billed charges,38% of total billed charges,3.21,38,,2.568,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,7.6,90,,6.08,percent of total billed charges,90% of total billed charges,2.95,35,,2.36,percent of total billed charges,35% of total billed charges,5.68,67.275,,4.544,percent of total billed charges,67.275% of total billed charges,6.75,80,,5.4,percent of total billed charges,80% of total billed charges,3.24,38.38,,2.592,percent of total billed charges,38.38% of total billed charges,6.75,80,,5.4,percent of total billed charges,80% of total billed charges,5.21,61.74,,4.168,percent of total billed charges,61.74% of total billed charges,8.61,102,,6.888,percent of total billed charges,102% of total billed charges,3.21,38,,2.568,percent of total billed charges,38% of total billed charges,2.95,8.61,
SOCK AID 4,3000713,CDM,270,RC,,,Outpatient,,,8.47,6.35,,6.61,78,,5.288,percent of total billed charges,78% of total billed charges,5.34,63,,4.272,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.22,38,,2.576,percent of total billed charges,38% of total billed charges,3.22,38,,2.576,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,7.62,90,,6.096,percent of total billed charges,90% of total billed charges,2.96,35,,2.368,percent of total billed charges,35% of total billed charges,5.7,67.275,,4.56,percent of total billed charges,67.275% of total billed charges,6.78,80,,5.424,percent of total billed charges,80% of total billed charges,3.25,38.38,,2.6,percent of total billed charges,38.38% of total billed charges,6.78,80,,5.424,percent of total billed charges,80% of total billed charges,5.23,61.74,,4.184,percent of total billed charges,61.74% of total billed charges,8.64,102,,6.912,percent of total billed charges,102% of total billed charges,3.22,38,,2.576,percent of total billed charges,38% of total billed charges,2.96,8.64,
TRACHEOSTOMY MASK TUBING,3003005,CDM,270,RC,,,Outpatient,,,8.48,6.36,,6.61,78,,5.288,percent of total billed charges,78% of total billed charges,5.34,63,,4.272,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.22,38,,2.576,percent of total billed charges,38% of total billed charges,3.22,38,,2.576,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,7.63,90,,6.104,percent of total billed charges,90% of total billed charges,2.97,35,,2.376,percent of total billed charges,35% of total billed charges,5.7,67.275,,4.56,percent of total billed charges,67.275% of total billed charges,6.78,80,,5.424,percent of total billed charges,80% of total billed charges,3.25,38.38,,2.6,percent of total billed charges,38.38% of total billed charges,6.78,80,,5.424,percent of total billed charges,80% of total billed charges,5.24,61.74,,4.192,percent of total billed charges,61.74% of total billed charges,8.65,102,,6.92,percent of total billed charges,102% of total billed charges,3.22,38,,2.576,percent of total billed charges,38% of total billed charges,2.97,8.65,
MULTIVENT MASK,3003004,CDM,270,RC,,,Outpatient,,,8.5,6.38,,6.63,78,,5.304,percent of total billed charges,78% of total billed charges,5.36,63,,4.288,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.23,38,,2.584,percent of total billed charges,38% of total billed charges,3.23,38,,2.584,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,7.65,90,,6.12,percent of total billed charges,90% of total billed charges,2.98,35,,2.384,percent of total billed charges,35% of total billed charges,5.72,67.275,,4.576,percent of total billed charges,67.275% of total billed charges,6.8,80,,5.44,percent of total billed charges,80% of total billed charges,3.26,38.38,,2.608,percent of total billed charges,38.38% of total billed charges,6.8,80,,5.44,percent of total billed charges,80% of total billed charges,5.25,61.74,,4.2,percent of total billed charges,61.74% of total billed charges,8.67,102,,6.936,percent of total billed charges,102% of total billed charges,3.23,38,,2.584,percent of total billed charges,38% of total billed charges,2.98,8.67,
INFANT NASAL CANNULA,3003063,CDM,270,RC,,,Outpatient,,,8.5,6.38,,6.63,78,,5.304,percent of total billed charges,78% of total billed charges,5.36,63,,4.288,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.23,38,,2.584,percent of total billed charges,38% of total billed charges,3.23,38,,2.584,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,7.65,90,,6.12,percent of total billed charges,90% of total billed charges,2.98,35,,2.384,percent of total billed charges,35% of total billed charges,5.72,67.275,,4.576,percent of total billed charges,67.275% of total billed charges,6.8,80,,5.44,percent of total billed charges,80% of total billed charges,3.26,38.38,,2.608,percent of total billed charges,38.38% of total billed charges,6.8,80,,5.44,percent of total billed charges,80% of total billed charges,5.25,61.74,,4.2,percent of total billed charges,61.74% of total billed charges,8.67,102,,6.936,percent of total billed charges,102% of total billed charges,3.23,38,,2.584,percent of total billed charges,38% of total billed charges,2.98,8.67,
ETHILON 3-0 FS-1,3001549,CDM,270,RC,,,Outpatient,,,8.51,6.38,,6.64,78,,5.312,percent of total billed charges,78% of total billed charges,5.36,63,,4.288,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.23,38,,2.584,percent of total billed charges,38% of total billed charges,3.23,38,,2.584,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,7.66,90,,6.128,percent of total billed charges,90% of total billed charges,2.98,35,,2.384,percent of total billed charges,35% of total billed charges,5.73,67.275,,4.584,percent of total billed charges,67.275% of total billed charges,6.81,80,,5.448,percent of total billed charges,80% of total billed charges,3.27,38.38,,2.616,percent of total billed charges,38.38% of total billed charges,6.81,80,,5.448,percent of total billed charges,80% of total billed charges,5.25,61.74,,4.2,percent of total billed charges,61.74% of total billed charges,8.68,102,,6.944,percent of total billed charges,102% of total billed charges,3.23,38,,2.584,percent of total billed charges,38% of total billed charges,2.98,8.68,
TRACH TIE,3004210,CDM,270,RC,,,Outpatient,,,8.51,6.38,,6.64,78,,5.312,percent of total billed charges,78% of total billed charges,5.36,63,,4.288,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.23,38,,2.584,percent of total billed charges,38% of total billed charges,3.23,38,,2.584,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,7.66,90,,6.128,percent of total billed charges,90% of total billed charges,2.98,35,,2.384,percent of total billed charges,35% of total billed charges,5.73,67.275,,4.584,percent of total billed charges,67.275% of total billed charges,6.81,80,,5.448,percent of total billed charges,80% of total billed charges,3.27,38.38,,2.616,percent of total billed charges,38.38% of total billed charges,6.81,80,,5.448,percent of total billed charges,80% of total billed charges,5.25,61.74,,4.2,percent of total billed charges,61.74% of total billed charges,8.68,102,,6.944,percent of total billed charges,102% of total billed charges,3.23,38,,2.584,percent of total billed charges,38% of total billed charges,2.98,8.68,
VALVE ONE WAY,3005666,CDM,270,RC,,,Outpatient,,,8.51,6.38,,6.64,78,,5.312,percent of total billed charges,78% of total billed charges,5.36,63,,4.288,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.23,38,,2.584,percent of total billed charges,38% of total billed charges,3.23,38,,2.584,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,7.66,90,,6.128,percent of total billed charges,90% of total billed charges,2.98,35,,2.384,percent of total billed charges,35% of total billed charges,5.73,67.275,,4.584,percent of total billed charges,67.275% of total billed charges,6.81,80,,5.448,percent of total billed charges,80% of total billed charges,3.27,38.38,,2.616,percent of total billed charges,38.38% of total billed charges,6.81,80,,5.448,percent of total billed charges,80% of total billed charges,5.25,61.74,,4.2,percent of total billed charges,61.74% of total billed charges,8.68,102,,6.944,percent of total billed charges,102% of total billed charges,3.23,38,,2.584,percent of total billed charges,38% of total billed charges,2.98,8.68,
VICRYL O CT-1,3001551,CDM,270,RC,,,Outpatient,,,8.69,6.52,,6.78,78,,5.424,percent of total billed charges,78% of total billed charges,5.47,63,,4.376,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.3,38,,2.64,percent of total billed charges,38% of total billed charges,3.3,38,,2.64,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,7.82,90,,6.256,percent of total billed charges,90% of total billed charges,3.04,35,,2.432,percent of total billed charges,35% of total billed charges,5.85,67.275,,4.68,percent of total billed charges,67.275% of total billed charges,6.95,80,,5.56,percent of total billed charges,80% of total billed charges,3.34,38.38,,2.672,percent of total billed charges,38.38% of total billed charges,6.95,80,,5.56,percent of total billed charges,80% of total billed charges,5.37,61.74,,4.296,percent of total billed charges,61.74% of total billed charges,8.86,102,,7.088,percent of total billed charges,102% of total billed charges,3.3,38,,2.64,percent of total billed charges,38% of total billed charges,3.04,8.86,
NASO PHARYNGEAL AIRWAY 30 FR,3001315,CDM,270,RC,,,Outpatient,,,8.78,6.59,,6.85,78,,5.48,percent of total billed charges,78% of total billed charges,5.53,63,,4.424,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.34,38,,2.672,percent of total billed charges,38% of total billed charges,3.34,38,,2.672,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,7.9,90,,6.32,percent of total billed charges,90% of total billed charges,3.07,35,,2.456,percent of total billed charges,35% of total billed charges,5.91,67.275,,4.728,percent of total billed charges,67.275% of total billed charges,7.02,80,,5.616,percent of total billed charges,80% of total billed charges,3.37,38.38,,2.696,percent of total billed charges,38.38% of total billed charges,7.02,80,,5.616,percent of total billed charges,80% of total billed charges,5.42,61.74,,4.336,percent of total billed charges,61.74% of total billed charges,8.96,102,,7.168,percent of total billed charges,102% of total billed charges,3.34,38,,2.672,percent of total billed charges,38% of total billed charges,3.07,8.96,
VICRYL 2-0 CT-2,3001557,CDM,270,RC,,,Outpatient,,,8.78,6.59,,6.85,78,,5.48,percent of total billed charges,78% of total billed charges,5.53,63,,4.424,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.34,38,,2.672,percent of total billed charges,38% of total billed charges,3.34,38,,2.672,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,7.9,90,,6.32,percent of total billed charges,90% of total billed charges,3.07,35,,2.456,percent of total billed charges,35% of total billed charges,5.91,67.275,,4.728,percent of total billed charges,67.275% of total billed charges,7.02,80,,5.616,percent of total billed charges,80% of total billed charges,3.37,38.38,,2.696,percent of total billed charges,38.38% of total billed charges,7.02,80,,5.616,percent of total billed charges,80% of total billed charges,5.42,61.74,,4.336,percent of total billed charges,61.74% of total billed charges,8.96,102,,7.168,percent of total billed charges,102% of total billed charges,3.34,38,,2.672,percent of total billed charges,38% of total billed charges,3.07,8.96,
ANTI - FOG SOLUTION,3004075,CDM,270,RC,,,Outpatient,,,8.82,6.62,,6.88,78,,5.504,percent of total billed charges,78% of total billed charges,5.56,63,,4.448,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.35,38,,2.68,percent of total billed charges,38% of total billed charges,3.35,38,,2.68,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,7.94,90,,6.352,percent of total billed charges,90% of total billed charges,3.09,35,,2.472,percent of total billed charges,35% of total billed charges,5.93,67.275,,4.744,percent of total billed charges,67.275% of total billed charges,7.06,80,,5.648,percent of total billed charges,80% of total billed charges,3.39,38.38,,2.712,percent of total billed charges,38.38% of total billed charges,7.06,80,,5.648,percent of total billed charges,80% of total billed charges,5.45,61.74,,4.36,percent of total billed charges,61.74% of total billed charges,9,102,,7.2,percent of total billed charges,102% of total billed charges,3.35,38,,2.68,percent of total billed charges,38% of total billed charges,3.09,9,
PENROSE DRAIN 1/4,3002317,CDM,270,RC,,,Outpatient,,,8.91,6.68,,6.95,78,,5.56,percent of total billed charges,78% of total billed charges,5.61,63,,4.488,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.39,38,,2.712,percent of total billed charges,38% of total billed charges,3.39,38,,2.712,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,8.02,90,,6.416,percent of total billed charges,90% of total billed charges,3.12,35,,2.496,percent of total billed charges,35% of total billed charges,5.99,67.275,,4.792,percent of total billed charges,67.275% of total billed charges,7.13,80,,5.704,percent of total billed charges,80% of total billed charges,3.42,38.38,,2.736,percent of total billed charges,38.38% of total billed charges,7.13,80,,5.704,percent of total billed charges,80% of total billed charges,5.5,61.74,,4.4,percent of total billed charges,61.74% of total billed charges,9.09,102,,7.272,percent of total billed charges,102% of total billed charges,3.39,38,,2.712,percent of total billed charges,38% of total billed charges,3.12,9.09,
VICRYL 0 CT-1  J346H,3004248,CDM,270,RC,,,Outpatient,,,8.94,6.71,,6.97,78,,5.576,percent of total billed charges,78% of total billed charges,5.63,63,,4.504,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.4,38,,2.72,percent of total billed charges,38% of total billed charges,3.4,38,,2.72,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,8.05,90,,6.44,percent of total billed charges,90% of total billed charges,3.13,35,,2.504,percent of total billed charges,35% of total billed charges,6.01,67.275,,4.808,percent of total billed charges,67.275% of total billed charges,7.15,80,,5.72,percent of total billed charges,80% of total billed charges,3.43,38.38,,2.744,percent of total billed charges,38.38% of total billed charges,7.15,80,,5.72,percent of total billed charges,80% of total billed charges,5.52,61.74,,4.416,percent of total billed charges,61.74% of total billed charges,9.12,102,,7.296,percent of total billed charges,102% of total billed charges,3.4,38,,2.72,percent of total billed charges,38% of total billed charges,3.13,9.12,
ETHILON 5-0 FS-2,3001547,CDM,270,RC,,,Outpatient,,,9.05,6.79,,7.06,78,,5.648,percent of total billed charges,78% of total billed charges,5.7,63,,4.56,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.44,38,,2.752,percent of total billed charges,38% of total billed charges,3.44,38,,2.752,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,8.15,90,,6.52,percent of total billed charges,90% of total billed charges,3.17,35,,2.536,percent of total billed charges,35% of total billed charges,6.09,67.275,,4.872,percent of total billed charges,67.275% of total billed charges,7.24,80,,5.792,percent of total billed charges,80% of total billed charges,3.47,38.38,,2.776,percent of total billed charges,38.38% of total billed charges,7.24,80,,5.792,percent of total billed charges,80% of total billed charges,5.59,61.74,,4.472,percent of total billed charges,61.74% of total billed charges,9.23,102,,7.384,percent of total billed charges,102% of total billed charges,3.44,38,,2.752,percent of total billed charges,38% of total billed charges,3.17,9.23,
AEROSOL DRAINAGE SYSTEM   1740,3003025,CDM,270,RC,,,Outpatient,,,9.05,6.79,,7.06,78,,5.648,percent of total billed charges,78% of total billed charges,5.7,63,,4.56,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.44,38,,2.752,percent of total billed charges,38% of total billed charges,3.44,38,,2.752,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,8.15,90,,6.52,percent of total billed charges,90% of total billed charges,3.17,35,,2.536,percent of total billed charges,35% of total billed charges,6.09,67.275,,4.872,percent of total billed charges,67.275% of total billed charges,7.24,80,,5.792,percent of total billed charges,80% of total billed charges,3.47,38.38,,2.776,percent of total billed charges,38.38% of total billed charges,7.24,80,,5.792,percent of total billed charges,80% of total billed charges,5.59,61.74,,4.472,percent of total billed charges,61.74% of total billed charges,9.23,102,,7.384,percent of total billed charges,102% of total billed charges,3.44,38,,2.752,percent of total billed charges,38% of total billed charges,3.17,9.23,
SILK 0 FSL,3004155,CDM,270,RC,,,Outpatient,,,9.05,6.79,,7.06,78,,5.648,percent of total billed charges,78% of total billed charges,5.7,63,,4.56,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.44,38,,2.752,percent of total billed charges,38% of total billed charges,3.44,38,,2.752,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,8.15,90,,6.52,percent of total billed charges,90% of total billed charges,3.17,35,,2.536,percent of total billed charges,35% of total billed charges,6.09,67.275,,4.872,percent of total billed charges,67.275% of total billed charges,7.24,80,,5.792,percent of total billed charges,80% of total billed charges,3.47,38.38,,2.776,percent of total billed charges,38.38% of total billed charges,7.24,80,,5.792,percent of total billed charges,80% of total billed charges,5.59,61.74,,4.472,percent of total billed charges,61.74% of total billed charges,9.23,102,,7.384,percent of total billed charges,102% of total billed charges,3.44,38,,2.752,percent of total billed charges,38% of total billed charges,3.17,9.23,
NASO GASTRIC SALEM SUMP 16 FR,3004175,CDM,270,RC,,,Outpatient,,,9.05,6.79,,7.06,78,,5.648,percent of total billed charges,78% of total billed charges,5.7,63,,4.56,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.44,38,,2.752,percent of total billed charges,38% of total billed charges,3.44,38,,2.752,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,8.15,90,,6.52,percent of total billed charges,90% of total billed charges,3.17,35,,2.536,percent of total billed charges,35% of total billed charges,6.09,67.275,,4.872,percent of total billed charges,67.275% of total billed charges,7.24,80,,5.792,percent of total billed charges,80% of total billed charges,3.47,38.38,,2.776,percent of total billed charges,38.38% of total billed charges,7.24,80,,5.792,percent of total billed charges,80% of total billed charges,5.59,61.74,,4.472,percent of total billed charges,61.74% of total billed charges,9.23,102,,7.384,percent of total billed charges,102% of total billed charges,3.44,38,,2.752,percent of total billed charges,38% of total billed charges,3.17,9.23,
CATHETER URETHRAL TRAY,3000205,CDM,270,RC,,,Outpatient,,,9.09,6.82,,7.09,78,,5.672,percent of total billed charges,78% of total billed charges,5.73,63,,4.584,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.45,38,,2.76,percent of total billed charges,38% of total billed charges,3.45,38,,2.76,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,8.18,90,,6.544,percent of total billed charges,90% of total billed charges,3.18,35,,2.544,percent of total billed charges,35% of total billed charges,6.12,67.275,,4.896,percent of total billed charges,67.275% of total billed charges,7.27,80,,5.816,percent of total billed charges,80% of total billed charges,3.49,38.38,,2.792,percent of total billed charges,38.38% of total billed charges,7.27,80,,5.816,percent of total billed charges,80% of total billed charges,5.61,61.74,,4.488,percent of total billed charges,61.74% of total billed charges,9.27,102,,7.416,percent of total billed charges,102% of total billed charges,3.45,38,,2.76,percent of total billed charges,38% of total billed charges,3.18,9.27,
ETHILON 2-0 CT-2 X411H,3001599,CDM,270,RC,,,Outpatient,,,9.14,6.86,,7.13,78,,5.704,percent of total billed charges,78% of total billed charges,5.76,63,,4.608,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.47,38,,2.776,percent of total billed charges,38% of total billed charges,3.47,38,,2.776,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,8.23,90,,6.584,percent of total billed charges,90% of total billed charges,3.2,35,,2.56,percent of total billed charges,35% of total billed charges,6.15,67.275,,4.92,percent of total billed charges,67.275% of total billed charges,7.31,80,,5.848,percent of total billed charges,80% of total billed charges,3.51,38.38,,2.808,percent of total billed charges,38.38% of total billed charges,7.31,80,,5.848,percent of total billed charges,80% of total billed charges,5.64,61.74,,4.512,percent of total billed charges,61.74% of total billed charges,9.32,102,,7.456,percent of total billed charges,102% of total billed charges,3.47,38,,2.776,percent of total billed charges,38% of total billed charges,3.2,9.32,
VICRYL TIE 0 J608H,3001595,CDM,270,RC,,,Outpatient,,,9.23,6.92,,7.2,78,,5.76,percent of total billed charges,78% of total billed charges,5.81,63,,4.648,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.51,38,,2.808,percent of total billed charges,38% of total billed charges,3.51,38,,2.808,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,8.31,90,,6.648,percent of total billed charges,90% of total billed charges,3.23,35,,2.584,percent of total billed charges,35% of total billed charges,6.21,67.275,,4.968,percent of total billed charges,67.275% of total billed charges,7.38,80,,5.904,percent of total billed charges,80% of total billed charges,3.54,38.38,,2.832,percent of total billed charges,38.38% of total billed charges,7.38,80,,5.904,percent of total billed charges,80% of total billed charges,5.7,61.74,,4.56,percent of total billed charges,61.74% of total billed charges,9.41,102,,7.528,percent of total billed charges,102% of total billed charges,3.51,38,,2.808,percent of total billed charges,38% of total billed charges,3.23,9.41,
"ETHIBOND - EXCEL, GREEN CT-1 X424H",3005014,CDM,270,RC,,,Outpatient,,,9.31,6.98,,7.26,78,,5.808,percent of total billed charges,78% of total billed charges,5.87,63,,4.696,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.54,38,,2.832,percent of total billed charges,38% of total billed charges,3.54,38,,2.832,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,8.38,90,,6.704,percent of total billed charges,90% of total billed charges,3.26,35,,2.608,percent of total billed charges,35% of total billed charges,6.26,67.275,,5.008,percent of total billed charges,67.275% of total billed charges,7.45,80,,5.96,percent of total billed charges,80% of total billed charges,3.57,38.38,,2.856,percent of total billed charges,38.38% of total billed charges,7.45,80,,5.96,percent of total billed charges,80% of total billed charges,5.75,61.74,,4.6,percent of total billed charges,61.74% of total billed charges,9.5,102,,7.6,percent of total billed charges,102% of total billed charges,3.54,38,,2.832,percent of total billed charges,38% of total billed charges,3.26,9.5,
GUEDEL AIRWAY - 90MM - YELLOW,3003567,CDM,270,RC,,,Outpatient,,,9.33,7,,7.28,78,,5.824,percent of total billed charges,78% of total billed charges,5.88,63,,4.704,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.55,38,,2.84,percent of total billed charges,38% of total billed charges,3.55,38,,2.84,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,8.4,90,,6.72,percent of total billed charges,90% of total billed charges,3.27,35,,2.616,percent of total billed charges,35% of total billed charges,6.28,67.275,,5.024,percent of total billed charges,67.275% of total billed charges,7.46,80,,5.968,percent of total billed charges,80% of total billed charges,3.58,38.38,,2.864,percent of total billed charges,38.38% of total billed charges,7.46,80,,5.968,percent of total billed charges,80% of total billed charges,5.76,61.74,,4.608,percent of total billed charges,61.74% of total billed charges,9.52,102,,7.616,percent of total billed charges,102% of total billed charges,3.55,38,,2.84,percent of total billed charges,38% of total billed charges,3.27,9.52,
GUEDEL AIRWAY - 60MM - BLACK,3003568,CDM,270,RC,,,Outpatient,,,9.33,7,,7.28,78,,5.824,percent of total billed charges,78% of total billed charges,5.88,63,,4.704,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.55,38,,2.84,percent of total billed charges,38% of total billed charges,3.55,38,,2.84,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,8.4,90,,6.72,percent of total billed charges,90% of total billed charges,3.27,35,,2.616,percent of total billed charges,35% of total billed charges,6.28,67.275,,5.024,percent of total billed charges,67.275% of total billed charges,7.46,80,,5.968,percent of total billed charges,80% of total billed charges,3.58,38.38,,2.864,percent of total billed charges,38.38% of total billed charges,7.46,80,,5.968,percent of total billed charges,80% of total billed charges,5.76,61.74,,4.608,percent of total billed charges,61.74% of total billed charges,9.52,102,,7.616,percent of total billed charges,102% of total billed charges,3.55,38,,2.84,percent of total billed charges,38% of total billed charges,3.27,9.52,
GUEDEL AIRWAY - 80MM - GREEN,3003569,CDM,270,RC,,,Outpatient,,,9.33,7,,7.28,78,,5.824,percent of total billed charges,78% of total billed charges,5.88,63,,4.704,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.55,38,,2.84,percent of total billed charges,38% of total billed charges,3.55,38,,2.84,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,8.4,90,,6.72,percent of total billed charges,90% of total billed charges,3.27,35,,2.616,percent of total billed charges,35% of total billed charges,6.28,67.275,,5.024,percent of total billed charges,67.275% of total billed charges,7.46,80,,5.968,percent of total billed charges,80% of total billed charges,3.58,38.38,,2.864,percent of total billed charges,38.38% of total billed charges,7.46,80,,5.968,percent of total billed charges,80% of total billed charges,5.76,61.74,,4.608,percent of total billed charges,61.74% of total billed charges,9.52,102,,7.616,percent of total billed charges,102% of total billed charges,3.55,38,,2.84,percent of total billed charges,38% of total billed charges,3.27,9.52,
GUEDEL AIRWAY - 100MM - RED,3003570,CDM,270,RC,,,Outpatient,,,9.33,7,,7.28,78,,5.824,percent of total billed charges,78% of total billed charges,5.88,63,,4.704,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.55,38,,2.84,percent of total billed charges,38% of total billed charges,3.55,38,,2.84,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,8.4,90,,6.72,percent of total billed charges,90% of total billed charges,3.27,35,,2.616,percent of total billed charges,35% of total billed charges,6.28,67.275,,5.024,percent of total billed charges,67.275% of total billed charges,7.46,80,,5.968,percent of total billed charges,80% of total billed charges,3.58,38.38,,2.864,percent of total billed charges,38.38% of total billed charges,7.46,80,,5.968,percent of total billed charges,80% of total billed charges,5.76,61.74,,4.608,percent of total billed charges,61.74% of total billed charges,9.52,102,,7.616,percent of total billed charges,102% of total billed charges,3.55,38,,2.84,percent of total billed charges,38% of total billed charges,3.27,9.52,
GUEDEL AIRWAY - 70MM - WHITE,3003571,CDM,270,RC,,,Outpatient,,,9.33,7,,7.28,78,,5.824,percent of total billed charges,78% of total billed charges,5.88,63,,4.704,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.55,38,,2.84,percent of total billed charges,38% of total billed charges,3.55,38,,2.84,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,8.4,90,,6.72,percent of total billed charges,90% of total billed charges,3.27,35,,2.616,percent of total billed charges,35% of total billed charges,6.28,67.275,,5.024,percent of total billed charges,67.275% of total billed charges,7.46,80,,5.968,percent of total billed charges,80% of total billed charges,3.58,38.38,,2.864,percent of total billed charges,38.38% of total billed charges,7.46,80,,5.968,percent of total billed charges,80% of total billed charges,5.76,61.74,,4.608,percent of total billed charges,61.74% of total billed charges,9.52,102,,7.616,percent of total billed charges,102% of total billed charges,3.55,38,,2.84,percent of total billed charges,38% of total billed charges,3.27,9.52,
GUEDEL AIRWAY - 40MM - PINK,3003572,CDM,270,RC,,,Outpatient,,,9.33,7,,7.28,78,,5.824,percent of total billed charges,78% of total billed charges,5.88,63,,4.704,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.55,38,,2.84,percent of total billed charges,38% of total billed charges,3.55,38,,2.84,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,8.4,90,,6.72,percent of total billed charges,90% of total billed charges,3.27,35,,2.616,percent of total billed charges,35% of total billed charges,6.28,67.275,,5.024,percent of total billed charges,67.275% of total billed charges,7.46,80,,5.968,percent of total billed charges,80% of total billed charges,3.58,38.38,,2.864,percent of total billed charges,38.38% of total billed charges,7.46,80,,5.968,percent of total billed charges,80% of total billed charges,5.76,61.74,,4.608,percent of total billed charges,61.74% of total billed charges,9.52,102,,7.616,percent of total billed charges,102% of total billed charges,3.55,38,,2.84,percent of total billed charges,38% of total billed charges,3.27,9.52,
GUEDEL AIRWAY - 30MM - CLEAR,3003573,CDM,270,RC,,,Outpatient,,,9.33,7,,7.28,78,,5.824,percent of total billed charges,78% of total billed charges,5.88,63,,4.704,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.55,38,,2.84,percent of total billed charges,38% of total billed charges,3.55,38,,2.84,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,8.4,90,,6.72,percent of total billed charges,90% of total billed charges,3.27,35,,2.616,percent of total billed charges,35% of total billed charges,6.28,67.275,,5.024,percent of total billed charges,67.275% of total billed charges,7.46,80,,5.968,percent of total billed charges,80% of total billed charges,3.58,38.38,,2.864,percent of total billed charges,38.38% of total billed charges,7.46,80,,5.968,percent of total billed charges,80% of total billed charges,5.76,61.74,,4.608,percent of total billed charges,61.74% of total billed charges,9.52,102,,7.616,percent of total billed charges,102% of total billed charges,3.55,38,,2.84,percent of total billed charges,38% of total billed charges,3.27,9.52,
GUEDEL AIRWAY - 50MM - BLUE,3003574,CDM,270,RC,,,Outpatient,,,9.33,7,,7.28,78,,5.824,percent of total billed charges,78% of total billed charges,5.88,63,,4.704,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.55,38,,2.84,percent of total billed charges,38% of total billed charges,3.55,38,,2.84,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,8.4,90,,6.72,percent of total billed charges,90% of total billed charges,3.27,35,,2.616,percent of total billed charges,35% of total billed charges,6.28,67.275,,5.024,percent of total billed charges,67.275% of total billed charges,7.46,80,,5.968,percent of total billed charges,80% of total billed charges,3.58,38.38,,2.864,percent of total billed charges,38.38% of total billed charges,7.46,80,,5.968,percent of total billed charges,80% of total billed charges,5.76,61.74,,4.608,percent of total billed charges,61.74% of total billed charges,9.52,102,,7.616,percent of total billed charges,102% of total billed charges,3.55,38,,2.84,percent of total billed charges,38% of total billed charges,3.27,9.52,
PENROSE DRAIN 1/2,3000312,CDM,270,RC,,,Outpatient,,,9.45,7.09,,7.37,78,,5.896,percent of total billed charges,78% of total billed charges,5.95,63,,4.76,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.59,38,,2.872,percent of total billed charges,38% of total billed charges,3.59,38,,2.872,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,8.51,90,,6.808,percent of total billed charges,90% of total billed charges,3.31,35,,2.648,percent of total billed charges,35% of total billed charges,6.36,67.275,,5.088,percent of total billed charges,67.275% of total billed charges,7.56,80,,6.048,percent of total billed charges,80% of total billed charges,3.63,38.38,,2.904,percent of total billed charges,38.38% of total billed charges,7.56,80,,6.048,percent of total billed charges,80% of total billed charges,5.83,61.74,,4.664,percent of total billed charges,61.74% of total billed charges,9.64,102,,7.712,percent of total billed charges,102% of total billed charges,3.59,38,,2.872,percent of total billed charges,38% of total billed charges,3.31,9.64,
SILK 2-0 SA85H,3001582,CDM,270,RC,,,Outpatient,,,9.51,7.13,,7.42,78,,5.936,percent of total billed charges,78% of total billed charges,5.99,63,,4.792,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.61,38,,2.888,percent of total billed charges,38% of total billed charges,3.61,38,,2.888,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,8.56,90,,6.848,percent of total billed charges,90% of total billed charges,3.33,35,,2.664,percent of total billed charges,35% of total billed charges,6.4,67.275,,5.12,percent of total billed charges,67.275% of total billed charges,7.61,80,,6.088,percent of total billed charges,80% of total billed charges,3.65,38.38,,2.92,percent of total billed charges,38.38% of total billed charges,7.61,80,,6.088,percent of total billed charges,80% of total billed charges,5.87,61.74,,4.696,percent of total billed charges,61.74% of total billed charges,9.7,102,,7.76,percent of total billed charges,102% of total billed charges,3.61,38,,2.888,percent of total billed charges,38% of total billed charges,3.33,9.7,
EMPTY NEBULIZER JAR,3004046,CDM,270,RC,,,Outpatient,,,9.63,7.22,,7.51,78,,6.008,percent of total billed charges,78% of total billed charges,6.07,63,,4.856,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.66,38,,2.928,percent of total billed charges,38% of total billed charges,3.66,38,,2.928,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,8.67,90,,6.936,percent of total billed charges,90% of total billed charges,3.37,35,,2.696,percent of total billed charges,35% of total billed charges,6.48,67.275,,5.184,percent of total billed charges,67.275% of total billed charges,7.7,80,,6.16,percent of total billed charges,80% of total billed charges,3.7,38.38,,2.96,percent of total billed charges,38.38% of total billed charges,7.7,80,,6.16,percent of total billed charges,80% of total billed charges,5.95,61.74,,4.76,percent of total billed charges,61.74% of total billed charges,9.82,102,,7.856,percent of total billed charges,102% of total billed charges,3.66,38,,2.928,percent of total billed charges,38% of total billed charges,3.37,9.82,
ETHIBOND 1 CT-1 X425H,3005023,CDM,270,RC,,,Outpatient,,,9.63,7.22,,7.51,78,,6.008,percent of total billed charges,78% of total billed charges,6.07,63,,4.856,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.66,38,,2.928,percent of total billed charges,38% of total billed charges,3.66,38,,2.928,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,8.67,90,,6.936,percent of total billed charges,90% of total billed charges,3.37,35,,2.696,percent of total billed charges,35% of total billed charges,6.48,67.275,,5.184,percent of total billed charges,67.275% of total billed charges,7.7,80,,6.16,percent of total billed charges,80% of total billed charges,3.7,38.38,,2.96,percent of total billed charges,38.38% of total billed charges,7.7,80,,6.16,percent of total billed charges,80% of total billed charges,5.95,61.74,,4.76,percent of total billed charges,61.74% of total billed charges,9.82,102,,7.856,percent of total billed charges,102% of total billed charges,3.66,38,,2.928,percent of total billed charges,38% of total billed charges,3.37,9.82,
SILK 3-0 SA64H,3001578,CDM,270,RC,,,Outpatient,,,9.68,7.26,,7.55,78,,6.04,percent of total billed charges,78% of total billed charges,6.1,63,,4.88,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.68,38,,2.944,percent of total billed charges,38% of total billed charges,3.68,38,,2.944,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,8.71,90,,6.968,percent of total billed charges,90% of total billed charges,3.39,35,,2.712,percent of total billed charges,35% of total billed charges,6.51,67.275,,5.208,percent of total billed charges,67.275% of total billed charges,7.74,80,,6.192,percent of total billed charges,80% of total billed charges,3.72,38.38,,2.976,percent of total billed charges,38.38% of total billed charges,7.74,80,,6.192,percent of total billed charges,80% of total billed charges,5.98,61.74,,4.784,percent of total billed charges,61.74% of total billed charges,9.87,102,,7.896,percent of total billed charges,102% of total billed charges,3.68,38,,2.944,percent of total billed charges,38% of total billed charges,3.39,9.87,
SILK 3/0 SA84H,3004246,CDM,270,RC,,,Outpatient,,,9.68,7.26,,7.55,78,,6.04,percent of total billed charges,78% of total billed charges,6.1,63,,4.88,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.68,38,,2.944,percent of total billed charges,38% of total billed charges,3.68,38,,2.944,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,8.71,90,,6.968,percent of total billed charges,90% of total billed charges,3.39,35,,2.712,percent of total billed charges,35% of total billed charges,6.51,67.275,,5.208,percent of total billed charges,67.275% of total billed charges,7.74,80,,6.192,percent of total billed charges,80% of total billed charges,3.72,38.38,,2.976,percent of total billed charges,38.38% of total billed charges,7.74,80,,6.192,percent of total billed charges,80% of total billed charges,5.98,61.74,,4.784,percent of total billed charges,61.74% of total billed charges,9.87,102,,7.896,percent of total billed charges,102% of total billed charges,3.68,38,,2.944,percent of total billed charges,38% of total billed charges,3.39,9.87,
SILK 0 SA86G,3001583,CDM,270,RC,,,Outpatient,,,9.72,7.29,,7.58,78,,6.064,percent of total billed charges,78% of total billed charges,6.12,63,,4.896,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.69,38,,2.952,percent of total billed charges,38% of total billed charges,3.69,38,,2.952,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,8.75,90,,7,percent of total billed charges,90% of total billed charges,3.4,35,,2.72,percent of total billed charges,35% of total billed charges,6.54,67.275,,5.232,percent of total billed charges,67.275% of total billed charges,7.78,80,,6.224,percent of total billed charges,80% of total billed charges,3.73,38.38,,2.984,percent of total billed charges,38.38% of total billed charges,7.78,80,,6.224,percent of total billed charges,80% of total billed charges,6,61.74,,4.8,percent of total billed charges,61.74% of total billed charges,9.91,102,,7.928,percent of total billed charges,102% of total billed charges,3.69,38,,2.952,percent of total billed charges,38% of total billed charges,3.4,9.91,
SPLINT ORTHO 2X12 PRE-CUT,3001910,CDM,270,RC,,,Outpatient,,,9.93,7.45,,7.75,78,,6.2,percent of total billed charges,78% of total billed charges,6.26,63,,5.008,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.77,38,,3.016,percent of total billed charges,38% of total billed charges,3.77,38,,3.016,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,8.94,90,,7.152,percent of total billed charges,90% of total billed charges,3.48,35,,2.784,percent of total billed charges,35% of total billed charges,6.68,67.275,,5.344,percent of total billed charges,67.275% of total billed charges,7.94,80,,6.352,percent of total billed charges,80% of total billed charges,3.81,38.38,,3.048,percent of total billed charges,38.38% of total billed charges,7.94,80,,6.352,percent of total billed charges,80% of total billed charges,6.13,61.74,,4.904,percent of total billed charges,61.74% of total billed charges,10.13,102,,8.104,percent of total billed charges,102% of total billed charges,3.77,38,,3.016,percent of total billed charges,38% of total billed charges,3.48,10.13,
AMC CHEM20,5000187,CDM,300,RC,,,Outpatient,,,10,7.5,,7.8,78,,6.24,percent of total billed charges,78% of total billed charges,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.8,38,,3.04,percent of total billed charges,38% of total billed charges,3.8,38,,3.04,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,9,90,,7.2,percent of total billed charges,90% of total billed charges,3.5,35,,2.8,percent of total billed charges,35% of total billed charges,6.73,67.275,,5.384,percent of total billed charges,67.275% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.84,38.38,,3.072,percent of total billed charges,38.38% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.17,61.74,,4.936,percent of total billed charges,61.74% of total billed charges,10.2,102,,8.16,percent of total billed charges,102% of total billed charges,3.8,38,,3.04,percent of total billed charges,38% of total billed charges,3.5,10.2,
DRUGSCREEN COLLECTION FEE,5001001,CDM,300,RC,,,Outpatient,,,10,7.5,,7.8,78,,6.24,percent of total billed charges,78% of total billed charges,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.8,38,,3.04,percent of total billed charges,38% of total billed charges,3.8,38,,3.04,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,9,90,,7.2,percent of total billed charges,90% of total billed charges,3.5,35,,2.8,percent of total billed charges,35% of total billed charges,6.73,67.275,,5.384,percent of total billed charges,67.275% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.84,38.38,,3.072,percent of total billed charges,38.38% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.17,61.74,,4.936,percent of total billed charges,61.74% of total billed charges,10.2,102,,8.16,percent of total billed charges,102% of total billed charges,3.8,38,,3.04,percent of total billed charges,38% of total billed charges,3.5,10.2,
.NUCLEIC ACID AMPLIFICATION,5001813,CDM,300,RC,83901,HCPCS,Outpatient,,,10,7.5,,7.8,78,,6.24,percent of total billed charges,78% of total billed charges,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.8,38,,3.04,percent of total billed charges,38% of total billed charges,3.8,38,,3.04,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,9,90,,7.2,percent of total billed charges,90% of total billed charges,3.5,35,,2.8,percent of total billed charges,35% of total billed charges,6.73,67.275,,5.384,percent of total billed charges,67.275% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.84,38.38,,3.072,percent of total billed charges,38.38% of total billed charges,8,80,,6.4,percent of total billed charges,80% of total billed charges,6.17,61.74,,4.936,percent of total billed charges,61.74% of total billed charges,10.2,102,,8.16,percent of total billed charges,102% of total billed charges,3.8,38,,3.04,percent of total billed charges,38% of total billed charges,3.5,10.2,
INSPIROMETER,3003018,CDM,270,RC,,,Outpatient,,,10.09,7.57,,7.87,78,,6.296,percent of total billed charges,78% of total billed charges,6.36,63,,5.088,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.83,38,,3.064,percent of total billed charges,38% of total billed charges,3.83,38,,3.064,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,9.08,90,,7.264,percent of total billed charges,90% of total billed charges,3.53,35,,2.824,percent of total billed charges,35% of total billed charges,6.79,67.275,,5.432,percent of total billed charges,67.275% of total billed charges,8.07,80,,6.456,percent of total billed charges,80% of total billed charges,3.87,38.38,,3.096,percent of total billed charges,38.38% of total billed charges,8.07,80,,6.456,percent of total billed charges,80% of total billed charges,6.23,61.74,,4.984,percent of total billed charges,61.74% of total billed charges,10.29,102,,8.232,percent of total billed charges,102% of total billed charges,3.83,38,,3.064,percent of total billed charges,38% of total billed charges,3.53,10.29,
PROLENE 5-0 FS-2,3003008,CDM,270,RC,,,Outpatient,,,10.14,7.61,,7.91,78,,6.328,percent of total billed charges,78% of total billed charges,6.39,63,,5.112,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.85,38,,3.08,percent of total billed charges,38% of total billed charges,3.85,38,,3.08,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,9.13,90,,7.304,percent of total billed charges,90% of total billed charges,3.55,35,,2.84,percent of total billed charges,35% of total billed charges,6.82,67.275,,5.456,percent of total billed charges,67.275% of total billed charges,8.11,80,,6.488,percent of total billed charges,80% of total billed charges,3.89,38.38,,3.112,percent of total billed charges,38.38% of total billed charges,8.11,80,,6.488,percent of total billed charges,80% of total billed charges,6.26,61.74,,5.008,percent of total billed charges,61.74% of total billed charges,10.34,102,,8.272,percent of total billed charges,102% of total billed charges,3.85,38,,3.08,percent of total billed charges,38% of total billed charges,3.55,10.34,
CONVEX FLEXWEAR WAFER,3001504,CDM,270,RC,,,Outpatient,,,10.15,7.61,,7.92,78,,6.336,percent of total billed charges,78% of total billed charges,6.39,63,,5.112,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.86,38,,3.088,percent of total billed charges,38% of total billed charges,3.86,38,,3.088,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,9.14,90,,7.312,percent of total billed charges,90% of total billed charges,3.55,35,,2.84,percent of total billed charges,35% of total billed charges,6.83,67.275,,5.464,percent of total billed charges,67.275% of total billed charges,8.12,80,,6.496,percent of total billed charges,80% of total billed charges,3.9,38.38,,3.12,percent of total billed charges,38.38% of total billed charges,8.12,80,,6.496,percent of total billed charges,80% of total billed charges,6.27,61.74,,5.016,percent of total billed charges,61.74% of total billed charges,10.35,102,,8.28,percent of total billed charges,102% of total billed charges,3.86,38,,3.088,percent of total billed charges,38% of total billed charges,3.55,10.35,
EZ  WRAP - CANNULA EAR CUSHION,3003031,CDM,270,RC,,,Outpatient,,,10.17,7.63,,7.93,78,,6.344,percent of total billed charges,78% of total billed charges,6.41,63,,5.128,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.86,38,,3.088,percent of total billed charges,38% of total billed charges,3.86,38,,3.088,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,9.15,90,,7.32,percent of total billed charges,90% of total billed charges,3.56,35,,2.848,percent of total billed charges,35% of total billed charges,6.84,67.275,,5.472,percent of total billed charges,67.275% of total billed charges,8.14,80,,6.512,percent of total billed charges,80% of total billed charges,3.9,38.38,,3.12,percent of total billed charges,38.38% of total billed charges,8.14,80,,6.512,percent of total billed charges,80% of total billed charges,6.28,61.74,,5.024,percent of total billed charges,61.74% of total billed charges,10.37,102,,8.296,percent of total billed charges,102% of total billed charges,3.86,38,,3.088,percent of total billed charges,38% of total billed charges,3.56,10.37,
VICRYL 0 J603H,3004245,CDM,270,RC,,,Outpatient,,,10.17,7.63,,7.93,78,,6.344,percent of total billed charges,78% of total billed charges,6.41,63,,5.128,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.86,38,,3.088,percent of total billed charges,38% of total billed charges,3.86,38,,3.088,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,9.15,90,,7.32,percent of total billed charges,90% of total billed charges,3.56,35,,2.848,percent of total billed charges,35% of total billed charges,6.84,67.275,,5.472,percent of total billed charges,67.275% of total billed charges,8.14,80,,6.512,percent of total billed charges,80% of total billed charges,3.9,38.38,,3.12,percent of total billed charges,38.38% of total billed charges,8.14,80,,6.512,percent of total billed charges,80% of total billed charges,6.28,61.74,,5.024,percent of total billed charges,61.74% of total billed charges,10.37,102,,8.296,percent of total billed charges,102% of total billed charges,3.86,38,,3.088,percent of total billed charges,38% of total billed charges,3.56,10.37,
zzzLEXAPRO TAB: 10MG,1001133,CDM,250,RC,,,Outpatient,,,10.2,7.65,,7.96,78,,6.368,percent of total billed charges,78% of total billed charges,6.43,63,,5.144,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.88,38,,3.104,percent of total billed charges,38% of total billed charges,3.88,38,,3.104,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,9.18,90,,7.344,percent of total billed charges,90% of total billed charges,3.57,35,,2.856,percent of total billed charges,35% of total billed charges,6.86,67.275,,5.488,percent of total billed charges,67.275% of total billed charges,8.16,80,,6.528,percent of total billed charges,80% of total billed charges,3.91,38.38,,3.128,percent of total billed charges,38.38% of total billed charges,8.16,80,,6.528,percent of total billed charges,80% of total billed charges,6.3,61.74,,5.04,percent of total billed charges,61.74% of total billed charges,10.4,102,,8.32,percent of total billed charges,102% of total billed charges,3.88,38,,3.104,percent of total billed charges,38% of total billed charges,3.57,10.4,
HEEL/ELBOW PROTECTOR,3005007,CDM,270,RC,,,Outpatient,,,10.31,7.73,,8.04,78,,6.432,percent of total billed charges,78% of total billed charges,6.5,63,,5.2,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.92,38,,3.136,percent of total billed charges,38% of total billed charges,3.92,38,,3.136,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,9.28,90,,7.424,percent of total billed charges,90% of total billed charges,3.61,35,,2.888,percent of total billed charges,35% of total billed charges,6.94,67.275,,5.552,percent of total billed charges,67.275% of total billed charges,8.25,80,,6.6,percent of total billed charges,80% of total billed charges,3.96,38.38,,3.168,percent of total billed charges,38.38% of total billed charges,8.25,80,,6.6,percent of total billed charges,80% of total billed charges,6.37,61.74,,5.096,percent of total billed charges,61.74% of total billed charges,10.52,102,,8.416,percent of total billed charges,102% of total billed charges,3.92,38,,3.136,percent of total billed charges,38% of total billed charges,3.61,10.52,
ARMBOARD IV NEO - 1X3 DISP,3001022,CDM,270,RC,,,Outpatient,,,10.33,7.75,,8.06,78,,6.448,percent of total billed charges,78% of total billed charges,6.51,63,,5.208,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.93,38,,3.144,percent of total billed charges,38% of total billed charges,3.93,38,,3.144,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,9.3,90,,7.44,percent of total billed charges,90% of total billed charges,3.62,35,,2.896,percent of total billed charges,35% of total billed charges,6.95,67.275,,5.56,percent of total billed charges,67.275% of total billed charges,8.26,80,,6.608,percent of total billed charges,80% of total billed charges,3.96,38.38,,3.168,percent of total billed charges,38.38% of total billed charges,8.26,80,,6.608,percent of total billed charges,80% of total billed charges,6.38,61.74,,5.104,percent of total billed charges,61.74% of total billed charges,10.54,102,,8.432,percent of total billed charges,102% of total billed charges,3.93,38,,3.144,percent of total billed charges,38% of total billed charges,3.62,10.54,
TUBES ENDO TRACH CUFFED 6.5,3002530,CDM,270,RC,,,Outpatient,,,10.33,7.75,,8.06,78,,6.448,percent of total billed charges,78% of total billed charges,6.51,63,,5.208,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.93,38,,3.144,percent of total billed charges,38% of total billed charges,3.93,38,,3.144,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,9.3,90,,7.44,percent of total billed charges,90% of total billed charges,3.62,35,,2.896,percent of total billed charges,35% of total billed charges,6.95,67.275,,5.56,percent of total billed charges,67.275% of total billed charges,8.26,80,,6.608,percent of total billed charges,80% of total billed charges,3.96,38.38,,3.168,percent of total billed charges,38.38% of total billed charges,8.26,80,,6.608,percent of total billed charges,80% of total billed charges,6.38,61.74,,5.104,percent of total billed charges,61.74% of total billed charges,10.54,102,,8.432,percent of total billed charges,102% of total billed charges,3.93,38,,3.144,percent of total billed charges,38% of total billed charges,3.62,10.54,
TUBES ENDO TRACH CUFFED 6.0,3002529,CDM,270,RC,,,Outpatient,,,10.35,7.76,,8.07,78,,6.456,percent of total billed charges,78% of total billed charges,6.52,63,,5.216,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.93,38,,3.144,percent of total billed charges,38% of total billed charges,3.93,38,,3.144,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,9.32,90,,7.456,percent of total billed charges,90% of total billed charges,3.62,35,,2.896,percent of total billed charges,35% of total billed charges,6.96,67.275,,5.568,percent of total billed charges,67.275% of total billed charges,8.28,80,,6.624,percent of total billed charges,80% of total billed charges,3.97,38.38,,3.176,percent of total billed charges,38.38% of total billed charges,8.28,80,,6.624,percent of total billed charges,80% of total billed charges,6.39,61.74,,5.112,percent of total billed charges,61.74% of total billed charges,10.56,102,,8.448,percent of total billed charges,102% of total billed charges,3.93,38,,3.144,percent of total billed charges,38% of total billed charges,3.62,10.56,
ESOPH STETH,3000417,CDM,270,RC,,,Outpatient,,,10.37,7.78,,8.09,78,,6.472,percent of total billed charges,78% of total billed charges,6.53,63,,5.224,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.94,38,,3.152,percent of total billed charges,38% of total billed charges,3.94,38,,3.152,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,9.33,90,,7.464,percent of total billed charges,90% of total billed charges,3.63,35,,2.904,percent of total billed charges,35% of total billed charges,6.98,67.275,,5.584,percent of total billed charges,67.275% of total billed charges,8.3,80,,6.64,percent of total billed charges,80% of total billed charges,3.98,38.38,,3.184,percent of total billed charges,38.38% of total billed charges,8.3,80,,6.64,percent of total billed charges,80% of total billed charges,6.4,61.74,,5.12,percent of total billed charges,61.74% of total billed charges,10.58,102,,8.464,percent of total billed charges,102% of total billed charges,3.94,38,,3.152,percent of total billed charges,38% of total billed charges,3.63,10.58,
BP CUFF DISP small ADULT - GE,3005072,CDM,270,RC,,,Outpatient,,,10.37,7.78,,8.09,78,,6.472,percent of total billed charges,78% of total billed charges,6.53,63,,5.224,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.94,38,,3.152,percent of total billed charges,38% of total billed charges,3.94,38,,3.152,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,9.33,90,,7.464,percent of total billed charges,90% of total billed charges,3.63,35,,2.904,percent of total billed charges,35% of total billed charges,6.98,67.275,,5.584,percent of total billed charges,67.275% of total billed charges,8.3,80,,6.64,percent of total billed charges,80% of total billed charges,3.98,38.38,,3.184,percent of total billed charges,38.38% of total billed charges,8.3,80,,6.64,percent of total billed charges,80% of total billed charges,6.4,61.74,,5.12,percent of total billed charges,61.74% of total billed charges,10.58,102,,8.464,percent of total billed charges,102% of total billed charges,3.94,38,,3.152,percent of total billed charges,38% of total billed charges,3.63,10.58,
COLOSTOMY WAFER STOMA - NATURA,3001500,CDM,270,RC,,,Outpatient,,,10.4,7.8,,8.11,78,,6.488,percent of total billed charges,78% of total billed charges,6.55,63,,5.24,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.95,38,,3.16,percent of total billed charges,38% of total billed charges,3.95,38,,3.16,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,9.36,90,,7.488,percent of total billed charges,90% of total billed charges,3.64,35,,2.912,percent of total billed charges,35% of total billed charges,7,67.275,,5.6,percent of total billed charges,67.275% of total billed charges,8.32,80,,6.656,percent of total billed charges,80% of total billed charges,3.99,38.38,,3.192,percent of total billed charges,38.38% of total billed charges,8.32,80,,6.656,percent of total billed charges,80% of total billed charges,6.42,61.74,,5.136,percent of total billed charges,61.74% of total billed charges,10.61,102,,8.488,percent of total billed charges,102% of total billed charges,3.95,38,,3.16,percent of total billed charges,38% of total billed charges,3.64,10.61,
K-WIRE 4,3000334,CDM,270,RC,,,Outpatient,,,10.49,7.87,,8.18,78,,6.544,percent of total billed charges,78% of total billed charges,6.61,63,,5.288,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.99,38,,3.192,percent of total billed charges,38% of total billed charges,3.99,38,,3.192,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,9.44,90,,7.552,percent of total billed charges,90% of total billed charges,3.67,35,,2.936,percent of total billed charges,35% of total billed charges,7.06,67.275,,5.648,percent of total billed charges,67.275% of total billed charges,8.39,80,,6.712,percent of total billed charges,80% of total billed charges,4.03,38.38,,3.224,percent of total billed charges,38.38% of total billed charges,8.39,80,,6.712,percent of total billed charges,80% of total billed charges,6.48,61.74,,5.184,percent of total billed charges,61.74% of total billed charges,10.7,102,,8.56,percent of total billed charges,102% of total billed charges,3.99,38,,3.192,percent of total billed charges,38% of total billed charges,3.67,10.7,
PDS 0 CT-1 Z340H,3001590,CDM,270,RC,,,Outpatient,,,10.49,7.87,,8.18,78,,6.544,percent of total billed charges,78% of total billed charges,6.61,63,,5.288,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3.99,38,,3.192,percent of total billed charges,38% of total billed charges,3.99,38,,3.192,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,9.44,90,,7.552,percent of total billed charges,90% of total billed charges,3.67,35,,2.936,percent of total billed charges,35% of total billed charges,7.06,67.275,,5.648,percent of total billed charges,67.275% of total billed charges,8.39,80,,6.712,percent of total billed charges,80% of total billed charges,4.03,38.38,,3.224,percent of total billed charges,38.38% of total billed charges,8.39,80,,6.712,percent of total billed charges,80% of total billed charges,6.48,61.74,,5.184,percent of total billed charges,61.74% of total billed charges,10.7,102,,8.56,percent of total billed charges,102% of total billed charges,3.99,38,,3.192,percent of total billed charges,38% of total billed charges,3.67,10.7,
EPUMP FEEDING TUBING,3001410,CDM,270,RC,,,Outpatient,,,10.59,7.94,,8.26,78,,6.608,percent of total billed charges,78% of total billed charges,6.67,63,,5.336,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.02,38,,3.216,percent of total billed charges,38% of total billed charges,4.02,38,,3.216,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,9.53,90,,7.624,percent of total billed charges,90% of total billed charges,3.71,35,,2.968,percent of total billed charges,35% of total billed charges,7.12,67.275,,5.696,percent of total billed charges,67.275% of total billed charges,8.47,80,,6.776,percent of total billed charges,80% of total billed charges,4.06,38.38,,3.248,percent of total billed charges,38.38% of total billed charges,8.47,80,,6.776,percent of total billed charges,80% of total billed charges,6.54,61.74,,5.232,percent of total billed charges,61.74% of total billed charges,10.8,102,,8.64,percent of total billed charges,102% of total billed charges,4.02,38,,3.216,percent of total billed charges,38% of total billed charges,3.71,10.8,
SILK 0 SA66G,3001580,CDM,270,RC,,,Outpatient,,,10.65,7.99,,8.31,78,,6.648,percent of total billed charges,78% of total billed charges,6.71,63,,5.368,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.05,38,,3.24,percent of total billed charges,38% of total billed charges,4.05,38,,3.24,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,9.59,90,,7.672,percent of total billed charges,90% of total billed charges,3.73,35,,2.984,percent of total billed charges,35% of total billed charges,7.16,67.275,,5.728,percent of total billed charges,67.275% of total billed charges,8.52,80,,6.816,percent of total billed charges,80% of total billed charges,4.09,38.38,,3.272,percent of total billed charges,38.38% of total billed charges,8.52,80,,6.816,percent of total billed charges,80% of total billed charges,6.58,61.74,,5.264,percent of total billed charges,61.74% of total billed charges,10.86,102,,8.688,percent of total billed charges,102% of total billed charges,4.05,38,,3.24,percent of total billed charges,38% of total billed charges,3.73,10.86,
ORTHO GLASS 1  x 30 FEET,3004258,CDM,270,RC,,,Outpatient,,,10.72,8.04,,8.36,78,,6.688,percent of total billed charges,78% of total billed charges,6.75,63,,5.4,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.07,38,,3.256,percent of total billed charges,38% of total billed charges,4.07,38,,3.256,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,9.65,90,,7.72,percent of total billed charges,90% of total billed charges,3.75,35,,3,percent of total billed charges,35% of total billed charges,7.21,67.275,,5.768,percent of total billed charges,67.275% of total billed charges,8.58,80,,6.864,percent of total billed charges,80% of total billed charges,4.11,38.38,,3.288,percent of total billed charges,38.38% of total billed charges,8.58,80,,6.864,percent of total billed charges,80% of total billed charges,6.62,61.74,,5.296,percent of total billed charges,61.74% of total billed charges,10.93,102,,8.744,percent of total billed charges,102% of total billed charges,4.07,38,,3.256,percent of total billed charges,38% of total billed charges,3.75,10.93,
PDS 1  Z341H,3004243,CDM,270,RC,,,Outpatient,,,10.76,8.07,,8.39,78,,6.712,percent of total billed charges,78% of total billed charges,6.78,63,,5.424,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.09,38,,3.272,percent of total billed charges,38% of total billed charges,4.09,38,,3.272,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,9.68,90,,7.744,percent of total billed charges,90% of total billed charges,3.77,35,,3.016,percent of total billed charges,35% of total billed charges,7.24,67.275,,5.792,percent of total billed charges,67.275% of total billed charges,8.61,80,,6.888,percent of total billed charges,80% of total billed charges,4.13,38.38,,3.304,percent of total billed charges,38.38% of total billed charges,8.61,80,,6.888,percent of total billed charges,80% of total billed charges,6.64,61.74,,5.312,percent of total billed charges,61.74% of total billed charges,10.98,102,,8.784,percent of total billed charges,102% of total billed charges,4.09,38,,3.272,percent of total billed charges,38% of total billed charges,3.77,10.98,
TUBES ENDO TRACH CUFFED 8.0,3002533,CDM,270,RC,,,Outpatient,,,10.78,8.09,,8.41,78,,6.728,percent of total billed charges,78% of total billed charges,6.79,63,,5.432,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.1,38,,3.28,percent of total billed charges,38% of total billed charges,4.1,38,,3.28,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,9.7,90,,7.76,percent of total billed charges,90% of total billed charges,3.77,35,,3.016,percent of total billed charges,35% of total billed charges,7.25,67.275,,5.8,percent of total billed charges,67.275% of total billed charges,8.62,80,,6.896,percent of total billed charges,80% of total billed charges,4.14,38.38,,3.312,percent of total billed charges,38.38% of total billed charges,8.62,80,,6.896,percent of total billed charges,80% of total billed charges,6.66,61.74,,5.328,percent of total billed charges,61.74% of total billed charges,11,102,,8.8,percent of total billed charges,102% of total billed charges,4.1,38,,3.28,percent of total billed charges,38% of total billed charges,3.77,11,
FLOW SENSOR,3002998,CDM,270,RC,,,Outpatient,,,10.8,8.1,,8.42,78,,6.736,percent of total billed charges,78% of total billed charges,6.8,63,,5.44,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.1,38,,3.28,percent of total billed charges,38% of total billed charges,4.1,38,,3.28,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,9.72,90,,7.776,percent of total billed charges,90% of total billed charges,3.78,35,,3.024,percent of total billed charges,35% of total billed charges,7.27,67.275,,5.816,percent of total billed charges,67.275% of total billed charges,8.64,80,,6.912,percent of total billed charges,80% of total billed charges,4.15,38.38,,3.32,percent of total billed charges,38.38% of total billed charges,8.64,80,,6.912,percent of total billed charges,80% of total billed charges,6.67,61.74,,5.336,percent of total billed charges,61.74% of total billed charges,11.02,102,,8.816,percent of total billed charges,102% of total billed charges,4.1,38,,3.28,percent of total billed charges,38% of total billed charges,3.78,11.02,
VICRYL 0  CTB-1,3004022,CDM,270,RC,,,Outpatient,,,10.8,8.1,,8.42,78,,6.736,percent of total billed charges,78% of total billed charges,6.8,63,,5.44,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.1,38,,3.28,percent of total billed charges,38% of total billed charges,4.1,38,,3.28,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,9.72,90,,7.776,percent of total billed charges,90% of total billed charges,3.78,35,,3.024,percent of total billed charges,35% of total billed charges,7.27,67.275,,5.816,percent of total billed charges,67.275% of total billed charges,8.64,80,,6.912,percent of total billed charges,80% of total billed charges,4.15,38.38,,3.32,percent of total billed charges,38.38% of total billed charges,8.64,80,,6.912,percent of total billed charges,80% of total billed charges,6.67,61.74,,5.336,percent of total billed charges,61.74% of total billed charges,11.02,102,,8.816,percent of total billed charges,102% of total billed charges,4.1,38,,3.28,percent of total billed charges,38% of total billed charges,3.78,11.02,
CLIPPER BLADE M9670,3004093,CDM,270,RC,,,Outpatient,,,10.8,8.1,,8.42,78,,6.736,percent of total billed charges,78% of total billed charges,6.8,63,,5.44,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.1,38,,3.28,percent of total billed charges,38% of total billed charges,4.1,38,,3.28,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,9.72,90,,7.776,percent of total billed charges,90% of total billed charges,3.78,35,,3.024,percent of total billed charges,35% of total billed charges,7.27,67.275,,5.816,percent of total billed charges,67.275% of total billed charges,8.64,80,,6.912,percent of total billed charges,80% of total billed charges,4.15,38.38,,3.32,percent of total billed charges,38.38% of total billed charges,8.64,80,,6.912,percent of total billed charges,80% of total billed charges,6.67,61.74,,5.336,percent of total billed charges,61.74% of total billed charges,11.02,102,,8.816,percent of total billed charges,102% of total billed charges,4.1,38,,3.28,percent of total billed charges,38% of total billed charges,3.78,11.02,
SILK 2-0 SA65H,3001579,CDM,270,RC,,,Outpatient,,,10.83,8.12,,8.45,78,,6.76,percent of total billed charges,78% of total billed charges,6.82,63,,5.456,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.12,38,,3.296,percent of total billed charges,38% of total billed charges,4.12,38,,3.296,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,9.75,90,,7.8,percent of total billed charges,90% of total billed charges,3.79,35,,3.032,percent of total billed charges,35% of total billed charges,7.29,67.275,,5.832,percent of total billed charges,67.275% of total billed charges,8.66,80,,6.928,percent of total billed charges,80% of total billed charges,4.16,38.38,,3.328,percent of total billed charges,38.38% of total billed charges,8.66,80,,6.928,percent of total billed charges,80% of total billed charges,6.69,61.74,,5.352,percent of total billed charges,61.74% of total billed charges,11.05,102,,8.84,percent of total billed charges,102% of total billed charges,4.12,38,,3.296,percent of total billed charges,38% of total billed charges,3.79,11.05,
PDS (GI) 2-0 SH NEEDLE Z317H,3001594,CDM,270,RC,,,Outpatient,,,10.91,8.18,,8.51,78,,6.808,percent of total billed charges,78% of total billed charges,6.87,63,,5.496,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.15,38,,3.32,percent of total billed charges,38% of total billed charges,4.15,38,,3.32,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,9.82,90,,7.856,percent of total billed charges,90% of total billed charges,3.82,35,,3.056,percent of total billed charges,35% of total billed charges,7.34,67.275,,5.872,percent of total billed charges,67.275% of total billed charges,8.73,80,,6.984,percent of total billed charges,80% of total billed charges,4.19,38.38,,3.352,percent of total billed charges,38.38% of total billed charges,8.73,80,,6.984,percent of total billed charges,80% of total billed charges,6.74,61.74,,5.392,percent of total billed charges,61.74% of total billed charges,11.13,102,,8.904,percent of total billed charges,102% of total billed charges,4.15,38,,3.32,percent of total billed charges,38% of total billed charges,3.82,11.13,
Collection of venous blood by venipuncture,5000100,CDM,300,RC,36415,HCPCS,Outpatient,,,11,8.25,,8.58,78,,6.864,percent of total billed charges,78% of total billed charges,6.93,63,,5.544,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,3.85,35,,3.08,percent of total billed charges,35% of total billed charges,7.4,67.275,,5.92,percent of total billed charges,67.275% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,8.66,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,6.79,61.74,,5.432,percent of total billed charges,61.74% of total billed charges,11.22,102,,8.976,percent of total billed charges,102% of total billed charges,8.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.85,11.22,
"PULSE OXIMETRY, MULTIPLE (eg exercise)",8000067,CDM,410,RC,94761,HCPCS,Outpatient,,,11,8.25,,8.58,78,,6.864,percent of total billed charges,78% of total billed charges,6.93,63,,5.544,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.18,38,,3.344,percent of total billed charges,38% of total billed charges,4.18,38,,3.344,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,3.85,35,,3.08,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,4.22,38.38,,3.376,percent of total billed charges,38.38% of total billed charges,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,6.79,61.74,,5.432,percent of total billed charges,61.74% of total billed charges,11.22,102,,8.976,percent of total billed charges,102% of total billed charges,4.18,38,,3.344,percent of total billed charges,38% of total billed charges,3.85,145.93,
VESSELOOP BLUE MAXI,3002029,CDM,250,RC,,,Outpatient,,,11.07,8.3,,8.63,78,,6.904,percent of total billed charges,78% of total billed charges,6.97,63,,5.576,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.21,38,,3.368,percent of total billed charges,38% of total billed charges,4.21,38,,3.368,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,9.96,90,,7.968,percent of total billed charges,90% of total billed charges,3.87,35,,3.096,percent of total billed charges,35% of total billed charges,7.45,67.275,,5.96,percent of total billed charges,67.275% of total billed charges,8.86,80,,7.088,percent of total billed charges,80% of total billed charges,4.25,38.38,,3.4,percent of total billed charges,38.38% of total billed charges,8.86,80,,7.088,percent of total billed charges,80% of total billed charges,6.83,61.74,,5.464,percent of total billed charges,61.74% of total billed charges,11.29,102,,9.032,percent of total billed charges,102% of total billed charges,4.21,38,,3.368,percent of total billed charges,38% of total billed charges,3.87,11.29,
ESMARK 4,3003101,CDM,270,RC,,,Outpatient,,,11.25,8.44,,8.78,78,,7.024,percent of total billed charges,78% of total billed charges,7.09,63,,5.672,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.28,38,,3.424,percent of total billed charges,38% of total billed charges,4.28,38,,3.424,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,10.13,90,,8.104,percent of total billed charges,90% of total billed charges,3.94,35,,3.152,percent of total billed charges,35% of total billed charges,7.57,67.275,,6.056,percent of total billed charges,67.275% of total billed charges,9,80,,7.2,percent of total billed charges,80% of total billed charges,4.32,38.38,,3.456,percent of total billed charges,38.38% of total billed charges,9,80,,7.2,percent of total billed charges,80% of total billed charges,6.95,61.74,,5.56,percent of total billed charges,61.74% of total billed charges,11.48,102,,9.184,percent of total billed charges,102% of total billed charges,4.28,38,,3.424,percent of total billed charges,38% of total billed charges,3.94,11.48,
HUMIDIFIER AQUA PK REFILL,3003035,CDM,270,RC,,,Outpatient,,,11.3,8.48,,8.81,78,,7.048,percent of total billed charges,78% of total billed charges,7.12,63,,5.696,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.29,38,,3.432,percent of total billed charges,38% of total billed charges,4.29,38,,3.432,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,10.17,90,,8.136,percent of total billed charges,90% of total billed charges,3.96,35,,3.168,percent of total billed charges,35% of total billed charges,7.6,67.275,,6.08,percent of total billed charges,67.275% of total billed charges,9.04,80,,7.232,percent of total billed charges,80% of total billed charges,4.34,38.38,,3.472,percent of total billed charges,38.38% of total billed charges,9.04,80,,7.232,percent of total billed charges,80% of total billed charges,6.98,61.74,,5.584,percent of total billed charges,61.74% of total billed charges,11.53,102,,9.224,percent of total billed charges,102% of total billed charges,4.29,38,,3.432,percent of total billed charges,38% of total billed charges,3.96,11.53,
SKIN REPAIR 2 OZ,3000567,CDM,270,RC,,,Outpatient,,,11.54,8.66,,9,78,,7.2,percent of total billed charges,78% of total billed charges,7.27,63,,5.816,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.39,38,,3.512,percent of total billed charges,38% of total billed charges,4.39,38,,3.512,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,10.39,90,,8.312,percent of total billed charges,90% of total billed charges,4.04,35,,3.232,percent of total billed charges,35% of total billed charges,7.76,67.275,,6.208,percent of total billed charges,67.275% of total billed charges,9.23,80,,7.384,percent of total billed charges,80% of total billed charges,4.43,38.38,,3.544,percent of total billed charges,38.38% of total billed charges,9.23,80,,7.384,percent of total billed charges,80% of total billed charges,7.12,61.74,,5.696,percent of total billed charges,61.74% of total billed charges,11.77,102,,9.416,percent of total billed charges,102% of total billed charges,4.39,38,,3.512,percent of total billed charges,38% of total billed charges,4.04,11.77,
CO-FLEX 4  MDS088004,3000526,CDM,270,RC,,,Outpatient,,,11.57,8.68,,9.02,78,,7.216,percent of total billed charges,78% of total billed charges,7.29,63,,5.832,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.4,38,,3.52,percent of total billed charges,38% of total billed charges,4.4,38,,3.52,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,10.41,90,,8.328,percent of total billed charges,90% of total billed charges,4.05,35,,3.24,percent of total billed charges,35% of total billed charges,7.78,67.275,,6.224,percent of total billed charges,67.275% of total billed charges,9.26,80,,7.408,percent of total billed charges,80% of total billed charges,4.44,38.38,,3.552,percent of total billed charges,38.38% of total billed charges,9.26,80,,7.408,percent of total billed charges,80% of total billed charges,7.14,61.74,,5.712,percent of total billed charges,61.74% of total billed charges,11.8,102,,9.44,percent of total billed charges,102% of total billed charges,4.4,38,,3.52,percent of total billed charges,38% of total billed charges,4.05,11.8,
ARMBOARD FOAM PADS,3000100,CDM,270,RC,,,Outpatient,,,11.91,8.93,,9.29,78,,7.432,percent of total billed charges,78% of total billed charges,7.5,63,,6,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.53,38,,3.624,percent of total billed charges,38% of total billed charges,4.53,38,,3.624,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,10.72,90,,8.576,percent of total billed charges,90% of total billed charges,4.17,35,,3.336,percent of total billed charges,35% of total billed charges,8.01,67.275,,6.408,percent of total billed charges,67.275% of total billed charges,9.53,80,,7.624,percent of total billed charges,80% of total billed charges,4.57,38.38,,3.656,percent of total billed charges,38.38% of total billed charges,9.53,80,,7.624,percent of total billed charges,80% of total billed charges,7.35,61.74,,5.88,percent of total billed charges,61.74% of total billed charges,12.15,102,,9.72,percent of total billed charges,102% of total billed charges,4.53,38,,3.624,percent of total billed charges,38% of total billed charges,4.17,12.15,
TEMP MONITOR CRYST ANEST SKIN,3001827,CDM,270,RC,,,Outpatient,,,11.93,8.95,,9.31,78,,7.448,percent of total billed charges,78% of total billed charges,7.52,63,,6.016,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.53,38,,3.624,percent of total billed charges,38% of total billed charges,4.53,38,,3.624,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,10.74,90,,8.592,percent of total billed charges,90% of total billed charges,4.18,35,,3.344,percent of total billed charges,35% of total billed charges,8.03,67.275,,6.424,percent of total billed charges,67.275% of total billed charges,9.54,80,,7.632,percent of total billed charges,80% of total billed charges,4.58,38.38,,3.664,percent of total billed charges,38.38% of total billed charges,9.54,80,,7.632,percent of total billed charges,80% of total billed charges,7.37,61.74,,5.896,percent of total billed charges,61.74% of total billed charges,12.17,102,,9.736,percent of total billed charges,102% of total billed charges,4.53,38,,3.624,percent of total billed charges,38% of total billed charges,4.18,12.17,
TUBES ENDO TRACH CUFFED 7.0,3002531,CDM,270,RC,,,Outpatient,,,12.13,9.1,,9.46,78,,7.568,percent of total billed charges,78% of total billed charges,7.64,63,,6.112,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.61,38,,3.688,percent of total billed charges,38% of total billed charges,4.61,38,,3.688,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,10.92,90,,8.736,percent of total billed charges,90% of total billed charges,4.25,35,,3.4,percent of total billed charges,35% of total billed charges,8.16,67.275,,6.528,percent of total billed charges,67.275% of total billed charges,9.7,80,,7.76,percent of total billed charges,80% of total billed charges,4.66,38.38,,3.728,percent of total billed charges,38.38% of total billed charges,9.7,80,,7.76,percent of total billed charges,80% of total billed charges,7.49,61.74,,5.992,percent of total billed charges,61.74% of total billed charges,12.37,102,,9.896,percent of total billed charges,102% of total billed charges,4.61,38,,3.688,percent of total billed charges,38% of total billed charges,4.25,12.37,
OPTIFOAM 4X4 MSC1244Z,3000524,CDM,270,RC,,,Outpatient,,,12.19,9.14,,9.51,78,,7.608,percent of total billed charges,78% of total billed charges,7.68,63,,6.144,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.63,38,,3.704,percent of total billed charges,38% of total billed charges,4.63,38,,3.704,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,10.97,90,,8.776,percent of total billed charges,90% of total billed charges,4.27,35,,3.416,percent of total billed charges,35% of total billed charges,8.2,67.275,,6.56,percent of total billed charges,67.275% of total billed charges,9.75,80,,7.8,percent of total billed charges,80% of total billed charges,4.68,38.38,,3.744,percent of total billed charges,38.38% of total billed charges,9.75,80,,7.8,percent of total billed charges,80% of total billed charges,7.53,61.74,,6.024,percent of total billed charges,61.74% of total billed charges,12.43,102,,9.944,percent of total billed charges,102% of total billed charges,4.63,38,,3.704,percent of total billed charges,38% of total billed charges,4.27,12.43,
DRESSING STICK 26,3004033,CDM,270,RC,,,Outpatient,,,12.59,9.44,,9.82,78,,7.856,percent of total billed charges,78% of total billed charges,7.93,63,,6.344,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.78,38,,3.824,percent of total billed charges,38% of total billed charges,4.78,38,,3.824,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,11.33,90,,9.064,percent of total billed charges,90% of total billed charges,4.41,35,,3.528,percent of total billed charges,35% of total billed charges,8.47,67.275,,6.776,percent of total billed charges,67.275% of total billed charges,10.07,80,,8.056,percent of total billed charges,80% of total billed charges,4.83,38.38,,3.864,percent of total billed charges,38.38% of total billed charges,10.07,80,,8.056,percent of total billed charges,80% of total billed charges,7.77,61.74,,6.216,percent of total billed charges,61.74% of total billed charges,12.84,102,,10.272,percent of total billed charges,102% of total billed charges,4.78,38,,3.824,percent of total billed charges,38% of total billed charges,4.41,12.84,
MAXORB CALCIUM  ALG 4X4,3000565,CDM,270,RC,,,Outpatient,,,12.67,9.5,,9.88,78,,7.904,percent of total billed charges,78% of total billed charges,7.98,63,,6.384,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.81,38,,3.848,percent of total billed charges,38% of total billed charges,4.81,38,,3.848,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,11.4,90,,9.12,percent of total billed charges,90% of total billed charges,4.43,35,,3.544,percent of total billed charges,35% of total billed charges,8.52,67.275,,6.816,percent of total billed charges,67.275% of total billed charges,10.14,80,,8.112,percent of total billed charges,80% of total billed charges,4.86,38.38,,3.888,percent of total billed charges,38.38% of total billed charges,10.14,80,,8.112,percent of total billed charges,80% of total billed charges,7.82,61.74,,6.256,percent of total billed charges,61.74% of total billed charges,12.92,102,,10.336,percent of total billed charges,102% of total billed charges,4.81,38,,3.848,percent of total billed charges,38% of total billed charges,4.43,12.92,
FOAM BORDER DRESSING 5X5,3000515,CDM,270,RC,,,Outpatient,,,12.74,9.56,,9.94,78,,7.952,percent of total billed charges,78% of total billed charges,8.03,63,,6.424,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.84,38,,3.872,percent of total billed charges,38% of total billed charges,4.84,38,,3.872,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,11.47,90,,9.176,percent of total billed charges,90% of total billed charges,4.46,35,,3.568,percent of total billed charges,35% of total billed charges,8.57,67.275,,6.856,percent of total billed charges,67.275% of total billed charges,10.19,80,,8.152,percent of total billed charges,80% of total billed charges,4.89,38.38,,3.912,percent of total billed charges,38.38% of total billed charges,10.19,80,,8.152,percent of total billed charges,80% of total billed charges,7.87,61.74,,6.296,percent of total billed charges,61.74% of total billed charges,12.99,102,,10.392,percent of total billed charges,102% of total billed charges,4.84,38,,3.872,percent of total billed charges,38% of total billed charges,4.46,12.99,
FOAM BORDER DRESSING 3X3,3000517,CDM,270,RC,,,Outpatient,,,12.74,9.56,,9.94,78,,7.952,percent of total billed charges,78% of total billed charges,8.03,63,,6.424,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.84,38,,3.872,percent of total billed charges,38% of total billed charges,4.84,38,,3.872,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,11.47,90,,9.176,percent of total billed charges,90% of total billed charges,4.46,35,,3.568,percent of total billed charges,35% of total billed charges,8.57,67.275,,6.856,percent of total billed charges,67.275% of total billed charges,10.19,80,,8.152,percent of total billed charges,80% of total billed charges,4.89,38.38,,3.912,percent of total billed charges,38.38% of total billed charges,10.19,80,,8.152,percent of total billed charges,80% of total billed charges,7.87,61.74,,6.296,percent of total billed charges,61.74% of total billed charges,12.99,102,,10.392,percent of total billed charges,102% of total billed charges,4.84,38,,3.872,percent of total billed charges,38% of total billed charges,4.46,12.99,
PROLENE 0 CT-2,3002112,CDM,270,RC,,,Outpatient,,,12.74,9.56,,9.94,78,,7.952,percent of total billed charges,78% of total billed charges,8.03,63,,6.424,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.84,38,,3.872,percent of total billed charges,38% of total billed charges,4.84,38,,3.872,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,11.47,90,,9.176,percent of total billed charges,90% of total billed charges,4.46,35,,3.568,percent of total billed charges,35% of total billed charges,8.57,67.275,,6.856,percent of total billed charges,67.275% of total billed charges,10.19,80,,8.152,percent of total billed charges,80% of total billed charges,4.89,38.38,,3.912,percent of total billed charges,38.38% of total billed charges,10.19,80,,8.152,percent of total billed charges,80% of total billed charges,7.87,61.74,,6.296,percent of total billed charges,61.74% of total billed charges,12.99,102,,10.392,percent of total billed charges,102% of total billed charges,4.84,38,,3.872,percent of total billed charges,38% of total billed charges,4.46,12.99,
"STOCKING, ANTI-EMBOLISM, KNEE - MD",3002109,CDM,270,RC,,,Outpatient,,,12.8,9.6,,9.98,78,,7.984,percent of total billed charges,78% of total billed charges,8.06,63,,6.448,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.86,38,,3.888,percent of total billed charges,38% of total billed charges,4.86,38,,3.888,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,11.52,90,,9.216,percent of total billed charges,90% of total billed charges,4.48,35,,3.584,percent of total billed charges,35% of total billed charges,8.61,67.275,,6.888,percent of total billed charges,67.275% of total billed charges,10.24,80,,8.192,percent of total billed charges,80% of total billed charges,4.91,38.38,,3.928,percent of total billed charges,38.38% of total billed charges,10.24,80,,8.192,percent of total billed charges,80% of total billed charges,7.9,61.74,,6.32,percent of total billed charges,61.74% of total billed charges,13.06,102,,10.448,percent of total billed charges,102% of total billed charges,4.86,38,,3.888,percent of total billed charges,38% of total billed charges,4.48,13.06,
"STOCKING, ANTI EMBOLISM, KNEE- LG",3002110,CDM,270,RC,,,Outpatient,,,12.8,9.6,,9.98,78,,7.984,percent of total billed charges,78% of total billed charges,8.06,63,,6.448,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.86,38,,3.888,percent of total billed charges,38% of total billed charges,4.86,38,,3.888,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,11.52,90,,9.216,percent of total billed charges,90% of total billed charges,4.48,35,,3.584,percent of total billed charges,35% of total billed charges,8.61,67.275,,6.888,percent of total billed charges,67.275% of total billed charges,10.24,80,,8.192,percent of total billed charges,80% of total billed charges,4.91,38.38,,3.928,percent of total billed charges,38.38% of total billed charges,10.24,80,,8.192,percent of total billed charges,80% of total billed charges,7.9,61.74,,6.32,percent of total billed charges,61.74% of total billed charges,13.06,102,,10.448,percent of total billed charges,102% of total billed charges,4.86,38,,3.888,percent of total billed charges,38% of total billed charges,4.48,13.06,
"STOCKING, ANTI-EMBOLISM, KNEE XL",3002111,CDM,270,RC,,,Outpatient,,,12.8,9.6,,9.98,78,,7.984,percent of total billed charges,78% of total billed charges,8.06,63,,6.448,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.86,38,,3.888,percent of total billed charges,38% of total billed charges,4.86,38,,3.888,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,11.52,90,,9.216,percent of total billed charges,90% of total billed charges,4.48,35,,3.584,percent of total billed charges,35% of total billed charges,8.61,67.275,,6.888,percent of total billed charges,67.275% of total billed charges,10.24,80,,8.192,percent of total billed charges,80% of total billed charges,4.91,38.38,,3.928,percent of total billed charges,38.38% of total billed charges,10.24,80,,8.192,percent of total billed charges,80% of total billed charges,7.9,61.74,,6.32,percent of total billed charges,61.74% of total billed charges,13.06,102,,10.448,percent of total billed charges,102% of total billed charges,4.86,38,,3.888,percent of total billed charges,38% of total billed charges,4.48,13.06,
ETHILON 4-0 P-3,3005069,CDM,270,RC,,,Outpatient,,,12.81,9.61,,9.99,78,,7.992,percent of total billed charges,78% of total billed charges,8.07,63,,6.456,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.87,38,,3.896,percent of total billed charges,38% of total billed charges,4.87,38,,3.896,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,11.53,90,,9.224,percent of total billed charges,90% of total billed charges,4.48,35,,3.584,percent of total billed charges,35% of total billed charges,8.62,67.275,,6.896,percent of total billed charges,67.275% of total billed charges,10.25,80,,8.2,percent of total billed charges,80% of total billed charges,4.92,38.38,,3.936,percent of total billed charges,38.38% of total billed charges,10.25,80,,8.2,percent of total billed charges,80% of total billed charges,7.91,61.74,,6.328,percent of total billed charges,61.74% of total billed charges,13.07,102,,10.456,percent of total billed charges,102% of total billed charges,4.87,38,,3.896,percent of total billed charges,38% of total billed charges,4.48,13.07,
GROUNDING PAD,3004070,CDM,270,RC,,,Outpatient,,,12.86,9.65,,10.03,78,,8.024,percent of total billed charges,78% of total billed charges,8.1,63,,6.48,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.89,38,,3.912,percent of total billed charges,38% of total billed charges,4.89,38,,3.912,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,11.57,90,,9.256,percent of total billed charges,90% of total billed charges,4.5,35,,3.6,percent of total billed charges,35% of total billed charges,8.65,67.275,,6.92,percent of total billed charges,67.275% of total billed charges,10.29,80,,8.232,percent of total billed charges,80% of total billed charges,4.94,38.38,,3.952,percent of total billed charges,38.38% of total billed charges,10.29,80,,8.232,percent of total billed charges,80% of total billed charges,7.94,61.74,,6.352,percent of total billed charges,61.74% of total billed charges,13.12,102,,10.496,percent of total billed charges,102% of total billed charges,4.89,38,,3.912,percent of total billed charges,38% of total billed charges,4.5,13.12,
K-WIRE 9  x 1.1MM X .045,3000311,CDM,270,RC,,,Outpatient,,,12.9,9.68,,10.06,78,,8.048,percent of total billed charges,78% of total billed charges,8.13,63,,6.504,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.9,38,,3.92,percent of total billed charges,38% of total billed charges,4.9,38,,3.92,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,11.61,90,,9.288,percent of total billed charges,90% of total billed charges,4.52,35,,3.616,percent of total billed charges,35% of total billed charges,8.68,67.275,,6.944,percent of total billed charges,67.275% of total billed charges,10.32,80,,8.256,percent of total billed charges,80% of total billed charges,4.95,38.38,,3.96,percent of total billed charges,38.38% of total billed charges,10.32,80,,8.256,percent of total billed charges,80% of total billed charges,7.96,61.74,,6.368,percent of total billed charges,61.74% of total billed charges,13.16,102,,10.528,percent of total billed charges,102% of total billed charges,4.9,38,,3.92,percent of total billed charges,38% of total billed charges,4.52,13.16,
ETHILON 6-0 P-1,3001550,CDM,270,RC,,,Outpatient,,,12.98,9.74,,10.12,78,,8.096,percent of total billed charges,78% of total billed charges,8.18,63,,6.544,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.93,38,,3.944,percent of total billed charges,38% of total billed charges,4.93,38,,3.944,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,11.68,90,,9.344,percent of total billed charges,90% of total billed charges,4.54,35,,3.632,percent of total billed charges,35% of total billed charges,8.73,67.275,,6.984,percent of total billed charges,67.275% of total billed charges,10.38,80,,8.304,percent of total billed charges,80% of total billed charges,4.98,38.38,,3.984,percent of total billed charges,38.38% of total billed charges,10.38,80,,8.304,percent of total billed charges,80% of total billed charges,8.01,61.74,,6.408,percent of total billed charges,61.74% of total billed charges,13.24,102,,10.592,percent of total billed charges,102% of total billed charges,4.93,38,,3.944,percent of total billed charges,38% of total billed charges,4.54,13.24,
WRIST/ANKLE RESTRAINT,3002103,CDM,270,RC,,,Outpatient,,,13,9.75,,10.14,78,,8.112,percent of total billed charges,78% of total billed charges,8.19,63,,6.552,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.94,38,,3.952,percent of total billed charges,38% of total billed charges,4.94,38,,3.952,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,4.55,35,,3.64,percent of total billed charges,35% of total billed charges,8.75,67.275,,7,percent of total billed charges,67.275% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,4.99,38.38,,3.992,percent of total billed charges,38.38% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.03,61.74,,6.424,percent of total billed charges,61.74% of total billed charges,13.26,102,,10.608,percent of total billed charges,102% of total billed charges,4.94,38,,3.952,percent of total billed charges,38% of total billed charges,4.55,13.26,
.HEP B AB-EMPLOYERS REQ,5000025,CDM,300,RC,86290,HCPCS,Outpatient,,,13,9.75,,10.14,78,,8.112,percent of total billed charges,78% of total billed charges,8.19,63,,6.552,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.94,38,,3.952,percent of total billed charges,38% of total billed charges,4.94,38,,3.952,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,4.55,35,,3.64,percent of total billed charges,35% of total billed charges,8.75,67.275,,7,percent of total billed charges,67.275% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,4.99,38.38,,3.992,percent of total billed charges,38.38% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.03,61.74,,6.424,percent of total billed charges,61.74% of total billed charges,13.26,102,,10.608,percent of total billed charges,102% of total billed charges,4.94,38,,3.952,percent of total billed charges,38% of total billed charges,4.55,13.26,
HEALTH SCREEN -00,5000104,CDM,300,RC,,,Outpatient,,,13,9.75,,10.14,78,,8.112,percent of total billed charges,78% of total billed charges,8.19,63,,6.552,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.94,38,,3.952,percent of total billed charges,38% of total billed charges,4.94,38,,3.952,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,4.55,35,,3.64,percent of total billed charges,35% of total billed charges,8.75,67.275,,7,percent of total billed charges,67.275% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,4.99,38.38,,3.992,percent of total billed charges,38.38% of total billed charges,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,8.03,61.74,,6.424,percent of total billed charges,61.74% of total billed charges,13.26,102,,10.608,percent of total billed charges,102% of total billed charges,4.94,38,,3.952,percent of total billed charges,38% of total billed charges,4.55,13.26,
TRACH INNER CANNULA SZ 6,3000335,CDM,270,RC,,,Outpatient,,,13.05,9.79,,10.18,78,,8.144,percent of total billed charges,78% of total billed charges,8.22,63,,6.576,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.96,38,,3.968,percent of total billed charges,38% of total billed charges,4.96,38,,3.968,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,11.75,90,,9.4,percent of total billed charges,90% of total billed charges,4.57,35,,3.656,percent of total billed charges,35% of total billed charges,8.78,67.275,,7.024,percent of total billed charges,67.275% of total billed charges,10.44,80,,8.352,percent of total billed charges,80% of total billed charges,5.01,38.38,,4.008,percent of total billed charges,38.38% of total billed charges,10.44,80,,8.352,percent of total billed charges,80% of total billed charges,8.06,61.74,,6.448,percent of total billed charges,61.74% of total billed charges,13.31,102,,10.648,percent of total billed charges,102% of total billed charges,4.96,38,,3.968,percent of total billed charges,38% of total billed charges,4.57,13.31,
PROLENE 4-0 FS-2 8683G,3001661,CDM,270,RC,,,Outpatient,,,13.05,9.79,,10.18,78,,8.144,percent of total billed charges,78% of total billed charges,8.22,63,,6.576,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.96,38,,3.968,percent of total billed charges,38% of total billed charges,4.96,38,,3.968,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,11.75,90,,9.4,percent of total billed charges,90% of total billed charges,4.57,35,,3.656,percent of total billed charges,35% of total billed charges,8.78,67.275,,7.024,percent of total billed charges,67.275% of total billed charges,10.44,80,,8.352,percent of total billed charges,80% of total billed charges,5.01,38.38,,4.008,percent of total billed charges,38.38% of total billed charges,10.44,80,,8.352,percent of total billed charges,80% of total billed charges,8.06,61.74,,6.448,percent of total billed charges,61.74% of total billed charges,13.31,102,,10.648,percent of total billed charges,102% of total billed charges,4.96,38,,3.968,percent of total billed charges,38% of total billed charges,4.57,13.31,
TRACH CLEANING TRAY,3003034,CDM,270,RC,,,Outpatient,,,13.05,9.79,,10.18,78,,8.144,percent of total billed charges,78% of total billed charges,8.22,63,,6.576,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,4.96,38,,3.968,percent of total billed charges,38% of total billed charges,4.96,38,,3.968,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,11.75,90,,9.4,percent of total billed charges,90% of total billed charges,4.57,35,,3.656,percent of total billed charges,35% of total billed charges,8.78,67.275,,7.024,percent of total billed charges,67.275% of total billed charges,10.44,80,,8.352,percent of total billed charges,80% of total billed charges,5.01,38.38,,4.008,percent of total billed charges,38.38% of total billed charges,10.44,80,,8.352,percent of total billed charges,80% of total billed charges,8.06,61.74,,6.448,percent of total billed charges,61.74% of total billed charges,13.31,102,,10.648,percent of total billed charges,102% of total billed charges,4.96,38,,3.968,percent of total billed charges,38% of total billed charges,4.57,13.31,
BP CUFF DISP L - GE,3005065,CDM,270,RC,,,Outpatient,,,13.15,9.86,,10.26,78,,8.208,percent of total billed charges,78% of total billed charges,8.28,63,,6.624,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5,38,,4,percent of total billed charges,38% of total billed charges,5,38,,4,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,11.84,90,,9.472,percent of total billed charges,90% of total billed charges,4.6,35,,3.68,percent of total billed charges,35% of total billed charges,8.85,67.275,,7.08,percent of total billed charges,67.275% of total billed charges,10.52,80,,8.416,percent of total billed charges,80% of total billed charges,5.05,38.38,,4.04,percent of total billed charges,38.38% of total billed charges,10.52,80,,8.416,percent of total billed charges,80% of total billed charges,8.12,61.74,,6.496,percent of total billed charges,61.74% of total billed charges,13.41,102,,10.728,percent of total billed charges,102% of total billed charges,5,38,,4,percent of total billed charges,38% of total billed charges,4.6,13.41,
STYLET INTUBATING 14FR,3000823,CDM,270,RC,,,Outpatient,,,13.16,9.87,,10.26,78,,8.208,percent of total billed charges,78% of total billed charges,8.29,63,,6.632,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5,38,,4,percent of total billed charges,38% of total billed charges,5,38,,4,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,11.84,90,,9.472,percent of total billed charges,90% of total billed charges,4.61,35,,3.688,percent of total billed charges,35% of total billed charges,8.85,67.275,,7.08,percent of total billed charges,67.275% of total billed charges,10.53,80,,8.424,percent of total billed charges,80% of total billed charges,5.05,38.38,,4.04,percent of total billed charges,38.38% of total billed charges,10.53,80,,8.424,percent of total billed charges,80% of total billed charges,8.12,61.74,,6.496,percent of total billed charges,61.74% of total billed charges,13.42,102,,10.736,percent of total billed charges,102% of total billed charges,5,38,,4,percent of total billed charges,38% of total billed charges,4.61,13.42,
OSTOMY BELT - ADJUSTABLE,3001503,CDM,270,RC,,,Outpatient,,,13.2,9.9,,10.3,78,,8.24,percent of total billed charges,78% of total billed charges,8.32,63,,6.656,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.02,38,,4.016,percent of total billed charges,38% of total billed charges,5.02,38,,4.016,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,11.88,90,,9.504,percent of total billed charges,90% of total billed charges,4.62,35,,3.696,percent of total billed charges,35% of total billed charges,8.88,67.275,,7.104,percent of total billed charges,67.275% of total billed charges,10.56,80,,8.448,percent of total billed charges,80% of total billed charges,5.07,38.38,,4.056,percent of total billed charges,38.38% of total billed charges,10.56,80,,8.448,percent of total billed charges,80% of total billed charges,8.15,61.74,,6.52,percent of total billed charges,61.74% of total billed charges,13.46,102,,10.768,percent of total billed charges,102% of total billed charges,5.02,38,,4.016,percent of total billed charges,38% of total billed charges,4.62,13.46,
UNDERCAST PADDING 6,3005043,CDM,270,RC,,,Outpatient,,,13.26,9.95,,10.34,78,,8.272,percent of total billed charges,78% of total billed charges,8.35,63,,6.68,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.04,38,,4.032,percent of total billed charges,38% of total billed charges,5.04,38,,4.032,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,11.93,90,,9.544,percent of total billed charges,90% of total billed charges,4.64,35,,3.712,percent of total billed charges,35% of total billed charges,8.92,67.275,,7.136,percent of total billed charges,67.275% of total billed charges,10.61,80,,8.488,percent of total billed charges,80% of total billed charges,5.09,38.38,,4.072,percent of total billed charges,38.38% of total billed charges,10.61,80,,8.488,percent of total billed charges,80% of total billed charges,8.19,61.74,,6.552,percent of total billed charges,61.74% of total billed charges,13.53,102,,10.824,percent of total billed charges,102% of total billed charges,5.04,38,,4.032,percent of total billed charges,38% of total billed charges,4.64,13.53,
STRATASORB 6X6 MSC3066Z,3000564,CDM,270,RC,,,Outpatient,,,13.34,10.01,,10.41,78,,8.328,percent of total billed charges,78% of total billed charges,8.4,63,,6.72,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.07,38,,4.056,percent of total billed charges,38% of total billed charges,5.07,38,,4.056,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,12.01,90,,9.608,percent of total billed charges,90% of total billed charges,4.67,35,,3.736,percent of total billed charges,35% of total billed charges,8.97,67.275,,7.176,percent of total billed charges,67.275% of total billed charges,10.67,80,,8.536,percent of total billed charges,80% of total billed charges,5.12,38.38,,4.096,percent of total billed charges,38.38% of total billed charges,10.67,80,,8.536,percent of total billed charges,80% of total billed charges,8.24,61.74,,6.592,percent of total billed charges,61.74% of total billed charges,13.61,102,,10.888,percent of total billed charges,102% of total billed charges,5.07,38,,4.056,percent of total billed charges,38% of total billed charges,4.67,13.61,
PETROLEUM CREAM,3000568,CDM,270,RC,,,Outpatient,,,13.55,10.16,,10.57,78,,8.456,percent of total billed charges,78% of total billed charges,8.54,63,,6.832,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.15,38,,4.12,percent of total billed charges,38% of total billed charges,5.15,38,,4.12,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,12.2,90,,9.76,percent of total billed charges,90% of total billed charges,4.74,35,,3.792,percent of total billed charges,35% of total billed charges,9.12,67.275,,7.296,percent of total billed charges,67.275% of total billed charges,10.84,80,,8.672,percent of total billed charges,80% of total billed charges,5.2,38.38,,4.16,percent of total billed charges,38.38% of total billed charges,10.84,80,,8.672,percent of total billed charges,80% of total billed charges,8.37,61.74,,6.696,percent of total billed charges,61.74% of total billed charges,13.82,102,,11.056,percent of total billed charges,102% of total billed charges,5.15,38,,4.12,percent of total billed charges,38% of total billed charges,4.74,13.82,
BP CUFF THIGH - GE,3005067,CDM,270,RC,,,Outpatient,,,13.59,10.19,,10.6,78,,8.48,percent of total billed charges,78% of total billed charges,8.56,63,,6.848,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.16,38,,4.128,percent of total billed charges,38% of total billed charges,5.16,38,,4.128,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,12.23,90,,9.784,percent of total billed charges,90% of total billed charges,4.76,35,,3.808,percent of total billed charges,35% of total billed charges,9.14,67.275,,7.312,percent of total billed charges,67.275% of total billed charges,10.87,80,,8.696,percent of total billed charges,80% of total billed charges,5.22,38.38,,4.176,percent of total billed charges,38.38% of total billed charges,10.87,80,,8.696,percent of total billed charges,80% of total billed charges,8.39,61.74,,6.712,percent of total billed charges,61.74% of total billed charges,13.86,102,,11.088,percent of total billed charges,102% of total billed charges,5.16,38,,4.128,percent of total billed charges,38% of total billed charges,4.76,13.86,
GAUZE IODOFORM PACKING 1/4,3004172,CDM,270,RC,,,Outpatient,,,13.73,10.3,,10.71,78,,8.568,percent of total billed charges,78% of total billed charges,8.65,63,,6.92,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.22,38,,4.176,percent of total billed charges,38% of total billed charges,5.22,38,,4.176,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,12.36,90,,9.888,percent of total billed charges,90% of total billed charges,4.81,35,,3.848,percent of total billed charges,35% of total billed charges,9.24,67.275,,7.392,percent of total billed charges,67.275% of total billed charges,10.98,80,,8.784,percent of total billed charges,80% of total billed charges,5.27,38.38,,4.216,percent of total billed charges,38.38% of total billed charges,10.98,80,,8.784,percent of total billed charges,80% of total billed charges,8.48,61.74,,6.784,percent of total billed charges,61.74% of total billed charges,14,102,,11.2,percent of total billed charges,102% of total billed charges,5.22,38,,4.176,percent of total billed charges,38% of total billed charges,4.81,14,
STOCKING - ANTI-EMBOLISM - KNEE - SM,3002108,CDM,270,RC,,,Outpatient,,,13.76,10.32,,10.73,78,,8.584,percent of total billed charges,78% of total billed charges,8.67,63,,6.936,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.23,38,,4.184,percent of total billed charges,38% of total billed charges,5.23,38,,4.184,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,12.38,90,,9.904,percent of total billed charges,90% of total billed charges,4.82,35,,3.856,percent of total billed charges,35% of total billed charges,9.26,67.275,,7.408,percent of total billed charges,67.275% of total billed charges,11.01,80,,8.808,percent of total billed charges,80% of total billed charges,5.28,38.38,,4.224,percent of total billed charges,38.38% of total billed charges,11.01,80,,8.808,percent of total billed charges,80% of total billed charges,8.5,61.74,,6.8,percent of total billed charges,61.74% of total billed charges,14.04,102,,11.232,percent of total billed charges,102% of total billed charges,5.23,38,,4.184,percent of total billed charges,38% of total billed charges,4.82,14.04,
POLYSORB 4-O SL3627,3004030,CDM,270,RC,,,Outpatient,,,13.95,10.46,,10.88,78,,8.704,percent of total billed charges,78% of total billed charges,8.79,63,,7.032,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.3,38,,4.24,percent of total billed charges,38% of total billed charges,5.3,38,,4.24,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,12.56,90,,10.048,percent of total billed charges,90% of total billed charges,4.88,35,,3.904,percent of total billed charges,35% of total billed charges,9.38,67.275,,7.504,percent of total billed charges,67.275% of total billed charges,11.16,80,,8.928,percent of total billed charges,80% of total billed charges,5.35,38.38,,4.28,percent of total billed charges,38.38% of total billed charges,11.16,80,,8.928,percent of total billed charges,80% of total billed charges,8.61,61.74,,6.888,percent of total billed charges,61.74% of total billed charges,14.23,102,,11.384,percent of total billed charges,102% of total billed charges,5.3,38,,4.24,percent of total billed charges,38% of total billed charges,4.88,14.23,
PROLENE 2-0 8685H,3005016,CDM,270,RC,,,Outpatient,,,14,10.5,,10.92,78,,8.736,percent of total billed charges,78% of total billed charges,8.82,63,,7.056,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.32,38,,4.256,percent of total billed charges,38% of total billed charges,5.32,38,,4.256,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,4.9,35,,3.92,percent of total billed charges,35% of total billed charges,9.42,67.275,,7.536,percent of total billed charges,67.275% of total billed charges,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,5.37,38.38,,4.296,percent of total billed charges,38.38% of total billed charges,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,8.64,61.74,,6.912,percent of total billed charges,61.74% of total billed charges,14.28,102,,11.424,percent of total billed charges,102% of total billed charges,5.32,38,,4.256,percent of total billed charges,38% of total billed charges,4.9,14.28,
SPECIAL HANDLING FEE,5000106,CDM,300,RC,99001,HCPCS,Outpatient,,,14,10.5,,10.92,78,,8.736,percent of total billed charges,78% of total billed charges,8.82,63,,7.056,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.32,38,,4.256,percent of total billed charges,38% of total billed charges,5.32,38,,4.256,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,4.9,35,,3.92,percent of total billed charges,35% of total billed charges,9.42,67.275,,7.536,percent of total billed charges,67.275% of total billed charges,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,5.37,38.38,,4.296,percent of total billed charges,38.38% of total billed charges,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,8.64,61.74,,6.912,percent of total billed charges,61.74% of total billed charges,14.28,102,,11.424,percent of total billed charges,102% of total billed charges,5.32,38,,4.256,percent of total billed charges,38% of total billed charges,4.9,14.28,
PROLENE 2-0 8411H,3004198,CDM,270,RC,,,Outpatient,,,14.03,10.52,,10.94,78,,8.752,percent of total billed charges,78% of total billed charges,8.84,63,,7.072,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.33,38,,4.264,percent of total billed charges,38% of total billed charges,5.33,38,,4.264,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,12.63,90,,10.104,percent of total billed charges,90% of total billed charges,4.91,35,,3.928,percent of total billed charges,35% of total billed charges,9.44,67.275,,7.552,percent of total billed charges,67.275% of total billed charges,11.22,80,,8.976,percent of total billed charges,80% of total billed charges,5.38,38.38,,4.304,percent of total billed charges,38.38% of total billed charges,11.22,80,,8.976,percent of total billed charges,80% of total billed charges,8.66,61.74,,6.928,percent of total billed charges,61.74% of total billed charges,14.31,102,,11.448,percent of total billed charges,102% of total billed charges,5.33,38,,4.264,percent of total billed charges,38% of total billed charges,4.91,14.31,
ARM SLING LARGE 79-99157,3000004,CDM,270,RC,,,Outpatient,,,14.05,10.54,,10.96,78,,8.768,percent of total billed charges,78% of total billed charges,8.85,63,,7.08,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.34,38,,4.272,percent of total billed charges,38% of total billed charges,5.34,38,,4.272,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,12.65,90,,10.12,percent of total billed charges,90% of total billed charges,4.92,35,,3.936,percent of total billed charges,35% of total billed charges,9.45,67.275,,7.56,percent of total billed charges,67.275% of total billed charges,11.24,80,,8.992,percent of total billed charges,80% of total billed charges,5.39,38.38,,4.312,percent of total billed charges,38.38% of total billed charges,11.24,80,,8.992,percent of total billed charges,80% of total billed charges,8.67,61.74,,6.936,percent of total billed charges,61.74% of total billed charges,14.33,102,,11.464,percent of total billed charges,102% of total billed charges,5.34,38,,4.272,percent of total billed charges,38% of total billed charges,4.92,14.33,
ORTHO GLASS 2  x 30 FEET,3004645,CDM,270,RC,,,Outpatient,,,14.11,10.58,,11.01,78,,8.808,percent of total billed charges,78% of total billed charges,8.89,63,,7.112,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.36,38,,4.288,percent of total billed charges,38% of total billed charges,5.36,38,,4.288,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,12.7,90,,10.16,percent of total billed charges,90% of total billed charges,4.94,35,,3.952,percent of total billed charges,35% of total billed charges,9.49,67.275,,7.592,percent of total billed charges,67.275% of total billed charges,11.29,80,,9.032,percent of total billed charges,80% of total billed charges,5.42,38.38,,4.336,percent of total billed charges,38.38% of total billed charges,11.29,80,,9.032,percent of total billed charges,80% of total billed charges,8.71,61.74,,6.968,percent of total billed charges,61.74% of total billed charges,14.39,102,,11.512,percent of total billed charges,102% of total billed charges,5.36,38,,4.288,percent of total billed charges,38% of total billed charges,4.94,14.39,
STYLET INTUBATING 6 FR,3000824,CDM,270,RC,,,Outpatient,,,14.19,10.64,,11.07,78,,8.856,percent of total billed charges,78% of total billed charges,8.94,63,,7.152,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.39,38,,4.312,percent of total billed charges,38% of total billed charges,5.39,38,,4.312,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,12.77,90,,10.216,percent of total billed charges,90% of total billed charges,4.97,35,,3.976,percent of total billed charges,35% of total billed charges,9.55,67.275,,7.64,percent of total billed charges,67.275% of total billed charges,11.35,80,,9.08,percent of total billed charges,80% of total billed charges,5.45,38.38,,4.36,percent of total billed charges,38.38% of total billed charges,11.35,80,,9.08,percent of total billed charges,80% of total billed charges,8.76,61.74,,7.008,percent of total billed charges,61.74% of total billed charges,14.47,102,,11.576,percent of total billed charges,102% of total billed charges,5.39,38,,4.312,percent of total billed charges,38% of total billed charges,4.97,14.47,
CHROMIC GUT 1-0 803H,3002340,CDM,270,RC,,,Outpatient,,,14.25,10.69,,11.12,78,,8.896,percent of total billed charges,78% of total billed charges,8.98,63,,7.184,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.42,38,,4.336,percent of total billed charges,38% of total billed charges,5.42,38,,4.336,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,12.83,90,,10.264,percent of total billed charges,90% of total billed charges,4.99,35,,3.992,percent of total billed charges,35% of total billed charges,9.59,67.275,,7.672,percent of total billed charges,67.275% of total billed charges,11.4,80,,9.12,percent of total billed charges,80% of total billed charges,5.47,38.38,,4.376,percent of total billed charges,38.38% of total billed charges,11.4,80,,9.12,percent of total billed charges,80% of total billed charges,8.8,61.74,,7.04,percent of total billed charges,61.74% of total billed charges,14.54,102,,11.632,percent of total billed charges,102% of total billed charges,5.42,38,,4.336,percent of total billed charges,38% of total billed charges,4.99,14.54,
TRACH TUBE UNCUFFED 5.5,3002456,CDM,270,RC,,,Outpatient,,,14.27,10.7,,11.13,78,,8.904,percent of total billed charges,78% of total billed charges,8.99,63,,7.192,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.42,38,,4.336,percent of total billed charges,38% of total billed charges,5.42,38,,4.336,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,12.84,90,,10.272,percent of total billed charges,90% of total billed charges,4.99,35,,3.992,percent of total billed charges,35% of total billed charges,9.6,67.275,,7.68,percent of total billed charges,67.275% of total billed charges,11.42,80,,9.136,percent of total billed charges,80% of total billed charges,5.48,38.38,,4.384,percent of total billed charges,38.38% of total billed charges,11.42,80,,9.136,percent of total billed charges,80% of total billed charges,8.81,61.74,,7.048,percent of total billed charges,61.74% of total billed charges,14.56,102,,11.648,percent of total billed charges,102% of total billed charges,5.42,38,,4.336,percent of total billed charges,38% of total billed charges,4.99,14.56,
PLAIN PACKING 1/4 INCH,3000613,CDM,270,RC,,,Outpatient,,,14.33,10.75,,11.18,78,,8.944,percent of total billed charges,78% of total billed charges,9.03,63,,7.224,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.45,38,,4.36,percent of total billed charges,38% of total billed charges,5.45,38,,4.36,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,12.9,90,,10.32,percent of total billed charges,90% of total billed charges,5.02,35,,4.016,percent of total billed charges,35% of total billed charges,9.64,67.275,,7.712,percent of total billed charges,67.275% of total billed charges,11.46,80,,9.168,percent of total billed charges,80% of total billed charges,5.5,38.38,,4.4,percent of total billed charges,38.38% of total billed charges,11.46,80,,9.168,percent of total billed charges,80% of total billed charges,8.85,61.74,,7.08,percent of total billed charges,61.74% of total billed charges,14.62,102,,11.696,percent of total billed charges,102% of total billed charges,5.45,38,,4.36,percent of total billed charges,38% of total billed charges,5.02,14.62,
BP CUFF DISP REG ADULT - OLD UNIT,3001508,CDM,270,RC,,,Outpatient,,,14.34,10.76,,11.19,78,,8.952,percent of total billed charges,78% of total billed charges,9.03,63,,7.224,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.45,38,,4.36,percent of total billed charges,38% of total billed charges,5.45,38,,4.36,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,12.91,90,,10.328,percent of total billed charges,90% of total billed charges,5.02,35,,4.016,percent of total billed charges,35% of total billed charges,9.65,67.275,,7.72,percent of total billed charges,67.275% of total billed charges,11.47,80,,9.176,percent of total billed charges,80% of total billed charges,5.5,38.38,,4.4,percent of total billed charges,38.38% of total billed charges,11.47,80,,9.176,percent of total billed charges,80% of total billed charges,8.85,61.74,,7.08,percent of total billed charges,61.74% of total billed charges,14.63,102,,11.704,percent of total billed charges,102% of total billed charges,5.45,38,,4.36,percent of total billed charges,38% of total billed charges,5.02,14.63,
POWDER - STOMA 1 OZ,3000224,CDM,270,RC,,,Outpatient,,,14.35,10.76,,11.19,78,,8.952,percent of total billed charges,78% of total billed charges,9.04,63,,7.232,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.45,38,,4.36,percent of total billed charges,38% of total billed charges,5.45,38,,4.36,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,12.92,90,,10.336,percent of total billed charges,90% of total billed charges,5.02,35,,4.016,percent of total billed charges,35% of total billed charges,9.65,67.275,,7.72,percent of total billed charges,67.275% of total billed charges,11.48,80,,9.184,percent of total billed charges,80% of total billed charges,5.51,38.38,,4.408,percent of total billed charges,38.38% of total billed charges,11.48,80,,9.184,percent of total billed charges,80% of total billed charges,8.86,61.74,,7.088,percent of total billed charges,61.74% of total billed charges,14.64,102,,11.712,percent of total billed charges,102% of total billed charges,5.45,38,,4.36,percent of total billed charges,38% of total billed charges,5.02,14.64,
"STOCKING, ANTI-EMBOLISM, KNEE XXL",3002114,CDM,270,RC,,,Outpatient,,,14.35,10.76,,11.19,78,,8.952,percent of total billed charges,78% of total billed charges,9.04,63,,7.232,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.45,38,,4.36,percent of total billed charges,38% of total billed charges,5.45,38,,4.36,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,12.92,90,,10.336,percent of total billed charges,90% of total billed charges,5.02,35,,4.016,percent of total billed charges,35% of total billed charges,9.65,67.275,,7.72,percent of total billed charges,67.275% of total billed charges,11.48,80,,9.184,percent of total billed charges,80% of total billed charges,5.51,38.38,,4.408,percent of total billed charges,38.38% of total billed charges,11.48,80,,9.184,percent of total billed charges,80% of total billed charges,8.86,61.74,,7.088,percent of total billed charges,61.74% of total billed charges,14.64,102,,11.712,percent of total billed charges,102% of total billed charges,5.45,38,,4.36,percent of total billed charges,38% of total billed charges,5.02,14.64,
ARM SLING XS 79-99152,3000021,CDM,270,RC,,,Outpatient,,,14.45,10.84,,11.27,78,,9.016,percent of total billed charges,78% of total billed charges,9.1,63,,7.28,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.49,38,,4.392,percent of total billed charges,38% of total billed charges,5.49,38,,4.392,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,13.01,90,,10.408,percent of total billed charges,90% of total billed charges,5.06,35,,4.048,percent of total billed charges,35% of total billed charges,9.72,67.275,,7.776,percent of total billed charges,67.275% of total billed charges,11.56,80,,9.248,percent of total billed charges,80% of total billed charges,5.55,38.38,,4.44,percent of total billed charges,38.38% of total billed charges,11.56,80,,9.248,percent of total billed charges,80% of total billed charges,8.92,61.74,,7.136,percent of total billed charges,61.74% of total billed charges,14.74,102,,11.792,percent of total billed charges,102% of total billed charges,5.49,38,,4.392,percent of total billed charges,38% of total billed charges,5.06,14.74,
ARM SLING MEDIUM 79-99155,3000022,CDM,270,RC,,,Outpatient,,,14.45,10.84,,11.27,78,,9.016,percent of total billed charges,78% of total billed charges,9.1,63,,7.28,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.49,38,,4.392,percent of total billed charges,38% of total billed charges,5.49,38,,4.392,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,13.01,90,,10.408,percent of total billed charges,90% of total billed charges,5.06,35,,4.048,percent of total billed charges,35% of total billed charges,9.72,67.275,,7.776,percent of total billed charges,67.275% of total billed charges,11.56,80,,9.248,percent of total billed charges,80% of total billed charges,5.55,38.38,,4.44,percent of total billed charges,38.38% of total billed charges,11.56,80,,9.248,percent of total billed charges,80% of total billed charges,8.92,61.74,,7.136,percent of total billed charges,61.74% of total billed charges,14.74,102,,11.792,percent of total billed charges,102% of total billed charges,5.49,38,,4.392,percent of total billed charges,38% of total billed charges,5.06,14.74,
ARM SLING SMALL 79-99153,3000023,CDM,270,RC,,,Outpatient,,,14.45,10.84,,11.27,78,,9.016,percent of total billed charges,78% of total billed charges,9.1,63,,7.28,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.49,38,,4.392,percent of total billed charges,38% of total billed charges,5.49,38,,4.392,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,13.01,90,,10.408,percent of total billed charges,90% of total billed charges,5.06,35,,4.048,percent of total billed charges,35% of total billed charges,9.72,67.275,,7.776,percent of total billed charges,67.275% of total billed charges,11.56,80,,9.248,percent of total billed charges,80% of total billed charges,5.55,38.38,,4.44,percent of total billed charges,38.38% of total billed charges,11.56,80,,9.248,percent of total billed charges,80% of total billed charges,8.92,61.74,,7.136,percent of total billed charges,61.74% of total billed charges,14.74,102,,11.792,percent of total billed charges,102% of total billed charges,5.49,38,,4.392,percent of total billed charges,38% of total billed charges,5.06,14.74,
ARM SLING X-L 79-99158,3000024,CDM,270,RC,,,Outpatient,,,14.45,10.84,,11.27,78,,9.016,percent of total billed charges,78% of total billed charges,9.1,63,,7.28,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.49,38,,4.392,percent of total billed charges,38% of total billed charges,5.49,38,,4.392,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,13.01,90,,10.408,percent of total billed charges,90% of total billed charges,5.06,35,,4.048,percent of total billed charges,35% of total billed charges,9.72,67.275,,7.776,percent of total billed charges,67.275% of total billed charges,11.56,80,,9.248,percent of total billed charges,80% of total billed charges,5.55,38.38,,4.44,percent of total billed charges,38.38% of total billed charges,11.56,80,,9.248,percent of total billed charges,80% of total billed charges,8.92,61.74,,7.136,percent of total billed charges,61.74% of total billed charges,14.74,102,,11.792,percent of total billed charges,102% of total billed charges,5.49,38,,4.392,percent of total billed charges,38% of total billed charges,5.06,14.74,
GAUZE IODOFORM 1/2,3000608,CDM,270,RC,,,Outpatient,,,14.46,10.85,,11.28,78,,9.024,percent of total billed charges,78% of total billed charges,9.11,63,,7.288,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.49,38,,4.392,percent of total billed charges,38% of total billed charges,5.49,38,,4.392,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,13.01,90,,10.408,percent of total billed charges,90% of total billed charges,5.06,35,,4.048,percent of total billed charges,35% of total billed charges,9.73,67.275,,7.784,percent of total billed charges,67.275% of total billed charges,11.57,80,,9.256,percent of total billed charges,80% of total billed charges,5.55,38.38,,4.44,percent of total billed charges,38.38% of total billed charges,11.57,80,,9.256,percent of total billed charges,80% of total billed charges,8.93,61.74,,7.144,percent of total billed charges,61.74% of total billed charges,14.75,102,,11.8,percent of total billed charges,102% of total billed charges,5.49,38,,4.392,percent of total billed charges,38% of total billed charges,5.06,14.75,
FIBRACOL  PLUS 2X2,3004178,CDM,270,RC,,,Outpatient,,,14.58,10.94,,11.37,78,,9.096,percent of total billed charges,78% of total billed charges,9.19,63,,7.352,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.54,38,,4.432,percent of total billed charges,38% of total billed charges,5.54,38,,4.432,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,13.12,90,,10.496,percent of total billed charges,90% of total billed charges,5.1,35,,4.08,percent of total billed charges,35% of total billed charges,9.81,67.275,,7.848,percent of total billed charges,67.275% of total billed charges,11.66,80,,9.328,percent of total billed charges,80% of total billed charges,5.6,38.38,,4.48,percent of total billed charges,38.38% of total billed charges,11.66,80,,9.328,percent of total billed charges,80% of total billed charges,9,61.74,,7.2,percent of total billed charges,61.74% of total billed charges,14.87,102,,11.896,percent of total billed charges,102% of total billed charges,5.54,38,,4.432,percent of total billed charges,38% of total billed charges,5.1,14.87,
URINARY LEG BAG - 20oz,3000331,CDM,270,RC,,,Outpatient,,,14.6,10.95,,11.39,78,,9.112,percent of total billed charges,78% of total billed charges,9.2,63,,7.36,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.55,38,,4.44,percent of total billed charges,38% of total billed charges,5.55,38,,4.44,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,13.14,90,,10.512,percent of total billed charges,90% of total billed charges,5.11,35,,4.088,percent of total billed charges,35% of total billed charges,9.82,67.275,,7.856,percent of total billed charges,67.275% of total billed charges,11.68,80,,9.344,percent of total billed charges,80% of total billed charges,5.6,38.38,,4.48,percent of total billed charges,38.38% of total billed charges,11.68,80,,9.344,percent of total billed charges,80% of total billed charges,9.01,61.74,,7.208,percent of total billed charges,61.74% of total billed charges,14.89,102,,11.912,percent of total billed charges,102% of total billed charges,5.55,38,,4.44,percent of total billed charges,38% of total billed charges,5.11,14.89,
VAGINAL OB SPEC W/LT SRC- MD,3002005,CDM,270,RC,,,Outpatient,,,14.75,11.06,,11.51,78,,9.208,percent of total billed charges,78% of total billed charges,9.29,63,,7.432,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.61,38,,4.488,percent of total billed charges,38% of total billed charges,5.61,38,,4.488,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,13.28,90,,10.624,percent of total billed charges,90% of total billed charges,5.16,35,,4.128,percent of total billed charges,35% of total billed charges,9.92,67.275,,7.936,percent of total billed charges,67.275% of total billed charges,11.8,80,,9.44,percent of total billed charges,80% of total billed charges,5.66,38.38,,4.528,percent of total billed charges,38.38% of total billed charges,11.8,80,,9.44,percent of total billed charges,80% of total billed charges,9.11,61.74,,7.288,percent of total billed charges,61.74% of total billed charges,15.05,102,,12.04,percent of total billed charges,102% of total billed charges,5.61,38,,4.488,percent of total billed charges,38% of total billed charges,5.16,15.05,
VAGINAL OB SPEC W/LT SRC- LG,3002007,CDM,270,RC,,,Outpatient,,,14.75,11.06,,11.51,78,,9.208,percent of total billed charges,78% of total billed charges,9.29,63,,7.432,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.61,38,,4.488,percent of total billed charges,38% of total billed charges,5.61,38,,4.488,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,13.28,90,,10.624,percent of total billed charges,90% of total billed charges,5.16,35,,4.128,percent of total billed charges,35% of total billed charges,9.92,67.275,,7.936,percent of total billed charges,67.275% of total billed charges,11.8,80,,9.44,percent of total billed charges,80% of total billed charges,5.66,38.38,,4.528,percent of total billed charges,38.38% of total billed charges,11.8,80,,9.44,percent of total billed charges,80% of total billed charges,9.11,61.74,,7.288,percent of total billed charges,61.74% of total billed charges,15.05,102,,12.04,percent of total billed charges,102% of total billed charges,5.61,38,,4.488,percent of total billed charges,38% of total billed charges,5.16,15.05,
TUBES ENDO TRACH CUFFED 9.0,3002535,CDM,270,RC,,,Outpatient,,,14.75,11.06,,11.51,78,,9.208,percent of total billed charges,78% of total billed charges,9.29,63,,7.432,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.61,38,,4.488,percent of total billed charges,38% of total billed charges,5.61,38,,4.488,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,13.28,90,,10.624,percent of total billed charges,90% of total billed charges,5.16,35,,4.128,percent of total billed charges,35% of total billed charges,9.92,67.275,,7.936,percent of total billed charges,67.275% of total billed charges,11.8,80,,9.44,percent of total billed charges,80% of total billed charges,5.66,38.38,,4.528,percent of total billed charges,38.38% of total billed charges,11.8,80,,9.44,percent of total billed charges,80% of total billed charges,9.11,61.74,,7.288,percent of total billed charges,61.74% of total billed charges,15.05,102,,12.04,percent of total billed charges,102% of total billed charges,5.61,38,,4.488,percent of total billed charges,38% of total billed charges,5.16,15.05,
LACERATION TRAY DISP,3001115,CDM,270,RC,,,Outpatient,,,14.88,11.16,,11.61,78,,9.288,percent of total billed charges,78% of total billed charges,9.37,63,,7.496,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.65,38,,4.52,percent of total billed charges,38% of total billed charges,5.65,38,,4.52,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,13.39,90,,10.712,percent of total billed charges,90% of total billed charges,5.21,35,,4.168,percent of total billed charges,35% of total billed charges,10.01,67.275,,8.008,percent of total billed charges,67.275% of total billed charges,11.9,80,,9.52,percent of total billed charges,80% of total billed charges,5.71,38.38,,4.568,percent of total billed charges,38.38% of total billed charges,11.9,80,,9.52,percent of total billed charges,80% of total billed charges,9.19,61.74,,7.352,percent of total billed charges,61.74% of total billed charges,15.18,102,,12.144,percent of total billed charges,102% of total billed charges,5.65,38,,4.52,percent of total billed charges,38% of total billed charges,5.21,15.18,
MASK NON-REBREATH ELONG,3003002,CDM,270,RC,,,Outpatient,,,15,11.25,,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.7,38,,4.56,percent of total billed charges,38% of total billed charges,5.7,38,,4.56,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,5.25,35,,4.2,percent of total billed charges,35% of total billed charges,10.09,67.275,,8.072,percent of total billed charges,67.275% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,5.76,38.38,,4.608,percent of total billed charges,38.38% of total billed charges,12,80,,9.6,percent of total billed charges,80% of total billed charges,9.26,61.74,,7.408,percent of total billed charges,61.74% of total billed charges,15.3,102,,12.24,percent of total billed charges,102% of total billed charges,5.7,38,,4.56,percent of total billed charges,38% of total billed charges,5.25,15.3,
CATHETER FOLEY SILICONE 24FR,3000273,CDM,270,RC,,,Outpatient,,,15.09,11.32,,11.77,78,,9.416,percent of total billed charges,78% of total billed charges,9.51,63,,7.608,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.73,38,,4.584,percent of total billed charges,38% of total billed charges,5.73,38,,4.584,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,13.58,90,,10.864,percent of total billed charges,90% of total billed charges,5.28,35,,4.224,percent of total billed charges,35% of total billed charges,10.15,67.275,,8.12,percent of total billed charges,67.275% of total billed charges,12.07,80,,9.656,percent of total billed charges,80% of total billed charges,5.79,38.38,,4.632,percent of total billed charges,38.38% of total billed charges,12.07,80,,9.656,percent of total billed charges,80% of total billed charges,9.32,61.74,,7.456,percent of total billed charges,61.74% of total billed charges,15.39,102,,12.312,percent of total billed charges,102% of total billed charges,5.73,38,,4.584,percent of total billed charges,38% of total billed charges,5.28,15.39,
FOLEY CATH 12FR- SILICONE,3004106,CDM,270,RC,,,Outpatient,,,15.09,11.32,,11.77,78,,9.416,percent of total billed charges,78% of total billed charges,9.51,63,,7.608,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.73,38,,4.584,percent of total billed charges,38% of total billed charges,5.73,38,,4.584,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,13.58,90,,10.864,percent of total billed charges,90% of total billed charges,5.28,35,,4.224,percent of total billed charges,35% of total billed charges,10.15,67.275,,8.12,percent of total billed charges,67.275% of total billed charges,12.07,80,,9.656,percent of total billed charges,80% of total billed charges,5.79,38.38,,4.632,percent of total billed charges,38.38% of total billed charges,12.07,80,,9.656,percent of total billed charges,80% of total billed charges,9.32,61.74,,7.456,percent of total billed charges,61.74% of total billed charges,15.39,102,,12.312,percent of total billed charges,102% of total billed charges,5.73,38,,4.584,percent of total billed charges,38% of total billed charges,5.28,15.39,
FOLEY CATH 14FR- SILICONE,3004108,CDM,270,RC,,,Outpatient,,,15.09,11.32,,11.77,78,,9.416,percent of total billed charges,78% of total billed charges,9.51,63,,7.608,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.73,38,,4.584,percent of total billed charges,38% of total billed charges,5.73,38,,4.584,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,13.58,90,,10.864,percent of total billed charges,90% of total billed charges,5.28,35,,4.224,percent of total billed charges,35% of total billed charges,10.15,67.275,,8.12,percent of total billed charges,67.275% of total billed charges,12.07,80,,9.656,percent of total billed charges,80% of total billed charges,5.79,38.38,,4.632,percent of total billed charges,38.38% of total billed charges,12.07,80,,9.656,percent of total billed charges,80% of total billed charges,9.32,61.74,,7.456,percent of total billed charges,61.74% of total billed charges,15.39,102,,12.312,percent of total billed charges,102% of total billed charges,5.73,38,,4.584,percent of total billed charges,38% of total billed charges,5.28,15.39,
FOLEY CATH 16FR- SILICONE,3004109,CDM,270,RC,,,Outpatient,,,15.09,11.32,,11.77,78,,9.416,percent of total billed charges,78% of total billed charges,9.51,63,,7.608,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.73,38,,4.584,percent of total billed charges,38% of total billed charges,5.73,38,,4.584,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,13.58,90,,10.864,percent of total billed charges,90% of total billed charges,5.28,35,,4.224,percent of total billed charges,35% of total billed charges,10.15,67.275,,8.12,percent of total billed charges,67.275% of total billed charges,12.07,80,,9.656,percent of total billed charges,80% of total billed charges,5.79,38.38,,4.632,percent of total billed charges,38.38% of total billed charges,12.07,80,,9.656,percent of total billed charges,80% of total billed charges,9.32,61.74,,7.456,percent of total billed charges,61.74% of total billed charges,15.39,102,,12.312,percent of total billed charges,102% of total billed charges,5.73,38,,4.584,percent of total billed charges,38% of total billed charges,5.28,15.39,
FOLEY CATH 18FR- SILICONE,3004110,CDM,270,RC,,,Outpatient,,,15.09,11.32,,11.77,78,,9.416,percent of total billed charges,78% of total billed charges,9.51,63,,7.608,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.73,38,,4.584,percent of total billed charges,38% of total billed charges,5.73,38,,4.584,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,13.58,90,,10.864,percent of total billed charges,90% of total billed charges,5.28,35,,4.224,percent of total billed charges,35% of total billed charges,10.15,67.275,,8.12,percent of total billed charges,67.275% of total billed charges,12.07,80,,9.656,percent of total billed charges,80% of total billed charges,5.79,38.38,,4.632,percent of total billed charges,38.38% of total billed charges,12.07,80,,9.656,percent of total billed charges,80% of total billed charges,9.32,61.74,,7.456,percent of total billed charges,61.74% of total billed charges,15.39,102,,12.312,percent of total billed charges,102% of total billed charges,5.73,38,,4.584,percent of total billed charges,38% of total billed charges,5.28,15.39,
STOCKINETTE 4  X 48  ST,3001770,CDM,270,RC,,,Outpatient,,,15.11,11.33,,11.79,78,,9.432,percent of total billed charges,78% of total billed charges,9.52,63,,7.616,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.74,38,,4.592,percent of total billed charges,38% of total billed charges,5.74,38,,4.592,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,13.6,90,,10.88,percent of total billed charges,90% of total billed charges,5.29,35,,4.232,percent of total billed charges,35% of total billed charges,10.17,67.275,,8.136,percent of total billed charges,67.275% of total billed charges,12.09,80,,9.672,percent of total billed charges,80% of total billed charges,5.8,38.38,,4.64,percent of total billed charges,38.38% of total billed charges,12.09,80,,9.672,percent of total billed charges,80% of total billed charges,9.33,61.74,,7.464,percent of total billed charges,61.74% of total billed charges,15.41,102,,12.328,percent of total billed charges,102% of total billed charges,5.74,38,,4.592,percent of total billed charges,38% of total billed charges,5.29,15.41,
URINARY DRAINAGE UNIT,3001903,CDM,270,RC,,,Outpatient,,,15.22,11.42,,11.87,78,,9.496,percent of total billed charges,78% of total billed charges,9.59,63,,7.672,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.78,38,,4.624,percent of total billed charges,38% of total billed charges,5.78,38,,4.624,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,13.7,90,,10.96,percent of total billed charges,90% of total billed charges,5.33,35,,4.264,percent of total billed charges,35% of total billed charges,10.24,67.275,,8.192,percent of total billed charges,67.275% of total billed charges,12.18,80,,9.744,percent of total billed charges,80% of total billed charges,5.84,38.38,,4.672,percent of total billed charges,38.38% of total billed charges,12.18,80,,9.744,percent of total billed charges,80% of total billed charges,9.4,61.74,,7.52,percent of total billed charges,61.74% of total billed charges,15.52,102,,12.416,percent of total billed charges,102% of total billed charges,5.78,38,,4.624,percent of total billed charges,38% of total billed charges,5.33,15.52,
ORTHO GLASS 3  X 15',3004647,CDM,270,RC,,,Outpatient,,,15.25,11.44,,11.9,78,,9.52,percent of total billed charges,78% of total billed charges,9.61,63,,7.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.8,38,,4.64,percent of total billed charges,38% of total billed charges,5.8,38,,4.64,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,13.73,90,,10.984,percent of total billed charges,90% of total billed charges,5.34,35,,4.272,percent of total billed charges,35% of total billed charges,10.26,67.275,,8.208,percent of total billed charges,67.275% of total billed charges,12.2,80,,9.76,percent of total billed charges,80% of total billed charges,5.85,38.38,,4.68,percent of total billed charges,38.38% of total billed charges,12.2,80,,9.76,percent of total billed charges,80% of total billed charges,9.42,61.74,,7.536,percent of total billed charges,61.74% of total billed charges,15.56,102,,12.448,percent of total billed charges,102% of total billed charges,5.8,38,,4.64,percent of total billed charges,38% of total billed charges,5.34,15.56,
CERVICAL SOFT COLLAR 3.75,3001324,CDM,270,RC,,,Outpatient,,,15.26,11.45,,11.9,78,,9.52,percent of total billed charges,78% of total billed charges,9.61,63,,7.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.8,38,,4.64,percent of total billed charges,38% of total billed charges,5.8,38,,4.64,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,13.73,90,,10.984,percent of total billed charges,90% of total billed charges,5.34,35,,4.272,percent of total billed charges,35% of total billed charges,10.27,67.275,,8.216,percent of total billed charges,67.275% of total billed charges,12.21,80,,9.768,percent of total billed charges,80% of total billed charges,5.86,38.38,,4.688,percent of total billed charges,38.38% of total billed charges,12.21,80,,9.768,percent of total billed charges,80% of total billed charges,9.42,61.74,,7.536,percent of total billed charges,61.74% of total billed charges,15.57,102,,12.456,percent of total billed charges,102% of total billed charges,5.8,38,,4.64,percent of total billed charges,38% of total billed charges,5.34,15.57,
BAZA SKIN CREME,3001179,CDM,270,RC,,,Outpatient,,,15.37,11.53,,11.99,78,,9.592,percent of total billed charges,78% of total billed charges,9.68,63,,7.744,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.84,38,,4.672,percent of total billed charges,38% of total billed charges,5.84,38,,4.672,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,13.83,90,,11.064,percent of total billed charges,90% of total billed charges,5.38,35,,4.304,percent of total billed charges,35% of total billed charges,10.34,67.275,,8.272,percent of total billed charges,67.275% of total billed charges,12.3,80,,9.84,percent of total billed charges,80% of total billed charges,5.9,38.38,,4.72,percent of total billed charges,38.38% of total billed charges,12.3,80,,9.84,percent of total billed charges,80% of total billed charges,9.49,61.74,,7.592,percent of total billed charges,61.74% of total billed charges,15.68,102,,12.544,percent of total billed charges,102% of total billed charges,5.84,38,,4.672,percent of total billed charges,38% of total billed charges,5.38,15.68,
FOLEY CATH  16FR - BARD - CATH ONLY,3005089,CDM,270,RC,,,Outpatient,,,15.65,11.74,,12.21,78,,9.768,percent of total billed charges,78% of total billed charges,9.86,63,,7.888,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.95,38,,4.76,percent of total billed charges,38% of total billed charges,5.95,38,,4.76,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,14.09,90,,11.272,percent of total billed charges,90% of total billed charges,5.48,35,,4.384,percent of total billed charges,35% of total billed charges,10.53,67.275,,8.424,percent of total billed charges,67.275% of total billed charges,12.52,80,,10.016,percent of total billed charges,80% of total billed charges,6.01,38.38,,4.808,percent of total billed charges,38.38% of total billed charges,12.52,80,,10.016,percent of total billed charges,80% of total billed charges,9.66,61.74,,7.728,percent of total billed charges,61.74% of total billed charges,15.96,102,,12.768,percent of total billed charges,102% of total billed charges,5.95,38,,4.76,percent of total billed charges,38% of total billed charges,5.48,15.96,
CALAZIME PROTECTANT PASTE 4 OZ,3000569,CDM,270,RC,,,Outpatient,,,15.69,11.77,,12.24,78,,9.792,percent of total billed charges,78% of total billed charges,9.88,63,,7.904,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,5.96,38,,4.768,percent of total billed charges,38% of total billed charges,5.96,38,,4.768,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,14.12,90,,11.296,percent of total billed charges,90% of total billed charges,5.49,35,,4.392,percent of total billed charges,35% of total billed charges,10.56,67.275,,8.448,percent of total billed charges,67.275% of total billed charges,12.55,80,,10.04,percent of total billed charges,80% of total billed charges,6.02,38.38,,4.816,percent of total billed charges,38.38% of total billed charges,12.55,80,,10.04,percent of total billed charges,80% of total billed charges,9.69,61.74,,7.752,percent of total billed charges,61.74% of total billed charges,16,102,,12.8,percent of total billed charges,102% of total billed charges,5.96,38,,4.768,percent of total billed charges,38% of total billed charges,5.49,16,
ANTIFUNGAL POWDER 3 OZ,3000522,CDM,270,RC,,,Outpatient,,,15.83,11.87,,12.35,78,,9.88,percent of total billed charges,78% of total billed charges,9.97,63,,7.976,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.02,38,,4.816,percent of total billed charges,38% of total billed charges,6.02,38,,4.816,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,14.25,90,,11.4,percent of total billed charges,90% of total billed charges,5.54,35,,4.432,percent of total billed charges,35% of total billed charges,10.65,67.275,,8.52,percent of total billed charges,67.275% of total billed charges,12.66,80,,10.128,percent of total billed charges,80% of total billed charges,6.08,38.38,,4.864,percent of total billed charges,38.38% of total billed charges,12.66,80,,10.128,percent of total billed charges,80% of total billed charges,9.77,61.74,,7.816,percent of total billed charges,61.74% of total billed charges,16.15,102,,12.92,percent of total billed charges,102% of total billed charges,6.02,38,,4.816,percent of total billed charges,38% of total billed charges,5.54,16.15,
PLAIN PACKING 1/2 INCH,3000612,CDM,270,RC,,,Outpatient,,,15.83,11.87,,12.35,78,,9.88,percent of total billed charges,78% of total billed charges,9.97,63,,7.976,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.02,38,,4.816,percent of total billed charges,38% of total billed charges,6.02,38,,4.816,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,14.25,90,,11.4,percent of total billed charges,90% of total billed charges,5.54,35,,4.432,percent of total billed charges,35% of total billed charges,10.65,67.275,,8.52,percent of total billed charges,67.275% of total billed charges,12.66,80,,10.128,percent of total billed charges,80% of total billed charges,6.08,38.38,,4.864,percent of total billed charges,38.38% of total billed charges,12.66,80,,10.128,percent of total billed charges,80% of total billed charges,9.77,61.74,,7.816,percent of total billed charges,61.74% of total billed charges,16.15,102,,12.92,percent of total billed charges,102% of total billed charges,6.02,38,,4.816,percent of total billed charges,38% of total billed charges,5.54,16.15,
CYSTO BLADDER IRRIGATION SET,3003071,CDM,270,RC,,,Outpatient,,,15.92,11.94,,12.42,78,,9.936,percent of total billed charges,78% of total billed charges,10.03,63,,8.024,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.05,38,,4.84,percent of total billed charges,38% of total billed charges,6.05,38,,4.84,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,14.33,90,,11.464,percent of total billed charges,90% of total billed charges,5.57,35,,4.456,percent of total billed charges,35% of total billed charges,10.71,67.275,,8.568,percent of total billed charges,67.275% of total billed charges,12.74,80,,10.192,percent of total billed charges,80% of total billed charges,6.11,38.38,,4.888,percent of total billed charges,38.38% of total billed charges,12.74,80,,10.192,percent of total billed charges,80% of total billed charges,9.83,61.74,,7.864,percent of total billed charges,61.74% of total billed charges,16.24,102,,12.992,percent of total billed charges,102% of total billed charges,6.05,38,,4.84,percent of total billed charges,38% of total billed charges,5.57,16.24,
CATH URETHRAL COUDE 14FR,3000240,CDM,270,RC,,,Outpatient,,,15.95,11.96,,12.44,78,,9.952,percent of total billed charges,78% of total billed charges,10.05,63,,8.04,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.06,38,,4.848,percent of total billed charges,38% of total billed charges,6.06,38,,4.848,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,14.36,90,,11.488,percent of total billed charges,90% of total billed charges,5.58,35,,4.464,percent of total billed charges,35% of total billed charges,10.73,67.275,,8.584,percent of total billed charges,67.275% of total billed charges,12.76,80,,10.208,percent of total billed charges,80% of total billed charges,6.12,38.38,,4.896,percent of total billed charges,38.38% of total billed charges,12.76,80,,10.208,percent of total billed charges,80% of total billed charges,9.85,61.74,,7.88,percent of total billed charges,61.74% of total billed charges,16.27,102,,13.016,percent of total billed charges,102% of total billed charges,6.06,38,,4.848,percent of total billed charges,38% of total billed charges,5.58,16.27,
CATH URETHRAL COUDE 16FR,3000246,CDM,270,RC,,,Outpatient,,,15.95,11.96,,12.44,78,,9.952,percent of total billed charges,78% of total billed charges,10.05,63,,8.04,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.06,38,,4.848,percent of total billed charges,38% of total billed charges,6.06,38,,4.848,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,14.36,90,,11.488,percent of total billed charges,90% of total billed charges,5.58,35,,4.464,percent of total billed charges,35% of total billed charges,10.73,67.275,,8.584,percent of total billed charges,67.275% of total billed charges,12.76,80,,10.208,percent of total billed charges,80% of total billed charges,6.12,38.38,,4.896,percent of total billed charges,38.38% of total billed charges,12.76,80,,10.208,percent of total billed charges,80% of total billed charges,9.85,61.74,,7.88,percent of total billed charges,61.74% of total billed charges,16.27,102,,13.016,percent of total billed charges,102% of total billed charges,6.06,38,,4.848,percent of total billed charges,38% of total billed charges,5.58,16.27,
Use of external hot or cold packs,9000015,CDM,420,RC,97010,HCPCS,Outpatient,,,16,12,,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,10.08,63,,8.064,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.08,38,,4.864,percent of total billed charges,38% of total billed charges,6.08,38,,4.864,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,5.6,35,,4.48,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,6.14,38.38,,4.912,percent of total billed charges,38.38% of total billed charges,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,9.88,61.74,,7.904,percent of total billed charges,61.74% of total billed charges,16.32,102,,13.056,percent of total billed charges,102% of total billed charges,6.08,38,,4.864,percent of total billed charges,38% of total billed charges,5.6,145.93,
UMBILICAL TAPE,3004010,CDM,270,RC,,,Outpatient,,,16.05,12.04,,12.52,78,,10.016,percent of total billed charges,78% of total billed charges,10.11,63,,8.088,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.1,38,,4.88,percent of total billed charges,38% of total billed charges,6.1,38,,4.88,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,14.45,90,,11.56,percent of total billed charges,90% of total billed charges,5.62,35,,4.496,percent of total billed charges,35% of total billed charges,10.8,67.275,,8.64,percent of total billed charges,67.275% of total billed charges,12.84,80,,10.272,percent of total billed charges,80% of total billed charges,6.16,38.38,,4.928,percent of total billed charges,38.38% of total billed charges,12.84,80,,10.272,percent of total billed charges,80% of total billed charges,9.91,61.74,,7.928,percent of total billed charges,61.74% of total billed charges,16.37,102,,13.096,percent of total billed charges,102% of total billed charges,6.1,38,,4.88,percent of total billed charges,38% of total billed charges,5.62,16.37,
CHROMIC 5-0 FS-2,3001566,CDM,270,RC,,,Outpatient,,,16.07,12.05,,12.53,78,,10.024,percent of total billed charges,78% of total billed charges,10.12,63,,8.096,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.11,38,,4.888,percent of total billed charges,38% of total billed charges,6.11,38,,4.888,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,14.46,90,,11.568,percent of total billed charges,90% of total billed charges,5.62,35,,4.496,percent of total billed charges,35% of total billed charges,10.81,67.275,,8.648,percent of total billed charges,67.275% of total billed charges,12.86,80,,10.288,percent of total billed charges,80% of total billed charges,6.17,38.38,,4.936,percent of total billed charges,38.38% of total billed charges,12.86,80,,10.288,percent of total billed charges,80% of total billed charges,9.92,61.74,,7.936,percent of total billed charges,61.74% of total billed charges,16.39,102,,13.112,percent of total billed charges,102% of total billed charges,6.11,38,,4.888,percent of total billed charges,38% of total billed charges,5.62,16.39,
STYLET INTUBATING 10 FR,3000825,CDM,270,RC,,,Outpatient,,,16.11,12.08,,12.57,78,,10.056,percent of total billed charges,78% of total billed charges,10.15,63,,8.12,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.12,38,,4.896,percent of total billed charges,38% of total billed charges,6.12,38,,4.896,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,14.5,90,,11.6,percent of total billed charges,90% of total billed charges,5.64,35,,4.512,percent of total billed charges,35% of total billed charges,10.84,67.275,,8.672,percent of total billed charges,67.275% of total billed charges,12.89,80,,10.312,percent of total billed charges,80% of total billed charges,6.18,38.38,,4.944,percent of total billed charges,38.38% of total billed charges,12.89,80,,10.312,percent of total billed charges,80% of total billed charges,9.95,61.74,,7.96,percent of total billed charges,61.74% of total billed charges,16.43,102,,13.144,percent of total billed charges,102% of total billed charges,6.12,38,,4.896,percent of total billed charges,38% of total billed charges,5.64,16.43,
BP CUFF DISP L - OLD UNIT,3001509,CDM,270,RC,,,Outpatient,,,16.16,12.12,,12.6,78,,10.08,percent of total billed charges,78% of total billed charges,10.18,63,,8.144,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.14,38,,4.912,percent of total billed charges,38% of total billed charges,6.14,38,,4.912,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,14.54,90,,11.632,percent of total billed charges,90% of total billed charges,5.66,35,,4.528,percent of total billed charges,35% of total billed charges,10.87,67.275,,8.696,percent of total billed charges,67.275% of total billed charges,12.93,80,,10.344,percent of total billed charges,80% of total billed charges,6.2,38.38,,4.96,percent of total billed charges,38.38% of total billed charges,12.93,80,,10.344,percent of total billed charges,80% of total billed charges,9.98,61.74,,7.984,percent of total billed charges,61.74% of total billed charges,16.48,102,,13.184,percent of total billed charges,102% of total billed charges,6.14,38,,4.912,percent of total billed charges,38% of total billed charges,5.66,16.48,
ETCO2 DRYLINE AIRWAY ADAPTER - STRAIGHT,3003017,CDM,270,RC,,,Outpatient,,,16.22,12.17,,12.65,78,,10.12,percent of total billed charges,78% of total billed charges,10.22,63,,8.176,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.16,38,,4.928,percent of total billed charges,38% of total billed charges,6.16,38,,4.928,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,14.6,90,,11.68,percent of total billed charges,90% of total billed charges,5.68,35,,4.544,percent of total billed charges,35% of total billed charges,10.91,67.275,,8.728,percent of total billed charges,67.275% of total billed charges,12.98,80,,10.384,percent of total billed charges,80% of total billed charges,6.23,38.38,,4.984,percent of total billed charges,38.38% of total billed charges,12.98,80,,10.384,percent of total billed charges,80% of total billed charges,10.01,61.74,,8.008,percent of total billed charges,61.74% of total billed charges,16.54,102,,13.232,percent of total billed charges,102% of total billed charges,6.16,38,,4.928,percent of total billed charges,38% of total billed charges,5.68,16.54,
XRAY MRI TUBE VALVE,3004275,CDM,270,RC,,,Outpatient,,,16.25,12.19,,12.68,78,,10.144,percent of total billed charges,78% of total billed charges,10.24,63,,8.192,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.18,38,,4.944,percent of total billed charges,38% of total billed charges,6.18,38,,4.944,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,14.63,90,,11.704,percent of total billed charges,90% of total billed charges,5.69,35,,4.552,percent of total billed charges,35% of total billed charges,10.93,67.275,,8.744,percent of total billed charges,67.275% of total billed charges,13,80,,10.4,percent of total billed charges,80% of total billed charges,6.24,38.38,,4.992,percent of total billed charges,38.38% of total billed charges,13,80,,10.4,percent of total billed charges,80% of total billed charges,10.03,61.74,,8.024,percent of total billed charges,61.74% of total billed charges,16.58,102,,13.264,percent of total billed charges,102% of total billed charges,6.18,38,,4.944,percent of total billed charges,38% of total billed charges,5.69,16.58,
WRIST/ANKLE RESTRAINT - SUB,3005077,CDM,270,RC,,,Outpatient,,,16.42,12.32,,12.81,78,,10.248,percent of total billed charges,78% of total billed charges,10.34,63,,8.272,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.24,38,,4.992,percent of total billed charges,38% of total billed charges,6.24,38,,4.992,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,14.78,90,,11.824,percent of total billed charges,90% of total billed charges,5.75,35,,4.6,percent of total billed charges,35% of total billed charges,11.05,67.275,,8.84,percent of total billed charges,67.275% of total billed charges,13.14,80,,10.512,percent of total billed charges,80% of total billed charges,6.3,38.38,,5.04,percent of total billed charges,38.38% of total billed charges,13.14,80,,10.512,percent of total billed charges,80% of total billed charges,10.14,61.74,,8.112,percent of total billed charges,61.74% of total billed charges,16.75,102,,13.4,percent of total billed charges,102% of total billed charges,6.24,38,,4.992,percent of total billed charges,38% of total billed charges,5.75,16.75,
BOVIE PENCIL,3004071,CDM,270,RC,,,Outpatient,,,16.52,12.39,,12.89,78,,10.312,percent of total billed charges,78% of total billed charges,10.41,63,,8.328,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.28,38,,5.024,percent of total billed charges,38% of total billed charges,6.28,38,,5.024,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,14.87,90,,11.896,percent of total billed charges,90% of total billed charges,5.78,35,,4.624,percent of total billed charges,35% of total billed charges,11.11,67.275,,8.888,percent of total billed charges,67.275% of total billed charges,13.22,80,,10.576,percent of total billed charges,80% of total billed charges,6.34,38.38,,5.072,percent of total billed charges,38.38% of total billed charges,13.22,80,,10.576,percent of total billed charges,80% of total billed charges,10.2,61.74,,8.16,percent of total billed charges,61.74% of total billed charges,16.85,102,,13.48,percent of total billed charges,102% of total billed charges,6.28,38,,5.024,percent of total billed charges,38% of total billed charges,5.78,16.85,
NEBULIZER FILTERED,3004025,CDM,270,RC,,,Outpatient,,,16.55,12.41,,12.91,78,,10.328,percent of total billed charges,78% of total billed charges,10.43,63,,8.344,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.29,38,,5.032,percent of total billed charges,38% of total billed charges,6.29,38,,5.032,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,14.9,90,,11.92,percent of total billed charges,90% of total billed charges,5.79,35,,4.632,percent of total billed charges,35% of total billed charges,11.13,67.275,,8.904,percent of total billed charges,67.275% of total billed charges,13.24,80,,10.592,percent of total billed charges,80% of total billed charges,6.35,38.38,,5.08,percent of total billed charges,38.38% of total billed charges,13.24,80,,10.592,percent of total billed charges,80% of total billed charges,10.22,61.74,,8.176,percent of total billed charges,61.74% of total billed charges,16.88,102,,13.504,percent of total billed charges,102% of total billed charges,6.29,38,,5.032,percent of total billed charges,38% of total billed charges,5.79,16.88,
DUO DERM 4 X 4,3000320,CDM,270,RC,,,Outpatient,,,16.63,12.47,,12.97,78,,10.376,percent of total billed charges,78% of total billed charges,10.48,63,,8.384,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.32,38,,5.056,percent of total billed charges,38% of total billed charges,6.32,38,,5.056,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,14.97,90,,11.976,percent of total billed charges,90% of total billed charges,5.82,35,,4.656,percent of total billed charges,35% of total billed charges,11.19,67.275,,8.952,percent of total billed charges,67.275% of total billed charges,13.3,80,,10.64,percent of total billed charges,80% of total billed charges,6.38,38.38,,5.104,percent of total billed charges,38.38% of total billed charges,13.3,80,,10.64,percent of total billed charges,80% of total billed charges,10.27,61.74,,8.216,percent of total billed charges,61.74% of total billed charges,16.96,102,,13.568,percent of total billed charges,102% of total billed charges,6.32,38,,5.056,percent of total billed charges,38% of total billed charges,5.82,16.96,
POCKET CHAMBER,3003038,CDM,270,RC,,,Outpatient,,,16.9,12.68,,13.18,78,,10.544,percent of total billed charges,78% of total billed charges,10.65,63,,8.52,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.42,38,,5.136,percent of total billed charges,38% of total billed charges,6.42,38,,5.136,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,15.21,90,,12.168,percent of total billed charges,90% of total billed charges,5.92,35,,4.736,percent of total billed charges,35% of total billed charges,11.37,67.275,,9.096,percent of total billed charges,67.275% of total billed charges,13.52,80,,10.816,percent of total billed charges,80% of total billed charges,6.49,38.38,,5.192,percent of total billed charges,38.38% of total billed charges,13.52,80,,10.816,percent of total billed charges,80% of total billed charges,10.43,61.74,,8.344,percent of total billed charges,61.74% of total billed charges,17.24,102,,13.792,percent of total billed charges,102% of total billed charges,6.42,38,,5.136,percent of total billed charges,38% of total billed charges,5.92,17.24,
VICRYL TIE 3-0 J644H,3001593,CDM,270,RC,,,Outpatient,,,16.97,12.73,,13.24,78,,10.592,percent of total billed charges,78% of total billed charges,10.69,63,,8.552,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.45,38,,5.16,percent of total billed charges,38% of total billed charges,6.45,38,,5.16,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,15.27,90,,12.216,percent of total billed charges,90% of total billed charges,5.94,35,,4.752,percent of total billed charges,35% of total billed charges,11.42,67.275,,9.136,percent of total billed charges,67.275% of total billed charges,13.58,80,,10.864,percent of total billed charges,80% of total billed charges,6.51,38.38,,5.208,percent of total billed charges,38.38% of total billed charges,13.58,80,,10.864,percent of total billed charges,80% of total billed charges,10.48,61.74,,8.384,percent of total billed charges,61.74% of total billed charges,17.31,102,,13.848,percent of total billed charges,102% of total billed charges,6.45,38,,5.16,percent of total billed charges,38% of total billed charges,5.94,17.31,
SITZ BATH,3001709,CDM,270,RC,,,Outpatient,,,16.98,12.74,,13.24,78,,10.592,percent of total billed charges,78% of total billed charges,10.7,63,,8.56,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.45,38,,5.16,percent of total billed charges,38% of total billed charges,6.45,38,,5.16,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,15.28,90,,12.224,percent of total billed charges,90% of total billed charges,5.94,35,,4.752,percent of total billed charges,35% of total billed charges,11.42,67.275,,9.136,percent of total billed charges,67.275% of total billed charges,13.58,80,,10.864,percent of total billed charges,80% of total billed charges,6.52,38.38,,5.216,percent of total billed charges,38.38% of total billed charges,13.58,80,,10.864,percent of total billed charges,80% of total billed charges,10.48,61.74,,8.384,percent of total billed charges,61.74% of total billed charges,17.32,102,,13.856,percent of total billed charges,102% of total billed charges,6.45,38,,5.16,percent of total billed charges,38% of total billed charges,5.94,17.32,
OBSERVATION OTHER HOURS,2000004,CDM,762,RC,,,Outpatient,,,17,12.75,,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,10.71,63,,8.568,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.46,38,,5.168,percent of total billed charges,38% of total billed charges,6.46,38,,5.168,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.95,35,,4.76,percent of total billed charges,35% of total billed charges,1802.97,67.275,,1442.376,percent of total billed charges,67.275% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,6.52,38.38,,5.216,percent of total billed charges,38.38% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,10.5,61.74,,8.4,percent of total billed charges,61.74% of total billed charges,17.34,102,,13.872,percent of total billed charges,102% of total billed charges,6.46,38,,5.168,percent of total billed charges,38% of total billed charges,5.95,1802.97,
.ADD GENITAL SLIDE,5002027,CDM,300,RC,,,Outpatient,,,17,12.75,,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,10.71,63,,8.568,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.46,38,,5.168,percent of total billed charges,38% of total billed charges,6.46,38,,5.168,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.95,35,,4.76,percent of total billed charges,35% of total billed charges,11.44,67.275,,9.152,percent of total billed charges,67.275% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,6.52,38.38,,5.216,percent of total billed charges,38.38% of total billed charges,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,10.5,61.74,,8.4,percent of total billed charges,61.74% of total billed charges,17.34,102,,13.872,percent of total billed charges,102% of total billed charges,6.46,38,,5.168,percent of total billed charges,38% of total billed charges,5.95,17.34,
CAST TAPE 3,3001011,CDM,270,RC,,,Outpatient,,,17.09,12.82,,13.33,78,,10.664,percent of total billed charges,78% of total billed charges,10.77,63,,8.616,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.49,38,,5.192,percent of total billed charges,38% of total billed charges,6.49,38,,5.192,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,15.38,90,,12.304,percent of total billed charges,90% of total billed charges,5.98,35,,4.784,percent of total billed charges,35% of total billed charges,11.5,67.275,,9.2,percent of total billed charges,67.275% of total billed charges,13.67,80,,10.936,percent of total billed charges,80% of total billed charges,6.56,38.38,,5.248,percent of total billed charges,38.38% of total billed charges,13.67,80,,10.936,percent of total billed charges,80% of total billed charges,10.55,61.74,,8.44,percent of total billed charges,61.74% of total billed charges,17.43,102,,13.944,percent of total billed charges,102% of total billed charges,6.49,38,,5.192,percent of total billed charges,38% of total billed charges,5.98,17.43,
NEBULIZER  - NEBUTECH UPDRAFT,3005087,CDM,270,RC,,,Outpatient,,,17.12,12.84,,13.35,78,,10.68,percent of total billed charges,78% of total billed charges,10.79,63,,8.632,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.51,38,,5.208,percent of total billed charges,38% of total billed charges,6.51,38,,5.208,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,15.41,90,,12.328,percent of total billed charges,90% of total billed charges,5.99,35,,4.792,percent of total billed charges,35% of total billed charges,11.52,67.275,,9.216,percent of total billed charges,67.275% of total billed charges,13.7,80,,10.96,percent of total billed charges,80% of total billed charges,6.57,38.38,,5.256,percent of total billed charges,38.38% of total billed charges,13.7,80,,10.96,percent of total billed charges,80% of total billed charges,10.57,61.74,,8.456,percent of total billed charges,61.74% of total billed charges,17.46,102,,13.968,percent of total billed charges,102% of total billed charges,6.51,38,,5.208,percent of total billed charges,38% of total billed charges,5.99,17.46,
"ZZZCEFACLOR: 500 MG, CAPS, 15 EA, BOTTLE",1002653,CDM,259,RC,,,Outpatient,,,17.16,12.87,,13.38,78,,10.704,percent of total billed charges,78% of total billed charges,10.81,63,,8.648,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.52,38,,5.216,percent of total billed charges,38% of total billed charges,6.52,38,,5.216,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,15.44,90,,12.352,percent of total billed charges,90% of total billed charges,6.01,35,,4.808,percent of total billed charges,35% of total billed charges,11.54,67.275,,9.232,percent of total billed charges,67.275% of total billed charges,13.73,80,,10.984,percent of total billed charges,80% of total billed charges,6.59,38.38,,5.272,percent of total billed charges,38.38% of total billed charges,13.73,80,,10.984,percent of total billed charges,80% of total billed charges,10.59,61.74,,8.472,percent of total billed charges,61.74% of total billed charges,17.5,102,,14,percent of total billed charges,102% of total billed charges,6.52,38,,5.216,percent of total billed charges,38% of total billed charges,6.01,17.5,
FOLEY CATH 5CC 18FR,3000306,CDM,270,RC,,,Outpatient,,,17.18,12.89,,13.4,78,,10.72,percent of total billed charges,78% of total billed charges,10.82,63,,8.656,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.53,38,,5.224,percent of total billed charges,38% of total billed charges,6.53,38,,5.224,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,15.46,90,,12.368,percent of total billed charges,90% of total billed charges,6.01,35,,4.808,percent of total billed charges,35% of total billed charges,11.56,67.275,,9.248,percent of total billed charges,67.275% of total billed charges,13.74,80,,10.992,percent of total billed charges,80% of total billed charges,6.59,38.38,,5.272,percent of total billed charges,38.38% of total billed charges,13.74,80,,10.992,percent of total billed charges,80% of total billed charges,10.61,61.74,,8.488,percent of total billed charges,61.74% of total billed charges,17.52,102,,14.016,percent of total billed charges,102% of total billed charges,6.53,38,,5.224,percent of total billed charges,38% of total billed charges,6.01,17.52,
FOLEY CATH 5CC 12FR,3000328,CDM,270,RC,,,Outpatient,,,17.18,12.89,,13.4,78,,10.72,percent of total billed charges,78% of total billed charges,10.82,63,,8.656,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.53,38,,5.224,percent of total billed charges,38% of total billed charges,6.53,38,,5.224,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,15.46,90,,12.368,percent of total billed charges,90% of total billed charges,6.01,35,,4.808,percent of total billed charges,35% of total billed charges,11.56,67.275,,9.248,percent of total billed charges,67.275% of total billed charges,13.74,80,,10.992,percent of total billed charges,80% of total billed charges,6.59,38.38,,5.272,percent of total billed charges,38.38% of total billed charges,13.74,80,,10.992,percent of total billed charges,80% of total billed charges,10.61,61.74,,8.488,percent of total billed charges,61.74% of total billed charges,17.52,102,,14.016,percent of total billed charges,102% of total billed charges,6.53,38,,5.224,percent of total billed charges,38% of total billed charges,6.01,17.52,
FOLEY CATH 5CC 14FR,3000418,CDM,270,RC,,,Outpatient,,,17.18,12.89,,13.4,78,,10.72,percent of total billed charges,78% of total billed charges,10.82,63,,8.656,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.53,38,,5.224,percent of total billed charges,38% of total billed charges,6.53,38,,5.224,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,15.46,90,,12.368,percent of total billed charges,90% of total billed charges,6.01,35,,4.808,percent of total billed charges,35% of total billed charges,11.56,67.275,,9.248,percent of total billed charges,67.275% of total billed charges,13.74,80,,10.992,percent of total billed charges,80% of total billed charges,6.59,38.38,,5.272,percent of total billed charges,38.38% of total billed charges,13.74,80,,10.992,percent of total billed charges,80% of total billed charges,10.61,61.74,,8.488,percent of total billed charges,61.74% of total billed charges,17.52,102,,14.016,percent of total billed charges,102% of total billed charges,6.53,38,,5.224,percent of total billed charges,38% of total billed charges,6.01,17.52,
CHLORAPREP 10.5 ML,3000492,CDM,270,RC,,,Outpatient,,,17.3,12.98,,13.49,78,,10.792,percent of total billed charges,78% of total billed charges,10.9,63,,8.72,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.57,38,,5.256,percent of total billed charges,38% of total billed charges,6.57,38,,5.256,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,15.57,90,,12.456,percent of total billed charges,90% of total billed charges,6.06,35,,4.848,percent of total billed charges,35% of total billed charges,11.64,67.275,,9.312,percent of total billed charges,67.275% of total billed charges,13.84,80,,11.072,percent of total billed charges,80% of total billed charges,6.64,38.38,,5.312,percent of total billed charges,38.38% of total billed charges,13.84,80,,11.072,percent of total billed charges,80% of total billed charges,10.68,61.74,,8.544,percent of total billed charges,61.74% of total billed charges,17.65,102,,14.12,percent of total billed charges,102% of total billed charges,6.57,38,,5.256,percent of total billed charges,38% of total billed charges,6.06,17.65,
SOCK AID 5,3000717,CDM,270,RC,,,Outpatient,,,17.45,13.09,,13.61,78,,10.888,percent of total billed charges,78% of total billed charges,10.99,63,,8.792,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.63,38,,5.304,percent of total billed charges,38% of total billed charges,6.63,38,,5.304,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,15.71,90,,12.568,percent of total billed charges,90% of total billed charges,6.11,35,,4.888,percent of total billed charges,35% of total billed charges,11.74,67.275,,9.392,percent of total billed charges,67.275% of total billed charges,13.96,80,,11.168,percent of total billed charges,80% of total billed charges,6.7,38.38,,5.36,percent of total billed charges,38.38% of total billed charges,13.96,80,,11.168,percent of total billed charges,80% of total billed charges,10.77,61.74,,8.616,percent of total billed charges,61.74% of total billed charges,17.8,102,,14.24,percent of total billed charges,102% of total billed charges,6.63,38,,5.304,percent of total billed charges,38% of total billed charges,6.11,17.8,
HME STRAIGHT FILTER,3003565,CDM,270,RC,,,Outpatient,,,17.46,13.1,,13.62,78,,10.896,percent of total billed charges,78% of total billed charges,11,63,,8.8,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.63,38,,5.304,percent of total billed charges,38% of total billed charges,6.63,38,,5.304,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,15.71,90,,12.568,percent of total billed charges,90% of total billed charges,6.11,35,,4.888,percent of total billed charges,35% of total billed charges,11.75,67.275,,9.4,percent of total billed charges,67.275% of total billed charges,13.97,80,,11.176,percent of total billed charges,80% of total billed charges,6.7,38.38,,5.36,percent of total billed charges,38.38% of total billed charges,13.97,80,,11.176,percent of total billed charges,80% of total billed charges,10.78,61.74,,8.624,percent of total billed charges,61.74% of total billed charges,17.81,102,,14.248,percent of total billed charges,102% of total billed charges,6.63,38,,5.304,percent of total billed charges,38% of total billed charges,6.11,17.81,
GAIT BELT - 72,3001831,CDM,270,RC,,,Outpatient,,,17.5,13.13,,13.65,78,,10.92,percent of total billed charges,78% of total billed charges,11.03,63,,8.824,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.65,38,,5.32,percent of total billed charges,38% of total billed charges,6.65,38,,5.32,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,15.75,90,,12.6,percent of total billed charges,90% of total billed charges,6.13,35,,4.904,percent of total billed charges,35% of total billed charges,11.77,67.275,,9.416,percent of total billed charges,67.275% of total billed charges,14,80,,11.2,percent of total billed charges,80% of total billed charges,6.72,38.38,,5.376,percent of total billed charges,38.38% of total billed charges,14,80,,11.2,percent of total billed charges,80% of total billed charges,10.8,61.74,,8.64,percent of total billed charges,61.74% of total billed charges,17.85,102,,14.28,percent of total billed charges,102% of total billed charges,6.65,38,,5.32,percent of total billed charges,38% of total billed charges,6.13,17.85,
REACHER - STANDARD 26,3004016,CDM,270,RC,,,Outpatient,,,17.55,13.16,,13.69,78,,10.952,percent of total billed charges,78% of total billed charges,11.06,63,,8.848,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.67,38,,5.336,percent of total billed charges,38% of total billed charges,6.67,38,,5.336,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,15.8,90,,12.64,percent of total billed charges,90% of total billed charges,6.14,35,,4.912,percent of total billed charges,35% of total billed charges,11.81,67.275,,9.448,percent of total billed charges,67.275% of total billed charges,14.04,80,,11.232,percent of total billed charges,80% of total billed charges,6.74,38.38,,5.392,percent of total billed charges,38.38% of total billed charges,14.04,80,,11.232,percent of total billed charges,80% of total billed charges,10.84,61.74,,8.672,percent of total billed charges,61.74% of total billed charges,17.9,102,,14.32,percent of total billed charges,102% of total billed charges,6.67,38,,5.336,percent of total billed charges,38% of total billed charges,6.14,17.9,
TEGADERM FOAM ADHESIVE DRESSING 6x6,3000527,CDM,270,RC,,,Outpatient,,,17.65,13.24,,13.77,78,,11.016,percent of total billed charges,78% of total billed charges,11.12,63,,8.896,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.71,38,,5.368,percent of total billed charges,38% of total billed charges,6.71,38,,5.368,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,15.89,90,,12.712,percent of total billed charges,90% of total billed charges,6.18,35,,4.944,percent of total billed charges,35% of total billed charges,11.87,67.275,,9.496,percent of total billed charges,67.275% of total billed charges,14.12,80,,11.296,percent of total billed charges,80% of total billed charges,6.77,38.38,,5.416,percent of total billed charges,38.38% of total billed charges,14.12,80,,11.296,percent of total billed charges,80% of total billed charges,10.9,61.74,,8.72,percent of total billed charges,61.74% of total billed charges,18,102,,14.4,percent of total billed charges,102% of total billed charges,6.71,38,,5.368,percent of total billed charges,38% of total billed charges,6.18,18,
STIRRUP STRAPS,3001515,CDM,270,RC,,,Outpatient,,,17.7,13.28,,13.81,78,,11.048,percent of total billed charges,78% of total billed charges,11.15,63,,8.92,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.73,38,,5.384,percent of total billed charges,38% of total billed charges,6.73,38,,5.384,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,15.93,90,,12.744,percent of total billed charges,90% of total billed charges,6.2,35,,4.96,percent of total billed charges,35% of total billed charges,11.91,67.275,,9.528,percent of total billed charges,67.275% of total billed charges,14.16,80,,11.328,percent of total billed charges,80% of total billed charges,6.79,38.38,,5.432,percent of total billed charges,38.38% of total billed charges,14.16,80,,11.328,percent of total billed charges,80% of total billed charges,10.93,61.74,,8.744,percent of total billed charges,61.74% of total billed charges,18.05,102,,14.44,percent of total billed charges,102% of total billed charges,6.73,38,,5.384,percent of total billed charges,38% of total billed charges,6.2,18.05,
PLAIN 843H,3002345,CDM,270,RC,,,Outpatient,,,17.7,13.28,,13.81,78,,11.048,percent of total billed charges,78% of total billed charges,11.15,63,,8.92,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.73,38,,5.384,percent of total billed charges,38% of total billed charges,6.73,38,,5.384,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,15.93,90,,12.744,percent of total billed charges,90% of total billed charges,6.2,35,,4.96,percent of total billed charges,35% of total billed charges,11.91,67.275,,9.528,percent of total billed charges,67.275% of total billed charges,14.16,80,,11.328,percent of total billed charges,80% of total billed charges,6.79,38.38,,5.432,percent of total billed charges,38.38% of total billed charges,14.16,80,,11.328,percent of total billed charges,80% of total billed charges,10.93,61.74,,8.744,percent of total billed charges,61.74% of total billed charges,18.05,102,,14.44,percent of total billed charges,102% of total billed charges,6.73,38,,5.384,percent of total billed charges,38% of total billed charges,6.2,18.05,
CATH URETHRAL COUDE 18FR,3000245,CDM,270,RC,,,Outpatient,,,17.8,13.35,,13.88,78,,11.104,percent of total billed charges,78% of total billed charges,11.21,63,,8.968,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.76,38,,5.408,percent of total billed charges,38% of total billed charges,6.76,38,,5.408,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,16.02,90,,12.816,percent of total billed charges,90% of total billed charges,6.23,35,,4.984,percent of total billed charges,35% of total billed charges,11.97,67.275,,9.576,percent of total billed charges,67.275% of total billed charges,14.24,80,,11.392,percent of total billed charges,80% of total billed charges,6.83,38.38,,5.464,percent of total billed charges,38.38% of total billed charges,14.24,80,,11.392,percent of total billed charges,80% of total billed charges,10.99,61.74,,8.792,percent of total billed charges,61.74% of total billed charges,18.16,102,,14.528,percent of total billed charges,102% of total billed charges,6.76,38,,5.408,percent of total billed charges,38% of total billed charges,6.23,18.16,
NASOPHARYNGEAL AIRWAY 28FR ROBERTAZZI,3003028,CDM,270,RC,,,Outpatient,,,17.83,13.37,,13.91,78,,11.128,percent of total billed charges,78% of total billed charges,11.23,63,,8.984,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.78,38,,5.424,percent of total billed charges,38% of total billed charges,6.78,38,,5.424,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,16.05,90,,12.84,percent of total billed charges,90% of total billed charges,6.24,35,,4.992,percent of total billed charges,35% of total billed charges,12,67.275,,9.6,percent of total billed charges,67.275% of total billed charges,14.26,80,,11.408,percent of total billed charges,80% of total billed charges,6.84,38.38,,5.472,percent of total billed charges,38.38% of total billed charges,14.26,80,,11.408,percent of total billed charges,80% of total billed charges,11.01,61.74,,8.808,percent of total billed charges,61.74% of total billed charges,18.19,102,,14.552,percent of total billed charges,102% of total billed charges,6.78,38,,5.424,percent of total billed charges,38% of total billed charges,6.24,18.19,
NASOPHARYNGEAL AIRWAY 32 FR. ROBERTAZZI,3004218,CDM,270,RC,,,Outpatient,,,17.83,13.37,,13.91,78,,11.128,percent of total billed charges,78% of total billed charges,11.23,63,,8.984,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.78,38,,5.424,percent of total billed charges,38% of total billed charges,6.78,38,,5.424,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,16.05,90,,12.84,percent of total billed charges,90% of total billed charges,6.24,35,,4.992,percent of total billed charges,35% of total billed charges,12,67.275,,9.6,percent of total billed charges,67.275% of total billed charges,14.26,80,,11.408,percent of total billed charges,80% of total billed charges,6.84,38.38,,5.472,percent of total billed charges,38.38% of total billed charges,14.26,80,,11.408,percent of total billed charges,80% of total billed charges,11.01,61.74,,8.808,percent of total billed charges,61.74% of total billed charges,18.19,102,,14.552,percent of total billed charges,102% of total billed charges,6.78,38,,5.424,percent of total billed charges,38% of total billed charges,6.24,18.19,
ANTIFUNGAL CREAM 4 OZ,3000600,CDM,270,RC,,,Outpatient,,,17.87,13.4,,13.94,78,,11.152,percent of total billed charges,78% of total billed charges,11.26,63,,9.008,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.79,38,,5.432,percent of total billed charges,38% of total billed charges,6.79,38,,5.432,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,16.08,90,,12.864,percent of total billed charges,90% of total billed charges,6.25,35,,5,percent of total billed charges,35% of total billed charges,12.02,67.275,,9.616,percent of total billed charges,67.275% of total billed charges,14.3,80,,11.44,percent of total billed charges,80% of total billed charges,6.86,38.38,,5.488,percent of total billed charges,38.38% of total billed charges,14.3,80,,11.44,percent of total billed charges,80% of total billed charges,11.03,61.74,,8.824,percent of total billed charges,61.74% of total billed charges,18.23,102,,14.584,percent of total billed charges,102% of total billed charges,6.79,38,,5.432,percent of total billed charges,38% of total billed charges,6.25,18.23,
PROLENE 2-0  MO-6,3005029,CDM,270,RC,,,Outpatient,,,17.9,13.43,,13.96,78,,11.168,percent of total billed charges,78% of total billed charges,11.28,63,,9.024,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.8,38,,5.44,percent of total billed charges,38% of total billed charges,6.8,38,,5.44,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,16.11,90,,12.888,percent of total billed charges,90% of total billed charges,6.27,35,,5.016,percent of total billed charges,35% of total billed charges,12.04,67.275,,9.632,percent of total billed charges,67.275% of total billed charges,14.32,80,,11.456,percent of total billed charges,80% of total billed charges,6.87,38.38,,5.496,percent of total billed charges,38.38% of total billed charges,14.32,80,,11.456,percent of total billed charges,80% of total billed charges,11.05,61.74,,8.84,percent of total billed charges,61.74% of total billed charges,18.26,102,,14.608,percent of total billed charges,102% of total billed charges,6.8,38,,5.44,percent of total billed charges,38% of total billed charges,6.27,18.26,
TELEMEDICINE SITE FEE-LIVE,1001400,CDM,510,RC,Q3014,HCPCS,Outpatient,,,18,13.5,,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,11.34,63,,9.072,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.84,38,,5.472,percent of total billed charges,38% of total billed charges,6.84,38,,5.472,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,6.3,35,,5.04,percent of total billed charges,35% of total billed charges,133.52,67.275,,106.816,percent of total billed charges,67.275% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.91,38.38,,5.528,percent of total billed charges,38.38% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.11,61.74,,8.888,percent of total billed charges,61.74% of total billed charges,18.36,102,,14.688,percent of total billed charges,102% of total billed charges,6.84,38,,5.472,percent of total billed charges,38% of total billed charges,6.3,133.52,
TELEMEDICINE SITE FEE STORE & FORWARD,1001401,CDM,510,RC,Q3014,HCPCS,Outpatient,,,18,13.5,,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,11.34,63,,9.072,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.84,38,,5.472,percent of total billed charges,38% of total billed charges,6.84,38,,5.472,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,6.3,35,,5.04,percent of total billed charges,35% of total billed charges,133.52,67.275,,106.816,percent of total billed charges,67.275% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.91,38.38,,5.528,percent of total billed charges,38.38% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.11,61.74,,8.888,percent of total billed charges,61.74% of total billed charges,18.36,102,,14.688,percent of total billed charges,102% of total billed charges,6.84,38,,5.472,percent of total billed charges,38% of total billed charges,6.3,133.52,
SPECIFIC GRAVITY,5000650,CDM,300,RC,,,Outpatient,,,18,13.5,,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,11.34,63,,9.072,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.84,38,,5.472,percent of total billed charges,38% of total billed charges,6.84,38,,5.472,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,6.3,35,,5.04,percent of total billed charges,35% of total billed charges,12.11,67.275,,9.688,percent of total billed charges,67.275% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.91,38.38,,5.528,percent of total billed charges,38.38% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.11,61.74,,8.888,percent of total billed charges,61.74% of total billed charges,18.36,102,,14.688,percent of total billed charges,102% of total billed charges,6.84,38,,5.472,percent of total billed charges,38% of total billed charges,6.3,18.36,
THROMBIN TIME; PLASMA,5003901,CDM,300,RC,85670,HCPCS,Outpatient,,,18,13.5,,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,7.26,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.77,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.77,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,7.62,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,12.11,67.275,,9.688,percent of total billed charges,67.275% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,5.83,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.11,61.74,,8.888,percent of total billed charges,61.74% of total billed charges,7.41,102,,,Fee Schedule,102% of GA Medicaid Rate,5.77,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.77,16.2,
"MM SCREEN, CAD +",7601001,CDM,403,RC,77052,HCPCS,Outpatient,,,18,13.5,,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,11.34,63,,9.072,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.84,38,,5.472,percent of total billed charges,38% of total billed charges,6.84,38,,5.472,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,6.3,35,,5.04,percent of total billed charges,35% of total billed charges,12.11,67.275,,9.688,percent of total billed charges,67.275% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.91,38.38,,5.528,percent of total billed charges,38.38% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.11,61.74,,8.888,percent of total billed charges,61.74% of total billed charges,18.36,102,,14.688,percent of total billed charges,102% of total billed charges,6.84,38,,5.472,percent of total billed charges,38% of total billed charges,6.3,18.36,
MM DIAGNOSTIC CAD+,7601060,CDM,401,RC,77051,HCPCS,Outpatient,,,18,13.5,,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,11.34,63,,9.072,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.84,38,,5.472,percent of total billed charges,38% of total billed charges,6.84,38,,5.472,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,6.3,35,,5.04,percent of total billed charges,35% of total billed charges,12.11,67.275,,9.688,percent of total billed charges,67.275% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.91,38.38,,5.528,percent of total billed charges,38.38% of total billed charges,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,11.11,61.74,,8.888,percent of total billed charges,61.74% of total billed charges,18.36,102,,14.688,percent of total billed charges,102% of total billed charges,6.84,38,,5.472,percent of total billed charges,38% of total billed charges,6.3,18.36,
CERVICAL COLLAR SOFT 3.5,3001016,CDM,270,RC,,,Outpatient,,,18.05,13.54,,14.08,78,,11.264,percent of total billed charges,78% of total billed charges,11.37,63,,9.096,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.86,38,,5.488,percent of total billed charges,38% of total billed charges,6.86,38,,5.488,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,16.25,90,,13,percent of total billed charges,90% of total billed charges,6.32,35,,5.056,percent of total billed charges,35% of total billed charges,12.14,67.275,,9.712,percent of total billed charges,67.275% of total billed charges,14.44,80,,11.552,percent of total billed charges,80% of total billed charges,6.93,38.38,,5.544,percent of total billed charges,38.38% of total billed charges,14.44,80,,11.552,percent of total billed charges,80% of total billed charges,11.14,61.74,,8.912,percent of total billed charges,61.74% of total billed charges,18.41,102,,14.728,percent of total billed charges,102% of total billed charges,6.86,38,,5.488,percent of total billed charges,38% of total billed charges,6.32,18.41,
CATH SPEC KIT NEONATAL,3003067,CDM,270,RC,,,Outpatient,,,18.05,13.54,,14.08,78,,11.264,percent of total billed charges,78% of total billed charges,11.37,63,,9.096,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.86,38,,5.488,percent of total billed charges,38% of total billed charges,6.86,38,,5.488,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,16.25,90,,13,percent of total billed charges,90% of total billed charges,6.32,35,,5.056,percent of total billed charges,35% of total billed charges,12.14,67.275,,9.712,percent of total billed charges,67.275% of total billed charges,14.44,80,,11.552,percent of total billed charges,80% of total billed charges,6.93,38.38,,5.544,percent of total billed charges,38.38% of total billed charges,14.44,80,,11.552,percent of total billed charges,80% of total billed charges,11.14,61.74,,8.912,percent of total billed charges,61.74% of total billed charges,18.41,102,,14.728,percent of total billed charges,102% of total billed charges,6.86,38,,5.488,percent of total billed charges,38% of total billed charges,6.32,18.41,
CHROMIC GUT 2-0 CT-2 883H,3002338,CDM,270,RC,,,Outpatient,,,18.25,13.69,,14.24,78,,11.392,percent of total billed charges,78% of total billed charges,11.5,63,,9.2,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.94,38,,5.552,percent of total billed charges,38% of total billed charges,6.94,38,,5.552,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,16.43,90,,13.144,percent of total billed charges,90% of total billed charges,6.39,35,,5.112,percent of total billed charges,35% of total billed charges,12.28,67.275,,9.824,percent of total billed charges,67.275% of total billed charges,14.6,80,,11.68,percent of total billed charges,80% of total billed charges,7,38.38,,5.6,percent of total billed charges,38.38% of total billed charges,14.6,80,,11.68,percent of total billed charges,80% of total billed charges,11.27,61.74,,9.016,percent of total billed charges,61.74% of total billed charges,18.62,102,,14.896,percent of total billed charges,102% of total billed charges,6.94,38,,5.552,percent of total billed charges,38% of total billed charges,6.39,18.62,
THORACIC CATHETER 24 FR CHEST,3002540,CDM,270,RC,,,Outpatient,,,18.25,13.69,,14.24,78,,11.392,percent of total billed charges,78% of total billed charges,11.5,63,,9.2,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.94,38,,5.552,percent of total billed charges,38% of total billed charges,6.94,38,,5.552,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,16.43,90,,13.144,percent of total billed charges,90% of total billed charges,6.39,35,,5.112,percent of total billed charges,35% of total billed charges,12.28,67.275,,9.824,percent of total billed charges,67.275% of total billed charges,14.6,80,,11.68,percent of total billed charges,80% of total billed charges,7,38.38,,5.6,percent of total billed charges,38.38% of total billed charges,14.6,80,,11.68,percent of total billed charges,80% of total billed charges,11.27,61.74,,9.016,percent of total billed charges,61.74% of total billed charges,18.62,102,,14.896,percent of total billed charges,102% of total billed charges,6.94,38,,5.552,percent of total billed charges,38% of total billed charges,6.39,18.62,
THORACIC CATHETER 16 FR CHEST,3002543,CDM,270,RC,,,Outpatient,,,18.25,13.69,,14.24,78,,11.392,percent of total billed charges,78% of total billed charges,11.5,63,,9.2,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.94,38,,5.552,percent of total billed charges,38% of total billed charges,6.94,38,,5.552,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,16.43,90,,13.144,percent of total billed charges,90% of total billed charges,6.39,35,,5.112,percent of total billed charges,35% of total billed charges,12.28,67.275,,9.824,percent of total billed charges,67.275% of total billed charges,14.6,80,,11.68,percent of total billed charges,80% of total billed charges,7,38.38,,5.6,percent of total billed charges,38.38% of total billed charges,14.6,80,,11.68,percent of total billed charges,80% of total billed charges,11.27,61.74,,9.016,percent of total billed charges,61.74% of total billed charges,18.62,102,,14.896,percent of total billed charges,102% of total billed charges,6.94,38,,5.552,percent of total billed charges,38% of total billed charges,6.39,18.62,
CLAVICLE SPLINT MD,3001323,CDM,270,RC,,,Outpatient,,,18.3,13.73,,14.27,78,,11.416,percent of total billed charges,78% of total billed charges,11.53,63,,9.224,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.95,38,,5.56,percent of total billed charges,38% of total billed charges,6.95,38,,5.56,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,16.47,90,,13.176,percent of total billed charges,90% of total billed charges,6.41,35,,5.128,percent of total billed charges,35% of total billed charges,12.31,67.275,,9.848,percent of total billed charges,67.275% of total billed charges,14.64,80,,11.712,percent of total billed charges,80% of total billed charges,7.02,38.38,,5.616,percent of total billed charges,38.38% of total billed charges,14.64,80,,11.712,percent of total billed charges,80% of total billed charges,11.3,61.74,,9.04,percent of total billed charges,61.74% of total billed charges,18.67,102,,14.936,percent of total billed charges,102% of total billed charges,6.95,38,,5.56,percent of total billed charges,38% of total billed charges,6.41,18.67,
TRACH INNER CANNULA SZ 4,3000303,CDM,270,RC,,,Outpatient,,,18.37,13.78,,14.33,78,,11.464,percent of total billed charges,78% of total billed charges,11.57,63,,9.256,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.98,38,,5.584,percent of total billed charges,38% of total billed charges,6.98,38,,5.584,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,16.53,90,,13.224,percent of total billed charges,90% of total billed charges,6.43,35,,5.144,percent of total billed charges,35% of total billed charges,12.36,67.275,,9.888,percent of total billed charges,67.275% of total billed charges,14.7,80,,11.76,percent of total billed charges,80% of total billed charges,7.05,38.38,,5.64,percent of total billed charges,38.38% of total billed charges,14.7,80,,11.76,percent of total billed charges,80% of total billed charges,11.34,61.74,,9.072,percent of total billed charges,61.74% of total billed charges,18.74,102,,14.992,percent of total billed charges,102% of total billed charges,6.98,38,,5.584,percent of total billed charges,38% of total billed charges,6.43,18.74,
FINGER SPLINT W/VELCRO SMALL 79-87123,3000506,CDM,270,RC,,,Outpatient,,,18.4,13.8,,14.35,78,,11.48,percent of total billed charges,78% of total billed charges,11.59,63,,9.272,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.99,38,,5.592,percent of total billed charges,38% of total billed charges,6.99,38,,5.592,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,16.56,90,,13.248,percent of total billed charges,90% of total billed charges,6.44,35,,5.152,percent of total billed charges,35% of total billed charges,12.38,67.275,,9.904,percent of total billed charges,67.275% of total billed charges,14.72,80,,11.776,percent of total billed charges,80% of total billed charges,7.06,38.38,,5.648,percent of total billed charges,38.38% of total billed charges,14.72,80,,11.776,percent of total billed charges,80% of total billed charges,11.36,61.74,,9.088,percent of total billed charges,61.74% of total billed charges,18.77,102,,15.016,percent of total billed charges,102% of total billed charges,6.99,38,,5.592,percent of total billed charges,38% of total billed charges,6.44,18.77,
PLAIN GUT 3-0 CT-1 842H,3004008,CDM,270,RC,,,Outpatient,,,18.4,13.8,,14.35,78,,11.48,percent of total billed charges,78% of total billed charges,11.59,63,,9.272,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,6.99,38,,5.592,percent of total billed charges,38% of total billed charges,6.99,38,,5.592,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,16.56,90,,13.248,percent of total billed charges,90% of total billed charges,6.44,35,,5.152,percent of total billed charges,35% of total billed charges,12.38,67.275,,9.904,percent of total billed charges,67.275% of total billed charges,14.72,80,,11.776,percent of total billed charges,80% of total billed charges,7.06,38.38,,5.648,percent of total billed charges,38.38% of total billed charges,14.72,80,,11.776,percent of total billed charges,80% of total billed charges,11.36,61.74,,9.088,percent of total billed charges,61.74% of total billed charges,18.77,102,,15.016,percent of total billed charges,102% of total billed charges,6.99,38,,5.592,percent of total billed charges,38% of total billed charges,6.44,18.77,
ETHILON 3/0  1663H,3004244,CDM,270,RC,,,Outpatient,,,18.41,13.81,,14.36,78,,11.488,percent of total billed charges,78% of total billed charges,11.6,63,,9.28,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,7,38,,5.6,percent of total billed charges,38% of total billed charges,7,38,,5.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,16.57,90,,13.256,percent of total billed charges,90% of total billed charges,6.44,35,,5.152,percent of total billed charges,35% of total billed charges,12.39,67.275,,9.912,percent of total billed charges,67.275% of total billed charges,14.73,80,,11.784,percent of total billed charges,80% of total billed charges,7.07,38.38,,5.656,percent of total billed charges,38.38% of total billed charges,14.73,80,,11.784,percent of total billed charges,80% of total billed charges,11.37,61.74,,9.096,percent of total billed charges,61.74% of total billed charges,18.78,102,,15.024,percent of total billed charges,102% of total billed charges,7,38,,5.6,percent of total billed charges,38% of total billed charges,6.44,18.78,
CHROMIC 0  G124H,3004247,CDM,270,RC,,,Outpatient,,,18.76,14.07,,14.63,78,,11.704,percent of total billed charges,78% of total billed charges,11.82,63,,9.456,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,7.13,38,,5.704,percent of total billed charges,38% of total billed charges,7.13,38,,5.704,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,16.88,90,,13.504,percent of total billed charges,90% of total billed charges,6.57,35,,5.256,percent of total billed charges,35% of total billed charges,12.62,67.275,,10.096,percent of total billed charges,67.275% of total billed charges,15.01,80,,12.008,percent of total billed charges,80% of total billed charges,7.2,38.38,,5.76,percent of total billed charges,38.38% of total billed charges,15.01,80,,12.008,percent of total billed charges,80% of total billed charges,11.58,61.74,,9.264,percent of total billed charges,61.74% of total billed charges,19.14,102,,15.312,percent of total billed charges,102% of total billed charges,7.13,38,,5.704,percent of total billed charges,38% of total billed charges,6.57,19.14,
SHOE HORN 24,3004031,CDM,270,RC,,,Outpatient,,,18.85,14.14,,14.7,78,,11.76,percent of total billed charges,78% of total billed charges,11.88,63,,9.504,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,7.16,38,,5.728,percent of total billed charges,38% of total billed charges,7.16,38,,5.728,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,16.97,90,,13.576,percent of total billed charges,90% of total billed charges,6.6,35,,5.28,percent of total billed charges,35% of total billed charges,12.68,67.275,,10.144,percent of total billed charges,67.275% of total billed charges,15.08,80,,12.064,percent of total billed charges,80% of total billed charges,7.23,38.38,,5.784,percent of total billed charges,38.38% of total billed charges,15.08,80,,12.064,percent of total billed charges,80% of total billed charges,11.64,61.74,,9.312,percent of total billed charges,61.74% of total billed charges,19.23,102,,15.384,percent of total billed charges,102% of total billed charges,7.16,38,,5.728,percent of total billed charges,38% of total billed charges,6.6,19.23,
GAIT BELT - 60,3001829,CDM,270,RC,,,Outpatient,,,18.95,14.21,,14.78,78,,11.824,percent of total billed charges,78% of total billed charges,11.94,63,,9.552,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,7.2,38,,5.76,percent of total billed charges,38% of total billed charges,7.2,38,,5.76,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,17.06,90,,13.648,percent of total billed charges,90% of total billed charges,6.63,35,,5.304,percent of total billed charges,35% of total billed charges,12.75,67.275,,10.2,percent of total billed charges,67.275% of total billed charges,15.16,80,,12.128,percent of total billed charges,80% of total billed charges,7.27,38.38,,5.816,percent of total billed charges,38.38% of total billed charges,15.16,80,,12.128,percent of total billed charges,80% of total billed charges,11.7,61.74,,9.36,percent of total billed charges,61.74% of total billed charges,19.33,102,,15.464,percent of total billed charges,102% of total billed charges,7.2,38,,5.76,percent of total billed charges,38% of total billed charges,6.63,19.33,
SHRIMP IgE,5001685,CDM,302,RC,86003,HCPCS,Outpatient,,,19,14.25,,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,12.78,67.275,,10.224,percent of total billed charges,67.275% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,5.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,11.73,61.74,,9.384,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,17.1,
HEMATOCRIT- MULTIPLE,5009120,CDM,305,RC,85014,HCPCS,Outpatient,,,19,14.25,,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,2.98,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,2.37,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,2.37,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,3.13,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,12.78,67.275,,10.224,percent of total billed charges,67.275% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,2.39,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,11.73,61.74,,9.384,percent of total billed charges,61.74% of total billed charges,3.04,102,,,Fee Schedule,102% of GA Medicaid Rate,2.37,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,2.37,17.1,
Blood test to measure levels of hemoglobin,5009150,CDM,305,RC,85018,HCPCS,Outpatient,,,19,14.25,,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,2.98,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,2.37,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,2.37,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,3.13,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,12.78,67.275,,10.224,percent of total billed charges,67.275% of total billed charges,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,2.39,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,11.73,61.74,,9.384,percent of total billed charges,61.74% of total billed charges,3.04,102,,,Fee Schedule,102% of GA Medicaid Rate,2.37,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,2.37,17.1,
TRACH INNER CANNULA SZ 8,3000314,CDM,270,RC,,,Outpatient,,,19.19,14.39,,14.97,78,,11.976,percent of total billed charges,78% of total billed charges,12.09,63,,9.672,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,7.29,38,,5.832,percent of total billed charges,38% of total billed charges,7.29,38,,5.832,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,17.27,90,,13.816,percent of total billed charges,90% of total billed charges,6.72,35,,5.376,percent of total billed charges,35% of total billed charges,12.91,67.275,,10.328,percent of total billed charges,67.275% of total billed charges,15.35,80,,12.28,percent of total billed charges,80% of total billed charges,7.37,38.38,,5.896,percent of total billed charges,38.38% of total billed charges,15.35,80,,12.28,percent of total billed charges,80% of total billed charges,11.85,61.74,,9.48,percent of total billed charges,61.74% of total billed charges,19.57,102,,15.656,percent of total billed charges,102% of total billed charges,7.29,38,,5.832,percent of total billed charges,38% of total billed charges,6.72,19.57,
CLAVICLE SPLINT LARGE,3001322,CDM,270,RC,,,Outpatient,,,19.2,14.4,,14.98,78,,11.984,percent of total billed charges,78% of total billed charges,12.1,63,,9.68,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,7.3,38,,5.84,percent of total billed charges,38% of total billed charges,7.3,38,,5.84,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,17.28,90,,13.824,percent of total billed charges,90% of total billed charges,6.72,35,,5.376,percent of total billed charges,35% of total billed charges,12.92,67.275,,10.336,percent of total billed charges,67.275% of total billed charges,15.36,80,,12.288,percent of total billed charges,80% of total billed charges,7.37,38.38,,5.896,percent of total billed charges,38.38% of total billed charges,15.36,80,,12.288,percent of total billed charges,80% of total billed charges,11.85,61.74,,9.48,percent of total billed charges,61.74% of total billed charges,19.58,102,,15.664,percent of total billed charges,102% of total billed charges,7.3,38,,5.84,percent of total billed charges,38% of total billed charges,6.72,19.58,
VICRYL 3-0 PS-2 J497G,3001663,CDM,270,RC,,,Outpatient,,,19.2,14.4,,14.98,78,,11.984,percent of total billed charges,78% of total billed charges,12.1,63,,9.68,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,7.3,38,,5.84,percent of total billed charges,38% of total billed charges,7.3,38,,5.84,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,17.28,90,,13.824,percent of total billed charges,90% of total billed charges,6.72,35,,5.376,percent of total billed charges,35% of total billed charges,12.92,67.275,,10.336,percent of total billed charges,67.275% of total billed charges,15.36,80,,12.288,percent of total billed charges,80% of total billed charges,7.37,38.38,,5.896,percent of total billed charges,38.38% of total billed charges,15.36,80,,12.288,percent of total billed charges,80% of total billed charges,11.85,61.74,,9.48,percent of total billed charges,61.74% of total billed charges,19.58,102,,15.664,percent of total billed charges,102% of total billed charges,7.3,38,,5.84,percent of total billed charges,38% of total billed charges,6.72,19.58,
SPLINT METAL FOREARM (SM-LT) NON-PADDED,3001721,CDM,270,RC,,,Outpatient,,,19.2,14.4,,14.98,78,,11.984,percent of total billed charges,78% of total billed charges,12.1,63,,9.68,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,7.3,38,,5.84,percent of total billed charges,38% of total billed charges,7.3,38,,5.84,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,17.28,90,,13.824,percent of total billed charges,90% of total billed charges,6.72,35,,5.376,percent of total billed charges,35% of total billed charges,12.92,67.275,,10.336,percent of total billed charges,67.275% of total billed charges,15.36,80,,12.288,percent of total billed charges,80% of total billed charges,7.37,38.38,,5.896,percent of total billed charges,38.38% of total billed charges,15.36,80,,12.288,percent of total billed charges,80% of total billed charges,11.85,61.74,,9.48,percent of total billed charges,61.74% of total billed charges,19.58,102,,15.664,percent of total billed charges,102% of total billed charges,7.3,38,,5.84,percent of total billed charges,38% of total billed charges,6.72,19.58,
SPLINT METAL FOREARM (LG LT),3002332,CDM,270,RC,,,Outpatient,,,19.2,14.4,,14.98,78,,11.984,percent of total billed charges,78% of total billed charges,12.1,63,,9.68,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,7.3,38,,5.84,percent of total billed charges,38% of total billed charges,7.3,38,,5.84,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,17.28,90,,13.824,percent of total billed charges,90% of total billed charges,6.72,35,,5.376,percent of total billed charges,35% of total billed charges,12.92,67.275,,10.336,percent of total billed charges,67.275% of total billed charges,15.36,80,,12.288,percent of total billed charges,80% of total billed charges,7.37,38.38,,5.896,percent of total billed charges,38.38% of total billed charges,15.36,80,,12.288,percent of total billed charges,80% of total billed charges,11.85,61.74,,9.48,percent of total billed charges,61.74% of total billed charges,19.58,102,,15.664,percent of total billed charges,102% of total billed charges,7.3,38,,5.84,percent of total billed charges,38% of total billed charges,6.72,19.58,
SPLINT WRIST SM LEFT,3002329,CDM,270,RC,,,Outpatient,,,19.25,14.44,,15.02,78,,12.016,percent of total billed charges,78% of total billed charges,12.13,63,,9.704,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,7.32,38,,5.856,percent of total billed charges,38% of total billed charges,7.32,38,,5.856,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,17.33,90,,13.864,percent of total billed charges,90% of total billed charges,6.74,35,,5.392,percent of total billed charges,35% of total billed charges,12.95,67.275,,10.36,percent of total billed charges,67.275% of total billed charges,15.4,80,,12.32,percent of total billed charges,80% of total billed charges,7.39,38.38,,5.912,percent of total billed charges,38.38% of total billed charges,15.4,80,,12.32,percent of total billed charges,80% of total billed charges,11.88,61.74,,9.504,percent of total billed charges,61.74% of total billed charges,19.64,102,,15.712,percent of total billed charges,102% of total billed charges,7.32,38,,5.856,percent of total billed charges,38% of total billed charges,6.74,19.64,
VICRYL 0 UR-6,3001553,CDM,270,RC,,,Outpatient,,,19.41,14.56,,15.14,78,,12.112,percent of total billed charges,78% of total billed charges,12.23,63,,9.784,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,7.38,38,,5.904,percent of total billed charges,38% of total billed charges,7.38,38,,5.904,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,17.47,90,,13.976,percent of total billed charges,90% of total billed charges,6.79,35,,5.432,percent of total billed charges,35% of total billed charges,13.06,67.275,,10.448,percent of total billed charges,67.275% of total billed charges,15.53,80,,12.424,percent of total billed charges,80% of total billed charges,7.45,38.38,,5.96,percent of total billed charges,38.38% of total billed charges,15.53,80,,12.424,percent of total billed charges,80% of total billed charges,11.98,61.74,,9.584,percent of total billed charges,61.74% of total billed charges,19.8,102,,15.84,percent of total billed charges,102% of total billed charges,7.38,38,,5.904,percent of total billed charges,38% of total billed charges,6.79,19.8,
ETHILON 2-0 593H,3001597,CDM,270,RC,,,Outpatient,,,19.45,14.59,,15.17,78,,12.136,percent of total billed charges,78% of total billed charges,12.25,63,,9.8,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,7.39,38,,5.912,percent of total billed charges,38% of total billed charges,7.39,38,,5.912,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,17.51,90,,14.008,percent of total billed charges,90% of total billed charges,6.81,35,,5.448,percent of total billed charges,35% of total billed charges,13.08,67.275,,10.464,percent of total billed charges,67.275% of total billed charges,15.56,80,,12.448,percent of total billed charges,80% of total billed charges,7.46,38.38,,5.968,percent of total billed charges,38.38% of total billed charges,15.56,80,,12.448,percent of total billed charges,80% of total billed charges,12.01,61.74,,9.608,percent of total billed charges,61.74% of total billed charges,19.84,102,,15.872,percent of total billed charges,102% of total billed charges,7.39,38,,5.912,percent of total billed charges,38% of total billed charges,6.81,19.84,
GAUZE IODOFORM 1 INCH,3000606,CDM,270,RC,,,Outpatient,,,19.5,14.63,,15.21,78,,12.168,percent of total billed charges,78% of total billed charges,12.29,63,,9.832,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,7.41,38,,5.928,percent of total billed charges,38% of total billed charges,7.41,38,,5.928,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,17.55,90,,14.04,percent of total billed charges,90% of total billed charges,6.83,35,,5.464,percent of total billed charges,35% of total billed charges,13.12,67.275,,10.496,percent of total billed charges,67.275% of total billed charges,15.6,80,,12.48,percent of total billed charges,80% of total billed charges,7.48,38.38,,5.984,percent of total billed charges,38.38% of total billed charges,15.6,80,,12.48,percent of total billed charges,80% of total billed charges,12.04,61.74,,9.632,percent of total billed charges,61.74% of total billed charges,19.89,102,,15.912,percent of total billed charges,102% of total billed charges,7.41,38,,5.928,percent of total billed charges,38% of total billed charges,6.83,19.89,
WAFER STOMA AUTOLOCK,3000701,CDM,270,RC,,,Outpatient,,,19.55,14.66,,15.25,78,,12.2,percent of total billed charges,78% of total billed charges,12.32,63,,9.856,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,7.43,38,,5.944,percent of total billed charges,38% of total billed charges,7.43,38,,5.944,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,17.6,90,,14.08,percent of total billed charges,90% of total billed charges,6.84,35,,5.472,percent of total billed charges,35% of total billed charges,13.15,67.275,,10.52,percent of total billed charges,67.275% of total billed charges,15.64,80,,12.512,percent of total billed charges,80% of total billed charges,7.5,38.38,,6,percent of total billed charges,38.38% of total billed charges,15.64,80,,12.512,percent of total billed charges,80% of total billed charges,12.07,61.74,,9.656,percent of total billed charges,61.74% of total billed charges,19.94,102,,15.952,percent of total billed charges,102% of total billed charges,7.43,38,,5.944,percent of total billed charges,38% of total billed charges,6.84,19.94,
CERVICAL COLLAR UNIV 3,3000238,CDM,270,RC,,,Outpatient,,,19.6,14.7,,15.29,78,,12.232,percent of total billed charges,78% of total billed charges,12.35,63,,9.88,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,7.45,38,,5.96,percent of total billed charges,38% of total billed charges,7.45,38,,5.96,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,17.64,90,,14.112,percent of total billed charges,90% of total billed charges,6.86,35,,5.488,percent of total billed charges,35% of total billed charges,13.19,67.275,,10.552,percent of total billed charges,67.275% of total billed charges,15.68,80,,12.544,percent of total billed charges,80% of total billed charges,7.52,38.38,,6.016,percent of total billed charges,38.38% of total billed charges,15.68,80,,12.544,percent of total billed charges,80% of total billed charges,12.1,61.74,,9.68,percent of total billed charges,61.74% of total billed charges,19.99,102,,15.992,percent of total billed charges,102% of total billed charges,7.45,38,,5.96,percent of total billed charges,38% of total billed charges,6.86,19.99,
FINGER SPLINT VELCRO MED,3001615,CDM,270,RC,,,Outpatient,,,19.65,14.74,,15.33,78,,12.264,percent of total billed charges,78% of total billed charges,12.38,63,,9.904,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,7.47,38,,5.976,percent of total billed charges,38% of total billed charges,7.47,38,,5.976,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,17.69,90,,14.152,percent of total billed charges,90% of total billed charges,6.88,35,,5.504,percent of total billed charges,35% of total billed charges,13.22,67.275,,10.576,percent of total billed charges,67.275% of total billed charges,15.72,80,,12.576,percent of total billed charges,80% of total billed charges,7.54,38.38,,6.032,percent of total billed charges,38.38% of total billed charges,15.72,80,,12.576,percent of total billed charges,80% of total billed charges,12.13,61.74,,9.704,percent of total billed charges,61.74% of total billed charges,20.04,102,,16.032,percent of total billed charges,102% of total billed charges,7.47,38,,5.976,percent of total billed charges,38% of total billed charges,6.88,20.04,
FINGER SPLINT VELCRO LARGE,3001616,CDM,270,RC,,,Outpatient,,,19.65,14.74,,15.33,78,,12.264,percent of total billed charges,78% of total billed charges,12.38,63,,9.904,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,7.47,38,,5.976,percent of total billed charges,38% of total billed charges,7.47,38,,5.976,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,17.69,90,,14.152,percent of total billed charges,90% of total billed charges,6.88,35,,5.504,percent of total billed charges,35% of total billed charges,13.22,67.275,,10.576,percent of total billed charges,67.275% of total billed charges,15.72,80,,12.576,percent of total billed charges,80% of total billed charges,7.54,38.38,,6.032,percent of total billed charges,38.38% of total billed charges,15.72,80,,12.576,percent of total billed charges,80% of total billed charges,12.13,61.74,,9.704,percent of total billed charges,61.74% of total billed charges,20.04,102,,16.032,percent of total billed charges,102% of total billed charges,7.47,38,,5.976,percent of total billed charges,38% of total billed charges,6.88,20.04,
NASAL AIRWAY ROBERTAZZI 30 FR,3003064,CDM,270,RC,,,Outpatient,,,19.78,14.84,,15.43,78,,12.344,percent of total billed charges,78% of total billed charges,12.46,63,,9.968,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,7.52,38,,6.016,percent of total billed charges,38% of total billed charges,7.52,38,,6.016,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,17.8,90,,14.24,percent of total billed charges,90% of total billed charges,6.92,35,,5.536,percent of total billed charges,35% of total billed charges,13.31,67.275,,10.648,percent of total billed charges,67.275% of total billed charges,15.82,80,,12.656,percent of total billed charges,80% of total billed charges,7.59,38.38,,6.072,percent of total billed charges,38.38% of total billed charges,15.82,80,,12.656,percent of total billed charges,80% of total billed charges,12.21,61.74,,9.768,percent of total billed charges,61.74% of total billed charges,20.18,102,,16.144,percent of total billed charges,102% of total billed charges,7.52,38,,6.016,percent of total billed charges,38% of total billed charges,6.92,20.18,
ETHILON 3-0 PS-2 1669H,3001544,CDM,270,RC,,,Outpatient,,,19.85,14.89,,15.48,78,,12.384,percent of total billed charges,78% of total billed charges,12.51,63,,10.008,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,7.54,38,,6.032,percent of total billed charges,38% of total billed charges,7.54,38,,6.032,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,17.87,90,,14.296,percent of total billed charges,90% of total billed charges,6.95,35,,5.56,percent of total billed charges,35% of total billed charges,13.35,67.275,,10.68,percent of total billed charges,67.275% of total billed charges,15.88,80,,12.704,percent of total billed charges,80% of total billed charges,7.62,38.38,,6.096,percent of total billed charges,38.38% of total billed charges,15.88,80,,12.704,percent of total billed charges,80% of total billed charges,12.26,61.74,,9.808,percent of total billed charges,61.74% of total billed charges,20.25,102,,16.2,percent of total billed charges,102% of total billed charges,7.54,38,,6.032,percent of total billed charges,38% of total billed charges,6.95,20.25,
STOCKINETTE IMPERVIOUS 9X36 STERILE,3001769,CDM,270,RC,,,Outpatient,,,19.85,14.89,,15.48,78,,12.384,percent of total billed charges,78% of total billed charges,12.51,63,,10.008,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,7.54,38,,6.032,percent of total billed charges,38% of total billed charges,7.54,38,,6.032,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,17.87,90,,14.296,percent of total billed charges,90% of total billed charges,6.95,35,,5.56,percent of total billed charges,35% of total billed charges,13.35,67.275,,10.68,percent of total billed charges,67.275% of total billed charges,15.88,80,,12.704,percent of total billed charges,80% of total billed charges,7.62,38.38,,6.096,percent of total billed charges,38.38% of total billed charges,15.88,80,,12.704,percent of total billed charges,80% of total billed charges,12.26,61.74,,9.808,percent of total billed charges,61.74% of total billed charges,20.25,102,,16.2,percent of total billed charges,102% of total billed charges,7.54,38,,6.032,percent of total billed charges,38% of total billed charges,6.95,20.25,
OSTOMY KIT - HOLLISTER,3001502,CDM,270,RC,,,Outpatient,,,19.87,14.9,,15.5,78,,12.4,percent of total billed charges,78% of total billed charges,12.52,63,,10.016,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,7.55,38,,6.04,percent of total billed charges,38% of total billed charges,7.55,38,,6.04,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,17.88,90,,14.304,percent of total billed charges,90% of total billed charges,6.95,35,,5.56,percent of total billed charges,35% of total billed charges,13.37,67.275,,10.696,percent of total billed charges,67.275% of total billed charges,15.9,80,,12.72,percent of total billed charges,80% of total billed charges,7.63,38.38,,6.104,percent of total billed charges,38.38% of total billed charges,15.9,80,,12.72,percent of total billed charges,80% of total billed charges,12.27,61.74,,9.816,percent of total billed charges,61.74% of total billed charges,20.27,102,,16.216,percent of total billed charges,102% of total billed charges,7.55,38,,6.04,percent of total billed charges,38% of total billed charges,6.95,20.27,
DUO DERM 4 X 4 EXTRA THIN,3000338,CDM,270,RC,,,Outpatient,,,19.89,14.92,,15.51,78,,12.408,percent of total billed charges,78% of total billed charges,12.53,63,,10.024,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,7.56,38,,6.048,percent of total billed charges,38% of total billed charges,7.56,38,,6.048,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,17.9,90,,14.32,percent of total billed charges,90% of total billed charges,6.96,35,,5.568,percent of total billed charges,35% of total billed charges,13.38,67.275,,10.704,percent of total billed charges,67.275% of total billed charges,15.91,80,,12.728,percent of total billed charges,80% of total billed charges,7.63,38.38,,6.104,percent of total billed charges,38.38% of total billed charges,15.91,80,,12.728,percent of total billed charges,80% of total billed charges,12.28,61.74,,9.824,percent of total billed charges,61.74% of total billed charges,20.29,102,,16.232,percent of total billed charges,102% of total billed charges,7.56,38,,6.048,percent of total billed charges,38% of total billed charges,6.96,20.29,
WOUND CLEANSER,3003073,CDM,270,RC,,,Outpatient,,,19.96,14.97,,15.57,78,,12.456,percent of total billed charges,78% of total billed charges,12.57,63,,10.056,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,7.58,38,,6.064,percent of total billed charges,38% of total billed charges,7.58,38,,6.064,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,17.96,90,,14.368,percent of total billed charges,90% of total billed charges,6.99,35,,5.592,percent of total billed charges,35% of total billed charges,13.43,67.275,,10.744,percent of total billed charges,67.275% of total billed charges,15.97,80,,12.776,percent of total billed charges,80% of total billed charges,7.66,38.38,,6.128,percent of total billed charges,38.38% of total billed charges,15.97,80,,12.776,percent of total billed charges,80% of total billed charges,12.32,61.74,,9.856,percent of total billed charges,61.74% of total billed charges,20.36,102,,16.288,percent of total billed charges,102% of total billed charges,7.58,38,,6.064,percent of total billed charges,38% of total billed charges,6.99,20.36,
EOSINOPHILS-URINE,5000042,CDM,300,RC,81015,HCPCS,Outpatient,,,20,15,,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,3.82,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,3.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,18,90,,14.4,percent of total billed charges,90% of total billed charges,4.01,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,13.46,67.275,,10.768,percent of total billed charges,67.275% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,3.08,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,16,80,,12.8,percent of total billed charges,80% of total billed charges,12.35,61.74,,9.88,percent of total billed charges,61.74% of total billed charges,3.9,102,,,Fee Schedule,102% of GA Medicaid Rate,3.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.05,18,
Medical test to find an infection,5000139,CDM,306,RC,87081,HCPCS,Outpatient,,,20,15,,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,8.33,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.63,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.63,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,18,90,,14.4,percent of total billed charges,90% of total billed charges,8.75,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,13.46,67.275,,10.768,percent of total billed charges,67.275% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,6.7,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,16,80,,12.8,percent of total billed charges,80% of total billed charges,12.35,61.74,,9.88,percent of total billed charges,61.74% of total billed charges,8.5,102,,,Fee Schedule,102% of GA Medicaid Rate,6.63,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.63,18,
Medical test to find an infection,5000140,CDM,306,RC,87081,HCPCS,Outpatient,,,20,15,,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,8.33,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.63,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.63,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,18,90,,14.4,percent of total billed charges,90% of total billed charges,8.75,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,13.46,67.275,,10.768,percent of total billed charges,67.275% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,6.7,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,16,80,,12.8,percent of total billed charges,80% of total billed charges,12.35,61.74,,9.88,percent of total billed charges,61.74% of total billed charges,8.5,102,,,Fee Schedule,102% of GA Medicaid Rate,6.63,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.63,18,
Medical test to find an infection,5000221,CDM,300,RC,87081,HCPCS,Outpatient,,,20,15,,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,8.33,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.63,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.63,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,18,90,,14.4,percent of total billed charges,90% of total billed charges,8.75,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,13.46,67.275,,10.768,percent of total billed charges,67.275% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,6.7,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,16,80,,12.8,percent of total billed charges,80% of total billed charges,12.35,61.74,,9.88,percent of total billed charges,61.74% of total billed charges,8.5,102,,,Fee Schedule,102% of GA Medicaid Rate,6.63,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.63,18,
Medical test to find an infection,5000223,CDM,306,RC,87081,HCPCS,Outpatient,,,20,15,,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,8.33,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.63,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.63,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,18,90,,14.4,percent of total billed charges,90% of total billed charges,8.75,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,13.46,67.275,,10.768,percent of total billed charges,67.275% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,6.7,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,16,80,,12.8,percent of total billed charges,80% of total billed charges,12.35,61.74,,9.88,percent of total billed charges,61.74% of total billed charges,8.5,102,,,Fee Schedule,102% of GA Medicaid Rate,6.63,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.63,18,
Medical test to find an infection,5000232,CDM,306,RC,87081,HCPCS,Outpatient,,,20,15,,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,8.33,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.63,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.63,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,18,90,,14.4,percent of total billed charges,90% of total billed charges,8.75,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,13.46,67.275,,10.768,percent of total billed charges,67.275% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,6.7,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,16,80,,12.8,percent of total billed charges,80% of total billed charges,12.35,61.74,,9.88,percent of total billed charges,61.74% of total billed charges,8.5,102,,,Fee Schedule,102% of GA Medicaid Rate,6.63,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.63,18,
Medical test to find an infection,5000260,CDM,300,RC,87081,HCPCS,Outpatient,,,20,15,,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,8.33,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.63,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.63,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,18,90,,14.4,percent of total billed charges,90% of total billed charges,8.75,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,13.46,67.275,,10.768,percent of total billed charges,67.275% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,6.7,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,16,80,,12.8,percent of total billed charges,80% of total billed charges,12.35,61.74,,9.88,percent of total billed charges,61.74% of total billed charges,8.5,102,,,Fee Schedule,102% of GA Medicaid Rate,6.63,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.63,18,
Medical test to find an infection,5000822,CDM,306,RC,87081,HCPCS,Outpatient,,,20,15,,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,8.33,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.63,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.63,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,18,90,,14.4,percent of total billed charges,90% of total billed charges,8.75,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,13.46,67.275,,10.768,percent of total billed charges,67.275% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,6.7,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,16,80,,12.8,percent of total billed charges,80% of total billed charges,12.35,61.74,,9.88,percent of total billed charges,61.74% of total billed charges,8.5,102,,,Fee Schedule,102% of GA Medicaid Rate,6.63,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.63,18,
Medical test to find an infection,5000823,CDM,306,RC,87081,HCPCS,Outpatient,,,20,15,,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,8.33,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.63,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.63,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,18,90,,14.4,percent of total billed charges,90% of total billed charges,8.75,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,13.46,67.275,,10.768,percent of total billed charges,67.275% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,6.7,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,16,80,,12.8,percent of total billed charges,80% of total billed charges,12.35,61.74,,9.88,percent of total billed charges,61.74% of total billed charges,8.5,102,,,Fee Schedule,102% of GA Medicaid Rate,6.63,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.63,18,
Collection of venous blood by venipuncture,5001688,CDM,300,RC,36415,HCPCS,Outpatient,,,20,15,,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,18,90,,14.4,percent of total billed charges,90% of total billed charges,7,35,,5.6,percent of total billed charges,35% of total billed charges,13.46,67.275,,10.768,percent of total billed charges,67.275% of total billed charges,16,80,,12.8,percent of total billed charges,80% of total billed charges,8.66,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,16,80,,12.8,percent of total billed charges,80% of total billed charges,12.35,61.74,,9.88,percent of total billed charges,61.74% of total billed charges,20.4,102,,16.32,percent of total billed charges,102% of total billed charges,8.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7,20.4,
"SPLINT, COCK-UP - SMALL",3001700,CDM,270,RC,,,Outpatient,,,20.05,15.04,,15.64,78,,12.512,percent of total billed charges,78% of total billed charges,12.63,63,,10.104,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,7.62,38,,6.096,percent of total billed charges,38% of total billed charges,7.62,38,,6.096,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,18.05,90,,14.44,percent of total billed charges,90% of total billed charges,7.02,35,,5.616,percent of total billed charges,35% of total billed charges,13.49,67.275,,10.792,percent of total billed charges,67.275% of total billed charges,16.04,80,,12.832,percent of total billed charges,80% of total billed charges,7.7,38.38,,6.16,percent of total billed charges,38.38% of total billed charges,16.04,80,,12.832,percent of total billed charges,80% of total billed charges,12.38,61.74,,9.904,percent of total billed charges,61.74% of total billed charges,20.45,102,,16.36,percent of total billed charges,102% of total billed charges,7.62,38,,6.096,percent of total billed charges,38% of total billed charges,7.02,20.45,
"SPLINT, COCK-UP - MD",3001701,CDM,270,RC,,,Outpatient,,,20.05,15.04,,15.64,78,,12.512,percent of total billed charges,78% of total billed charges,12.63,63,,10.104,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,7.62,38,,6.096,percent of total billed charges,38% of total billed charges,7.62,38,,6.096,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,18.05,90,,14.44,percent of total billed charges,90% of total billed charges,7.02,35,,5.616,percent of total billed charges,35% of total billed charges,13.49,67.275,,10.792,percent of total billed charges,67.275% of total billed charges,16.04,80,,12.832,percent of total billed charges,80% of total billed charges,7.7,38.38,,6.16,percent of total billed charges,38.38% of total billed charges,16.04,80,,12.832,percent of total billed charges,80% of total billed charges,12.38,61.74,,9.904,percent of total billed charges,61.74% of total billed charges,20.45,102,,16.36,percent of total billed charges,102% of total billed charges,7.62,38,,6.096,percent of total billed charges,38% of total billed charges,7.02,20.45,
"SPLINT, COCK-UP - LG",3001702,CDM,270,RC,,,Outpatient,,,20.05,15.04,,15.64,78,,12.512,percent of total billed charges,78% of total billed charges,12.63,63,,10.104,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,7.62,38,,6.096,percent of total billed charges,38% of total billed charges,7.62,38,,6.096,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,18.05,90,,14.44,percent of total billed charges,90% of total billed charges,7.02,35,,5.616,percent of total billed charges,35% of total billed charges,13.49,67.275,,10.792,percent of total billed charges,67.275% of total billed charges,16.04,80,,12.832,percent of total billed charges,80% of total billed charges,7.7,38.38,,6.16,percent of total billed charges,38.38% of total billed charges,16.04,80,,12.832,percent of total billed charges,80% of total billed charges,12.38,61.74,,9.904,percent of total billed charges,61.74% of total billed charges,20.45,102,,16.36,percent of total billed charges,102% of total billed charges,7.62,38,,6.096,percent of total billed charges,38% of total billed charges,7.02,20.45,
THORACIC CATHETER 12FR CHEST,3002538,CDM,270,RC,,,Outpatient,,,20.2,15.15,,15.76,78,,12.608,percent of total billed charges,78% of total billed charges,12.73,63,,10.184,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,7.68,38,,6.144,percent of total billed charges,38% of total billed charges,7.68,38,,6.144,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,18.18,90,,14.544,percent of total billed charges,90% of total billed charges,7.07,35,,5.656,percent of total billed charges,35% of total billed charges,13.59,67.275,,10.872,percent of total billed charges,67.275% of total billed charges,16.16,80,,12.928,percent of total billed charges,80% of total billed charges,7.75,38.38,,6.2,percent of total billed charges,38.38% of total billed charges,16.16,80,,12.928,percent of total billed charges,80% of total billed charges,12.47,61.74,,9.976,percent of total billed charges,61.74% of total billed charges,20.6,102,,16.48,percent of total billed charges,102% of total billed charges,7.68,38,,6.144,percent of total billed charges,38% of total billed charges,7.07,20.6,
THORACIC CATHETER 32FR CHEST,3002539,CDM,270,RC,,,Outpatient,,,20.2,15.15,,15.76,78,,12.608,percent of total billed charges,78% of total billed charges,12.73,63,,10.184,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,7.68,38,,6.144,percent of total billed charges,38% of total billed charges,7.68,38,,6.144,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,18.18,90,,14.544,percent of total billed charges,90% of total billed charges,7.07,35,,5.656,percent of total billed charges,35% of total billed charges,13.59,67.275,,10.872,percent of total billed charges,67.275% of total billed charges,16.16,80,,12.928,percent of total billed charges,80% of total billed charges,7.75,38.38,,6.2,percent of total billed charges,38.38% of total billed charges,16.16,80,,12.928,percent of total billed charges,80% of total billed charges,12.47,61.74,,9.976,percent of total billed charges,61.74% of total billed charges,20.6,102,,16.48,percent of total billed charges,102% of total billed charges,7.68,38,,6.144,percent of total billed charges,38% of total billed charges,7.07,20.6,
THORACIC CATHETER 28 FR CHEST,3002541,CDM,270,RC,,,Outpatient,,,20.2,15.15,,15.76,78,,12.608,percent of total billed charges,78% of total billed charges,12.73,63,,10.184,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,7.68,38,,6.144,percent of total billed charges,38% of total billed charges,7.68,38,,6.144,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,18.18,90,,14.544,percent of total billed charges,90% of total billed charges,7.07,35,,5.656,percent of total billed charges,35% of total billed charges,13.59,67.275,,10.872,percent of total billed charges,67.275% of total billed charges,16.16,80,,12.928,percent of total billed charges,80% of total billed charges,7.75,38.38,,6.2,percent of total billed charges,38.38% of total billed charges,16.16,80,,12.928,percent of total billed charges,80% of total billed charges,12.47,61.74,,9.976,percent of total billed charges,61.74% of total billed charges,20.6,102,,16.48,percent of total billed charges,102% of total billed charges,7.68,38,,6.144,percent of total billed charges,38% of total billed charges,7.07,20.6,
CHROMIC SUTURE 3-0,3002313,CDM,270,RC,,,Outpatient,,,20.65,15.49,,16.11,78,,12.888,percent of total billed charges,78% of total billed charges,13.01,63,,10.408,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,7.85,38,,6.28,percent of total billed charges,38% of total billed charges,7.85,38,,6.28,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,18.59,90,,14.872,percent of total billed charges,90% of total billed charges,7.23,35,,5.784,percent of total billed charges,35% of total billed charges,13.89,67.275,,11.112,percent of total billed charges,67.275% of total billed charges,16.52,80,,13.216,percent of total billed charges,80% of total billed charges,7.93,38.38,,6.344,percent of total billed charges,38.38% of total billed charges,16.52,80,,13.216,percent of total billed charges,80% of total billed charges,12.75,61.74,,10.2,percent of total billed charges,61.74% of total billed charges,21.06,102,,16.848,percent of total billed charges,102% of total billed charges,7.85,38,,6.28,percent of total billed charges,38% of total billed charges,7.23,21.06,
WEIGHTED UTENSIL - FORK,3001121,CDM,270,RC,,,Outpatient,,,20.75,15.56,,16.19,78,,12.952,percent of total billed charges,78% of total billed charges,13.07,63,,10.456,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,7.89,38,,6.312,percent of total billed charges,38% of total billed charges,7.89,38,,6.312,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,18.68,90,,14.944,percent of total billed charges,90% of total billed charges,7.26,35,,5.808,percent of total billed charges,35% of total billed charges,13.96,67.275,,11.168,percent of total billed charges,67.275% of total billed charges,16.6,80,,13.28,percent of total billed charges,80% of total billed charges,7.96,38.38,,6.368,percent of total billed charges,38.38% of total billed charges,16.6,80,,13.28,percent of total billed charges,80% of total billed charges,12.81,61.74,,10.248,percent of total billed charges,61.74% of total billed charges,21.17,102,,16.936,percent of total billed charges,102% of total billed charges,7.89,38,,6.312,percent of total billed charges,38% of total billed charges,7.26,21.17,
EPUMP FEEDING W/ 1000ML BAG,3001409,CDM,270,RC,,,Outpatient,,,20.85,15.64,,16.26,78,,13.008,percent of total billed charges,78% of total billed charges,13.14,63,,10.512,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,7.92,38,,6.336,percent of total billed charges,38% of total billed charges,7.92,38,,6.336,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,18.77,90,,15.016,percent of total billed charges,90% of total billed charges,7.3,35,,5.84,percent of total billed charges,35% of total billed charges,14.03,67.275,,11.224,percent of total billed charges,67.275% of total billed charges,16.68,80,,13.344,percent of total billed charges,80% of total billed charges,8,38.38,,6.4,percent of total billed charges,38.38% of total billed charges,16.68,80,,13.344,percent of total billed charges,80% of total billed charges,12.87,61.74,,10.296,percent of total billed charges,61.74% of total billed charges,21.27,102,,17.016,percent of total billed charges,102% of total billed charges,7.92,38,,6.336,percent of total billed charges,38% of total billed charges,7.3,21.27,
SPLINT ORTHO 4x15  PRE-CUT,3004270,CDM,270,RC,,,Outpatient,,,20.85,15.64,,16.26,78,,13.008,percent of total billed charges,78% of total billed charges,13.14,63,,10.512,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,7.92,38,,6.336,percent of total billed charges,38% of total billed charges,7.92,38,,6.336,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,18.77,90,,15.016,percent of total billed charges,90% of total billed charges,7.3,35,,5.84,percent of total billed charges,35% of total billed charges,14.03,67.275,,11.224,percent of total billed charges,67.275% of total billed charges,16.68,80,,13.344,percent of total billed charges,80% of total billed charges,8,38.38,,6.4,percent of total billed charges,38.38% of total billed charges,16.68,80,,13.344,percent of total billed charges,80% of total billed charges,12.87,61.74,,10.296,percent of total billed charges,61.74% of total billed charges,21.27,102,,17.016,percent of total billed charges,102% of total billed charges,7.92,38,,6.336,percent of total billed charges,38% of total billed charges,7.3,21.27,
Blood test to measure levels of hemoglobin,5000825,CDM,305,RC,85018,HCPCS,Outpatient,,,21,15.75,,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,2.98,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,2.37,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,2.37,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,3.13,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,14.13,67.275,,11.304,percent of total billed charges,67.275% of total billed charges,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,2.39,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,12.97,61.74,,10.376,percent of total billed charges,61.74% of total billed charges,3.04,102,,,Fee Schedule,102% of GA Medicaid Rate,2.37,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,2.37,18.9,
VICRYL 4-0 PS-2  J496G,3001662,CDM,270,RC,,,Outpatient,,,21.13,15.85,,16.48,78,,13.184,percent of total billed charges,78% of total billed charges,13.31,63,,10.648,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.03,38,,6.424,percent of total billed charges,38% of total billed charges,8.03,38,,6.424,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,19.02,90,,15.216,percent of total billed charges,90% of total billed charges,7.4,35,,5.92,percent of total billed charges,35% of total billed charges,14.22,67.275,,11.376,percent of total billed charges,67.275% of total billed charges,16.9,80,,13.52,percent of total billed charges,80% of total billed charges,8.11,38.38,,6.488,percent of total billed charges,38.38% of total billed charges,16.9,80,,13.52,percent of total billed charges,80% of total billed charges,13.05,61.74,,10.44,percent of total billed charges,61.74% of total billed charges,21.55,102,,17.24,percent of total billed charges,102% of total billed charges,8.03,38,,6.424,percent of total billed charges,38% of total billed charges,7.4,21.55,
HUBER NEEDLE 20 x  .5,3003562,CDM,270,RC,,,Outpatient,,,21.15,15.86,,16.5,78,,13.2,percent of total billed charges,78% of total billed charges,13.32,63,,10.656,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.04,38,,6.432,percent of total billed charges,38% of total billed charges,8.04,38,,6.432,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,19.04,90,,15.232,percent of total billed charges,90% of total billed charges,7.4,35,,5.92,percent of total billed charges,35% of total billed charges,14.23,67.275,,11.384,percent of total billed charges,67.275% of total billed charges,16.92,80,,13.536,percent of total billed charges,80% of total billed charges,8.12,38.38,,6.496,percent of total billed charges,38.38% of total billed charges,16.92,80,,13.536,percent of total billed charges,80% of total billed charges,13.06,61.74,,10.448,percent of total billed charges,61.74% of total billed charges,21.57,102,,17.256,percent of total billed charges,102% of total billed charges,8.04,38,,6.432,percent of total billed charges,38% of total billed charges,7.4,21.57,
ESOPHAGEAL DETECTOR,3002997,CDM,270,RC,,,Outpatient,,,21.25,15.94,,16.58,78,,13.264,percent of total billed charges,78% of total billed charges,13.39,63,,10.712,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.08,38,,6.464,percent of total billed charges,38% of total billed charges,8.08,38,,6.464,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,19.13,90,,15.304,percent of total billed charges,90% of total billed charges,7.44,35,,5.952,percent of total billed charges,35% of total billed charges,14.3,67.275,,11.44,percent of total billed charges,67.275% of total billed charges,17,80,,13.6,percent of total billed charges,80% of total billed charges,8.16,38.38,,6.528,percent of total billed charges,38.38% of total billed charges,17,80,,13.6,percent of total billed charges,80% of total billed charges,13.12,61.74,,10.496,percent of total billed charges,61.74% of total billed charges,21.68,102,,17.344,percent of total billed charges,102% of total billed charges,8.08,38,,6.464,percent of total billed charges,38% of total billed charges,7.44,21.68,
OPTIFOAM 6X6,3000508,CDM,270,RC,,,Outpatient,,,21.27,15.95,,16.59,78,,13.272,percent of total billed charges,78% of total billed charges,13.4,63,,10.72,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.08,38,,6.464,percent of total billed charges,38% of total billed charges,8.08,38,,6.464,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,19.14,90,,15.312,percent of total billed charges,90% of total billed charges,7.44,35,,5.952,percent of total billed charges,35% of total billed charges,14.31,67.275,,11.448,percent of total billed charges,67.275% of total billed charges,17.02,80,,13.616,percent of total billed charges,80% of total billed charges,8.16,38.38,,6.528,percent of total billed charges,38.38% of total billed charges,17.02,80,,13.616,percent of total billed charges,80% of total billed charges,13.13,61.74,,10.504,percent of total billed charges,61.74% of total billed charges,21.7,102,,17.36,percent of total billed charges,102% of total billed charges,8.08,38,,6.464,percent of total billed charges,38% of total billed charges,7.44,21.7,
RIB BELTS (FEMALE),3001606,CDM,270,RC,,,Outpatient,,,21.28,15.96,,16.6,78,,13.28,percent of total billed charges,78% of total billed charges,13.41,63,,10.728,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.09,38,,6.472,percent of total billed charges,38% of total billed charges,8.09,38,,6.472,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,19.15,90,,15.32,percent of total billed charges,90% of total billed charges,7.45,35,,5.96,percent of total billed charges,35% of total billed charges,14.32,67.275,,11.456,percent of total billed charges,67.275% of total billed charges,17.02,80,,13.616,percent of total billed charges,80% of total billed charges,8.17,38.38,,6.536,percent of total billed charges,38.38% of total billed charges,17.02,80,,13.616,percent of total billed charges,80% of total billed charges,13.14,61.74,,10.512,percent of total billed charges,61.74% of total billed charges,21.71,102,,17.368,percent of total billed charges,102% of total billed charges,8.09,38,,6.472,percent of total billed charges,38% of total billed charges,7.45,21.71,
"ACTICOAT FLEX 3, 2X2",3000124,CDM,270,RC,,,Outpatient,,,21.3,15.98,,16.61,78,,13.288,percent of total billed charges,78% of total billed charges,13.42,63,,10.736,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.09,38,,6.472,percent of total billed charges,38% of total billed charges,8.09,38,,6.472,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,19.17,90,,15.336,percent of total billed charges,90% of total billed charges,7.46,35,,5.968,percent of total billed charges,35% of total billed charges,14.33,67.275,,11.464,percent of total billed charges,67.275% of total billed charges,17.04,80,,13.632,percent of total billed charges,80% of total billed charges,8.17,38.38,,6.536,percent of total billed charges,38.38% of total billed charges,17.04,80,,13.632,percent of total billed charges,80% of total billed charges,13.15,61.74,,10.52,percent of total billed charges,61.74% of total billed charges,21.73,102,,17.384,percent of total billed charges,102% of total billed charges,8.09,38,,6.472,percent of total billed charges,38% of total billed charges,7.46,21.73,
ETHILON 5-0 1666G,3001658,CDM,270,RC,,,Outpatient,,,21.42,16.07,,16.71,78,,13.368,percent of total billed charges,78% of total billed charges,13.49,63,,10.792,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.14,38,,6.512,percent of total billed charges,38% of total billed charges,8.14,38,,6.512,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,19.28,90,,15.424,percent of total billed charges,90% of total billed charges,7.5,35,,6,percent of total billed charges,35% of total billed charges,14.41,67.275,,11.528,percent of total billed charges,67.275% of total billed charges,17.14,80,,13.712,percent of total billed charges,80% of total billed charges,8.22,38.38,,6.576,percent of total billed charges,38.38% of total billed charges,17.14,80,,13.712,percent of total billed charges,80% of total billed charges,13.22,61.74,,10.576,percent of total billed charges,61.74% of total billed charges,21.85,102,,17.48,percent of total billed charges,102% of total billed charges,8.14,38,,6.512,percent of total billed charges,38% of total billed charges,7.5,21.85,
LUKEN TUBE,3001108,CDM,270,RC,,,Outpatient,,,21.5,16.13,,16.77,78,,13.416,percent of total billed charges,78% of total billed charges,13.55,63,,10.84,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.17,38,,6.536,percent of total billed charges,38% of total billed charges,8.17,38,,6.536,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,19.35,90,,15.48,percent of total billed charges,90% of total billed charges,7.53,35,,6.024,percent of total billed charges,35% of total billed charges,14.46,67.275,,11.568,percent of total billed charges,67.275% of total billed charges,17.2,80,,13.76,percent of total billed charges,80% of total billed charges,8.25,38.38,,6.6,percent of total billed charges,38.38% of total billed charges,17.2,80,,13.76,percent of total billed charges,80% of total billed charges,13.27,61.74,,10.616,percent of total billed charges,61.74% of total billed charges,21.93,102,,17.544,percent of total billed charges,102% of total billed charges,8.17,38,,6.536,percent of total billed charges,38% of total billed charges,7.53,21.93,
CHROMIC 4-0 V-5 U233H,3001631,CDM,270,RC,,,Outpatient,,,21.65,16.24,,16.89,78,,13.512,percent of total billed charges,78% of total billed charges,13.64,63,,10.912,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.23,38,,6.584,percent of total billed charges,38% of total billed charges,8.23,38,,6.584,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,19.49,90,,15.592,percent of total billed charges,90% of total billed charges,7.58,35,,6.064,percent of total billed charges,35% of total billed charges,14.57,67.275,,11.656,percent of total billed charges,67.275% of total billed charges,17.32,80,,13.856,percent of total billed charges,80% of total billed charges,8.31,38.38,,6.648,percent of total billed charges,38.38% of total billed charges,17.32,80,,13.856,percent of total billed charges,80% of total billed charges,13.37,61.74,,10.696,percent of total billed charges,61.74% of total billed charges,22.08,102,,17.664,percent of total billed charges,102% of total billed charges,8.23,38,,6.584,percent of total billed charges,38% of total billed charges,7.58,22.08,
POST OP SHOE SM FEMALE 79-90193,3001837,CDM,270,RC,,,Outpatient,,,21.65,16.24,,16.89,78,,13.512,percent of total billed charges,78% of total billed charges,13.64,63,,10.912,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.23,38,,6.584,percent of total billed charges,38% of total billed charges,8.23,38,,6.584,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,19.49,90,,15.592,percent of total billed charges,90% of total billed charges,7.58,35,,6.064,percent of total billed charges,35% of total billed charges,14.57,67.275,,11.656,percent of total billed charges,67.275% of total billed charges,17.32,80,,13.856,percent of total billed charges,80% of total billed charges,8.31,38.38,,6.648,percent of total billed charges,38.38% of total billed charges,17.32,80,,13.856,percent of total billed charges,80% of total billed charges,13.37,61.74,,10.696,percent of total billed charges,61.74% of total billed charges,22.08,102,,17.664,percent of total billed charges,102% of total billed charges,8.23,38,,6.584,percent of total billed charges,38% of total billed charges,7.58,22.08,
POST OP SHOE MALE SMALL 79-90183,3001517,CDM,270,RC,,,Outpatient,,,21.7,16.28,,16.93,78,,13.544,percent of total billed charges,78% of total billed charges,13.67,63,,10.936,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.25,38,,6.6,percent of total billed charges,38% of total billed charges,8.25,38,,6.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,19.53,90,,15.624,percent of total billed charges,90% of total billed charges,7.6,35,,6.08,percent of total billed charges,35% of total billed charges,14.6,67.275,,11.68,percent of total billed charges,67.275% of total billed charges,17.36,80,,13.888,percent of total billed charges,80% of total billed charges,8.33,38.38,,6.664,percent of total billed charges,38.38% of total billed charges,17.36,80,,13.888,percent of total billed charges,80% of total billed charges,13.4,61.74,,10.72,percent of total billed charges,61.74% of total billed charges,22.13,102,,17.704,percent of total billed charges,102% of total billed charges,8.25,38,,6.6,percent of total billed charges,38% of total billed charges,7.6,22.13,
POST OP SHOE MED MALE 79-90185,3001835,CDM,270,RC,,,Outpatient,,,21.7,16.28,,16.93,78,,13.544,percent of total billed charges,78% of total billed charges,13.67,63,,10.936,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.25,38,,6.6,percent of total billed charges,38% of total billed charges,8.25,38,,6.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,19.53,90,,15.624,percent of total billed charges,90% of total billed charges,7.6,35,,6.08,percent of total billed charges,35% of total billed charges,14.6,67.275,,11.68,percent of total billed charges,67.275% of total billed charges,17.36,80,,13.888,percent of total billed charges,80% of total billed charges,8.33,38.38,,6.664,percent of total billed charges,38.38% of total billed charges,17.36,80,,13.888,percent of total billed charges,80% of total billed charges,13.4,61.74,,10.72,percent of total billed charges,61.74% of total billed charges,22.13,102,,17.704,percent of total billed charges,102% of total billed charges,8.25,38,,6.6,percent of total billed charges,38% of total billed charges,7.6,22.13,
POST OP SHOE LG MALE 79-90187,3001836,CDM,270,RC,,,Outpatient,,,21.7,16.28,,16.93,78,,13.544,percent of total billed charges,78% of total billed charges,13.67,63,,10.936,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.25,38,,6.6,percent of total billed charges,38% of total billed charges,8.25,38,,6.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,19.53,90,,15.624,percent of total billed charges,90% of total billed charges,7.6,35,,6.08,percent of total billed charges,35% of total billed charges,14.6,67.275,,11.68,percent of total billed charges,67.275% of total billed charges,17.36,80,,13.888,percent of total billed charges,80% of total billed charges,8.33,38.38,,6.664,percent of total billed charges,38.38% of total billed charges,17.36,80,,13.888,percent of total billed charges,80% of total billed charges,13.4,61.74,,10.72,percent of total billed charges,61.74% of total billed charges,22.13,102,,17.704,percent of total billed charges,102% of total billed charges,8.25,38,,6.6,percent of total billed charges,38% of total billed charges,7.6,22.13,
STOCKINETTE IMPERVIOUS 12X48 STERILE,3000302,CDM,270,RC,,,Outpatient,,,22.2,16.65,,17.32,78,,13.856,percent of total billed charges,78% of total billed charges,13.99,63,,11.192,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.44,38,,6.752,percent of total billed charges,38% of total billed charges,8.44,38,,6.752,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,19.98,90,,15.984,percent of total billed charges,90% of total billed charges,7.77,35,,6.216,percent of total billed charges,35% of total billed charges,14.94,67.275,,11.952,percent of total billed charges,67.275% of total billed charges,17.76,80,,14.208,percent of total billed charges,80% of total billed charges,8.52,38.38,,6.816,percent of total billed charges,38.38% of total billed charges,17.76,80,,14.208,percent of total billed charges,80% of total billed charges,13.71,61.74,,10.968,percent of total billed charges,61.74% of total billed charges,22.64,102,,18.112,percent of total billed charges,102% of total billed charges,8.44,38,,6.752,percent of total billed charges,38% of total billed charges,7.77,22.64,
CAST TAPE 4,3001012,CDM,270,RC,,,Outpatient,,,22.2,16.65,,17.32,78,,13.856,percent of total billed charges,78% of total billed charges,13.99,63,,11.192,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.44,38,,6.752,percent of total billed charges,38% of total billed charges,8.44,38,,6.752,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,19.98,90,,15.984,percent of total billed charges,90% of total billed charges,7.77,35,,6.216,percent of total billed charges,35% of total billed charges,14.94,67.275,,11.952,percent of total billed charges,67.275% of total billed charges,17.76,80,,14.208,percent of total billed charges,80% of total billed charges,8.52,38.38,,6.816,percent of total billed charges,38.38% of total billed charges,17.76,80,,14.208,percent of total billed charges,80% of total billed charges,13.71,61.74,,10.968,percent of total billed charges,61.74% of total billed charges,22.64,102,,18.112,percent of total billed charges,102% of total billed charges,8.44,38,,6.752,percent of total billed charges,38% of total billed charges,7.77,22.64,
PICC LINE SECUREMENT,3004014,CDM,270,RC,,,Outpatient,,,22.25,16.69,,17.36,78,,13.888,percent of total billed charges,78% of total billed charges,14.02,63,,11.216,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.46,38,,6.768,percent of total billed charges,38% of total billed charges,8.46,38,,6.768,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,20.03,90,,16.024,percent of total billed charges,90% of total billed charges,7.79,35,,6.232,percent of total billed charges,35% of total billed charges,14.97,67.275,,11.976,percent of total billed charges,67.275% of total billed charges,17.8,80,,14.24,percent of total billed charges,80% of total billed charges,8.54,38.38,,6.832,percent of total billed charges,38.38% of total billed charges,17.8,80,,14.24,percent of total billed charges,80% of total billed charges,13.74,61.74,,10.992,percent of total billed charges,61.74% of total billed charges,22.7,102,,18.16,percent of total billed charges,102% of total billed charges,8.46,38,,6.768,percent of total billed charges,38% of total billed charges,7.79,22.7,
FOLEY LINE STABILIZER,3004015,CDM,270,RC,,,Outpatient,,,22.25,16.69,,17.36,78,,13.888,percent of total billed charges,78% of total billed charges,14.02,63,,11.216,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.46,38,,6.768,percent of total billed charges,38% of total billed charges,8.46,38,,6.768,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,20.03,90,,16.024,percent of total billed charges,90% of total billed charges,7.79,35,,6.232,percent of total billed charges,35% of total billed charges,14.97,67.275,,11.976,percent of total billed charges,67.275% of total billed charges,17.8,80,,14.24,percent of total billed charges,80% of total billed charges,8.54,38.38,,6.832,percent of total billed charges,38.38% of total billed charges,17.8,80,,14.24,percent of total billed charges,80% of total billed charges,13.74,61.74,,10.992,percent of total billed charges,61.74% of total billed charges,22.7,102,,18.16,percent of total billed charges,102% of total billed charges,8.46,38,,6.768,percent of total billed charges,38% of total billed charges,7.79,22.7,
"SPRAY, NO-STING SKIN PREP",3000225,CDM,270,RC,,,Outpatient,,,22.31,16.73,,17.4,78,,13.92,percent of total billed charges,78% of total billed charges,14.06,63,,11.248,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.48,38,,6.784,percent of total billed charges,38% of total billed charges,8.48,38,,6.784,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,20.08,90,,16.064,percent of total billed charges,90% of total billed charges,7.81,35,,6.248,percent of total billed charges,35% of total billed charges,15.01,67.275,,12.008,percent of total billed charges,67.275% of total billed charges,17.85,80,,14.28,percent of total billed charges,80% of total billed charges,8.56,38.38,,6.848,percent of total billed charges,38.38% of total billed charges,17.85,80,,14.28,percent of total billed charges,80% of total billed charges,13.77,61.74,,11.016,percent of total billed charges,61.74% of total billed charges,22.76,102,,18.208,percent of total billed charges,102% of total billed charges,8.48,38,,6.784,percent of total billed charges,38% of total billed charges,7.81,22.76,
VICRYL 6/0 P-3,3004114,CDM,270,RC,,,Outpatient,,,22.4,16.8,,17.47,78,,13.976,percent of total billed charges,78% of total billed charges,14.11,63,,11.288,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.51,38,,6.808,percent of total billed charges,38% of total billed charges,8.51,38,,6.808,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,20.16,90,,16.128,percent of total billed charges,90% of total billed charges,7.84,35,,6.272,percent of total billed charges,35% of total billed charges,15.07,67.275,,12.056,percent of total billed charges,67.275% of total billed charges,17.92,80,,14.336,percent of total billed charges,80% of total billed charges,8.6,38.38,,6.88,percent of total billed charges,38.38% of total billed charges,17.92,80,,14.336,percent of total billed charges,80% of total billed charges,13.83,61.74,,11.064,percent of total billed charges,61.74% of total billed charges,22.85,102,,18.28,percent of total billed charges,102% of total billed charges,8.51,38,,6.808,percent of total billed charges,38% of total billed charges,7.84,22.85,
CLAVICLE SPLINT SM 79-85003,3000216,CDM,270,RC,,,Outpatient,,,22.5,16.88,,17.55,78,,14.04,percent of total billed charges,78% of total billed charges,14.18,63,,11.344,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.55,38,,6.84,percent of total billed charges,38% of total billed charges,8.55,38,,6.84,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,20.25,90,,16.2,percent of total billed charges,90% of total billed charges,7.88,35,,6.304,percent of total billed charges,35% of total billed charges,15.14,67.275,,12.112,percent of total billed charges,67.275% of total billed charges,18,80,,14.4,percent of total billed charges,80% of total billed charges,8.64,38.38,,6.912,percent of total billed charges,38.38% of total billed charges,18,80,,14.4,percent of total billed charges,80% of total billed charges,13.89,61.74,,11.112,percent of total billed charges,61.74% of total billed charges,22.95,102,,18.36,percent of total billed charges,102% of total billed charges,8.55,38,,6.84,percent of total billed charges,38% of total billed charges,7.88,22.95,
CLAVICAL SPLINT MEDIUM,3001321,CDM,270,RC,,,Outpatient,,,22.5,16.88,,17.55,78,,14.04,percent of total billed charges,78% of total billed charges,14.18,63,,11.344,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.55,38,,6.84,percent of total billed charges,38% of total billed charges,8.55,38,,6.84,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,20.25,90,,16.2,percent of total billed charges,90% of total billed charges,7.88,35,,6.304,percent of total billed charges,35% of total billed charges,15.14,67.275,,12.112,percent of total billed charges,67.275% of total billed charges,18,80,,14.4,percent of total billed charges,80% of total billed charges,8.64,38.38,,6.912,percent of total billed charges,38.38% of total billed charges,18,80,,14.4,percent of total billed charges,80% of total billed charges,13.89,61.74,,11.112,percent of total billed charges,61.74% of total billed charges,22.95,102,,18.36,percent of total billed charges,102% of total billed charges,8.55,38,,6.84,percent of total billed charges,38% of total billed charges,7.88,22.95,
RIB BELTS (MALE),3001603,CDM,270,RC,,,Outpatient,,,22.5,16.88,,17.55,78,,14.04,percent of total billed charges,78% of total billed charges,14.18,63,,11.344,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.55,38,,6.84,percent of total billed charges,38% of total billed charges,8.55,38,,6.84,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,20.25,90,,16.2,percent of total billed charges,90% of total billed charges,7.88,35,,6.304,percent of total billed charges,35% of total billed charges,15.14,67.275,,12.112,percent of total billed charges,67.275% of total billed charges,18,80,,14.4,percent of total billed charges,80% of total billed charges,8.64,38.38,,6.912,percent of total billed charges,38.38% of total billed charges,18,80,,14.4,percent of total billed charges,80% of total billed charges,13.89,61.74,,11.112,percent of total billed charges,61.74% of total billed charges,22.95,102,,18.36,percent of total billed charges,102% of total billed charges,8.55,38,,6.84,percent of total billed charges,38% of total billed charges,7.88,22.95,
TECHFORM 3  CAST TAPE,3004280,CDM,270,RC,,,Outpatient,,,22.5,16.88,,17.55,78,,14.04,percent of total billed charges,78% of total billed charges,14.18,63,,11.344,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.55,38,,6.84,percent of total billed charges,38% of total billed charges,8.55,38,,6.84,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,20.25,90,,16.2,percent of total billed charges,90% of total billed charges,7.88,35,,6.304,percent of total billed charges,35% of total billed charges,15.14,67.275,,12.112,percent of total billed charges,67.275% of total billed charges,18,80,,14.4,percent of total billed charges,80% of total billed charges,8.64,38.38,,6.912,percent of total billed charges,38.38% of total billed charges,18,80,,14.4,percent of total billed charges,80% of total billed charges,13.89,61.74,,11.112,percent of total billed charges,61.74% of total billed charges,22.95,102,,18.36,percent of total billed charges,102% of total billed charges,8.55,38,,6.84,percent of total billed charges,38% of total billed charges,7.88,22.95,
SPLINT METACARPAL LG RT PADDED,3001728,CDM,270,RC,,,Outpatient,,,22.6,16.95,,17.63,78,,14.104,percent of total billed charges,78% of total billed charges,14.24,63,,11.392,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.59,38,,6.872,percent of total billed charges,38% of total billed charges,8.59,38,,6.872,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,20.34,90,,16.272,percent of total billed charges,90% of total billed charges,7.91,35,,6.328,percent of total billed charges,35% of total billed charges,15.2,67.275,,12.16,percent of total billed charges,67.275% of total billed charges,18.08,80,,14.464,percent of total billed charges,80% of total billed charges,8.67,38.38,,6.936,percent of total billed charges,38.38% of total billed charges,18.08,80,,14.464,percent of total billed charges,80% of total billed charges,13.95,61.74,,11.16,percent of total billed charges,61.74% of total billed charges,23.05,102,,18.44,percent of total billed charges,102% of total billed charges,8.59,38,,6.872,percent of total billed charges,38% of total billed charges,7.91,23.05,
SPLINT METACARPAL MED RT PADDED,3002324,CDM,270,RC,,,Outpatient,,,22.6,16.95,,17.63,78,,14.104,percent of total billed charges,78% of total billed charges,14.24,63,,11.392,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.59,38,,6.872,percent of total billed charges,38% of total billed charges,8.59,38,,6.872,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,20.34,90,,16.272,percent of total billed charges,90% of total billed charges,7.91,35,,6.328,percent of total billed charges,35% of total billed charges,15.2,67.275,,12.16,percent of total billed charges,67.275% of total billed charges,18.08,80,,14.464,percent of total billed charges,80% of total billed charges,8.67,38.38,,6.936,percent of total billed charges,38.38% of total billed charges,18.08,80,,14.464,percent of total billed charges,80% of total billed charges,13.95,61.74,,11.16,percent of total billed charges,61.74% of total billed charges,23.05,102,,18.44,percent of total billed charges,102% of total billed charges,8.59,38,,6.872,percent of total billed charges,38% of total billed charges,7.91,23.05,
SPLINT METACARPAL LG LEFT PADDED,3002325,CDM,270,RC,,,Outpatient,,,22.6,16.95,,17.63,78,,14.104,percent of total billed charges,78% of total billed charges,14.24,63,,11.392,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.59,38,,6.872,percent of total billed charges,38% of total billed charges,8.59,38,,6.872,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,20.34,90,,16.272,percent of total billed charges,90% of total billed charges,7.91,35,,6.328,percent of total billed charges,35% of total billed charges,15.2,67.275,,12.16,percent of total billed charges,67.275% of total billed charges,18.08,80,,14.464,percent of total billed charges,80% of total billed charges,8.67,38.38,,6.936,percent of total billed charges,38.38% of total billed charges,18.08,80,,14.464,percent of total billed charges,80% of total billed charges,13.95,61.74,,11.16,percent of total billed charges,61.74% of total billed charges,23.05,102,,18.44,percent of total billed charges,102% of total billed charges,8.59,38,,6.872,percent of total billed charges,38% of total billed charges,7.91,23.05,
SPLINT METACARPAL MEDIUM LEFT PADDED,3002335,CDM,270,RC,,,Outpatient,,,22.6,16.95,,17.63,78,,14.104,percent of total billed charges,78% of total billed charges,14.24,63,,11.392,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.59,38,,6.872,percent of total billed charges,38% of total billed charges,8.59,38,,6.872,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,20.34,90,,16.272,percent of total billed charges,90% of total billed charges,7.91,35,,6.328,percent of total billed charges,35% of total billed charges,15.2,67.275,,12.16,percent of total billed charges,67.275% of total billed charges,18.08,80,,14.464,percent of total billed charges,80% of total billed charges,8.67,38.38,,6.936,percent of total billed charges,38.38% of total billed charges,18.08,80,,14.464,percent of total billed charges,80% of total billed charges,13.95,61.74,,11.16,percent of total billed charges,61.74% of total billed charges,23.05,102,,18.44,percent of total billed charges,102% of total billed charges,8.59,38,,6.872,percent of total billed charges,38% of total billed charges,7.91,23.05,
MONOCRYL 4-0 Y426H,3001585,CDM,270,RC,,,Outpatient,,,22.9,17.18,,17.86,78,,14.288,percent of total billed charges,78% of total billed charges,14.43,63,,11.544,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.7,38,,6.96,percent of total billed charges,38% of total billed charges,8.7,38,,6.96,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,20.61,90,,16.488,percent of total billed charges,90% of total billed charges,8.02,35,,6.416,percent of total billed charges,35% of total billed charges,15.41,67.275,,12.328,percent of total billed charges,67.275% of total billed charges,18.32,80,,14.656,percent of total billed charges,80% of total billed charges,8.79,38.38,,7.032,percent of total billed charges,38.38% of total billed charges,18.32,80,,14.656,percent of total billed charges,80% of total billed charges,14.14,61.74,,11.312,percent of total billed charges,61.74% of total billed charges,23.36,102,,18.688,percent of total billed charges,102% of total billed charges,8.7,38,,6.96,percent of total billed charges,38% of total billed charges,8.02,23.36,
REDUCER CAP 1SEAL,3004236,CDM,270,RC,,,Outpatient,,,22.93,17.2,,17.89,78,,14.312,percent of total billed charges,78% of total billed charges,14.45,63,,11.56,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.71,38,,6.968,percent of total billed charges,38% of total billed charges,8.71,38,,6.968,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,20.64,90,,16.512,percent of total billed charges,90% of total billed charges,8.03,35,,6.424,percent of total billed charges,35% of total billed charges,15.43,67.275,,12.344,percent of total billed charges,67.275% of total billed charges,18.34,80,,14.672,percent of total billed charges,80% of total billed charges,8.8,38.38,,7.04,percent of total billed charges,38.38% of total billed charges,18.34,80,,14.672,percent of total billed charges,80% of total billed charges,14.16,61.74,,11.328,percent of total billed charges,61.74% of total billed charges,23.39,102,,18.712,percent of total billed charges,102% of total billed charges,8.71,38,,6.968,percent of total billed charges,38% of total billed charges,8.03,23.39,
BINDER ABD 3-panel 9  (45-62),3000115,CDM,270,RC,,,Outpatient,,,23,17.25,,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,14.49,63,,11.592,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.74,38,,6.992,percent of total billed charges,38% of total billed charges,8.74,38,,6.992,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,8.05,35,,6.44,percent of total billed charges,35% of total billed charges,15.47,67.275,,12.376,percent of total billed charges,67.275% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,8.83,38.38,,7.064,percent of total billed charges,38.38% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.2,61.74,,11.36,percent of total billed charges,61.74% of total billed charges,23.46,102,,18.768,percent of total billed charges,102% of total billed charges,8.74,38,,6.992,percent of total billed charges,38% of total billed charges,8.05,23.46,
PH BY DIPSTICK-FLUID,5000455,CDM,301,RC,83986,HCPCS,Outpatient,,,23,17.25,,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,4.5,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,3.58,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.58,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,4.73,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,15.47,67.275,,12.376,percent of total billed charges,67.275% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,3.62,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.2,61.74,,11.36,percent of total billed charges,61.74% of total billed charges,4.59,102,,,Fee Schedule,102% of GA Medicaid Rate,3.58,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.58,20.7,
PH FECES,5000458,CDM,301,RC,83986,HCPCS,Outpatient,,,23,17.25,,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,4.5,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,3.58,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.58,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,4.73,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,15.47,67.275,,12.376,percent of total billed charges,67.275% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,3.62,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.2,61.74,,11.36,percent of total billed charges,61.74% of total billed charges,4.59,102,,,Fee Schedule,102% of GA Medicaid Rate,3.58,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.58,20.7,
HEMATOCRIT,5000820,CDM,305,RC,85014,HCPCS,Outpatient,,,23,17.25,,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,2.98,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,2.37,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,2.37,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,3.13,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,15.47,67.275,,12.376,percent of total billed charges,67.275% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,2.39,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.2,61.74,,11.36,percent of total billed charges,61.74% of total billed charges,3.04,102,,,Fee Schedule,102% of GA Medicaid Rate,2.37,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,2.37,20.7,
RBC,5000835,CDM,305,RC,85041,HCPCS,Outpatient,,,23,17.25,,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,3.78,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,3.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,3.97,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,15.47,67.275,,12.376,percent of total billed charges,67.275% of total billed charges,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,3.05,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,14.2,61.74,,11.36,percent of total billed charges,61.74% of total billed charges,3.86,102,,,Fee Schedule,102% of GA Medicaid Rate,3.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.02,20.7,
JACKSON PRATT DRAIN FLAT - 10 MM,3000903,CDM,270,RC,,,Outpatient,,,23.05,17.29,,17.98,78,,14.384,percent of total billed charges,78% of total billed charges,14.52,63,,11.616,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.76,38,,7.008,percent of total billed charges,38% of total billed charges,8.76,38,,7.008,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,20.75,90,,16.6,percent of total billed charges,90% of total billed charges,8.07,35,,6.456,percent of total billed charges,35% of total billed charges,15.51,67.275,,12.408,percent of total billed charges,67.275% of total billed charges,18.44,80,,14.752,percent of total billed charges,80% of total billed charges,8.85,38.38,,7.08,percent of total billed charges,38.38% of total billed charges,18.44,80,,14.752,percent of total billed charges,80% of total billed charges,14.23,61.74,,11.384,percent of total billed charges,61.74% of total billed charges,23.51,102,,18.808,percent of total billed charges,102% of total billed charges,8.76,38,,7.008,percent of total billed charges,38% of total billed charges,8.07,23.51,
UNNA -Z BANDAGE,3000308,CDM,270,RC,,,Outpatient,,,23.1,17.33,,18.02,78,,14.416,percent of total billed charges,78% of total billed charges,14.55,63,,11.64,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.78,38,,7.024,percent of total billed charges,38% of total billed charges,8.78,38,,7.024,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,20.79,90,,16.632,percent of total billed charges,90% of total billed charges,8.09,35,,6.472,percent of total billed charges,35% of total billed charges,15.54,67.275,,12.432,percent of total billed charges,67.275% of total billed charges,18.48,80,,14.784,percent of total billed charges,80% of total billed charges,8.87,38.38,,7.096,percent of total billed charges,38.38% of total billed charges,18.48,80,,14.784,percent of total billed charges,80% of total billed charges,14.26,61.74,,11.408,percent of total billed charges,61.74% of total billed charges,23.56,102,,18.848,percent of total billed charges,102% of total billed charges,8.78,38,,7.024,percent of total billed charges,38% of total billed charges,8.09,23.56,
POST OP SHOE MED FEMALE 79-90195,3001838,CDM,270,RC,,,Outpatient,,,23.2,17.4,,18.1,78,,14.48,percent of total billed charges,78% of total billed charges,14.62,63,,11.696,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.82,38,,7.056,percent of total billed charges,38% of total billed charges,8.82,38,,7.056,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,20.88,90,,16.704,percent of total billed charges,90% of total billed charges,8.12,35,,6.496,percent of total billed charges,35% of total billed charges,15.61,67.275,,12.488,percent of total billed charges,67.275% of total billed charges,18.56,80,,14.848,percent of total billed charges,80% of total billed charges,8.9,38.38,,7.12,percent of total billed charges,38.38% of total billed charges,18.56,80,,14.848,percent of total billed charges,80% of total billed charges,14.32,61.74,,11.456,percent of total billed charges,61.74% of total billed charges,23.66,102,,18.928,percent of total billed charges,102% of total billed charges,8.82,38,,7.056,percent of total billed charges,38% of total billed charges,8.12,23.66,
POST OP SHOE LG FEMALE,3001839,CDM,270,RC,,,Outpatient,,,23.2,17.4,,18.1,78,,14.48,percent of total billed charges,78% of total billed charges,14.62,63,,11.696,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.82,38,,7.056,percent of total billed charges,38% of total billed charges,8.82,38,,7.056,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,20.88,90,,16.704,percent of total billed charges,90% of total billed charges,8.12,35,,6.496,percent of total billed charges,35% of total billed charges,15.61,67.275,,12.488,percent of total billed charges,67.275% of total billed charges,18.56,80,,14.848,percent of total billed charges,80% of total billed charges,8.9,38.38,,7.12,percent of total billed charges,38.38% of total billed charges,18.56,80,,14.848,percent of total billed charges,80% of total billed charges,14.32,61.74,,11.456,percent of total billed charges,61.74% of total billed charges,23.66,102,,18.928,percent of total billed charges,102% of total billed charges,8.82,38,,7.056,percent of total billed charges,38% of total billed charges,8.12,23.66,
SPLINT METAL FOREARM (MD LT),3002331,CDM,270,RC,,,Outpatient,,,23.25,17.44,,18.14,78,,14.512,percent of total billed charges,78% of total billed charges,14.65,63,,11.72,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.84,38,,7.072,percent of total billed charges,38% of total billed charges,8.84,38,,7.072,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,20.93,90,,16.744,percent of total billed charges,90% of total billed charges,8.14,35,,6.512,percent of total billed charges,35% of total billed charges,15.64,67.275,,12.512,percent of total billed charges,67.275% of total billed charges,18.6,80,,14.88,percent of total billed charges,80% of total billed charges,8.92,38.38,,7.136,percent of total billed charges,38.38% of total billed charges,18.6,80,,14.88,percent of total billed charges,80% of total billed charges,14.35,61.74,,11.48,percent of total billed charges,61.74% of total billed charges,23.72,102,,18.976,percent of total billed charges,102% of total billed charges,8.84,38,,7.072,percent of total billed charges,38% of total billed charges,8.14,23.72,
WEIGHTED UTENSIL - TBSPOON,3001122,CDM,270,RC,,,Outpatient,,,23.3,17.48,,18.17,78,,14.536,percent of total billed charges,78% of total billed charges,14.68,63,,11.744,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.85,38,,7.08,percent of total billed charges,38% of total billed charges,8.85,38,,7.08,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,20.97,90,,16.776,percent of total billed charges,90% of total billed charges,8.16,35,,6.528,percent of total billed charges,35% of total billed charges,15.68,67.275,,12.544,percent of total billed charges,67.275% of total billed charges,18.64,80,,14.912,percent of total billed charges,80% of total billed charges,8.94,38.38,,7.152,percent of total billed charges,38.38% of total billed charges,18.64,80,,14.912,percent of total billed charges,80% of total billed charges,14.39,61.74,,11.512,percent of total billed charges,61.74% of total billed charges,23.77,102,,19.016,percent of total billed charges,102% of total billed charges,8.85,38,,7.08,percent of total billed charges,38% of total billed charges,8.16,23.77,
SPLINT METACARPAL SM LEFT NON-PADDED,3002326,CDM,270,RC,,,Outpatient,,,23.35,17.51,,18.21,78,,14.568,percent of total billed charges,78% of total billed charges,14.71,63,,11.768,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.87,38,,7.096,percent of total billed charges,38% of total billed charges,8.87,38,,7.096,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,21.02,90,,16.816,percent of total billed charges,90% of total billed charges,8.17,35,,6.536,percent of total billed charges,35% of total billed charges,15.71,67.275,,12.568,percent of total billed charges,67.275% of total billed charges,18.68,80,,14.944,percent of total billed charges,80% of total billed charges,8.96,38.38,,7.168,percent of total billed charges,38.38% of total billed charges,18.68,80,,14.944,percent of total billed charges,80% of total billed charges,14.42,61.74,,11.536,percent of total billed charges,61.74% of total billed charges,23.82,102,,19.056,percent of total billed charges,102% of total billed charges,8.87,38,,7.096,percent of total billed charges,38% of total billed charges,8.17,23.82,
STOCKINETTE IMPERVIOUS MED,3001738,CDM,270,RC,,,Outpatient,,,23.6,17.7,,18.41,78,,14.728,percent of total billed charges,78% of total billed charges,14.87,63,,11.896,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8.97,38,,7.176,percent of total billed charges,38% of total billed charges,8.97,38,,7.176,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,21.24,90,,16.992,percent of total billed charges,90% of total billed charges,8.26,35,,6.608,percent of total billed charges,35% of total billed charges,15.88,67.275,,12.704,percent of total billed charges,67.275% of total billed charges,18.88,80,,15.104,percent of total billed charges,80% of total billed charges,9.06,38.38,,7.248,percent of total billed charges,38.38% of total billed charges,18.88,80,,15.104,percent of total billed charges,80% of total billed charges,14.57,61.74,,11.656,percent of total billed charges,61.74% of total billed charges,24.07,102,,19.256,percent of total billed charges,102% of total billed charges,8.97,38,,7.176,percent of total billed charges,38% of total billed charges,8.26,24.07,
LARYNG BLADE DISP - MILLER 4,3000104,CDM,270,RC,,,Outpatient,,,23.75,17.81,,18.53,78,,14.824,percent of total billed charges,78% of total billed charges,14.96,63,,11.968,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.03,38,,7.224,percent of total billed charges,38% of total billed charges,9.03,38,,7.224,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,21.38,90,,17.104,percent of total billed charges,90% of total billed charges,8.31,35,,6.648,percent of total billed charges,35% of total billed charges,15.98,67.275,,12.784,percent of total billed charges,67.275% of total billed charges,19,80,,15.2,percent of total billed charges,80% of total billed charges,9.12,38.38,,7.296,percent of total billed charges,38.38% of total billed charges,19,80,,15.2,percent of total billed charges,80% of total billed charges,14.66,61.74,,11.728,percent of total billed charges,61.74% of total billed charges,24.23,102,,19.384,percent of total billed charges,102% of total billed charges,9.03,38,,7.224,percent of total billed charges,38% of total billed charges,8.31,24.23,
LARYNG BLADE DISP - MILLER 3,3000105,CDM,270,RC,,,Outpatient,,,23.75,17.81,,18.53,78,,14.824,percent of total billed charges,78% of total billed charges,14.96,63,,11.968,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.03,38,,7.224,percent of total billed charges,38% of total billed charges,9.03,38,,7.224,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,21.38,90,,17.104,percent of total billed charges,90% of total billed charges,8.31,35,,6.648,percent of total billed charges,35% of total billed charges,15.98,67.275,,12.784,percent of total billed charges,67.275% of total billed charges,19,80,,15.2,percent of total billed charges,80% of total billed charges,9.12,38.38,,7.296,percent of total billed charges,38.38% of total billed charges,19,80,,15.2,percent of total billed charges,80% of total billed charges,14.66,61.74,,11.728,percent of total billed charges,61.74% of total billed charges,24.23,102,,19.384,percent of total billed charges,102% of total billed charges,9.03,38,,7.224,percent of total billed charges,38% of total billed charges,8.31,24.23,
LARYNG BLADE DISP - MILLER 2,3000106,CDM,270,RC,,,Outpatient,,,23.75,17.81,,18.53,78,,14.824,percent of total billed charges,78% of total billed charges,14.96,63,,11.968,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.03,38,,7.224,percent of total billed charges,38% of total billed charges,9.03,38,,7.224,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,21.38,90,,17.104,percent of total billed charges,90% of total billed charges,8.31,35,,6.648,percent of total billed charges,35% of total billed charges,15.98,67.275,,12.784,percent of total billed charges,67.275% of total billed charges,19,80,,15.2,percent of total billed charges,80% of total billed charges,9.12,38.38,,7.296,percent of total billed charges,38.38% of total billed charges,19,80,,15.2,percent of total billed charges,80% of total billed charges,14.66,61.74,,11.728,percent of total billed charges,61.74% of total billed charges,24.23,102,,19.384,percent of total billed charges,102% of total billed charges,9.03,38,,7.224,percent of total billed charges,38% of total billed charges,8.31,24.23,
LARYNG BLADE DISP - MILLER 1,3000108,CDM,270,RC,,,Outpatient,,,23.75,17.81,,18.53,78,,14.824,percent of total billed charges,78% of total billed charges,14.96,63,,11.968,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.03,38,,7.224,percent of total billed charges,38% of total billed charges,9.03,38,,7.224,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,21.38,90,,17.104,percent of total billed charges,90% of total billed charges,8.31,35,,6.648,percent of total billed charges,35% of total billed charges,15.98,67.275,,12.784,percent of total billed charges,67.275% of total billed charges,19,80,,15.2,percent of total billed charges,80% of total billed charges,9.12,38.38,,7.296,percent of total billed charges,38.38% of total billed charges,19,80,,15.2,percent of total billed charges,80% of total billed charges,14.66,61.74,,11.728,percent of total billed charges,61.74% of total billed charges,24.23,102,,19.384,percent of total billed charges,102% of total billed charges,9.03,38,,7.224,percent of total billed charges,38% of total billed charges,8.31,24.23,
LARYNG BLADE DISP - MILLER 0,3000112,CDM,270,RC,,,Outpatient,,,23.75,17.81,,18.53,78,,14.824,percent of total billed charges,78% of total billed charges,14.96,63,,11.968,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.03,38,,7.224,percent of total billed charges,38% of total billed charges,9.03,38,,7.224,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,21.38,90,,17.104,percent of total billed charges,90% of total billed charges,8.31,35,,6.648,percent of total billed charges,35% of total billed charges,15.98,67.275,,12.784,percent of total billed charges,67.275% of total billed charges,19,80,,15.2,percent of total billed charges,80% of total billed charges,9.12,38.38,,7.296,percent of total billed charges,38.38% of total billed charges,19,80,,15.2,percent of total billed charges,80% of total billed charges,14.66,61.74,,11.728,percent of total billed charges,61.74% of total billed charges,24.23,102,,19.384,percent of total billed charges,102% of total billed charges,9.03,38,,7.224,percent of total billed charges,38% of total billed charges,8.31,24.23,
LARYNG BLADE DISP - MAC 4,3000113,CDM,270,RC,,,Outpatient,,,23.75,17.81,,18.53,78,,14.824,percent of total billed charges,78% of total billed charges,14.96,63,,11.968,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.03,38,,7.224,percent of total billed charges,38% of total billed charges,9.03,38,,7.224,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,21.38,90,,17.104,percent of total billed charges,90% of total billed charges,8.31,35,,6.648,percent of total billed charges,35% of total billed charges,15.98,67.275,,12.784,percent of total billed charges,67.275% of total billed charges,19,80,,15.2,percent of total billed charges,80% of total billed charges,9.12,38.38,,7.296,percent of total billed charges,38.38% of total billed charges,19,80,,15.2,percent of total billed charges,80% of total billed charges,14.66,61.74,,11.728,percent of total billed charges,61.74% of total billed charges,24.23,102,,19.384,percent of total billed charges,102% of total billed charges,9.03,38,,7.224,percent of total billed charges,38% of total billed charges,8.31,24.23,
LARYNG BLADE DISP - MAC 3,3000117,CDM,270,RC,,,Outpatient,,,23.75,17.81,,18.53,78,,14.824,percent of total billed charges,78% of total billed charges,14.96,63,,11.968,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.03,38,,7.224,percent of total billed charges,38% of total billed charges,9.03,38,,7.224,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,21.38,90,,17.104,percent of total billed charges,90% of total billed charges,8.31,35,,6.648,percent of total billed charges,35% of total billed charges,15.98,67.275,,12.784,percent of total billed charges,67.275% of total billed charges,19,80,,15.2,percent of total billed charges,80% of total billed charges,9.12,38.38,,7.296,percent of total billed charges,38.38% of total billed charges,19,80,,15.2,percent of total billed charges,80% of total billed charges,14.66,61.74,,11.728,percent of total billed charges,61.74% of total billed charges,24.23,102,,19.384,percent of total billed charges,102% of total billed charges,9.03,38,,7.224,percent of total billed charges,38% of total billed charges,8.31,24.23,
LARYNG BLADE DISP - MAC 2,3000118,CDM,270,RC,,,Outpatient,,,23.75,17.81,,18.53,78,,14.824,percent of total billed charges,78% of total billed charges,14.96,63,,11.968,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.03,38,,7.224,percent of total billed charges,38% of total billed charges,9.03,38,,7.224,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,21.38,90,,17.104,percent of total billed charges,90% of total billed charges,8.31,35,,6.648,percent of total billed charges,35% of total billed charges,15.98,67.275,,12.784,percent of total billed charges,67.275% of total billed charges,19,80,,15.2,percent of total billed charges,80% of total billed charges,9.12,38.38,,7.296,percent of total billed charges,38.38% of total billed charges,19,80,,15.2,percent of total billed charges,80% of total billed charges,14.66,61.74,,11.728,percent of total billed charges,61.74% of total billed charges,24.23,102,,19.384,percent of total billed charges,102% of total billed charges,9.03,38,,7.224,percent of total billed charges,38% of total billed charges,8.31,24.23,
SPLINT ORTHO 3X12  PRE-CUT,3004500,CDM,270,RC,,,Outpatient,,,23.8,17.85,,18.56,78,,14.848,percent of total billed charges,78% of total billed charges,14.99,63,,11.992,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.04,38,,7.232,percent of total billed charges,38% of total billed charges,9.04,38,,7.232,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,21.42,90,,17.136,percent of total billed charges,90% of total billed charges,8.33,35,,6.664,percent of total billed charges,35% of total billed charges,16.01,67.275,,12.808,percent of total billed charges,67.275% of total billed charges,19.04,80,,15.232,percent of total billed charges,80% of total billed charges,9.13,38.38,,7.304,percent of total billed charges,38.38% of total billed charges,19.04,80,,15.232,percent of total billed charges,80% of total billed charges,14.69,61.74,,11.752,percent of total billed charges,61.74% of total billed charges,24.28,102,,19.424,percent of total billed charges,102% of total billed charges,9.04,38,,7.232,percent of total billed charges,38% of total billed charges,8.33,24.28,
"STOCKING, ANTI-EMBOLISM, THIGH - SM",3001717,CDM,270,RC,,,Outpatient,,,23.9,17.93,,18.64,78,,14.912,percent of total billed charges,78% of total billed charges,15.06,63,,12.048,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.08,38,,7.264,percent of total billed charges,38% of total billed charges,9.08,38,,7.264,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,21.51,90,,17.208,percent of total billed charges,90% of total billed charges,8.37,35,,6.696,percent of total billed charges,35% of total billed charges,16.08,67.275,,12.864,percent of total billed charges,67.275% of total billed charges,19.12,80,,15.296,percent of total billed charges,80% of total billed charges,9.17,38.38,,7.336,percent of total billed charges,38.38% of total billed charges,19.12,80,,15.296,percent of total billed charges,80% of total billed charges,14.76,61.74,,11.808,percent of total billed charges,61.74% of total billed charges,24.38,102,,19.504,percent of total billed charges,102% of total billed charges,9.08,38,,7.264,percent of total billed charges,38% of total billed charges,8.37,24.38,
SPLINT FOREARM X-S RIGHT NON-PADDED,3002315,CDM,270,RC,,,Outpatient,,,23.9,17.93,,18.64,78,,14.912,percent of total billed charges,78% of total billed charges,15.06,63,,12.048,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.08,38,,7.264,percent of total billed charges,38% of total billed charges,9.08,38,,7.264,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,21.51,90,,17.208,percent of total billed charges,90% of total billed charges,8.37,35,,6.696,percent of total billed charges,35% of total billed charges,16.08,67.275,,12.864,percent of total billed charges,67.275% of total billed charges,19.12,80,,15.296,percent of total billed charges,80% of total billed charges,9.17,38.38,,7.336,percent of total billed charges,38.38% of total billed charges,19.12,80,,15.296,percent of total billed charges,80% of total billed charges,14.76,61.74,,11.808,percent of total billed charges,61.74% of total billed charges,24.38,102,,19.504,percent of total billed charges,102% of total billed charges,9.08,38,,7.264,percent of total billed charges,38% of total billed charges,8.37,24.38,
SPLINT FOREARM X-S LEFT NON-PADDED,3004228,CDM,270,RC,,,Outpatient,,,23.9,17.93,,18.64,78,,14.912,percent of total billed charges,78% of total billed charges,15.06,63,,12.048,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.08,38,,7.264,percent of total billed charges,38% of total billed charges,9.08,38,,7.264,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,21.51,90,,17.208,percent of total billed charges,90% of total billed charges,8.37,35,,6.696,percent of total billed charges,35% of total billed charges,16.08,67.275,,12.864,percent of total billed charges,67.275% of total billed charges,19.12,80,,15.296,percent of total billed charges,80% of total billed charges,9.17,38.38,,7.336,percent of total billed charges,38.38% of total billed charges,19.12,80,,15.296,percent of total billed charges,80% of total billed charges,14.76,61.74,,11.808,percent of total billed charges,61.74% of total billed charges,24.38,102,,19.504,percent of total billed charges,102% of total billed charges,9.08,38,,7.264,percent of total billed charges,38% of total billed charges,8.37,24.38,
ETHILON 5-0 PC-1,3001546,CDM,270,RC,,,Outpatient,,,23.99,17.99,,18.71,78,,14.968,percent of total billed charges,78% of total billed charges,15.11,63,,12.088,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.12,38,,7.296,percent of total billed charges,38% of total billed charges,9.12,38,,7.296,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,21.59,90,,17.272,percent of total billed charges,90% of total billed charges,8.4,35,,6.72,percent of total billed charges,35% of total billed charges,16.14,67.275,,12.912,percent of total billed charges,67.275% of total billed charges,19.19,80,,15.352,percent of total billed charges,80% of total billed charges,9.21,38.38,,7.368,percent of total billed charges,38.38% of total billed charges,19.19,80,,15.352,percent of total billed charges,80% of total billed charges,14.81,61.74,,11.848,percent of total billed charges,61.74% of total billed charges,24.47,102,,19.576,percent of total billed charges,102% of total billed charges,9.12,38,,7.296,percent of total billed charges,38% of total billed charges,8.4,24.47,
.MOLECULAR DX INTERP/RPT,5001897,CDM,301,RC,,,Outpatient,,,24,18,,18.72,78,,14.976,percent of total billed charges,78% of total billed charges,15.12,63,,12.096,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.12,38,,7.296,percent of total billed charges,38% of total billed charges,9.12,38,,7.296,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,8.4,35,,6.72,percent of total billed charges,35% of total billed charges,16.15,67.275,,12.92,percent of total billed charges,67.275% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,9.21,38.38,,7.368,percent of total billed charges,38.38% of total billed charges,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,14.82,61.74,,11.856,percent of total billed charges,61.74% of total billed charges,24.48,102,,19.584,percent of total billed charges,102% of total billed charges,9.12,38,,7.296,percent of total billed charges,38% of total billed charges,8.4,24.48,
LACERATION TRAY DISP - sub,3001118,CDM,270,RC,,,Outpatient,,,24.03,18.02,,18.74,78,,14.992,percent of total billed charges,78% of total billed charges,15.14,63,,12.112,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.13,38,,7.304,percent of total billed charges,38% of total billed charges,9.13,38,,7.304,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,21.63,90,,17.304,percent of total billed charges,90% of total billed charges,8.41,35,,6.728,percent of total billed charges,35% of total billed charges,16.17,67.275,,12.936,percent of total billed charges,67.275% of total billed charges,19.22,80,,15.376,percent of total billed charges,80% of total billed charges,9.22,38.38,,7.376,percent of total billed charges,38.38% of total billed charges,19.22,80,,15.376,percent of total billed charges,80% of total billed charges,14.84,61.74,,11.872,percent of total billed charges,61.74% of total billed charges,24.51,102,,19.608,percent of total billed charges,102% of total billed charges,9.13,38,,7.304,percent of total billed charges,38% of total billed charges,8.41,24.51,
IRRIGATION Y CYSTO,3002200,CDM,270,RC,,,Outpatient,,,24.2,18.15,,18.88,78,,15.104,percent of total billed charges,78% of total billed charges,15.25,63,,12.2,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.2,38,,7.36,percent of total billed charges,38% of total billed charges,9.2,38,,7.36,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,21.78,90,,17.424,percent of total billed charges,90% of total billed charges,8.47,35,,6.776,percent of total billed charges,35% of total billed charges,16.28,67.275,,13.024,percent of total billed charges,67.275% of total billed charges,19.36,80,,15.488,percent of total billed charges,80% of total billed charges,9.29,38.38,,7.432,percent of total billed charges,38.38% of total billed charges,19.36,80,,15.488,percent of total billed charges,80% of total billed charges,14.94,61.74,,11.952,percent of total billed charges,61.74% of total billed charges,24.68,102,,19.744,percent of total billed charges,102% of total billed charges,9.2,38,,7.36,percent of total billed charges,38% of total billed charges,8.47,24.68,
RIB BELTS MALE XXL,3001604,CDM,270,RC,,,Outpatient,,,24.4,18.3,,19.03,78,,15.224,percent of total billed charges,78% of total billed charges,15.37,63,,12.296,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.27,38,,7.416,percent of total billed charges,38% of total billed charges,9.27,38,,7.416,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,21.96,90,,17.568,percent of total billed charges,90% of total billed charges,8.54,35,,6.832,percent of total billed charges,35% of total billed charges,16.42,67.275,,13.136,percent of total billed charges,67.275% of total billed charges,19.52,80,,15.616,percent of total billed charges,80% of total billed charges,9.36,38.38,,7.488,percent of total billed charges,38.38% of total billed charges,19.52,80,,15.616,percent of total billed charges,80% of total billed charges,15.06,61.74,,12.048,percent of total billed charges,61.74% of total billed charges,24.89,102,,19.912,percent of total billed charges,102% of total billed charges,9.27,38,,7.416,percent of total billed charges,38% of total billed charges,8.54,24.89,
WEIGHTED UTENSIL - KNIFE,3001120,CDM,270,RC,,,Outpatient,,,24.6,18.45,,19.19,78,,15.352,percent of total billed charges,78% of total billed charges,15.5,63,,12.4,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.35,38,,7.48,percent of total billed charges,38% of total billed charges,9.35,38,,7.48,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,22.14,90,,17.712,percent of total billed charges,90% of total billed charges,8.61,35,,6.888,percent of total billed charges,35% of total billed charges,16.55,67.275,,13.24,percent of total billed charges,67.275% of total billed charges,19.68,80,,15.744,percent of total billed charges,80% of total billed charges,9.44,38.38,,7.552,percent of total billed charges,38.38% of total billed charges,19.68,80,,15.744,percent of total billed charges,80% of total billed charges,15.19,61.74,,12.152,percent of total billed charges,61.74% of total billed charges,25.09,102,,20.072,percent of total billed charges,102% of total billed charges,9.35,38,,7.48,percent of total billed charges,38% of total billed charges,8.61,25.09,
SHOE HORN 30,3004032,CDM,270,RC,,,Outpatient,,,24.85,18.64,,19.38,78,,15.504,percent of total billed charges,78% of total billed charges,15.66,63,,12.528,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.44,38,,7.552,percent of total billed charges,38% of total billed charges,9.44,38,,7.552,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,22.37,90,,17.896,percent of total billed charges,90% of total billed charges,8.7,35,,6.96,percent of total billed charges,35% of total billed charges,16.72,67.275,,13.376,percent of total billed charges,67.275% of total billed charges,19.88,80,,15.904,percent of total billed charges,80% of total billed charges,9.54,38.38,,7.632,percent of total billed charges,38.38% of total billed charges,19.88,80,,15.904,percent of total billed charges,80% of total billed charges,15.34,61.74,,12.272,percent of total billed charges,61.74% of total billed charges,25.35,102,,20.28,percent of total billed charges,102% of total billed charges,9.44,38,,7.552,percent of total billed charges,38% of total billed charges,8.7,25.35,
SALEM SUMP ANTI REFLUX VALVE,3001614,CDM,270,RC,,,Outpatient,,,24.91,18.68,,19.43,78,,15.544,percent of total billed charges,78% of total billed charges,15.69,63,,12.552,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.47,38,,7.576,percent of total billed charges,38% of total billed charges,9.47,38,,7.576,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,22.42,90,,17.936,percent of total billed charges,90% of total billed charges,8.72,35,,6.976,percent of total billed charges,35% of total billed charges,16.76,67.275,,13.408,percent of total billed charges,67.275% of total billed charges,19.93,80,,15.944,percent of total billed charges,80% of total billed charges,9.56,38.38,,7.648,percent of total billed charges,38.38% of total billed charges,19.93,80,,15.944,percent of total billed charges,80% of total billed charges,15.38,61.74,,12.304,percent of total billed charges,61.74% of total billed charges,25.41,102,,20.328,percent of total billed charges,102% of total billed charges,9.47,38,,7.576,percent of total billed charges,38% of total billed charges,8.72,25.41,
PLEURX VALVE CAP,3001176,CDM,270,RC,,,Outpatient,,,25,18.75,,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.5,38,,7.6,percent of total billed charges,38% of total billed charges,9.5,38,,7.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,22.5,90,,18,percent of total billed charges,90% of total billed charges,8.75,35,,7,percent of total billed charges,35% of total billed charges,16.82,67.275,,13.456,percent of total billed charges,67.275% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,9.6,38.38,,7.68,percent of total billed charges,38.38% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,15.44,61.74,,12.352,percent of total billed charges,61.74% of total billed charges,25.5,102,,20.4,percent of total billed charges,102% of total billed charges,9.5,38,,7.6,percent of total billed charges,38% of total billed charges,8.75,25.5,
WBC W/DIFF,5000855,CDM,305,RC,85048,HCPCS,Outpatient,,,25,18.75,,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,3.2,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,2.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,2.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,22.5,90,,18,percent of total billed charges,90% of total billed charges,3.36,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,16.82,67.275,,13.456,percent of total billed charges,67.275% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,2.57,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,20,80,,16,percent of total billed charges,80% of total billed charges,15.44,61.74,,12.352,percent of total billed charges,61.74% of total billed charges,3.26,102,,,Fee Schedule,102% of GA Medicaid Rate,2.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,2.54,22.5,
"Use of sound waves to treat medical problems, especially musculoskeletal problems like inflammation from injuries",9590016,CDM,420,RC,97035,HCPCS,Outpatient,,,25,18.75,,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.5,38,,7.6,percent of total billed charges,38% of total billed charges,9.5,38,,7.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,22.5,90,,18,percent of total billed charges,90% of total billed charges,8.75,35,,7,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,9.6,38.38,,7.68,percent of total billed charges,38.38% of total billed charges,20,80,,16,percent of total billed charges,80% of total billed charges,15.44,61.74,,12.352,percent of total billed charges,61.74% of total billed charges,25.5,102,,20.4,percent of total billed charges,102% of total billed charges,9.5,38,,7.6,percent of total billed charges,38% of total billed charges,8.75,145.93,
CLAVICLE SPLINT X-LG 79-85008,3000215,CDM,270,RC,,,Outpatient,,,25.05,18.79,,19.54,78,,15.632,percent of total billed charges,78% of total billed charges,15.78,63,,12.624,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.52,38,,7.616,percent of total billed charges,38% of total billed charges,9.52,38,,7.616,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,22.55,90,,18.04,percent of total billed charges,90% of total billed charges,8.77,35,,7.016,percent of total billed charges,35% of total billed charges,16.85,67.275,,13.48,percent of total billed charges,67.275% of total billed charges,20.04,80,,16.032,percent of total billed charges,80% of total billed charges,9.61,38.38,,7.688,percent of total billed charges,38.38% of total billed charges,20.04,80,,16.032,percent of total billed charges,80% of total billed charges,15.47,61.74,,12.376,percent of total billed charges,61.74% of total billed charges,25.55,102,,20.44,percent of total billed charges,102% of total billed charges,9.52,38,,7.616,percent of total billed charges,38% of total billed charges,8.77,25.55,
CABLE MONOPOLAR DISP,3004006,CDM,270,RC,,,Outpatient,,,25.15,18.86,,19.62,78,,15.696,percent of total billed charges,78% of total billed charges,15.84,63,,12.672,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.56,38,,7.648,percent of total billed charges,38% of total billed charges,9.56,38,,7.648,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,22.64,90,,18.112,percent of total billed charges,90% of total billed charges,8.8,35,,7.04,percent of total billed charges,35% of total billed charges,16.92,67.275,,13.536,percent of total billed charges,67.275% of total billed charges,20.12,80,,16.096,percent of total billed charges,80% of total billed charges,9.65,38.38,,7.72,percent of total billed charges,38.38% of total billed charges,20.12,80,,16.096,percent of total billed charges,80% of total billed charges,15.53,61.74,,12.424,percent of total billed charges,61.74% of total billed charges,25.65,102,,20.52,percent of total billed charges,102% of total billed charges,9.56,38,,7.648,percent of total billed charges,38% of total billed charges,8.8,25.65,
"EVACUATOR, SILICONE RESEVOIR",3000904,CDM,270,RC,,,Outpatient,,,25.45,19.09,,19.85,78,,15.88,percent of total billed charges,78% of total billed charges,16.03,63,,12.824,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.67,38,,7.736,percent of total billed charges,38% of total billed charges,9.67,38,,7.736,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,22.91,90,,18.328,percent of total billed charges,90% of total billed charges,8.91,35,,7.128,percent of total billed charges,35% of total billed charges,17.12,67.275,,13.696,percent of total billed charges,67.275% of total billed charges,20.36,80,,16.288,percent of total billed charges,80% of total billed charges,9.77,38.38,,7.816,percent of total billed charges,38.38% of total billed charges,20.36,80,,16.288,percent of total billed charges,80% of total billed charges,15.71,61.74,,12.568,percent of total billed charges,61.74% of total billed charges,25.96,102,,20.768,percent of total billed charges,102% of total billed charges,9.67,38,,7.736,percent of total billed charges,38% of total billed charges,8.91,25.96,
REACHER - LONG 32,3004026,CDM,270,RC,,,Outpatient,,,25.6,19.2,,19.97,78,,15.976,percent of total billed charges,78% of total billed charges,16.13,63,,12.904,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.73,38,,7.784,percent of total billed charges,38% of total billed charges,9.73,38,,7.784,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,23.04,90,,18.432,percent of total billed charges,90% of total billed charges,8.96,35,,7.168,percent of total billed charges,35% of total billed charges,17.22,67.275,,13.776,percent of total billed charges,67.275% of total billed charges,20.48,80,,16.384,percent of total billed charges,80% of total billed charges,9.83,38.38,,7.864,percent of total billed charges,38.38% of total billed charges,20.48,80,,16.384,percent of total billed charges,80% of total billed charges,15.81,61.74,,12.648,percent of total billed charges,61.74% of total billed charges,26.11,102,,20.888,percent of total billed charges,102% of total billed charges,9.73,38,,7.784,percent of total billed charges,38% of total billed charges,8.96,26.11,
PEEP VALVE - EM VENTILATOR,3004036,CDM,270,RC,,,Outpatient,,,25.6,19.2,,19.97,78,,15.976,percent of total billed charges,78% of total billed charges,16.13,63,,12.904,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.73,38,,7.784,percent of total billed charges,38% of total billed charges,9.73,38,,7.784,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,23.04,90,,18.432,percent of total billed charges,90% of total billed charges,8.96,35,,7.168,percent of total billed charges,35% of total billed charges,17.22,67.275,,13.776,percent of total billed charges,67.275% of total billed charges,20.48,80,,16.384,percent of total billed charges,80% of total billed charges,9.83,38.38,,7.864,percent of total billed charges,38.38% of total billed charges,20.48,80,,16.384,percent of total billed charges,80% of total billed charges,15.81,61.74,,12.648,percent of total billed charges,61.74% of total billed charges,26.11,102,,20.888,percent of total billed charges,102% of total billed charges,9.73,38,,7.784,percent of total billed charges,38% of total billed charges,8.96,26.11,
SHOULDER IMMOBILIZER MED,3002014,CDM,270,RC,,,Outpatient,,,25.75,19.31,,20.09,78,,16.072,percent of total billed charges,78% of total billed charges,16.22,63,,12.976,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.79,38,,7.832,percent of total billed charges,38% of total billed charges,9.79,38,,7.832,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,23.18,90,,18.544,percent of total billed charges,90% of total billed charges,9.01,35,,7.208,percent of total billed charges,35% of total billed charges,17.32,67.275,,13.856,percent of total billed charges,67.275% of total billed charges,20.6,80,,16.48,percent of total billed charges,80% of total billed charges,9.88,38.38,,7.904,percent of total billed charges,38.38% of total billed charges,20.6,80,,16.48,percent of total billed charges,80% of total billed charges,15.9,61.74,,12.72,percent of total billed charges,61.74% of total billed charges,26.27,102,,21.016,percent of total billed charges,102% of total billed charges,9.79,38,,7.832,percent of total billed charges,38% of total billed charges,9.01,26.27,
SHOULDER IMMOBILIZER LG 79-84167,3002015,CDM,270,RC,,,Outpatient,,,25.75,19.31,,20.09,78,,16.072,percent of total billed charges,78% of total billed charges,16.22,63,,12.976,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.79,38,,7.832,percent of total billed charges,38% of total billed charges,9.79,38,,7.832,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,23.18,90,,18.544,percent of total billed charges,90% of total billed charges,9.01,35,,7.208,percent of total billed charges,35% of total billed charges,17.32,67.275,,13.856,percent of total billed charges,67.275% of total billed charges,20.6,80,,16.48,percent of total billed charges,80% of total billed charges,9.88,38.38,,7.904,percent of total billed charges,38.38% of total billed charges,20.6,80,,16.48,percent of total billed charges,80% of total billed charges,15.9,61.74,,12.72,percent of total billed charges,61.74% of total billed charges,26.27,102,,21.016,percent of total billed charges,102% of total billed charges,9.79,38,,7.832,percent of total billed charges,38% of total billed charges,9.01,26.27,
SHOULDER IMMOBILIZER XLG,3002017,CDM,270,RC,,,Outpatient,,,25.75,19.31,,20.09,78,,16.072,percent of total billed charges,78% of total billed charges,16.22,63,,12.976,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.79,38,,7.832,percent of total billed charges,38% of total billed charges,9.79,38,,7.832,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,23.18,90,,18.544,percent of total billed charges,90% of total billed charges,9.01,35,,7.208,percent of total billed charges,35% of total billed charges,17.32,67.275,,13.856,percent of total billed charges,67.275% of total billed charges,20.6,80,,16.48,percent of total billed charges,80% of total billed charges,9.88,38.38,,7.904,percent of total billed charges,38.38% of total billed charges,20.6,80,,16.48,percent of total billed charges,80% of total billed charges,15.9,61.74,,12.72,percent of total billed charges,61.74% of total billed charges,26.27,102,,21.016,percent of total billed charges,102% of total billed charges,9.79,38,,7.832,percent of total billed charges,38% of total billed charges,9.01,26.27,
SCOPE WARMER,3003062,CDM,270,RC,,,Outpatient,,,25.75,19.31,,20.09,78,,16.072,percent of total billed charges,78% of total billed charges,16.22,63,,12.976,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.79,38,,7.832,percent of total billed charges,38% of total billed charges,9.79,38,,7.832,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,23.18,90,,18.544,percent of total billed charges,90% of total billed charges,9.01,35,,7.208,percent of total billed charges,35% of total billed charges,17.32,67.275,,13.856,percent of total billed charges,67.275% of total billed charges,20.6,80,,16.48,percent of total billed charges,80% of total billed charges,9.88,38.38,,7.904,percent of total billed charges,38.38% of total billed charges,20.6,80,,16.48,percent of total billed charges,80% of total billed charges,15.9,61.74,,12.72,percent of total billed charges,61.74% of total billed charges,26.27,102,,21.016,percent of total billed charges,102% of total billed charges,9.79,38,,7.832,percent of total billed charges,38% of total billed charges,9.01,26.27,
CLAVICLE SPLINT X-S 79-85002,3000219,CDM,270,RC,,,Outpatient,,,25.85,19.39,,20.16,78,,16.128,percent of total billed charges,78% of total billed charges,16.29,63,,13.032,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.82,38,,7.856,percent of total billed charges,38% of total billed charges,9.82,38,,7.856,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,23.27,90,,18.616,percent of total billed charges,90% of total billed charges,9.05,35,,7.24,percent of total billed charges,35% of total billed charges,17.39,67.275,,13.912,percent of total billed charges,67.275% of total billed charges,20.68,80,,16.544,percent of total billed charges,80% of total billed charges,9.92,38.38,,7.936,percent of total billed charges,38.38% of total billed charges,20.68,80,,16.544,percent of total billed charges,80% of total billed charges,15.96,61.74,,12.768,percent of total billed charges,61.74% of total billed charges,26.37,102,,21.096,percent of total billed charges,102% of total billed charges,9.82,38,,7.856,percent of total billed charges,38% of total billed charges,9.05,26.37,
ARMBOARD - LG - Adult,3000125,CDM,270,RC,,,Outpatient,,,26,19.5,,20.28,78,,16.224,percent of total billed charges,78% of total billed charges,16.38,63,,13.104,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.88,38,,7.904,percent of total billed charges,38% of total billed charges,9.88,38,,7.904,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,9.1,35,,7.28,percent of total billed charges,35% of total billed charges,17.49,67.275,,13.992,percent of total billed charges,67.275% of total billed charges,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,9.98,38.38,,7.984,percent of total billed charges,38.38% of total billed charges,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,16.05,61.74,,12.84,percent of total billed charges,61.74% of total billed charges,26.52,102,,21.216,percent of total billed charges,102% of total billed charges,9.88,38,,7.904,percent of total billed charges,38% of total billed charges,9.1,26.52,
CATHETER FOLEY SILICONE 20FR,3000272,CDM,270,RC,,,Outpatient,,,26,19.5,,20.28,78,,16.224,percent of total billed charges,78% of total billed charges,16.38,63,,13.104,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.88,38,,7.904,percent of total billed charges,38% of total billed charges,9.88,38,,7.904,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,9.1,35,,7.28,percent of total billed charges,35% of total billed charges,17.49,67.275,,13.992,percent of total billed charges,67.275% of total billed charges,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,9.98,38.38,,7.984,percent of total billed charges,38.38% of total billed charges,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,16.05,61.74,,12.84,percent of total billed charges,61.74% of total billed charges,26.52,102,,21.216,percent of total billed charges,102% of total billed charges,9.88,38,,7.904,percent of total billed charges,38% of total billed charges,9.1,26.52,
SILVASORB GEL .25 OZ,3000529,CDM,270,RC,,,Outpatient,,,26,19.5,,20.28,78,,16.224,percent of total billed charges,78% of total billed charges,16.38,63,,13.104,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.88,38,,7.904,percent of total billed charges,38% of total billed charges,9.88,38,,7.904,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,9.1,35,,7.28,percent of total billed charges,35% of total billed charges,17.49,67.275,,13.992,percent of total billed charges,67.275% of total billed charges,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,9.98,38.38,,7.984,percent of total billed charges,38.38% of total billed charges,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,16.05,61.74,,12.84,percent of total billed charges,61.74% of total billed charges,26.52,102,,21.216,percent of total billed charges,102% of total billed charges,9.88,38,,7.904,percent of total billed charges,38% of total billed charges,9.1,26.52,
MUSOCAL  ATOMIZER,3006020,CDM,270,RC,,,Outpatient,,,26.13,19.6,,20.38,78,,16.304,percent of total billed charges,78% of total billed charges,16.46,63,,13.168,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.93,38,,7.944,percent of total billed charges,38% of total billed charges,9.93,38,,7.944,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,23.52,90,,18.816,percent of total billed charges,90% of total billed charges,9.15,35,,7.32,percent of total billed charges,35% of total billed charges,17.58,67.275,,14.064,percent of total billed charges,67.275% of total billed charges,20.9,80,,16.72,percent of total billed charges,80% of total billed charges,10.03,38.38,,8.024,percent of total billed charges,38.38% of total billed charges,20.9,80,,16.72,percent of total billed charges,80% of total billed charges,16.13,61.74,,12.904,percent of total billed charges,61.74% of total billed charges,26.65,102,,21.32,percent of total billed charges,102% of total billed charges,9.93,38,,7.944,percent of total billed charges,38% of total billed charges,9.15,26.65,
BLADE SAG 9.5X25.5X0.4MM,3003095,CDM,270,RC,,,Outpatient,,,26.15,19.61,,20.4,78,,16.32,percent of total billed charges,78% of total billed charges,16.47,63,,13.176,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.94,38,,7.952,percent of total billed charges,38% of total billed charges,9.94,38,,7.952,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,23.54,90,,18.832,percent of total billed charges,90% of total billed charges,9.15,35,,7.32,percent of total billed charges,35% of total billed charges,17.59,67.275,,14.072,percent of total billed charges,67.275% of total billed charges,20.92,80,,16.736,percent of total billed charges,80% of total billed charges,10.04,38.38,,8.032,percent of total billed charges,38.38% of total billed charges,20.92,80,,16.736,percent of total billed charges,80% of total billed charges,16.15,61.74,,12.92,percent of total billed charges,61.74% of total billed charges,26.67,102,,21.336,percent of total billed charges,102% of total billed charges,9.94,38,,7.952,percent of total billed charges,38% of total billed charges,9.15,26.67,
HUBER NEEDLE 20 X .75 - SAFETY,3000709,CDM,270,RC,,,Outpatient,,,26.51,19.88,,20.68,78,,16.544,percent of total billed charges,78% of total billed charges,16.7,63,,13.36,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,10.07,38,,8.056,percent of total billed charges,38% of total billed charges,10.07,38,,8.056,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,23.86,90,,19.088,percent of total billed charges,90% of total billed charges,9.28,35,,7.424,percent of total billed charges,35% of total billed charges,17.83,67.275,,14.264,percent of total billed charges,67.275% of total billed charges,21.21,80,,16.968,percent of total billed charges,80% of total billed charges,10.17,38.38,,8.136,percent of total billed charges,38.38% of total billed charges,21.21,80,,16.968,percent of total billed charges,80% of total billed charges,16.37,61.74,,13.096,percent of total billed charges,61.74% of total billed charges,27.04,102,,21.632,percent of total billed charges,102% of total billed charges,10.07,38,,8.056,percent of total billed charges,38% of total billed charges,9.28,27.04,
HUBER NEEDLE 20 x 1-SAFETY,3000715,CDM,270,RC,,,Outpatient,,,26.51,19.88,,20.68,78,,16.544,percent of total billed charges,78% of total billed charges,16.7,63,,13.36,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,10.07,38,,8.056,percent of total billed charges,38% of total billed charges,10.07,38,,8.056,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,23.86,90,,19.088,percent of total billed charges,90% of total billed charges,9.28,35,,7.424,percent of total billed charges,35% of total billed charges,17.83,67.275,,14.264,percent of total billed charges,67.275% of total billed charges,21.21,80,,16.968,percent of total billed charges,80% of total billed charges,10.17,38.38,,8.136,percent of total billed charges,38.38% of total billed charges,21.21,80,,16.968,percent of total billed charges,80% of total billed charges,16.37,61.74,,13.096,percent of total billed charges,61.74% of total billed charges,27.04,102,,21.632,percent of total billed charges,102% of total billed charges,10.07,38,,8.056,percent of total billed charges,38% of total billed charges,9.28,27.04,
PDS 1 Z880G,3001586,CDM,270,RC,,,Outpatient,,,26.56,19.92,,20.72,78,,16.576,percent of total billed charges,78% of total billed charges,16.73,63,,13.384,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,10.09,38,,8.072,percent of total billed charges,38% of total billed charges,10.09,38,,8.072,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,23.9,90,,19.12,percent of total billed charges,90% of total billed charges,9.3,35,,7.44,percent of total billed charges,35% of total billed charges,17.87,67.275,,14.296,percent of total billed charges,67.275% of total billed charges,21.25,80,,17,percent of total billed charges,80% of total billed charges,10.19,38.38,,8.152,percent of total billed charges,38.38% of total billed charges,21.25,80,,17,percent of total billed charges,80% of total billed charges,16.4,61.74,,13.12,percent of total billed charges,61.74% of total billed charges,27.09,102,,21.672,percent of total billed charges,102% of total billed charges,10.09,38,,8.072,percent of total billed charges,38% of total billed charges,9.3,27.09,
SPLINT WRIST XLG RIGHT,3000424,CDM,270,RC,,,Outpatient,,,26.6,19.95,,20.75,78,,16.6,percent of total billed charges,78% of total billed charges,16.76,63,,13.408,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,10.11,38,,8.088,percent of total billed charges,38% of total billed charges,10.11,38,,8.088,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,23.94,90,,19.152,percent of total billed charges,90% of total billed charges,9.31,35,,7.448,percent of total billed charges,35% of total billed charges,17.9,67.275,,14.32,percent of total billed charges,67.275% of total billed charges,21.28,80,,17.024,percent of total billed charges,80% of total billed charges,10.21,38.38,,8.168,percent of total billed charges,38.38% of total billed charges,21.28,80,,17.024,percent of total billed charges,80% of total billed charges,16.42,61.74,,13.136,percent of total billed charges,61.74% of total billed charges,27.13,102,,21.704,percent of total billed charges,102% of total billed charges,10.11,38,,8.088,percent of total billed charges,38% of total billed charges,9.31,27.13,
SPLINT WRIST SM RIGHT,3002321,CDM,270,RC,,,Outpatient,,,26.6,19.95,,20.75,78,,16.6,percent of total billed charges,78% of total billed charges,16.76,63,,13.408,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,10.11,38,,8.088,percent of total billed charges,38% of total billed charges,10.11,38,,8.088,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,23.94,90,,19.152,percent of total billed charges,90% of total billed charges,9.31,35,,7.448,percent of total billed charges,35% of total billed charges,17.9,67.275,,14.32,percent of total billed charges,67.275% of total billed charges,21.28,80,,17.024,percent of total billed charges,80% of total billed charges,10.21,38.38,,8.168,percent of total billed charges,38.38% of total billed charges,21.28,80,,17.024,percent of total billed charges,80% of total billed charges,16.42,61.74,,13.136,percent of total billed charges,61.74% of total billed charges,27.13,102,,21.704,percent of total billed charges,102% of total billed charges,10.11,38,,8.088,percent of total billed charges,38% of total billed charges,9.31,27.13,
SPLINT WRIST LARGE LEFT,3002330,CDM,270,RC,,,Outpatient,,,26.6,19.95,,20.75,78,,16.6,percent of total billed charges,78% of total billed charges,16.76,63,,13.408,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,10.11,38,,8.088,percent of total billed charges,38% of total billed charges,10.11,38,,8.088,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,23.94,90,,19.152,percent of total billed charges,90% of total billed charges,9.31,35,,7.448,percent of total billed charges,35% of total billed charges,17.9,67.275,,14.32,percent of total billed charges,67.275% of total billed charges,21.28,80,,17.024,percent of total billed charges,80% of total billed charges,10.21,38.38,,8.168,percent of total billed charges,38.38% of total billed charges,21.28,80,,17.024,percent of total billed charges,80% of total billed charges,16.42,61.74,,13.136,percent of total billed charges,61.74% of total billed charges,27.13,102,,21.704,percent of total billed charges,102% of total billed charges,10.11,38,,8.088,percent of total billed charges,38% of total billed charges,9.31,27.13,
SPLINT WRIST XS RIGHT,3003092,CDM,270,RC,,,Outpatient,,,26.6,19.95,,20.75,78,,16.6,percent of total billed charges,78% of total billed charges,16.76,63,,13.408,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,10.11,38,,8.088,percent of total billed charges,38% of total billed charges,10.11,38,,8.088,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,23.94,90,,19.152,percent of total billed charges,90% of total billed charges,9.31,35,,7.448,percent of total billed charges,35% of total billed charges,17.9,67.275,,14.32,percent of total billed charges,67.275% of total billed charges,21.28,80,,17.024,percent of total billed charges,80% of total billed charges,10.21,38.38,,8.168,percent of total billed charges,38.38% of total billed charges,21.28,80,,17.024,percent of total billed charges,80% of total billed charges,16.42,61.74,,13.136,percent of total billed charges,61.74% of total billed charges,27.13,102,,21.704,percent of total billed charges,102% of total billed charges,10.11,38,,8.088,percent of total billed charges,38% of total billed charges,9.31,27.13,
SPLINT WRIST XS LEFT,3003999,CDM,270,RC,,,Outpatient,,,26.6,19.95,,20.75,78,,16.6,percent of total billed charges,78% of total billed charges,16.76,63,,13.408,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,10.11,38,,8.088,percent of total billed charges,38% of total billed charges,10.11,38,,8.088,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,23.94,90,,19.152,percent of total billed charges,90% of total billed charges,9.31,35,,7.448,percent of total billed charges,35% of total billed charges,17.9,67.275,,14.32,percent of total billed charges,67.275% of total billed charges,21.28,80,,17.024,percent of total billed charges,80% of total billed charges,10.21,38.38,,8.168,percent of total billed charges,38.38% of total billed charges,21.28,80,,17.024,percent of total billed charges,80% of total billed charges,16.42,61.74,,13.136,percent of total billed charges,61.74% of total billed charges,27.13,102,,21.704,percent of total billed charges,102% of total billed charges,10.11,38,,8.088,percent of total billed charges,38% of total billed charges,9.31,27.13,
ETHILON 3-0 FS-1 663G,3002339,CDM,270,RC,,,Outpatient,,,26.82,20.12,,20.92,78,,16.736,percent of total billed charges,78% of total billed charges,16.9,63,,13.52,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,10.19,38,,8.152,percent of total billed charges,38% of total billed charges,10.19,38,,8.152,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,24.14,90,,19.312,percent of total billed charges,90% of total billed charges,9.39,35,,7.512,percent of total billed charges,35% of total billed charges,18.04,67.275,,14.432,percent of total billed charges,67.275% of total billed charges,21.46,80,,17.168,percent of total billed charges,80% of total billed charges,10.29,38.38,,8.232,percent of total billed charges,38.38% of total billed charges,21.46,80,,17.168,percent of total billed charges,80% of total billed charges,16.56,61.74,,13.248,percent of total billed charges,61.74% of total billed charges,27.36,102,,21.888,percent of total billed charges,102% of total billed charges,10.19,38,,8.152,percent of total billed charges,38% of total billed charges,9.39,27.36,
NEEDLE FREE 1/2  TROCAR,3002010,CDM,270,RC,,,Outpatient,,,26.95,20.21,,21.02,78,,16.816,percent of total billed charges,78% of total billed charges,16.98,63,,13.584,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,10.24,38,,8.192,percent of total billed charges,38% of total billed charges,10.24,38,,8.192,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,24.26,90,,19.408,percent of total billed charges,90% of total billed charges,9.43,35,,7.544,percent of total billed charges,35% of total billed charges,18.13,67.275,,14.504,percent of total billed charges,67.275% of total billed charges,21.56,80,,17.248,percent of total billed charges,80% of total billed charges,10.34,38.38,,8.272,percent of total billed charges,38.38% of total billed charges,21.56,80,,17.248,percent of total billed charges,80% of total billed charges,16.64,61.74,,13.312,percent of total billed charges,61.74% of total billed charges,27.49,102,,21.992,percent of total billed charges,102% of total billed charges,10.24,38,,8.192,percent of total billed charges,38% of total billed charges,9.43,27.49,
THORACIC CATH 16FR STRAIGHT ARGYLE,3002542,CDM,270,RC,,,Outpatient,,,26.97,20.23,,21.04,78,,16.832,percent of total billed charges,78% of total billed charges,16.99,63,,13.592,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,10.25,38,,8.2,percent of total billed charges,38% of total billed charges,10.25,38,,8.2,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,24.27,90,,19.416,percent of total billed charges,90% of total billed charges,9.44,35,,7.552,percent of total billed charges,35% of total billed charges,18.14,67.275,,14.512,percent of total billed charges,67.275% of total billed charges,21.58,80,,17.264,percent of total billed charges,80% of total billed charges,10.35,38.38,,8.28,percent of total billed charges,38.38% of total billed charges,21.58,80,,17.264,percent of total billed charges,80% of total billed charges,16.65,61.74,,13.32,percent of total billed charges,61.74% of total billed charges,27.51,102,,22.008,percent of total billed charges,102% of total billed charges,10.25,38,,8.2,percent of total billed charges,38% of total billed charges,9.44,27.51,
Blood test that measures the amount of iron carried in the blood,5001423,CDM,300,RC,83550,HCPCS,Outpatient,,,27,20.25,,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,10.99,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,11.54,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,18.16,67.275,,14.528,percent of total billed charges,67.275% of total billed charges,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,8.83,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,16.67,61.74,,13.336,percent of total billed charges,61.74% of total billed charges,11.21,102,,,Fee Schedule,102% of GA Medicaid Rate,8.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.74,24.3,
BABY FOIL BUNTING,3002002,CDM,270,RC,,,Outpatient,,,27.55,20.66,,21.49,78,,17.192,percent of total billed charges,78% of total billed charges,17.36,63,,13.888,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,10.47,38,,8.376,percent of total billed charges,38% of total billed charges,10.47,38,,8.376,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,24.8,90,,19.84,percent of total billed charges,90% of total billed charges,9.64,35,,7.712,percent of total billed charges,35% of total billed charges,18.53,67.275,,14.824,percent of total billed charges,67.275% of total billed charges,22.04,80,,17.632,percent of total billed charges,80% of total billed charges,10.57,38.38,,8.456,percent of total billed charges,38.38% of total billed charges,22.04,80,,17.632,percent of total billed charges,80% of total billed charges,17.01,61.74,,13.608,percent of total billed charges,61.74% of total billed charges,28.1,102,,22.48,percent of total billed charges,102% of total billed charges,10.47,38,,8.376,percent of total billed charges,38% of total billed charges,9.64,28.1,
CAST SHOE SMALL,3000213,CDM,270,RC,,,Outpatient,,,27.65,20.74,,21.57,78,,17.256,percent of total billed charges,78% of total billed charges,17.42,63,,13.936,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,10.51,38,,8.408,percent of total billed charges,38% of total billed charges,10.51,38,,8.408,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,24.89,90,,19.912,percent of total billed charges,90% of total billed charges,9.68,35,,7.744,percent of total billed charges,35% of total billed charges,18.6,67.275,,14.88,percent of total billed charges,67.275% of total billed charges,22.12,80,,17.696,percent of total billed charges,80% of total billed charges,10.61,38.38,,8.488,percent of total billed charges,38.38% of total billed charges,22.12,80,,17.696,percent of total billed charges,80% of total billed charges,17.07,61.74,,13.656,percent of total billed charges,61.74% of total billed charges,28.2,102,,22.56,percent of total billed charges,102% of total billed charges,10.51,38,,8.408,percent of total billed charges,38% of total billed charges,9.68,28.2,
CAST SHOE LARGE,3001526,CDM,270,RC,,,Outpatient,,,27.65,20.74,,21.57,78,,17.256,percent of total billed charges,78% of total billed charges,17.42,63,,13.936,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,10.51,38,,8.408,percent of total billed charges,38% of total billed charges,10.51,38,,8.408,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,24.89,90,,19.912,percent of total billed charges,90% of total billed charges,9.68,35,,7.744,percent of total billed charges,35% of total billed charges,18.6,67.275,,14.88,percent of total billed charges,67.275% of total billed charges,22.12,80,,17.696,percent of total billed charges,80% of total billed charges,10.61,38.38,,8.488,percent of total billed charges,38.38% of total billed charges,22.12,80,,17.696,percent of total billed charges,80% of total billed charges,17.07,61.74,,13.656,percent of total billed charges,61.74% of total billed charges,28.2,102,,22.56,percent of total billed charges,102% of total billed charges,10.51,38,,8.408,percent of total billed charges,38% of total billed charges,9.68,28.2,
PROLENE 5-0 PC-1,3006018,CDM,270,RC,,,Outpatient,,,27.65,20.74,,21.57,78,,17.256,percent of total billed charges,78% of total billed charges,17.42,63,,13.936,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,10.51,38,,8.408,percent of total billed charges,38% of total billed charges,10.51,38,,8.408,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,24.89,90,,19.912,percent of total billed charges,90% of total billed charges,9.68,35,,7.744,percent of total billed charges,35% of total billed charges,18.6,67.275,,14.88,percent of total billed charges,67.275% of total billed charges,22.12,80,,17.696,percent of total billed charges,80% of total billed charges,10.61,38.38,,8.488,percent of total billed charges,38.38% of total billed charges,22.12,80,,17.696,percent of total billed charges,80% of total billed charges,17.07,61.74,,13.656,percent of total billed charges,61.74% of total billed charges,28.2,102,,22.56,percent of total billed charges,102% of total billed charges,10.51,38,,8.408,percent of total billed charges,38% of total billed charges,9.68,28.2,
PROLENE 5-0 PC-1,3006040,CDM,270,RC,,,Outpatient,,,27.65,20.74,,21.57,78,,17.256,percent of total billed charges,78% of total billed charges,17.42,63,,13.936,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,10.51,38,,8.408,percent of total billed charges,38% of total billed charges,10.51,38,,8.408,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,24.89,90,,19.912,percent of total billed charges,90% of total billed charges,9.68,35,,7.744,percent of total billed charges,35% of total billed charges,18.6,67.275,,14.88,percent of total billed charges,67.275% of total billed charges,22.12,80,,17.696,percent of total billed charges,80% of total billed charges,10.61,38.38,,8.488,percent of total billed charges,38.38% of total billed charges,22.12,80,,17.696,percent of total billed charges,80% of total billed charges,17.07,61.74,,13.656,percent of total billed charges,61.74% of total billed charges,28.2,102,,22.56,percent of total billed charges,102% of total billed charges,10.51,38,,8.408,percent of total billed charges,38% of total billed charges,9.68,28.2,
PROLENE 5-0 PC-1,3006041,CDM,270,RC,,,Outpatient,,,27.65,20.74,,21.57,78,,17.256,percent of total billed charges,78% of total billed charges,17.42,63,,13.936,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,10.51,38,,8.408,percent of total billed charges,38% of total billed charges,10.51,38,,8.408,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,24.89,90,,19.912,percent of total billed charges,90% of total billed charges,9.68,35,,7.744,percent of total billed charges,35% of total billed charges,18.6,67.275,,14.88,percent of total billed charges,67.275% of total billed charges,22.12,80,,17.696,percent of total billed charges,80% of total billed charges,10.61,38.38,,8.488,percent of total billed charges,38.38% of total billed charges,22.12,80,,17.696,percent of total billed charges,80% of total billed charges,17.07,61.74,,13.656,percent of total billed charges,61.74% of total billed charges,28.2,102,,22.56,percent of total billed charges,102% of total billed charges,10.51,38,,8.408,percent of total billed charges,38% of total billed charges,9.68,28.2,
SILK 1   SH   K835H,3005224,CDM,270,RC,,,Outpatient,,,27.83,20.87,,21.71,78,,17.368,percent of total billed charges,78% of total billed charges,17.53,63,,14.024,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,10.58,38,,8.464,percent of total billed charges,38% of total billed charges,10.58,38,,8.464,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,25.05,90,,20.04,percent of total billed charges,90% of total billed charges,9.74,35,,7.792,percent of total billed charges,35% of total billed charges,18.72,67.275,,14.976,percent of total billed charges,67.275% of total billed charges,22.26,80,,17.808,percent of total billed charges,80% of total billed charges,10.68,38.38,,8.544,percent of total billed charges,38.38% of total billed charges,22.26,80,,17.808,percent of total billed charges,80% of total billed charges,17.18,61.74,,13.744,percent of total billed charges,61.74% of total billed charges,28.39,102,,22.712,percent of total billed charges,102% of total billed charges,10.58,38,,8.464,percent of total billed charges,38% of total billed charges,9.74,28.39,
KETONES URINE,5000029,CDM,300,RC,82009,HCPCS,Outpatient,,,28,21,,21.84,78,,17.472,percent of total billed charges,78% of total billed charges,4.13,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.52,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.52,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,4.34,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,18.84,67.275,,15.072,percent of total billed charges,67.275% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,4.57,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,17.29,61.74,,13.832,percent of total billed charges,61.74% of total billed charges,4.21,102,,,Fee Schedule,102% of GA Medicaid Rate,4.52,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.13,25.2,
A lab test to screen for evidence of vaginal infection,5000218,CDM,306,RC,87210,HCPCS,Outpatient,,,28,21,,21.84,78,,17.472,percent of total billed charges,78% of total billed charges,5.36,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.82,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.82,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,5.63,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,18.84,67.275,,15.072,percent of total billed charges,67.275% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,5.88,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,17.29,61.74,,13.832,percent of total billed charges,61.74% of total billed charges,5.47,102,,,Fee Schedule,102% of GA Medicaid Rate,5.82,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.36,25.2,
A lab test to screen for evidence of vaginal infection,5000257,CDM,306,RC,87210,HCPCS,Outpatient,,,28,21,,21.84,78,,17.472,percent of total billed charges,78% of total billed charges,5.36,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.82,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.82,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,5.63,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,18.84,67.275,,15.072,percent of total billed charges,67.275% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,5.88,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,17.29,61.74,,13.832,percent of total billed charges,61.74% of total billed charges,5.47,102,,,Fee Schedule,102% of GA Medicaid Rate,5.82,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.36,25.2,
KETONES SERUM,5000703,CDM,301,RC,82009,HCPCS,Outpatient,,,28,21,,21.84,78,,17.472,percent of total billed charges,78% of total billed charges,4.13,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.52,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.52,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,4.34,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,18.84,67.275,,15.072,percent of total billed charges,67.275% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,4.57,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,17.29,61.74,,13.832,percent of total billed charges,61.74% of total billed charges,4.21,102,,,Fee Schedule,102% of GA Medicaid Rate,4.52,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.13,25.2,
RETICULOCYTE COUNT,5000840,CDM,305,RC,85045,HCPCS,Outpatient,,,28,21,,21.84,78,,17.472,percent of total billed charges,78% of total billed charges,5.03,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,3.99,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.99,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,5.28,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,18.84,67.275,,15.072,percent of total billed charges,67.275% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,4.03,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,17.29,61.74,,13.832,percent of total billed charges,61.74% of total billed charges,5.13,102,,,Fee Schedule,102% of GA Medicaid Rate,3.99,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.99,25.2,
Blood test to screen for syphilis,5001440,CDM,302,RC,86592,HCPCS,Outpatient,,,28,21,,21.84,78,,17.472,percent of total billed charges,78% of total billed charges,4.65,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,4.88,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,18.84,67.275,,15.072,percent of total billed charges,67.275% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,4.31,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,17.29,61.74,,13.832,percent of total billed charges,61.74% of total billed charges,4.74,102,,,Fee Schedule,102% of GA Medicaid Rate,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.27,25.2,
PINWORM PREP,5001526,CDM,306,RC,87172,HCPCS,Outpatient,,,28,21,,21.84,78,,17.472,percent of total billed charges,78% of total billed charges,5.36,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,5.63,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,18.84,67.275,,15.072,percent of total billed charges,67.275% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,4.31,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,17.29,61.74,,13.832,percent of total billed charges,61.74% of total billed charges,5.47,102,,,Fee Schedule,102% of GA Medicaid Rate,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.27,25.2,
Blood test to screen for syphilis,5001605,CDM,302,RC,86592,HCPCS,Outpatient,,,28,21,,21.84,78,,17.472,percent of total billed charges,78% of total billed charges,4.65,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,4.88,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,18.84,67.275,,15.072,percent of total billed charges,67.275% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,4.31,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,17.29,61.74,,13.832,percent of total billed charges,61.74% of total billed charges,4.74,102,,,Fee Schedule,102% of GA Medicaid Rate,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.27,25.2,
Blood test to screen for syphilis,5001606,CDM,302,RC,86592,HCPCS,Outpatient,,,28,21,,21.84,78,,17.472,percent of total billed charges,78% of total billed charges,4.65,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,4.88,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,18.84,67.275,,15.072,percent of total billed charges,67.275% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,4.31,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,17.29,61.74,,13.832,percent of total billed charges,61.74% of total billed charges,4.74,102,,,Fee Schedule,102% of GA Medicaid Rate,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.27,25.2,
KETONES- MULTIPLE,5009103,CDM,300,RC,82009,HCPCS,Outpatient,,,28,21,,21.84,78,,17.472,percent of total billed charges,78% of total billed charges,4.13,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.52,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.52,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,4.34,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,18.84,67.275,,15.072,percent of total billed charges,67.275% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,4.57,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,17.29,61.74,,13.832,percent of total billed charges,61.74% of total billed charges,4.21,102,,,Fee Schedule,102% of GA Medicaid Rate,4.52,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.13,25.2,
ALBUMIN MULTIPLE,5009107,CDM,301,RC,82040,HCPCS,Outpatient,,,28,21,,21.84,78,,17.472,percent of total billed charges,78% of total billed charges,3.62,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.95,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.95,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,3.8,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,18.84,67.275,,15.072,percent of total billed charges,67.275% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,5,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,17.29,61.74,,13.832,percent of total billed charges,61.74% of total billed charges,3.69,102,,,Fee Schedule,102% of GA Medicaid Rate,4.95,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.62,25.2,
POTASSIUM- MULTIPLE,5009148,CDM,301,RC,84132,HCPCS,Outpatient,,,28,21,,21.84,78,,17.472,percent of total billed charges,78% of total billed charges,5.78,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.76,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.76,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,6.07,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,18.84,67.275,,15.072,percent of total billed charges,67.275% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,4.81,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,17.29,61.74,,13.832,percent of total billed charges,61.74% of total billed charges,5.9,102,,,Fee Schedule,102% of GA Medicaid Rate,4.76,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.76,25.2,
TRANSAMNASE SGOT MULTIPLE,5009160,CDM,301,RC,84450,HCPCS,Outpatient,,,28,21,,21.84,78,,17.472,percent of total billed charges,78% of total billed charges,6.35,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,6.67,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,18.84,67.275,,15.072,percent of total billed charges,67.275% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,5.23,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,17.29,61.74,,13.832,percent of total billed charges,61.74% of total billed charges,6.48,102,,,Fee Schedule,102% of GA Medicaid Rate,5.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.18,25.2,
BUN MULTIPLE,5009163,CDM,301,RC,84520,HCPCS,Outpatient,,,28,21,,21.84,78,,17.472,percent of total billed charges,78% of total billed charges,4.96,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,3.95,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.95,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,5.21,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,18.84,67.275,,15.072,percent of total billed charges,67.275% of total billed charges,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,3.99,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,17.29,61.74,,13.832,percent of total billed charges,61.74% of total billed charges,5.06,102,,,Fee Schedule,102% of GA Medicaid Rate,3.95,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.95,25.2,
URIMETER,3003037,CDM,270,RC,,,Outpatient,,,28.16,21.12,,21.96,78,,17.568,percent of total billed charges,78% of total billed charges,17.74,63,,14.192,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,10.7,38,,8.56,percent of total billed charges,38% of total billed charges,10.7,38,,8.56,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,25.34,90,,20.272,percent of total billed charges,90% of total billed charges,9.86,35,,7.888,percent of total billed charges,35% of total billed charges,18.94,67.275,,15.152,percent of total billed charges,67.275% of total billed charges,22.53,80,,18.024,percent of total billed charges,80% of total billed charges,10.81,38.38,,8.648,percent of total billed charges,38.38% of total billed charges,22.53,80,,18.024,percent of total billed charges,80% of total billed charges,17.39,61.74,,13.912,percent of total billed charges,61.74% of total billed charges,28.72,102,,22.976,percent of total billed charges,102% of total billed charges,10.7,38,,8.56,percent of total billed charges,38% of total billed charges,9.86,28.72,
CERVICAL COLLAR -PEDS,3000253,CDM,270,RC,,,Outpatient,,,28.45,21.34,,22.19,78,,17.752,percent of total billed charges,78% of total billed charges,17.92,63,,14.336,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,10.81,38,,8.648,percent of total billed charges,38% of total billed charges,10.81,38,,8.648,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,25.61,90,,20.488,percent of total billed charges,90% of total billed charges,9.96,35,,7.968,percent of total billed charges,35% of total billed charges,19.14,67.275,,15.312,percent of total billed charges,67.275% of total billed charges,22.76,80,,18.208,percent of total billed charges,80% of total billed charges,10.92,38.38,,8.736,percent of total billed charges,38.38% of total billed charges,22.76,80,,18.208,percent of total billed charges,80% of total billed charges,17.57,61.74,,14.056,percent of total billed charges,61.74% of total billed charges,29.02,102,,23.216,percent of total billed charges,102% of total billed charges,10.81,38,,8.648,percent of total billed charges,38% of total billed charges,9.96,29.02,
SPLINT WRIST MED LEFT,3002318,CDM,270,RC,,,Outpatient,,,28.55,21.41,,22.27,78,,17.816,percent of total billed charges,78% of total billed charges,17.99,63,,14.392,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,10.85,38,,8.68,percent of total billed charges,38% of total billed charges,10.85,38,,8.68,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,25.7,90,,20.56,percent of total billed charges,90% of total billed charges,9.99,35,,7.992,percent of total billed charges,35% of total billed charges,19.21,67.275,,15.368,percent of total billed charges,67.275% of total billed charges,22.84,80,,18.272,percent of total billed charges,80% of total billed charges,10.96,38.38,,8.768,percent of total billed charges,38.38% of total billed charges,22.84,80,,18.272,percent of total billed charges,80% of total billed charges,17.63,61.74,,14.104,percent of total billed charges,61.74% of total billed charges,29.12,102,,23.296,percent of total billed charges,102% of total billed charges,10.85,38,,8.68,percent of total billed charges,38% of total billed charges,9.99,29.12,
SPLINT WRIST XLG LEFT,3002320,CDM,270,RC,,,Outpatient,,,28.55,21.41,,22.27,78,,17.816,percent of total billed charges,78% of total billed charges,17.99,63,,14.392,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,10.85,38,,8.68,percent of total billed charges,38% of total billed charges,10.85,38,,8.68,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,25.7,90,,20.56,percent of total billed charges,90% of total billed charges,9.99,35,,7.992,percent of total billed charges,35% of total billed charges,19.21,67.275,,15.368,percent of total billed charges,67.275% of total billed charges,22.84,80,,18.272,percent of total billed charges,80% of total billed charges,10.96,38.38,,8.768,percent of total billed charges,38.38% of total billed charges,22.84,80,,18.272,percent of total billed charges,80% of total billed charges,17.63,61.74,,14.104,percent of total billed charges,61.74% of total billed charges,29.12,102,,23.296,percent of total billed charges,102% of total billed charges,10.85,38,,8.68,percent of total billed charges,38% of total billed charges,9.99,29.12,
SPLINT WRIST MED RIGHT,3002322,CDM,270,RC,,,Outpatient,,,28.55,21.41,,22.27,78,,17.816,percent of total billed charges,78% of total billed charges,17.99,63,,14.392,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,10.85,38,,8.68,percent of total billed charges,38% of total billed charges,10.85,38,,8.68,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,25.7,90,,20.56,percent of total billed charges,90% of total billed charges,9.99,35,,7.992,percent of total billed charges,35% of total billed charges,19.21,67.275,,15.368,percent of total billed charges,67.275% of total billed charges,22.84,80,,18.272,percent of total billed charges,80% of total billed charges,10.96,38.38,,8.768,percent of total billed charges,38.38% of total billed charges,22.84,80,,18.272,percent of total billed charges,80% of total billed charges,17.63,61.74,,14.104,percent of total billed charges,61.74% of total billed charges,29.12,102,,23.296,percent of total billed charges,102% of total billed charges,10.85,38,,8.68,percent of total billed charges,38% of total billed charges,9.99,29.12,
SPLINT WRIST LG RIGHT,3002323,CDM,270,RC,,,Outpatient,,,28.55,21.41,,22.27,78,,17.816,percent of total billed charges,78% of total billed charges,17.99,63,,14.392,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,10.85,38,,8.68,percent of total billed charges,38% of total billed charges,10.85,38,,8.68,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,25.7,90,,20.56,percent of total billed charges,90% of total billed charges,9.99,35,,7.992,percent of total billed charges,35% of total billed charges,19.21,67.275,,15.368,percent of total billed charges,67.275% of total billed charges,22.84,80,,18.272,percent of total billed charges,80% of total billed charges,10.96,38.38,,8.768,percent of total billed charges,38.38% of total billed charges,22.84,80,,18.272,percent of total billed charges,80% of total billed charges,17.63,61.74,,14.104,percent of total billed charges,61.74% of total billed charges,29.12,102,,23.296,percent of total billed charges,102% of total billed charges,10.85,38,,8.68,percent of total billed charges,38% of total billed charges,9.99,29.12,
"STOCKING, ANTI-EMBOLISM, THIGH - MD",3002105,CDM,270,RC,,,Outpatient,,,28.7,21.53,,22.39,78,,17.912,percent of total billed charges,78% of total billed charges,18.08,63,,14.464,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,10.91,38,,8.728,percent of total billed charges,38% of total billed charges,10.91,38,,8.728,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,25.83,90,,20.664,percent of total billed charges,90% of total billed charges,10.05,35,,8.04,percent of total billed charges,35% of total billed charges,19.31,67.275,,15.448,percent of total billed charges,67.275% of total billed charges,22.96,80,,18.368,percent of total billed charges,80% of total billed charges,11.02,38.38,,8.816,percent of total billed charges,38.38% of total billed charges,22.96,80,,18.368,percent of total billed charges,80% of total billed charges,17.72,61.74,,14.176,percent of total billed charges,61.74% of total billed charges,29.27,102,,23.416,percent of total billed charges,102% of total billed charges,10.91,38,,8.728,percent of total billed charges,38% of total billed charges,10.05,29.27,
"STOCKING, ANTI-EMBOLISM, THIGH - XLG",3002107,CDM,270,RC,,,Outpatient,,,28.7,21.53,,22.39,78,,17.912,percent of total billed charges,78% of total billed charges,18.08,63,,14.464,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,10.91,38,,8.728,percent of total billed charges,38% of total billed charges,10.91,38,,8.728,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,25.83,90,,20.664,percent of total billed charges,90% of total billed charges,10.05,35,,8.04,percent of total billed charges,35% of total billed charges,19.31,67.275,,15.448,percent of total billed charges,67.275% of total billed charges,22.96,80,,18.368,percent of total billed charges,80% of total billed charges,11.02,38.38,,8.816,percent of total billed charges,38.38% of total billed charges,22.96,80,,18.368,percent of total billed charges,80% of total billed charges,17.72,61.74,,14.176,percent of total billed charges,61.74% of total billed charges,29.27,102,,23.416,percent of total billed charges,102% of total billed charges,10.91,38,,8.728,percent of total billed charges,38% of total billed charges,10.05,29.27,
"STOCKING, ANTI-EMBOLISM, THIGH - XXL",3002115,CDM,270,RC,,,Outpatient,,,28.73,21.55,,22.41,78,,17.928,percent of total billed charges,78% of total billed charges,18.1,63,,14.48,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,10.92,38,,8.736,percent of total billed charges,38% of total billed charges,10.92,38,,8.736,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,25.86,90,,20.688,percent of total billed charges,90% of total billed charges,10.06,35,,8.048,percent of total billed charges,35% of total billed charges,19.33,67.275,,15.464,percent of total billed charges,67.275% of total billed charges,22.98,80,,18.384,percent of total billed charges,80% of total billed charges,11.03,38.38,,8.824,percent of total billed charges,38.38% of total billed charges,22.98,80,,18.384,percent of total billed charges,80% of total billed charges,17.74,61.74,,14.192,percent of total billed charges,61.74% of total billed charges,29.3,102,,23.44,percent of total billed charges,102% of total billed charges,10.92,38,,8.736,percent of total billed charges,38% of total billed charges,10.06,29.3,
BINDER ABDOMINAL 4-panel 12  (45-62),3000116,CDM,270,RC,,,Outpatient,,,28.8,21.6,,22.46,78,,17.968,percent of total billed charges,78% of total billed charges,18.14,63,,14.512,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,10.94,38,,8.752,percent of total billed charges,38% of total billed charges,10.94,38,,8.752,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,25.92,90,,20.736,percent of total billed charges,90% of total billed charges,10.08,35,,8.064,percent of total billed charges,35% of total billed charges,19.38,67.275,,15.504,percent of total billed charges,67.275% of total billed charges,23.04,80,,18.432,percent of total billed charges,80% of total billed charges,11.05,38.38,,8.84,percent of total billed charges,38.38% of total billed charges,23.04,80,,18.432,percent of total billed charges,80% of total billed charges,17.78,61.74,,14.224,percent of total billed charges,61.74% of total billed charges,29.38,102,,23.504,percent of total billed charges,102% of total billed charges,10.94,38,,8.752,percent of total billed charges,38% of total billed charges,10.08,29.38,
PROLENE 6-0 PC-3,3005071,CDM,270,RC,,,Outpatient,,,28.8,21.6,,22.46,78,,17.968,percent of total billed charges,78% of total billed charges,18.14,63,,14.512,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,10.94,38,,8.752,percent of total billed charges,38% of total billed charges,10.94,38,,8.752,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,25.92,90,,20.736,percent of total billed charges,90% of total billed charges,10.08,35,,8.064,percent of total billed charges,35% of total billed charges,19.38,67.275,,15.504,percent of total billed charges,67.275% of total billed charges,23.04,80,,18.432,percent of total billed charges,80% of total billed charges,11.05,38.38,,8.84,percent of total billed charges,38.38% of total billed charges,23.04,80,,18.432,percent of total billed charges,80% of total billed charges,17.78,61.74,,14.224,percent of total billed charges,61.74% of total billed charges,29.38,102,,23.504,percent of total billed charges,102% of total billed charges,10.94,38,,8.752,percent of total billed charges,38% of total billed charges,10.08,29.38,
.GLUCOSE ADD'L HR,5000018,CDM,301,RC,82952,HCPCS,Outpatient,,,29,21.75,,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,4.93,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,3.92,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.92,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,5.18,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,19.51,67.275,,15.608,percent of total billed charges,67.275% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,3.96,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,17.9,61.74,,14.32,percent of total billed charges,61.74% of total billed charges,5.03,102,,,Fee Schedule,102% of GA Medicaid Rate,3.92,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.92,26.1,
GLUCOSE TOLERANCE BEY 3EA,5000194,CDM,301,RC,82952,HCPCS,Outpatient,,,29,21.75,,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,4.93,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,3.92,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.92,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,5.18,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,19.51,67.275,,15.608,percent of total billed charges,67.275% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,3.96,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,17.9,61.74,,14.32,percent of total billed charges,61.74% of total billed charges,5.03,102,,,Fee Schedule,102% of GA Medicaid Rate,3.92,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.92,26.1,
.MHA-TP,5001439,CDM,302,RC,86781,HCPCS,Outpatient,,,29,21.75,,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,18.27,63,,14.616,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,11.02,38,,8.816,percent of total billed charges,38% of total billed charges,11.02,38,,8.816,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,10.15,35,,8.12,percent of total billed charges,35% of total billed charges,19.51,67.275,,15.608,percent of total billed charges,67.275% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,11.13,38.38,,8.904,percent of total billed charges,38.38% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,17.9,61.74,,14.32,percent of total billed charges,61.74% of total billed charges,29.58,102,,23.664,percent of total billed charges,102% of total billed charges,11.02,38,,8.816,percent of total billed charges,38% of total billed charges,10.15,29.58,
.MUTATION IDENT EA SEGMENT,5001901,CDM,301,RC,,,Outpatient,,,29,21.75,,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,18.27,63,,14.616,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,11.02,38,,8.816,percent of total billed charges,38% of total billed charges,11.02,38,,8.816,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,10.15,35,,8.12,percent of total billed charges,35% of total billed charges,19.51,67.275,,15.608,percent of total billed charges,67.275% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,11.13,38.38,,8.904,percent of total billed charges,38.38% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,17.9,61.74,,14.32,percent of total billed charges,61.74% of total billed charges,29.58,102,,23.664,percent of total billed charges,102% of total billed charges,11.02,38,,8.816,percent of total billed charges,38% of total billed charges,10.15,29.58,
VAS DIFFER TISSUE PROC,5003210,CDM,300,RC,,,Outpatient,,,29,21.75,,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,18.27,63,,14.616,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,11.02,38,,8.816,percent of total billed charges,38% of total billed charges,11.02,38,,8.816,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,10.15,35,,8.12,percent of total billed charges,35% of total billed charges,19.51,67.275,,15.608,percent of total billed charges,67.275% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,11.13,38.38,,8.904,percent of total billed charges,38.38% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,17.9,61.74,,14.32,percent of total billed charges,61.74% of total billed charges,29.58,102,,23.664,percent of total billed charges,102% of total billed charges,11.02,38,,8.816,percent of total billed charges,38% of total billed charges,10.15,29.58,
CREATININE MULTIPLE,5009127,CDM,301,RC,82565,HCPCS,Outpatient,,,29,21.75,,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,6.35,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.12,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.12,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,6.67,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,19.51,67.275,,15.608,percent of total billed charges,67.275% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,5.17,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,17.9,61.74,,14.32,percent of total billed charges,61.74% of total billed charges,6.48,102,,,Fee Schedule,102% of GA Medicaid Rate,5.12,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.12,26.1,
Form of decompression therapy of the spine,9590019,CDM,420,RC,97012,HCPCS,Outpatient,,,29,21.75,,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,18.27,63,,14.616,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,11.02,38,,8.816,percent of total billed charges,38% of total billed charges,11.02,38,,8.816,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,10.15,35,,8.12,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,11.13,38.38,,8.904,percent of total billed charges,38.38% of total billed charges,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,17.9,61.74,,14.32,percent of total billed charges,61.74% of total billed charges,29.58,102,,23.664,percent of total billed charges,102% of total billed charges,11.02,38,,8.816,percent of total billed charges,38% of total billed charges,10.15,145.93,
HUBER NEEDLE 20 x 1.25  - SAFETY,3000714,CDM,270,RC,,,Outpatient,,,29.13,21.85,,22.72,78,,18.176,percent of total billed charges,78% of total billed charges,18.35,63,,14.68,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,11.07,38,,8.856,percent of total billed charges,38% of total billed charges,11.07,38,,8.856,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,26.22,90,,20.976,percent of total billed charges,90% of total billed charges,10.2,35,,8.16,percent of total billed charges,35% of total billed charges,19.6,67.275,,15.68,percent of total billed charges,67.275% of total billed charges,23.3,80,,18.64,percent of total billed charges,80% of total billed charges,11.18,38.38,,8.944,percent of total billed charges,38.38% of total billed charges,23.3,80,,18.64,percent of total billed charges,80% of total billed charges,17.98,61.74,,14.384,percent of total billed charges,61.74% of total billed charges,29.71,102,,23.768,percent of total billed charges,102% of total billed charges,11.07,38,,8.856,percent of total billed charges,38% of total billed charges,10.2,29.71,
MORGAN MEDI-FLOW DELIVERY SET,3003091,CDM,270,RC,,,Outpatient,,,29.15,21.86,,22.74,78,,18.192,percent of total billed charges,78% of total billed charges,18.36,63,,14.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,11.08,38,,8.864,percent of total billed charges,38% of total billed charges,11.08,38,,8.864,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,26.24,90,,20.992,percent of total billed charges,90% of total billed charges,10.2,35,,8.16,percent of total billed charges,35% of total billed charges,19.61,67.275,,15.688,percent of total billed charges,67.275% of total billed charges,23.32,80,,18.656,percent of total billed charges,80% of total billed charges,11.19,38.38,,8.952,percent of total billed charges,38.38% of total billed charges,23.32,80,,18.656,percent of total billed charges,80% of total billed charges,18,61.74,,14.4,percent of total billed charges,61.74% of total billed charges,29.73,102,,23.784,percent of total billed charges,102% of total billed charges,11.08,38,,8.864,percent of total billed charges,38% of total billed charges,10.2,29.73,
DURAPREP OR,3000323,CDM,270,RC,,,Outpatient,,,29.21,21.91,,22.78,78,,18.224,percent of total billed charges,78% of total billed charges,18.4,63,,14.72,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,11.1,38,,8.88,percent of total billed charges,38% of total billed charges,11.1,38,,8.88,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,26.29,90,,21.032,percent of total billed charges,90% of total billed charges,10.22,35,,8.176,percent of total billed charges,35% of total billed charges,19.65,67.275,,15.72,percent of total billed charges,67.275% of total billed charges,23.37,80,,18.696,percent of total billed charges,80% of total billed charges,11.21,38.38,,8.968,percent of total billed charges,38.38% of total billed charges,23.37,80,,18.696,percent of total billed charges,80% of total billed charges,18.03,61.74,,14.424,percent of total billed charges,61.74% of total billed charges,29.79,102,,23.832,percent of total billed charges,102% of total billed charges,11.1,38,,8.88,percent of total billed charges,38% of total billed charges,10.22,29.79,
CIRCUIT BIPAP VISION,3000012,CDM,270,RC,,,Outpatient,,,29.29,21.97,,22.85,78,,18.28,percent of total billed charges,78% of total billed charges,18.45,63,,14.76,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,11.13,38,,8.904,percent of total billed charges,38% of total billed charges,11.13,38,,8.904,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,26.36,90,,21.088,percent of total billed charges,90% of total billed charges,10.25,35,,8.2,percent of total billed charges,35% of total billed charges,19.7,67.275,,15.76,percent of total billed charges,67.275% of total billed charges,23.43,80,,18.744,percent of total billed charges,80% of total billed charges,11.24,38.38,,8.992,percent of total billed charges,38.38% of total billed charges,23.43,80,,18.744,percent of total billed charges,80% of total billed charges,18.08,61.74,,14.464,percent of total billed charges,61.74% of total billed charges,29.88,102,,23.904,percent of total billed charges,102% of total billed charges,11.13,38,,8.904,percent of total billed charges,38% of total billed charges,10.25,29.88,
CIRCUIT BIPAP V60,3000013,CDM,270,RC,,,Outpatient,,,29.29,21.97,,22.85,78,,18.28,percent of total billed charges,78% of total billed charges,18.45,63,,14.76,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,11.13,38,,8.904,percent of total billed charges,38% of total billed charges,11.13,38,,8.904,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,26.36,90,,21.088,percent of total billed charges,90% of total billed charges,10.25,35,,8.2,percent of total billed charges,35% of total billed charges,19.7,67.275,,15.76,percent of total billed charges,67.275% of total billed charges,23.43,80,,18.744,percent of total billed charges,80% of total billed charges,11.24,38.38,,8.992,percent of total billed charges,38.38% of total billed charges,23.43,80,,18.744,percent of total billed charges,80% of total billed charges,18.08,61.74,,14.464,percent of total billed charges,61.74% of total billed charges,29.88,102,,23.904,percent of total billed charges,102% of total billed charges,11.13,38,,8.904,percent of total billed charges,38% of total billed charges,10.25,29.88,
SPLINT METACARPAL SMALL LEFT,3002333,CDM,270,RC,,,Outpatient,,,29.65,22.24,,23.13,78,,18.504,percent of total billed charges,78% of total billed charges,18.68,63,,14.944,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,11.27,38,,9.016,percent of total billed charges,38% of total billed charges,11.27,38,,9.016,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,26.69,90,,21.352,percent of total billed charges,90% of total billed charges,10.38,35,,8.304,percent of total billed charges,35% of total billed charges,19.95,67.275,,15.96,percent of total billed charges,67.275% of total billed charges,23.72,80,,18.976,percent of total billed charges,80% of total billed charges,11.38,38.38,,9.104,percent of total billed charges,38.38% of total billed charges,23.72,80,,18.976,percent of total billed charges,80% of total billed charges,18.31,61.74,,14.648,percent of total billed charges,61.74% of total billed charges,30.24,102,,24.192,percent of total billed charges,102% of total billed charges,11.27,38,,9.016,percent of total billed charges,38% of total billed charges,10.38,30.24,
SPLINT METACARPAL SMALL RIGHT NON-PADDED,3002334,CDM,270,RC,,,Outpatient,,,29.65,22.24,,23.13,78,,18.504,percent of total billed charges,78% of total billed charges,18.68,63,,14.944,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,11.27,38,,9.016,percent of total billed charges,38% of total billed charges,11.27,38,,9.016,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,26.69,90,,21.352,percent of total billed charges,90% of total billed charges,10.38,35,,8.304,percent of total billed charges,35% of total billed charges,19.95,67.275,,15.96,percent of total billed charges,67.275% of total billed charges,23.72,80,,18.976,percent of total billed charges,80% of total billed charges,11.38,38.38,,9.104,percent of total billed charges,38.38% of total billed charges,23.72,80,,18.976,percent of total billed charges,80% of total billed charges,18.31,61.74,,14.648,percent of total billed charges,61.74% of total billed charges,30.24,102,,24.192,percent of total billed charges,102% of total billed charges,11.27,38,,9.016,percent of total billed charges,38% of total billed charges,10.38,30.24,
NEBULIZER CONTINUOUS KIT,3004002,CDM,270,RC,,,Outpatient,,,29.68,22.26,,23.15,78,,18.52,percent of total billed charges,78% of total billed charges,18.7,63,,14.96,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,11.28,38,,9.024,percent of total billed charges,38% of total billed charges,11.28,38,,9.024,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,26.71,90,,21.368,percent of total billed charges,90% of total billed charges,10.39,35,,8.312,percent of total billed charges,35% of total billed charges,19.97,67.275,,15.976,percent of total billed charges,67.275% of total billed charges,23.74,80,,18.992,percent of total billed charges,80% of total billed charges,11.39,38.38,,9.112,percent of total billed charges,38.38% of total billed charges,23.74,80,,18.992,percent of total billed charges,80% of total billed charges,18.32,61.74,,14.656,percent of total billed charges,61.74% of total billed charges,30.27,102,,24.216,percent of total billed charges,102% of total billed charges,11.28,38,,9.024,percent of total billed charges,38% of total billed charges,10.39,30.27,
MASK ELBOW - BLUE -AF531,3000230,CDM,270,RC,,,Outpatient,,,29.75,22.31,,23.21,78,,18.568,percent of total billed charges,78% of total billed charges,18.74,63,,14.992,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,11.31,38,,9.048,percent of total billed charges,38% of total billed charges,11.31,38,,9.048,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,26.78,90,,21.424,percent of total billed charges,90% of total billed charges,10.41,35,,8.328,percent of total billed charges,35% of total billed charges,20.01,67.275,,16.008,percent of total billed charges,67.275% of total billed charges,23.8,80,,19.04,percent of total billed charges,80% of total billed charges,11.42,38.38,,9.136,percent of total billed charges,38.38% of total billed charges,23.8,80,,19.04,percent of total billed charges,80% of total billed charges,18.37,61.74,,14.696,percent of total billed charges,61.74% of total billed charges,30.35,102,,24.28,percent of total billed charges,102% of total billed charges,11.31,38,,9.048,percent of total billed charges,38% of total billed charges,10.41,30.35,
Visco-Paste,3000329,CDM,270,RC,,,Outpatient,,,29.82,22.37,,23.26,78,,18.608,percent of total billed charges,78% of total billed charges,18.79,63,,15.032,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,11.33,38,,9.064,percent of total billed charges,38% of total billed charges,11.33,38,,9.064,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,26.84,90,,21.472,percent of total billed charges,90% of total billed charges,10.44,35,,8.352,percent of total billed charges,35% of total billed charges,20.06,67.275,,16.048,percent of total billed charges,67.275% of total billed charges,23.86,80,,19.088,percent of total billed charges,80% of total billed charges,11.44,38.38,,9.152,percent of total billed charges,38.38% of total billed charges,23.86,80,,19.088,percent of total billed charges,80% of total billed charges,18.41,61.74,,14.728,percent of total billed charges,61.74% of total billed charges,30.42,102,,24.336,percent of total billed charges,102% of total billed charges,11.33,38,,9.064,percent of total billed charges,38% of total billed charges,10.44,30.42,
CERVICAL COLLAR - ADULT PATRIOT,3000223,CDM,270,RC,,,Outpatient,,,29.85,22.39,,23.28,78,,18.624,percent of total billed charges,78% of total billed charges,18.81,63,,15.048,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,11.34,38,,9.072,percent of total billed charges,38% of total billed charges,11.34,38,,9.072,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,26.87,90,,21.496,percent of total billed charges,90% of total billed charges,10.45,35,,8.36,percent of total billed charges,35% of total billed charges,20.08,67.275,,16.064,percent of total billed charges,67.275% of total billed charges,23.88,80,,19.104,percent of total billed charges,80% of total billed charges,11.46,38.38,,9.168,percent of total billed charges,38.38% of total billed charges,23.88,80,,19.104,percent of total billed charges,80% of total billed charges,18.43,61.74,,14.744,percent of total billed charges,61.74% of total billed charges,30.45,102,,24.36,percent of total billed charges,102% of total billed charges,11.34,38,,9.072,percent of total billed charges,38% of total billed charges,10.45,30.45,
MAXORB SILVER ALG ROPE,3000523,CDM,270,RC,,,Outpatient,,,29.9,22.43,,23.32,78,,18.656,percent of total billed charges,78% of total billed charges,18.84,63,,15.072,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,11.36,38,,9.088,percent of total billed charges,38% of total billed charges,11.36,38,,9.088,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,26.91,90,,21.528,percent of total billed charges,90% of total billed charges,10.47,35,,8.376,percent of total billed charges,35% of total billed charges,20.12,67.275,,16.096,percent of total billed charges,67.275% of total billed charges,23.92,80,,19.136,percent of total billed charges,80% of total billed charges,11.48,38.38,,9.184,percent of total billed charges,38.38% of total billed charges,23.92,80,,19.136,percent of total billed charges,80% of total billed charges,18.46,61.74,,14.768,percent of total billed charges,61.74% of total billed charges,30.5,102,,24.4,percent of total billed charges,102% of total billed charges,11.36,38,,9.088,percent of total billed charges,38% of total billed charges,10.47,30.5,
SHOULDER IMMOBILIZER SM,3001711,CDM,270,RC,,,Outpatient,,,29.9,22.43,,23.32,78,,18.656,percent of total billed charges,78% of total billed charges,18.84,63,,15.072,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,11.36,38,,9.088,percent of total billed charges,38% of total billed charges,11.36,38,,9.088,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,26.91,90,,21.528,percent of total billed charges,90% of total billed charges,10.47,35,,8.376,percent of total billed charges,35% of total billed charges,20.12,67.275,,16.096,percent of total billed charges,67.275% of total billed charges,23.92,80,,19.136,percent of total billed charges,80% of total billed charges,11.48,38.38,,9.184,percent of total billed charges,38.38% of total billed charges,23.92,80,,19.136,percent of total billed charges,80% of total billed charges,18.46,61.74,,14.768,percent of total billed charges,61.74% of total billed charges,30.5,102,,24.4,percent of total billed charges,102% of total billed charges,11.36,38,,9.088,percent of total billed charges,38% of total billed charges,10.47,30.5,
FACILITY FEE BLOOD ALCOHO,1000009,CDM,450,RC,,,Outpatient,,,30,22.5,,23.4,78,,18.72,percent of total billed charges,78% of total billed charges,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,11.4,38,,9.12,percent of total billed charges,38% of total billed charges,11.4,38,,9.12,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,27,90,,21.6,percent of total billed charges,90% of total billed charges,10.5,35,,8.4,percent of total billed charges,35% of total billed charges,20.18,67.275,,16.144,percent of total billed charges,67.275% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,11.51,38.38,,9.208,percent of total billed charges,38.38% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,18.52,61.74,,14.816,percent of total billed charges,61.74% of total billed charges,30.6,102,,24.48,percent of total billed charges,102% of total billed charges,11.4,38,,9.12,percent of total billed charges,38% of total billed charges,10.5,30.6,
"IMMUNIZATION ADMIN, EACH ADD'L",1001147,CDM,450,RC,90472,HCPCS,Outpatient,,,30,22.5,,23.4,78,,18.72,percent of total billed charges,78% of total billed charges,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,11.4,38,,9.12,percent of total billed charges,38% of total billed charges,11.4,38,,9.12,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,27,90,,21.6,percent of total billed charges,90% of total billed charges,10.5,35,,8.4,percent of total billed charges,35% of total billed charges,20.18,67.275,,16.144,percent of total billed charges,67.275% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,11.51,38.38,,9.208,percent of total billed charges,38.38% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,18.52,61.74,,14.816,percent of total billed charges,61.74% of total billed charges,30.6,102,,24.48,percent of total billed charges,102% of total billed charges,11.4,38,,9.12,percent of total billed charges,38% of total billed charges,10.5,30.6,
BINDER ABDOMINAL 4-panel 12  (30-45),3000119,CDM,270,RC,,,Outpatient,,,30,22.5,,23.4,78,,18.72,percent of total billed charges,78% of total billed charges,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,11.4,38,,9.12,percent of total billed charges,38% of total billed charges,11.4,38,,9.12,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,27,90,,21.6,percent of total billed charges,90% of total billed charges,10.5,35,,8.4,percent of total billed charges,35% of total billed charges,20.18,67.275,,16.144,percent of total billed charges,67.275% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,11.51,38.38,,9.208,percent of total billed charges,38.38% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,18.52,61.74,,14.816,percent of total billed charges,61.74% of total billed charges,30.6,102,,24.48,percent of total billed charges,102% of total billed charges,11.4,38,,9.12,percent of total billed charges,38% of total billed charges,10.5,30.6,
INSUFFLATION TUBING,3004049,CDM,270,RC,,,Outpatient,,,30,22.5,,23.4,78,,18.72,percent of total billed charges,78% of total billed charges,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,11.4,38,,9.12,percent of total billed charges,38% of total billed charges,11.4,38,,9.12,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,27,90,,21.6,percent of total billed charges,90% of total billed charges,10.5,35,,8.4,percent of total billed charges,35% of total billed charges,20.18,67.275,,16.144,percent of total billed charges,67.275% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,11.51,38.38,,9.208,percent of total billed charges,38.38% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,18.52,61.74,,14.816,percent of total billed charges,61.74% of total billed charges,30.6,102,,24.48,percent of total billed charges,102% of total billed charges,11.4,38,,9.12,percent of total billed charges,38% of total billed charges,10.5,30.6,
CREATINE 24 HR URINE,5002005,CDM,301,RC,82540,HCPCS,Outpatient,,,30,22.5,,23.4,78,,18.72,percent of total billed charges,78% of total billed charges,5.83,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,27,90,,21.6,percent of total billed charges,90% of total billed charges,6.12,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,20.18,67.275,,16.144,percent of total billed charges,67.275% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,4.69,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,24,80,,19.2,percent of total billed charges,80% of total billed charges,18.52,61.74,,14.816,percent of total billed charges,61.74% of total billed charges,5.95,102,,,Fee Schedule,102% of GA Medicaid Rate,4.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.64,27,
CREATINE SERUM,5009123,CDM,301,RC,82540,HCPCS,Outpatient,,,30,22.5,,23.4,78,,18.72,percent of total billed charges,78% of total billed charges,5.83,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,27,90,,21.6,percent of total billed charges,90% of total billed charges,6.12,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,20.18,67.275,,16.144,percent of total billed charges,67.275% of total billed charges,24,80,,19.2,percent of total billed charges,80% of total billed charges,4.69,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,24,80,,19.2,percent of total billed charges,80% of total billed charges,18.52,61.74,,14.816,percent of total billed charges,61.74% of total billed charges,5.95,102,,,Fee Schedule,102% of GA Medicaid Rate,4.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.64,27,
"THUMB SPLINT, SPICA, UNIVERSAL",3001774,CDM,270,RC,,,Outpatient,,,30.05,22.54,,23.44,78,,18.752,percent of total billed charges,78% of total billed charges,18.93,63,,15.144,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,11.42,38,,9.136,percent of total billed charges,38% of total billed charges,11.42,38,,9.136,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,27.05,90,,21.64,percent of total billed charges,90% of total billed charges,10.52,35,,8.416,percent of total billed charges,35% of total billed charges,20.22,67.275,,16.176,percent of total billed charges,67.275% of total billed charges,24.04,80,,19.232,percent of total billed charges,80% of total billed charges,11.53,38.38,,9.224,percent of total billed charges,38.38% of total billed charges,24.04,80,,19.232,percent of total billed charges,80% of total billed charges,18.55,61.74,,14.84,percent of total billed charges,61.74% of total billed charges,30.65,102,,24.52,percent of total billed charges,102% of total billed charges,11.42,38,,9.136,percent of total billed charges,38% of total billed charges,10.52,30.65,
ET TUBE HOLDER- sub,3004212,CDM,270,RC,,,Outpatient,,,30.5,22.88,,23.79,78,,19.032,percent of total billed charges,78% of total billed charges,19.22,63,,15.376,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,11.59,38,,9.272,percent of total billed charges,38% of total billed charges,11.59,38,,9.272,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,27.45,90,,21.96,percent of total billed charges,90% of total billed charges,10.68,35,,8.544,percent of total billed charges,35% of total billed charges,20.52,67.275,,16.416,percent of total billed charges,67.275% of total billed charges,24.4,80,,19.52,percent of total billed charges,80% of total billed charges,11.71,38.38,,9.368,percent of total billed charges,38.38% of total billed charges,24.4,80,,19.52,percent of total billed charges,80% of total billed charges,18.83,61.74,,15.064,percent of total billed charges,61.74% of total billed charges,31.11,102,,24.888,percent of total billed charges,102% of total billed charges,11.59,38,,9.272,percent of total billed charges,38% of total billed charges,10.68,31.11,
TOP FILL ENTERAL NUTRITION BAG,3005120,CDM,270,RC,,,Outpatient,,,30.75,23.06,,23.99,78,,19.192,percent of total billed charges,78% of total billed charges,19.37,63,,15.496,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,11.69,38,,9.352,percent of total billed charges,38% of total billed charges,11.69,38,,9.352,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,27.68,90,,22.144,percent of total billed charges,90% of total billed charges,10.76,35,,8.608,percent of total billed charges,35% of total billed charges,20.69,67.275,,16.552,percent of total billed charges,67.275% of total billed charges,24.6,80,,19.68,percent of total billed charges,80% of total billed charges,11.8,38.38,,9.44,percent of total billed charges,38.38% of total billed charges,24.6,80,,19.68,percent of total billed charges,80% of total billed charges,18.99,61.74,,15.192,percent of total billed charges,61.74% of total billed charges,31.37,102,,25.096,percent of total billed charges,102% of total billed charges,11.69,38,,9.352,percent of total billed charges,38% of total billed charges,10.76,31.37,
DRAIN CLOSED WOUND FLAT - 7 MM,3000899,CDM,270,RC,,,Outpatient,,,30.8,23.1,,24.02,78,,19.216,percent of total billed charges,78% of total billed charges,19.4,63,,15.52,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,11.7,38,,9.36,percent of total billed charges,38% of total billed charges,11.7,38,,9.36,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,27.72,90,,22.176,percent of total billed charges,90% of total billed charges,10.78,35,,8.624,percent of total billed charges,35% of total billed charges,20.72,67.275,,16.576,percent of total billed charges,67.275% of total billed charges,24.64,80,,19.712,percent of total billed charges,80% of total billed charges,11.82,38.38,,9.456,percent of total billed charges,38.38% of total billed charges,24.64,80,,19.712,percent of total billed charges,80% of total billed charges,19.02,61.74,,15.216,percent of total billed charges,61.74% of total billed charges,31.42,102,,25.136,percent of total billed charges,102% of total billed charges,11.7,38,,9.36,percent of total billed charges,38% of total billed charges,10.78,31.42,
Measurement of direct bilirubin,5000691,CDM,301,RC,82248,HCPCS,Outpatient,,,31,23.25,,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,6.32,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,6.64,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,20.86,67.275,,16.688,percent of total billed charges,67.275% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,5.07,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,19.14,61.74,,15.312,percent of total billed charges,61.74% of total billed charges,6.45,102,,,Fee Schedule,102% of GA Medicaid Rate,5.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.02,27.9,
DEXTROSTIX (GLUCOSE),5000730,CDM,270,RC,82962,HCPCS,Outpatient,,,31,23.25,,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,2.94,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,3.28,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.28,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,3.09,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,20.86,67.275,,16.688,percent of total billed charges,67.275% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,3.31,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,19.14,61.74,,15.312,percent of total billed charges,61.74% of total billed charges,3,102,,,Fee Schedule,102% of GA Medicaid Rate,3.28,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,2.94,27.9,
Test of glucose level in the blood,5000740,CDM,301,RC,82950,HCPCS,Outpatient,,,31,23.25,,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,5.98,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,6.28,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,20.86,67.275,,16.688,percent of total billed charges,67.275% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,4.8,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,19.14,61.74,,15.312,percent of total billed charges,61.74% of total billed charges,6.1,102,,,Fee Schedule,102% of GA Medicaid Rate,4.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.75,27.9,
ALBUMIN,5000764,CDM,301,RC,82040,HCPCS,Outpatient,,,31,23.25,,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,3.62,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.95,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.95,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,3.8,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,20.86,67.275,,16.688,percent of total billed charges,67.275% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,5,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,19.14,61.74,,15.312,percent of total billed charges,61.74% of total billed charges,3.69,102,,,Fee Schedule,102% of GA Medicaid Rate,4.95,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.62,27.9,
Test of glucose level in the blood,5000775,CDM,301,RC,82950,HCPCS,Outpatient,,,31,23.25,,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,5.98,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,6.28,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,20.86,67.275,,16.688,percent of total billed charges,67.275% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,4.8,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,19.14,61.74,,15.312,percent of total billed charges,61.74% of total billed charges,6.1,102,,,Fee Schedule,102% of GA Medicaid Rate,4.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.75,27.9,
Blood test to assess for infection,5000815,CDM,305,RC,85007,HCPCS,Outpatient,,,31,23.25,,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,4.33,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,3.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,4.55,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,20.86,67.275,,16.688,percent of total billed charges,67.275% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,3.84,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,19.14,61.74,,15.312,percent of total billed charges,61.74% of total billed charges,4.42,102,,,Fee Schedule,102% of GA Medicaid Rate,3.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.8,27.9,
VAS TEST,5000899,CDM,306,RC,87181,HCPCS,Outpatient,,,31,23.25,,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,5.98,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,6.28,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,20.86,67.275,,16.688,percent of total billed charges,67.275% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,4.8,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,19.14,61.74,,15.312,percent of total billed charges,61.74% of total billed charges,6.1,102,,,Fee Schedule,102% of GA Medicaid Rate,4.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.75,27.9,
MRO EVAL,5001632,CDM,300,RC,,,Outpatient,,,31,23.25,,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,19.53,63,,15.624,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,11.78,38,,9.424,percent of total billed charges,38% of total billed charges,11.78,38,,9.424,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,10.85,35,,8.68,percent of total billed charges,35% of total billed charges,20.86,67.275,,16.688,percent of total billed charges,67.275% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,11.9,38.38,,9.52,percent of total billed charges,38.38% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,19.14,61.74,,15.312,percent of total billed charges,61.74% of total billed charges,31.62,102,,25.296,percent of total billed charges,102% of total billed charges,11.78,38,,9.424,percent of total billed charges,38% of total billed charges,10.85,31.62,
URIC ACID 24HR URINE,5001855,CDM,301,RC,84560,HCPCS,Outpatient,,,31,23.25,,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,5.98,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,6.28,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,20.86,67.275,,16.688,percent of total billed charges,67.275% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,5.13,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,19.14,61.74,,15.312,percent of total billed charges,61.74% of total billed charges,6.1,102,,,Fee Schedule,102% of GA Medicaid Rate,5.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.08,27.9,
UREA NITROGEN UR 24HR,5001861,CDM,301,RC,84540,HCPCS,Outpatient,,,31,23.25,,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,5.98,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.56,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.56,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,6.28,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,20.86,67.275,,16.688,percent of total billed charges,67.275% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,5.62,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,19.14,61.74,,15.312,percent of total billed charges,61.74% of total billed charges,6.1,102,,,Fee Schedule,102% of GA Medicaid Rate,5.56,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.56,27.9,
URIC ACID SYNOVIAL FUILD,5001878,CDM,301,RC,84560,HCPCS,Outpatient,,,31,23.25,,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,5.98,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,6.28,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,20.86,67.275,,16.688,percent of total billed charges,67.275% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,5.13,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,19.14,61.74,,15.312,percent of total billed charges,61.74% of total billed charges,6.1,102,,,Fee Schedule,102% of GA Medicaid Rate,5.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.08,27.9,
TOTAL BILIRUBIN MULTIPLE,5009109,CDM,301,RC,82247,HCPCS,Outpatient,,,31,23.25,,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,6.32,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,6.64,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,20.86,67.275,,16.688,percent of total billed charges,67.275% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,5.07,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,19.14,61.74,,15.312,percent of total billed charges,61.74% of total billed charges,6.45,102,,,Fee Schedule,102% of GA Medicaid Rate,5.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.02,27.9,
Manual urinalysis test with examination with or without using microscope,5009131,CDM,300,RC,81001,HCPCS,Outpatient,,,31,23.25,,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,3.99,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,3.17,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.17,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,4.19,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,20.86,67.275,,16.688,percent of total billed charges,67.275% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,3.2,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,19.14,61.74,,15.312,percent of total billed charges,61.74% of total billed charges,4.07,102,,,Fee Schedule,102% of GA Medicaid Rate,3.17,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.17,27.9,
PT GROUP THERAPY,9590018,CDM,420,RC,97150,HCPCS,Outpatient,,,31,23.25,,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,19.53,63,,15.624,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,11.78,38,,9.424,percent of total billed charges,38% of total billed charges,11.78,38,,9.424,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,10.85,35,,8.68,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,11.9,38.38,,9.52,percent of total billed charges,38.38% of total billed charges,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,19.14,61.74,,15.312,percent of total billed charges,61.74% of total billed charges,31.62,102,,25.296,percent of total billed charges,102% of total billed charges,11.78,38,,9.424,percent of total billed charges,38% of total billed charges,10.85,145.93,
LMA DISP SIZE 4,3003076,CDM,270,RC,,,Outpatient,,,31.05,23.29,,24.22,78,,19.376,percent of total billed charges,78% of total billed charges,19.56,63,,15.648,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,11.8,38,,9.44,percent of total billed charges,38% of total billed charges,11.8,38,,9.44,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,27.95,90,,22.36,percent of total billed charges,90% of total billed charges,10.87,35,,8.696,percent of total billed charges,35% of total billed charges,20.89,67.275,,16.712,percent of total billed charges,67.275% of total billed charges,24.84,80,,19.872,percent of total billed charges,80% of total billed charges,11.92,38.38,,9.536,percent of total billed charges,38.38% of total billed charges,24.84,80,,19.872,percent of total billed charges,80% of total billed charges,19.17,61.74,,15.336,percent of total billed charges,61.74% of total billed charges,31.67,102,,25.336,percent of total billed charges,102% of total billed charges,11.8,38,,9.44,percent of total billed charges,38% of total billed charges,10.87,31.67,
LMA DISP SIZE 5,3003089,CDM,270,RC,,,Outpatient,,,31.05,23.29,,24.22,78,,19.376,percent of total billed charges,78% of total billed charges,19.56,63,,15.648,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,11.8,38,,9.44,percent of total billed charges,38% of total billed charges,11.8,38,,9.44,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,27.95,90,,22.36,percent of total billed charges,90% of total billed charges,10.87,35,,8.696,percent of total billed charges,35% of total billed charges,20.89,67.275,,16.712,percent of total billed charges,67.275% of total billed charges,24.84,80,,19.872,percent of total billed charges,80% of total billed charges,11.92,38.38,,9.536,percent of total billed charges,38.38% of total billed charges,24.84,80,,19.872,percent of total billed charges,80% of total billed charges,19.17,61.74,,15.336,percent of total billed charges,61.74% of total billed charges,31.67,102,,25.336,percent of total billed charges,102% of total billed charges,11.8,38,,9.44,percent of total billed charges,38% of total billed charges,10.87,31.67,
LMA DISP SIZE 2 - PEDIATRIC,3003094,CDM,270,RC,,,Outpatient,,,31.05,23.29,,24.22,78,,19.376,percent of total billed charges,78% of total billed charges,19.56,63,,15.648,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,11.8,38,,9.44,percent of total billed charges,38% of total billed charges,11.8,38,,9.44,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,27.95,90,,22.36,percent of total billed charges,90% of total billed charges,10.87,35,,8.696,percent of total billed charges,35% of total billed charges,20.89,67.275,,16.712,percent of total billed charges,67.275% of total billed charges,24.84,80,,19.872,percent of total billed charges,80% of total billed charges,11.92,38.38,,9.536,percent of total billed charges,38.38% of total billed charges,24.84,80,,19.872,percent of total billed charges,80% of total billed charges,19.17,61.74,,15.336,percent of total billed charges,61.74% of total billed charges,31.67,102,,25.336,percent of total billed charges,102% of total billed charges,11.8,38,,9.44,percent of total billed charges,38% of total billed charges,10.87,31.67,
LMA DISP SIZE 2.5 - PEDIATRIC,3003096,CDM,270,RC,,,Outpatient,,,31.05,23.29,,24.22,78,,19.376,percent of total billed charges,78% of total billed charges,19.56,63,,15.648,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,11.8,38,,9.44,percent of total billed charges,38% of total billed charges,11.8,38,,9.44,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,27.95,90,,22.36,percent of total billed charges,90% of total billed charges,10.87,35,,8.696,percent of total billed charges,35% of total billed charges,20.89,67.275,,16.712,percent of total billed charges,67.275% of total billed charges,24.84,80,,19.872,percent of total billed charges,80% of total billed charges,11.92,38.38,,9.536,percent of total billed charges,38.38% of total billed charges,24.84,80,,19.872,percent of total billed charges,80% of total billed charges,19.17,61.74,,15.336,percent of total billed charges,61.74% of total billed charges,31.67,102,,25.336,percent of total billed charges,102% of total billed charges,11.8,38,,9.44,percent of total billed charges,38% of total billed charges,10.87,31.67,
CHLORAPREP 26 ML,3000339,CDM,270,RC,,,Outpatient,,,31.1,23.33,,24.26,78,,19.408,percent of total billed charges,78% of total billed charges,19.59,63,,15.672,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,11.82,38,,9.456,percent of total billed charges,38% of total billed charges,11.82,38,,9.456,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,27.99,90,,22.392,percent of total billed charges,90% of total billed charges,10.89,35,,8.712,percent of total billed charges,35% of total billed charges,20.92,67.275,,16.736,percent of total billed charges,67.275% of total billed charges,24.88,80,,19.904,percent of total billed charges,80% of total billed charges,11.94,38.38,,9.552,percent of total billed charges,38.38% of total billed charges,24.88,80,,19.904,percent of total billed charges,80% of total billed charges,19.2,61.74,,15.36,percent of total billed charges,61.74% of total billed charges,31.72,102,,25.376,percent of total billed charges,102% of total billed charges,11.82,38,,9.456,percent of total billed charges,38% of total billed charges,10.89,31.72,
BODY ALIGNMENT WEDGE,3000220,CDM,270,RC,,,Outpatient,,,31.35,23.51,,24.45,78,,19.56,percent of total billed charges,78% of total billed charges,19.75,63,,15.8,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,11.91,38,,9.528,percent of total billed charges,38% of total billed charges,11.91,38,,9.528,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,28.22,90,,22.576,percent of total billed charges,90% of total billed charges,10.97,35,,8.776,percent of total billed charges,35% of total billed charges,21.09,67.275,,16.872,percent of total billed charges,67.275% of total billed charges,25.08,80,,20.064,percent of total billed charges,80% of total billed charges,12.03,38.38,,9.624,percent of total billed charges,38.38% of total billed charges,25.08,80,,20.064,percent of total billed charges,80% of total billed charges,19.36,61.74,,15.488,percent of total billed charges,61.74% of total billed charges,31.98,102,,25.584,percent of total billed charges,102% of total billed charges,11.91,38,,9.528,percent of total billed charges,38% of total billed charges,10.97,31.98,
CO2,5000718,CDM,301,RC,82374,HCPCS,Outpatient,,,32,24,,24.96,78,,19.968,percent of total billed charges,78% of total billed charges,6.15,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,6.46,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,21.53,67.275,,17.224,percent of total billed charges,67.275% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,4.93,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,19.76,61.74,,15.808,percent of total billed charges,61.74% of total billed charges,6.27,102,,,Fee Schedule,102% of GA Medicaid Rate,4.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.88,28.8,
"CHLORIDE, FECES",5000734,CDM,301,RC,82438,HCPCS,Outpatient,,,32,24,,24.96,78,,19.968,percent of total billed charges,78% of total billed charges,6.15,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,6.46,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,21.53,67.275,,17.224,percent of total billed charges,67.275% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,5.05,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,19.76,61.74,,15.808,percent of total billed charges,61.74% of total billed charges,6.27,102,,,Fee Schedule,102% of GA Medicaid Rate,5,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5,28.8,
POTASSIUM,5000748,CDM,301,RC,84132,HCPCS,Outpatient,,,32,24,,24.96,78,,19.968,percent of total billed charges,78% of total billed charges,5.78,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.76,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.76,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,6.07,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,21.53,67.275,,17.224,percent of total billed charges,67.275% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,4.81,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,19.76,61.74,,15.808,percent of total billed charges,61.74% of total billed charges,5.9,102,,,Fee Schedule,102% of GA Medicaid Rate,4.76,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.76,28.8,
Blood test to assess for infection,5000860,CDM,305,RC,85007,HCPCS,Outpatient,,,32,24,,24.96,78,,19.968,percent of total billed charges,78% of total billed charges,4.33,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,3.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,4.55,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,21.53,67.275,,17.224,percent of total billed charges,67.275% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,3.84,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,19.76,61.74,,15.808,percent of total billed charges,61.74% of total billed charges,4.42,102,,,Fee Schedule,102% of GA Medicaid Rate,3.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.8,28.8,
E COLI 0157:H7 SEROTYPING,5001507,CDM,306,RC,87147,HCPCS,Outpatient,,,32,24,,24.96,78,,19.968,percent of total billed charges,78% of total billed charges,5.61,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,5.89,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,21.53,67.275,,17.224,percent of total billed charges,67.275% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,5.23,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,19.76,61.74,,15.808,percent of total billed charges,61.74% of total billed charges,5.72,102,,,Fee Schedule,102% of GA Medicaid Rate,5.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.18,28.8,
"BICARBONATE, URINE",5001789,CDM,301,RC,82374,HCPCS,Outpatient,,,32,24,,24.96,78,,19.968,percent of total billed charges,78% of total billed charges,6.15,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,6.46,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,21.53,67.275,,17.224,percent of total billed charges,67.275% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,4.93,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,19.76,61.74,,15.808,percent of total billed charges,61.74% of total billed charges,6.27,102,,,Fee Schedule,102% of GA Medicaid Rate,4.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.88,28.8,
TOTAL PROTEIN MULTIPLE,5009161,CDM,301,RC,84155,HCPCS,Outpatient,,,32,24,,24.96,78,,19.968,percent of total billed charges,78% of total billed charges,4.61,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,3.67,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.67,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,4.84,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,21.53,67.275,,17.224,percent of total billed charges,67.275% of total billed charges,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,3.71,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,19.76,61.74,,15.808,percent of total billed charges,61.74% of total billed charges,4.7,102,,,Fee Schedule,102% of GA Medicaid Rate,3.67,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.67,28.8,
XRAY CT SYRINGE,3004209,CDM,270,RC,,,Outpatient,,,32.1,24.08,,25.04,78,,20.032,percent of total billed charges,78% of total billed charges,20.22,63,,16.176,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,12.2,38,,9.76,percent of total billed charges,38% of total billed charges,12.2,38,,9.76,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,28.89,90,,23.112,percent of total billed charges,90% of total billed charges,11.24,35,,8.992,percent of total billed charges,35% of total billed charges,21.6,67.275,,17.28,percent of total billed charges,67.275% of total billed charges,25.68,80,,20.544,percent of total billed charges,80% of total billed charges,12.32,38.38,,9.856,percent of total billed charges,38.38% of total billed charges,25.68,80,,20.544,percent of total billed charges,80% of total billed charges,19.82,61.74,,15.856,percent of total billed charges,61.74% of total billed charges,32.74,102,,26.192,percent of total billed charges,102% of total billed charges,12.2,38,,9.76,percent of total billed charges,38% of total billed charges,11.24,32.74,
AMBU BAG DISP,3000017,CDM,270,RC,,,Outpatient,,,32.46,24.35,,25.32,78,,20.256,percent of total billed charges,78% of total billed charges,20.45,63,,16.36,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,12.33,38,,9.864,percent of total billed charges,38% of total billed charges,12.33,38,,9.864,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,29.21,90,,23.368,percent of total billed charges,90% of total billed charges,11.36,35,,9.088,percent of total billed charges,35% of total billed charges,21.84,67.275,,17.472,percent of total billed charges,67.275% of total billed charges,25.97,80,,20.776,percent of total billed charges,80% of total billed charges,12.46,38.38,,9.968,percent of total billed charges,38.38% of total billed charges,25.97,80,,20.776,percent of total billed charges,80% of total billed charges,20.04,61.74,,16.032,percent of total billed charges,61.74% of total billed charges,33.11,102,,26.488,percent of total billed charges,102% of total billed charges,12.33,38,,9.864,percent of total billed charges,38% of total billed charges,11.36,33.11,
PUREWICK FEMALE EXT CATHETHER,3001905,CDM,270,RC,,,Outpatient,,,32.5,24.38,,25.35,78,,20.28,percent of total billed charges,78% of total billed charges,20.48,63,,16.384,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,12.35,38,,9.88,percent of total billed charges,38% of total billed charges,12.35,38,,9.88,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,29.25,90,,23.4,percent of total billed charges,90% of total billed charges,11.38,35,,9.104,percent of total billed charges,35% of total billed charges,21.86,67.275,,17.488,percent of total billed charges,67.275% of total billed charges,26,80,,20.8,percent of total billed charges,80% of total billed charges,12.47,38.38,,9.976,percent of total billed charges,38.38% of total billed charges,26,80,,20.8,percent of total billed charges,80% of total billed charges,20.07,61.74,,16.056,percent of total billed charges,61.74% of total billed charges,33.15,102,,26.52,percent of total billed charges,102% of total billed charges,12.35,38,,9.88,percent of total billed charges,38% of total billed charges,11.38,33.15,
ETCO2 ADULT SAMPLING LINE,3003015,CDM,270,RC,,,Outpatient,,,32.57,24.43,,25.4,78,,20.32,percent of total billed charges,78% of total billed charges,20.52,63,,16.416,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,12.38,38,,9.904,percent of total billed charges,38% of total billed charges,12.38,38,,9.904,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,29.31,90,,23.448,percent of total billed charges,90% of total billed charges,11.4,35,,9.12,percent of total billed charges,35% of total billed charges,21.91,67.275,,17.528,percent of total billed charges,67.275% of total billed charges,26.06,80,,20.848,percent of total billed charges,80% of total billed charges,12.5,38.38,,10,percent of total billed charges,38.38% of total billed charges,26.06,80,,20.848,percent of total billed charges,80% of total billed charges,20.11,61.74,,16.088,percent of total billed charges,61.74% of total billed charges,33.22,102,,26.576,percent of total billed charges,102% of total billed charges,12.38,38,,9.904,percent of total billed charges,38% of total billed charges,11.4,33.22,
HYDROFERA BLUE 4X4,3004177,CDM,270,RC,,,Outpatient,,,32.83,24.62,,25.61,78,,20.488,percent of total billed charges,78% of total billed charges,20.68,63,,16.544,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,12.48,38,,9.984,percent of total billed charges,38% of total billed charges,12.48,38,,9.984,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,29.55,90,,23.64,percent of total billed charges,90% of total billed charges,11.49,35,,9.192,percent of total billed charges,35% of total billed charges,22.09,67.275,,17.672,percent of total billed charges,67.275% of total billed charges,26.26,80,,21.008,percent of total billed charges,80% of total billed charges,12.6,38.38,,10.08,percent of total billed charges,38.38% of total billed charges,26.26,80,,21.008,percent of total billed charges,80% of total billed charges,20.27,61.74,,16.216,percent of total billed charges,61.74% of total billed charges,33.49,102,,26.792,percent of total billed charges,102% of total billed charges,12.48,38,,9.984,percent of total billed charges,38% of total billed charges,11.49,33.49,
STOOL FOR FAT-QUAL,5000502,CDM,301,RC,82705,HCPCS,Outpatient,,,33,24.75,,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,6.4,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.1,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.1,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,6.72,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.2,67.275,,17.76,percent of total billed charges,67.275% of total billed charges,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,5.15,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,20.37,61.74,,16.296,percent of total billed charges,61.74% of total billed charges,6.53,102,,,Fee Schedule,102% of GA Medicaid Rate,5.1,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.1,29.7,
FECAL FAT QUALITATIVE,5000732,CDM,301,RC,82705,HCPCS,Outpatient,,,33,24.75,,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,6.4,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.1,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.1,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,6.72,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.2,67.275,,17.76,percent of total billed charges,67.275% of total billed charges,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,5.15,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,20.37,61.74,,16.296,percent of total billed charges,61.74% of total billed charges,6.53,102,,,Fee Schedule,102% of GA Medicaid Rate,5.1,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.1,29.7,
PT CONTRAST BATH,9590028,CDM,420,RC,97034,HCPCS,Outpatient,,,33,24.75,,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,20.79,63,,16.632,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,12.54,38,,10.032,percent of total billed charges,38% of total billed charges,12.54,38,,10.032,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,11.55,35,,9.24,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,12.67,38.38,,10.136,percent of total billed charges,38.38% of total billed charges,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,20.37,61.74,,16.296,percent of total billed charges,61.74% of total billed charges,33.66,102,,26.928,percent of total billed charges,102% of total billed charges,12.54,38,,10.032,percent of total billed charges,38% of total billed charges,11.55,145.93,
ALLG SPEC IGE EA,5000030,CDM,302,RC,86003,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,30.6,
LAMB IGE,5000032,CDM,302,RC,86003,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,30.6,
SALMON ALL SPEC IGE,5000033,CDM,302,RC,86003,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,30.6,
HALIBUT ALLER SPEC IGE,5000034,CDM,302,RC,86003,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,30.6,
TOMATO ALLER SPEC IGE,5000035,CDM,302,RC,86003,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,30.6,
CELERY IGE,5000045,CDM,302,RC,86003,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,30.6,
MILK IGE,5000046,CDM,302,RC,86003,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,30.6,
ORANGE IGE,5000047,CDM,302,RC,86003,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,30.6,
PINEAPPLE IGE,5000048,CDM,302,RC,86003,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,30.6,
GRAPE IGE,5000049,CDM,302,RC,86003,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,30.6,
EGG WHITE IGE,5000050,CDM,302,RC,86003,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,30.6,
EGG YOKE IGE,5000051,CDM,302,RC,86003,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,30.6,
SOY IGE,5000052,CDM,302,RC,86003,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,30.6,
PEANUT IGE,5000053,CDM,302,RC,86003,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,30.6,
BEEF IGE,5000054,CDM,302,RC,86003,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,30.6,
PORK IGE,5000055,CDM,302,RC,86003,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,30.6,
APPLE IGE,5000056,CDM,302,RC,86003,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,30.6,
ONION IGE,5000057,CDM,302,RC,86003,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,30.6,
GREEN PEPPER IGE,5000058,CDM,302,RC,86003,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,30.6,
TOMATO IGE,5000059,CDM,302,RC,86003,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,30.6,
WHEAT IGE,5000060,CDM,302,RC,86003,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,30.6,
DERMATOPHAGOIDES PTERONYSSINUS,5000061,CDM,302,RC,86003,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,30.6,
CORN IgE,5000065,CDM,302,RC,86003,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,30.6,
COCKROACH IGE,5000074,CDM,302,RC,86003,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,30.6,
CAT DANDER IGE,5000075,CDM,302,RC,86003,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,30.6,
DOG DANDER IGE,5000076,CDM,302,RC,86003,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,30.6,
ALTERNARIA ALTERNATA IGE,5000077,CDM,302,RC,86003,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,30.6,
CODFISH IGE,5000078,CDM,302,RC,86003,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,30.6,
LATEX (K82) IGE,5000213,CDM,302,RC,86003,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,30.6,
"SODIUM,URINE",5000752,CDM,300,RC,84300,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,4.35,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.06,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.06,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,4.57,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.11,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,4.44,102,,,Fee Schedule,102% of GA Medicaid Rate,5.06,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.35,30.6,
AST,5000760,CDM,301,RC,84450,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.35,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.67,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.23,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.48,102,,,Fee Schedule,102% of GA Medicaid Rate,5.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.18,30.6,
"ALBUMIN, FLUID",5000772,CDM,301,RC,82042,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.51,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,7.78,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.78,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.84,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,7.86,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.64,102,,,Fee Schedule,102% of GA Medicaid Rate,7.78,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.51,30.6,
SODIUM 24 HR URINE,5000773,CDM,300,RC,84300,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,4.35,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.06,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.06,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,4.57,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.11,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,4.44,102,,,Fee Schedule,102% of GA Medicaid Rate,5.06,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.35,30.6,
"Complete blood count, automated",5000812,CDM,305,RC,85027,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,8.14,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,8.55,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,6.53,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,8.3,102,,,Fee Schedule,102% of GA Medicaid Rate,6.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.47,30.6,
COAGULASE,5000903,CDM,306,RC,87450,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,12.05,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.92,38,,10.336,percent of total billed charges,38% of total billed charges,12.92,38,,10.336,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,12.65,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,13.05,38.38,,10.44,percent of total billed charges,38.38% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,12.29,102,,,Fee Schedule,102% of GA Medicaid Rate,12.92,38,,10.336,percent of total billed charges,38% of total billed charges,12.05,30.6,
RAST FOOD SCREEN X3,5001842,CDM,302,RC,86003,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,30.6,
RAST FOOD SCREEN SINGLE,5001843,CDM,302,RC,86003,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,30.6,
HETEROPHILE SCREEN,5001872,CDM,302,RC,86308,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.51,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.84,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.23,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.64,102,,,Fee Schedule,102% of GA Medicaid Rate,5.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.18,30.6,
C-REACTIVE PROTEIN,5001875,CDM,302,RC,86140,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.51,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.84,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.23,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.64,102,,,Fee Schedule,102% of GA Medicaid Rate,5.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.18,30.6,
Test to measure creatinine in the urine,5001880,CDM,301,RC,82570,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.51,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.84,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.23,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.64,102,,,Fee Schedule,102% of GA Medicaid Rate,5.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.18,30.6,
Test to measure creatinine in the urine,5001883,CDM,301,RC,82570,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.51,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.84,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.23,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.64,102,,,Fee Schedule,102% of GA Medicaid Rate,5.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.18,30.6,
Test to measure creatinine in the urine,5001936,CDM,301,RC,82570,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.51,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.84,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.23,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.64,102,,,Fee Schedule,102% of GA Medicaid Rate,5.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.18,30.6,
DERMATO PTERONYSSINUS,5003715,CDM,302,RC,86003,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,30.6,
DERMATO FARINAE,5003716,CDM,302,RC,86003,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,5.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,30.6,
Blood test to measure a certain protein in the blood to determine heart muscle damage,5009152,CDM,301,RC,84484,HCPCS,Outpatient,,,34,25.5,,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,12.38,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,13,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,22.87,67.275,,18.296,percent of total billed charges,67.275% of total billed charges,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,12.59,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,20.99,61.74,,16.792,percent of total billed charges,61.74% of total billed charges,12.63,102,,,Fee Schedule,102% of GA Medicaid Rate,12.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.38,30.6,
FIBRACOL  PLUS 4X4,3004176,CDM,270,RC,,,Outpatient,,,34.1,25.58,,26.6,78,,21.28,percent of total billed charges,78% of total billed charges,21.48,63,,17.184,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,12.96,38,,10.368,percent of total billed charges,38% of total billed charges,12.96,38,,10.368,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,30.69,90,,24.552,percent of total billed charges,90% of total billed charges,11.94,35,,9.552,percent of total billed charges,35% of total billed charges,22.94,67.275,,18.352,percent of total billed charges,67.275% of total billed charges,27.28,80,,21.824,percent of total billed charges,80% of total billed charges,13.09,38.38,,10.472,percent of total billed charges,38.38% of total billed charges,27.28,80,,21.824,percent of total billed charges,80% of total billed charges,21.05,61.74,,16.84,percent of total billed charges,61.74% of total billed charges,34.78,102,,27.824,percent of total billed charges,102% of total billed charges,12.96,38,,10.368,percent of total billed charges,38% of total billed charges,11.94,34.78,
CERVICAL COLLAR - PEDIATRIC,3005402,CDM,270,RC,,,Outpatient,,,34.1,25.58,,26.6,78,,21.28,percent of total billed charges,78% of total billed charges,21.48,63,,17.184,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,12.96,38,,10.368,percent of total billed charges,38% of total billed charges,12.96,38,,10.368,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,30.69,90,,24.552,percent of total billed charges,90% of total billed charges,11.94,35,,9.552,percent of total billed charges,35% of total billed charges,22.94,67.275,,18.352,percent of total billed charges,67.275% of total billed charges,27.28,80,,21.824,percent of total billed charges,80% of total billed charges,13.09,38.38,,10.472,percent of total billed charges,38.38% of total billed charges,27.28,80,,21.824,percent of total billed charges,80% of total billed charges,21.05,61.74,,16.84,percent of total billed charges,61.74% of total billed charges,34.78,102,,27.824,percent of total billed charges,102% of total billed charges,12.96,38,,10.368,percent of total billed charges,38% of total billed charges,11.94,34.78,
BINDER ABD 3-PANEL 9   (30-45),3000114,CDM,270,RC,,,Outpatient,,,34.75,26.06,,27.11,78,,21.688,percent of total billed charges,78% of total billed charges,21.89,63,,17.512,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,13.21,38,,10.568,percent of total billed charges,38% of total billed charges,13.21,38,,10.568,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,31.28,90,,25.024,percent of total billed charges,90% of total billed charges,12.16,35,,9.728,percent of total billed charges,35% of total billed charges,23.38,67.275,,18.704,percent of total billed charges,67.275% of total billed charges,27.8,80,,22.24,percent of total billed charges,80% of total billed charges,13.34,38.38,,10.672,percent of total billed charges,38.38% of total billed charges,27.8,80,,22.24,percent of total billed charges,80% of total billed charges,21.45,61.74,,17.16,percent of total billed charges,61.74% of total billed charges,35.45,102,,28.36,percent of total billed charges,102% of total billed charges,13.21,38,,10.568,percent of total billed charges,38% of total billed charges,12.16,35.45,
VOLUME VENT CIRCUIT 1607,3003000,CDM,270,RC,,,Outpatient,,,34.85,26.14,,27.18,78,,21.744,percent of total billed charges,78% of total billed charges,21.96,63,,17.568,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,13.24,38,,10.592,percent of total billed charges,38% of total billed charges,13.24,38,,10.592,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,31.37,90,,25.096,percent of total billed charges,90% of total billed charges,12.2,35,,9.76,percent of total billed charges,35% of total billed charges,23.45,67.275,,18.76,percent of total billed charges,67.275% of total billed charges,27.88,80,,22.304,percent of total billed charges,80% of total billed charges,13.38,38.38,,10.704,percent of total billed charges,38.38% of total billed charges,27.88,80,,22.304,percent of total billed charges,80% of total billed charges,21.52,61.74,,17.216,percent of total billed charges,61.74% of total billed charges,35.55,102,,28.44,percent of total billed charges,102% of total billed charges,13.24,38,,10.592,percent of total billed charges,38% of total billed charges,12.2,35.55,
K-WIRE 9  x .035,3008005,CDM,270,RC,,,Outpatient,,,34.9,26.18,,27.22,78,,21.776,percent of total billed charges,78% of total billed charges,21.99,63,,17.592,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,13.26,38,,10.608,percent of total billed charges,38% of total billed charges,13.26,38,,10.608,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,31.41,90,,25.128,percent of total billed charges,90% of total billed charges,12.22,35,,9.776,percent of total billed charges,35% of total billed charges,23.48,67.275,,18.784,percent of total billed charges,67.275% of total billed charges,27.92,80,,22.336,percent of total billed charges,80% of total billed charges,13.39,38.38,,10.712,percent of total billed charges,38.38% of total billed charges,27.92,80,,22.336,percent of total billed charges,80% of total billed charges,21.55,61.74,,17.24,percent of total billed charges,61.74% of total billed charges,35.6,102,,28.48,percent of total billed charges,102% of total billed charges,13.26,38,,10.608,percent of total billed charges,38% of total billed charges,12.22,35.6,
IV INSERTION,1200198,CDM,981,RC,36000,HCPCS,Outpatient,,,35,26.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.2,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,10.2,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.2,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.2,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,10.2,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,19.67,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,10.21,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,21.18,61.74,,16.944,percent of total billed charges,61.74% of total billed charges,18.73,102,,,Fee Schedule,102% of GA Medicaid Rate,10.2,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.2,21.18,
ARTERIAL PUNCTURE,1200201,CDM,981,RC,,,Outpatient,,,35,26.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.18,61.74,,16.944,percent of total billed charges,61.74% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.18,21.18,
RHYTHM ECG INTERPR/STRIP,1200210,CDM,981,RC,93042,HCPCS,Outpatient,,,35,26.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.61,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,7.61,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.61,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.61,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,7.61,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,8.58,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.96,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,21.18,61.74,,16.944,percent of total billed charges,61.74% of total billed charges,8.17,102,,,Fee Schedule,102% of GA Medicaid Rate,7.61,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.61,21.18,
"Complete blood cell count, with differential white blood cells, automated",5000142,CDM,305,RC,85025,HCPCS,Outpatient,,,35,26.25,,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,9.77,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,7.77,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.77,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,10.26,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,23.55,67.275,,18.84,percent of total billed charges,67.275% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,7.85,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,28,80,,22.4,percent of total billed charges,80% of total billed charges,21.61,61.74,,17.288,percent of total billed charges,61.74% of total billed charges,9.97,102,,,Fee Schedule,102% of GA Medicaid Rate,7.77,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.77,31.5,
SCABIES,5000181,CDM,302,RC,87220,HCPCS,Outpatient,,,35,26.25,,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,5.36,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,5.63,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,23.55,67.275,,18.84,percent of total billed charges,67.275% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,4.31,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,28,80,,22.4,percent of total billed charges,80% of total billed charges,21.61,61.74,,17.288,percent of total billed charges,61.74% of total billed charges,5.47,102,,,Fee Schedule,102% of GA Medicaid Rate,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.27,31.5,
KOH PREP,5000219,CDM,306,RC,87220,HCPCS,Outpatient,,,35,26.25,,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,5.36,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,5.63,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,23.55,67.275,,18.84,percent of total billed charges,67.275% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,4.31,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,28,80,,22.4,percent of total billed charges,80% of total billed charges,21.61,61.74,,17.288,percent of total billed charges,61.74% of total billed charges,5.47,102,,,Fee Schedule,102% of GA Medicaid Rate,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.27,31.5,
FUNGAL STAIN,5000290,CDM,306,RC,87206,HCPCS,Outpatient,,,35,26.25,,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,6.75,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,7.09,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,23.55,67.275,,18.84,percent of total billed charges,67.275% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,5.44,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,28,80,,22.4,percent of total billed charges,80% of total billed charges,21.61,61.74,,17.288,percent of total billed charges,61.74% of total billed charges,6.89,102,,,Fee Schedule,102% of GA Medicaid Rate,5.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.39,31.5,
Measurement of direct bilirubin,5000610,CDM,300,RC,82248,HCPCS,Outpatient,,,35,26.25,,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,6.32,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,6.64,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,23.55,67.275,,18.84,percent of total billed charges,67.275% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,5.07,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,28,80,,22.4,percent of total billed charges,80% of total billed charges,21.61,61.74,,17.288,percent of total billed charges,61.74% of total billed charges,6.45,102,,,Fee Schedule,102% of GA Medicaid Rate,5.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.02,31.5,
"CHLORIDE, URINE (RANDOM)",5000725,CDM,301,RC,82436,HCPCS,Outpatient,,,35,26.25,,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,6.32,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,6.64,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,23.55,67.275,,18.84,percent of total billed charges,67.275% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,5.81,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,28,80,,22.4,percent of total billed charges,80% of total billed charges,21.61,61.74,,17.288,percent of total billed charges,61.74% of total billed charges,6.45,102,,,Fee Schedule,102% of GA Medicaid Rate,5.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.75,31.5,
ACID FAST SMEAR,5001505,CDM,306,RC,87206,HCPCS,Outpatient,,,35,26.25,,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,6.75,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,7.09,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,23.55,67.275,,18.84,percent of total billed charges,67.275% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,5.44,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,28,80,,22.4,percent of total billed charges,80% of total billed charges,21.61,61.74,,17.288,percent of total billed charges,61.74% of total billed charges,6.89,102,,,Fee Schedule,102% of GA Medicaid Rate,5.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.39,31.5,
CHLORIDE (URINE),5002092,CDM,300,RC,82436,HCPCS,Outpatient,,,35,26.25,,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,6.32,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,6.64,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,23.55,67.275,,18.84,percent of total billed charges,67.275% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,5.81,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,28,80,,22.4,percent of total billed charges,80% of total billed charges,21.61,61.74,,17.288,percent of total billed charges,61.74% of total billed charges,6.45,102,,,Fee Schedule,102% of GA Medicaid Rate,5.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.75,31.5,
Quantitative measure of glucose build up in the blood over time,5009112,CDM,301,RC,82947,HCPCS,Outpatient,,,35,26.25,,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,4.93,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,3.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,5.18,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,23.55,67.275,,18.84,percent of total billed charges,67.275% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,3.97,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,28,80,,22.4,percent of total billed charges,80% of total billed charges,21.61,61.74,,17.288,percent of total billed charges,61.74% of total billed charges,5.03,102,,,Fee Schedule,102% of GA Medicaid Rate,3.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.93,31.5,
KOH FOR FUNGI/PARASITES/MITES,5087220,CDM,300,RC,87220,HCPCS,Outpatient,,,35,26.25,,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,5.36,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,5.63,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,23.55,67.275,,18.84,percent of total billed charges,67.275% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,4.31,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,28,80,,22.4,percent of total billed charges,80% of total billed charges,21.61,61.74,,17.288,percent of total billed charges,61.74% of total billed charges,5.47,102,,,Fee Schedule,102% of GA Medicaid Rate,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.27,31.5,
PT E-STIM UNATTENDED,9000027,CDM,420,RC,G0283,HCPCS,Outpatient,,,35,26.25,,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,13.3,38,,10.64,percent of total billed charges,38% of total billed charges,13.3,38,,10.64,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,12.25,35,,9.8,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,13.43,38.38,,10.744,percent of total billed charges,38.38% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,21.61,61.74,,17.288,percent of total billed charges,61.74% of total billed charges,35.7,102,,28.56,percent of total billed charges,102% of total billed charges,13.3,38,,10.64,percent of total billed charges,38% of total billed charges,12.25,145.93,
CHROMIC 4-0 P-3,3001565,CDM,270,RC,,,Outpatient,,,35.48,26.61,,27.67,78,,22.136,percent of total billed charges,78% of total billed charges,22.35,63,,17.88,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,13.48,38,,10.784,percent of total billed charges,38% of total billed charges,13.48,38,,10.784,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,31.93,90,,25.544,percent of total billed charges,90% of total billed charges,12.42,35,,9.936,percent of total billed charges,35% of total billed charges,23.87,67.275,,19.096,percent of total billed charges,67.275% of total billed charges,28.38,80,,22.704,percent of total billed charges,80% of total billed charges,13.62,38.38,,10.896,percent of total billed charges,38.38% of total billed charges,28.38,80,,22.704,percent of total billed charges,80% of total billed charges,21.91,61.74,,17.528,percent of total billed charges,61.74% of total billed charges,36.19,102,,28.952,percent of total billed charges,102% of total billed charges,13.48,38,,10.784,percent of total billed charges,38% of total billed charges,12.42,36.19,
SHOULDER SLING/SWATHE - XL,3003118,CDM,270,RC,,,Outpatient,,,35.6,26.7,,27.77,78,,22.216,percent of total billed charges,78% of total billed charges,22.43,63,,17.944,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,13.53,38,,10.824,percent of total billed charges,38% of total billed charges,13.53,38,,10.824,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,32.04,90,,25.632,percent of total billed charges,90% of total billed charges,12.46,35,,9.968,percent of total billed charges,35% of total billed charges,23.95,67.275,,19.16,percent of total billed charges,67.275% of total billed charges,28.48,80,,22.784,percent of total billed charges,80% of total billed charges,13.66,38.38,,10.928,percent of total billed charges,38.38% of total billed charges,28.48,80,,22.784,percent of total billed charges,80% of total billed charges,21.98,61.74,,17.584,percent of total billed charges,61.74% of total billed charges,36.31,102,,29.048,percent of total billed charges,102% of total billed charges,13.53,38,,10.824,percent of total billed charges,38% of total billed charges,12.46,36.31,
CATHETER 3-WAY SILIC FOLEY 22FR,3000280,CDM,270,RC,,,Outpatient,,,35.65,26.74,,27.81,78,,22.248,percent of total billed charges,78% of total billed charges,22.46,63,,17.968,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,13.55,38,,10.84,percent of total billed charges,38% of total billed charges,13.55,38,,10.84,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,32.09,90,,25.672,percent of total billed charges,90% of total billed charges,12.48,35,,9.984,percent of total billed charges,35% of total billed charges,23.98,67.275,,19.184,percent of total billed charges,67.275% of total billed charges,28.52,80,,22.816,percent of total billed charges,80% of total billed charges,13.68,38.38,,10.944,percent of total billed charges,38.38% of total billed charges,28.52,80,,22.816,percent of total billed charges,80% of total billed charges,22.01,61.74,,17.608,percent of total billed charges,61.74% of total billed charges,36.36,102,,29.088,percent of total billed charges,102% of total billed charges,13.55,38,,10.84,percent of total billed charges,38% of total billed charges,12.48,36.36,
CATHETER 3-WAY SILIC FOLEY 18FR,3000281,CDM,270,RC,,,Outpatient,,,35.65,26.74,,27.81,78,,22.248,percent of total billed charges,78% of total billed charges,22.46,63,,17.968,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,13.55,38,,10.84,percent of total billed charges,38% of total billed charges,13.55,38,,10.84,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,32.09,90,,25.672,percent of total billed charges,90% of total billed charges,12.48,35,,9.984,percent of total billed charges,35% of total billed charges,23.98,67.275,,19.184,percent of total billed charges,67.275% of total billed charges,28.52,80,,22.816,percent of total billed charges,80% of total billed charges,13.68,38.38,,10.944,percent of total billed charges,38.38% of total billed charges,28.52,80,,22.816,percent of total billed charges,80% of total billed charges,22.01,61.74,,17.608,percent of total billed charges,61.74% of total billed charges,36.36,102,,29.088,percent of total billed charges,102% of total billed charges,13.55,38,,10.84,percent of total billed charges,38% of total billed charges,12.48,36.36,
BIOPATCH 1  4MM,3001021,CDM,270,RC,,,Outpatient,,,35.78,26.84,,27.91,78,,22.328,percent of total billed charges,78% of total billed charges,22.54,63,,18.032,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,13.6,38,,10.88,percent of total billed charges,38% of total billed charges,13.6,38,,10.88,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,32.2,90,,25.76,percent of total billed charges,90% of total billed charges,12.52,35,,10.016,percent of total billed charges,35% of total billed charges,24.07,67.275,,19.256,percent of total billed charges,67.275% of total billed charges,28.62,80,,22.896,percent of total billed charges,80% of total billed charges,13.73,38.38,,10.984,percent of total billed charges,38.38% of total billed charges,28.62,80,,22.896,percent of total billed charges,80% of total billed charges,22.09,61.74,,17.672,percent of total billed charges,61.74% of total billed charges,36.5,102,,29.2,percent of total billed charges,102% of total billed charges,13.6,38,,10.88,percent of total billed charges,38% of total billed charges,12.52,36.5,
DEBRID OVER 10% + ADD 10%,1200180,CDM,981,RC,11001,HCPCS,Outpatient,,,36,27,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,16.7,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,16.7,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.7,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.7,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,16.7,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,20.2,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,16.96,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,21.78,61.74,,17.424,percent of total billed charges,61.74% of total billed charges,19.24,102,,,Fee Schedule,102% of GA Medicaid Rate,16.7,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.7,21.78,
SICKLE CELL SCREEN,5000312,CDM,305,RC,85660,HCPCS,Outpatient,,,36,27,,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,6.94,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.51,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.51,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,7.29,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,24.22,67.275,,19.376,percent of total billed charges,67.275% of total billed charges,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,5.57,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,22.23,61.74,,17.784,percent of total billed charges,61.74% of total billed charges,7.08,102,,,Fee Schedule,102% of GA Medicaid Rate,5.51,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.51,32.4,
OCCULT BLOOD DIAG (1-3 SPECIMENS),5000523,CDM,301,RC,82272,HCPCS,Outpatient,,,36,27,,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,4.04,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.23,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.23,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,4.24,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,24.22,67.275,,19.376,percent of total billed charges,67.275% of total billed charges,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,4.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,22.23,61.74,,17.784,percent of total billed charges,61.74% of total billed charges,4.12,102,,,Fee Schedule,102% of GA Medicaid Rate,4.23,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.04,32.4,
SED RATE,5000845,CDM,305,RC,85651,HCPCS,Outpatient,,,36,27,,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,4.46,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,4.68,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,24.22,67.275,,19.376,percent of total billed charges,67.275% of total billed charges,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,4.31,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,22.23,61.74,,17.784,percent of total billed charges,61.74% of total billed charges,4.55,102,,,Fee Schedule,102% of GA Medicaid Rate,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.27,32.4,
GASTROCULT,5003726,CDM,301,RC,82272,HCPCS,Outpatient,,,36,27,,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,4.04,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.23,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.23,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,4.24,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,24.22,67.275,,19.376,percent of total billed charges,67.275% of total billed charges,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,4.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,22.23,61.74,,17.784,percent of total billed charges,61.74% of total billed charges,4.12,102,,,Fee Schedule,102% of GA Medicaid Rate,4.23,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.04,32.4,
BB SCREEN SICKLE Hgb,5200030,CDM,300,RC,85660,HCPCS,Outpatient,,,36,27,,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,6.94,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.51,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.51,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,7.29,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,24.22,67.275,,19.376,percent of total billed charges,67.275% of total billed charges,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,5.57,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,22.23,61.74,,17.784,percent of total billed charges,61.74% of total billed charges,7.08,102,,,Fee Schedule,102% of GA Medicaid Rate,5.51,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.51,32.4,
Form of decompression therapy of the spine,9000019,CDM,420,RC,97012,HCPCS,Outpatient,,,36,27,,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,22.68,63,,18.144,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,13.68,38,,10.944,percent of total billed charges,38% of total billed charges,13.68,38,,10.944,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,12.6,35,,10.08,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,13.82,38.38,,11.056,percent of total billed charges,38.38% of total billed charges,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,22.23,61.74,,17.784,percent of total billed charges,61.74% of total billed charges,36.72,102,,29.376,percent of total billed charges,102% of total billed charges,13.68,38,,10.944,percent of total billed charges,38% of total billed charges,12.6,145.93,
PT CONTRAST BATH,9000028,CDM,420,RC,97034,HCPCS,Outpatient,,,36,27,,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,22.68,63,,18.144,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,13.68,38,,10.944,percent of total billed charges,38% of total billed charges,13.68,38,,10.944,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,12.6,35,,10.08,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,13.82,38.38,,11.056,percent of total billed charges,38.38% of total billed charges,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,22.23,61.74,,17.784,percent of total billed charges,61.74% of total billed charges,36.72,102,,29.376,percent of total billed charges,102% of total billed charges,13.68,38,,10.944,percent of total billed charges,38% of total billed charges,12.6,145.93,
Repeated application to one or more parts of the body,9590027,CDM,420,RC,97032,HCPCS,Outpatient,,,36,27,,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,22.68,63,,18.144,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,13.68,38,,10.944,percent of total billed charges,38% of total billed charges,13.68,38,,10.944,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,12.6,35,,10.08,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,13.82,38.38,,11.056,percent of total billed charges,38.38% of total billed charges,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,22.23,61.74,,17.784,percent of total billed charges,61.74% of total billed charges,36.72,102,,29.376,percent of total billed charges,102% of total billed charges,13.68,38,,10.944,percent of total billed charges,38% of total billed charges,12.6,145.93,
LEVINE TUBE PED 14FR,3001817,CDM,270,RC,,,Outpatient,,,36.25,27.19,,28.28,78,,22.624,percent of total billed charges,78% of total billed charges,22.84,63,,18.272,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,13.78,38,,11.024,percent of total billed charges,38% of total billed charges,13.78,38,,11.024,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,32.63,90,,26.104,percent of total billed charges,90% of total billed charges,12.69,35,,10.152,percent of total billed charges,35% of total billed charges,24.39,67.275,,19.512,percent of total billed charges,67.275% of total billed charges,29,80,,23.2,percent of total billed charges,80% of total billed charges,13.91,38.38,,11.128,percent of total billed charges,38.38% of total billed charges,29,80,,23.2,percent of total billed charges,80% of total billed charges,22.38,61.74,,17.904,percent of total billed charges,61.74% of total billed charges,36.98,102,,29.584,percent of total billed charges,102% of total billed charges,13.78,38,,11.024,percent of total billed charges,38% of total billed charges,12.69,36.98,
CERVICAL COLLAR - ADULT LOW,3000252,CDM,270,RC,,,Outpatient,,,36.55,27.41,,28.51,78,,22.808,percent of total billed charges,78% of total billed charges,23.03,63,,18.424,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,13.89,38,,11.112,percent of total billed charges,38% of total billed charges,13.89,38,,11.112,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,32.9,90,,26.32,percent of total billed charges,90% of total billed charges,12.79,35,,10.232,percent of total billed charges,35% of total billed charges,24.59,67.275,,19.672,percent of total billed charges,67.275% of total billed charges,29.24,80,,23.392,percent of total billed charges,80% of total billed charges,14.03,38.38,,11.224,percent of total billed charges,38.38% of total billed charges,29.24,80,,23.392,percent of total billed charges,80% of total billed charges,22.57,61.74,,18.056,percent of total billed charges,61.74% of total billed charges,37.28,102,,29.824,percent of total billed charges,102% of total billed charges,13.89,38,,11.112,percent of total billed charges,38% of total billed charges,12.79,37.28,
CERVICAL COLLAR - ADULT SHORT,3000254,CDM,270,RC,,,Outpatient,,,36.55,27.41,,28.51,78,,22.808,percent of total billed charges,78% of total billed charges,23.03,63,,18.424,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,13.89,38,,11.112,percent of total billed charges,38% of total billed charges,13.89,38,,11.112,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,32.9,90,,26.32,percent of total billed charges,90% of total billed charges,12.79,35,,10.232,percent of total billed charges,35% of total billed charges,24.59,67.275,,19.672,percent of total billed charges,67.275% of total billed charges,29.24,80,,23.392,percent of total billed charges,80% of total billed charges,14.03,38.38,,11.224,percent of total billed charges,38.38% of total billed charges,29.24,80,,23.392,percent of total billed charges,80% of total billed charges,22.57,61.74,,18.056,percent of total billed charges,61.74% of total billed charges,37.28,102,,29.824,percent of total billed charges,102% of total billed charges,13.89,38,,11.112,percent of total billed charges,38% of total billed charges,12.79,37.28,
CERVICAL COLLAR - INFANT,3000204,CDM,270,RC,,,Outpatient,,,36.6,27.45,,28.55,78,,22.84,percent of total billed charges,78% of total billed charges,23.06,63,,18.448,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,13.91,38,,11.128,percent of total billed charges,38% of total billed charges,13.91,38,,11.128,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,32.94,90,,26.352,percent of total billed charges,90% of total billed charges,12.81,35,,10.248,percent of total billed charges,35% of total billed charges,24.62,67.275,,19.696,percent of total billed charges,67.275% of total billed charges,29.28,80,,23.424,percent of total billed charges,80% of total billed charges,14.05,38.38,,11.24,percent of total billed charges,38.38% of total billed charges,29.28,80,,23.424,percent of total billed charges,80% of total billed charges,22.6,61.74,,18.08,percent of total billed charges,61.74% of total billed charges,37.33,102,,29.864,percent of total billed charges,102% of total billed charges,13.91,38,,11.128,percent of total billed charges,38% of total billed charges,12.81,37.33,
"VICRYL, VIOLET TIES 2-0",3005013,CDM,270,RC,,,Outpatient,,,36.71,27.53,,28.63,78,,22.904,percent of total billed charges,78% of total billed charges,23.13,63,,18.504,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,13.95,38,,11.16,percent of total billed charges,38% of total billed charges,13.95,38,,11.16,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,33.04,90,,26.432,percent of total billed charges,90% of total billed charges,12.85,35,,10.28,percent of total billed charges,35% of total billed charges,24.7,67.275,,19.76,percent of total billed charges,67.275% of total billed charges,29.37,80,,23.496,percent of total billed charges,80% of total billed charges,14.09,38.38,,11.272,percent of total billed charges,38.38% of total billed charges,29.37,80,,23.496,percent of total billed charges,80% of total billed charges,22.66,61.74,,18.128,percent of total billed charges,61.74% of total billed charges,37.44,102,,29.952,percent of total billed charges,102% of total billed charges,13.95,38,,11.16,percent of total billed charges,38% of total billed charges,12.85,37.44,
BLADE SAG 5.5X25.5X0.4MM,3003098,CDM,270,RC,,,Outpatient,,,36.75,27.56,,28.67,78,,22.936,percent of total billed charges,78% of total billed charges,23.15,63,,18.52,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,13.97,38,,11.176,percent of total billed charges,38% of total billed charges,13.97,38,,11.176,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,33.08,90,,26.464,percent of total billed charges,90% of total billed charges,12.86,35,,10.288,percent of total billed charges,35% of total billed charges,24.72,67.275,,19.776,percent of total billed charges,67.275% of total billed charges,29.4,80,,23.52,percent of total billed charges,80% of total billed charges,14.1,38.38,,11.28,percent of total billed charges,38.38% of total billed charges,29.4,80,,23.52,percent of total billed charges,80% of total billed charges,22.69,61.74,,18.152,percent of total billed charges,61.74% of total billed charges,37.49,102,,29.992,percent of total billed charges,102% of total billed charges,13.97,38,,11.176,percent of total billed charges,38% of total billed charges,12.86,37.49,
"PROTEIN TOTAL, PLEURAL FLUID",5000062,CDM,301,RC,84157,HCPCS,Outpatient,,,37,27.75,,28.86,78,,23.088,percent of total billed charges,78% of total billed charges,4.61,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,4.84,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,24.89,67.275,,19.912,percent of total billed charges,67.275% of total billed charges,29.6,80,,23.68,percent of total billed charges,80% of total billed charges,4.04,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,29.6,80,,23.68,percent of total billed charges,80% of total billed charges,22.84,61.74,,18.272,percent of total billed charges,61.74% of total billed charges,4.7,102,,,Fee Schedule,102% of GA Medicaid Rate,4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4,33.3,
"PROTEIN, TOTAL, PERITONEAL FLUID",5000066,CDM,301,RC,84157,HCPCS,Outpatient,,,37,27.75,,28.86,78,,23.088,percent of total billed charges,78% of total billed charges,4.61,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,4.84,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,24.89,67.275,,19.912,percent of total billed charges,67.275% of total billed charges,29.6,80,,23.68,percent of total billed charges,80% of total billed charges,4.04,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,29.6,80,,23.68,percent of total billed charges,80% of total billed charges,22.84,61.74,,18.272,percent of total billed charges,61.74% of total billed charges,4.7,102,,,Fee Schedule,102% of GA Medicaid Rate,4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4,33.3,
RHEUMATOID FACTOR,5000305,CDM,302,RC,86430,HCPCS,Outpatient,,,37,27.75,,28.86,78,,23.088,percent of total billed charges,78% of total billed charges,7.14,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.14,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.14,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,7.5,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,24.89,67.275,,19.912,percent of total billed charges,67.275% of total billed charges,29.6,80,,23.68,percent of total billed charges,80% of total billed charges,6.2,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,29.6,80,,23.68,percent of total billed charges,80% of total billed charges,22.84,61.74,,18.272,percent of total billed charges,61.74% of total billed charges,7.28,102,,,Fee Schedule,102% of GA Medicaid Rate,6.14,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.14,33.3,
A test of the stool to diagnose Clostridium difficile (C. diff) infection,5000511,CDM,306,RC,87324,HCPCS,Outpatient,,,37,27.75,,28.86,78,,23.088,percent of total billed charges,78% of total billed charges,15.08,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,11.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,15.83,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,24.89,67.275,,19.912,percent of total billed charges,67.275% of total billed charges,29.6,80,,23.68,percent of total billed charges,80% of total billed charges,12.1,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,29.6,80,,23.68,percent of total billed charges,80% of total billed charges,22.84,61.74,,18.272,percent of total billed charges,61.74% of total billed charges,15.38,102,,,Fee Schedule,102% of GA Medicaid Rate,11.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.98,33.3,
POTASSIUM (URINE),5000749,CDM,301,RC,84133,HCPCS,Outpatient,,,37,27.75,,28.86,78,,23.088,percent of total billed charges,78% of total billed charges,5.41,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.73,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.73,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,5.68,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,24.89,67.275,,19.912,percent of total billed charges,67.275% of total billed charges,29.6,80,,23.68,percent of total billed charges,80% of total billed charges,4.78,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,29.6,80,,23.68,percent of total billed charges,80% of total billed charges,22.84,61.74,,18.272,percent of total billed charges,61.74% of total billed charges,5.52,102,,,Fee Schedule,102% of GA Medicaid Rate,4.73,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.73,33.3,
TOTAL PROTEIN,5000761,CDM,300,RC,84155,HCPCS,Outpatient,,,37,27.75,,28.86,78,,23.088,percent of total billed charges,78% of total billed charges,4.61,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,3.67,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.67,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,4.84,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,24.89,67.275,,19.912,percent of total billed charges,67.275% of total billed charges,29.6,80,,23.68,percent of total billed charges,80% of total billed charges,3.71,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,29.6,80,,23.68,percent of total billed charges,80% of total billed charges,22.84,61.74,,18.272,percent of total billed charges,61.74% of total billed charges,4.7,102,,,Fee Schedule,102% of GA Medicaid Rate,3.67,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.67,33.3,
PROTEIN SYNOVIAL FLUID,5000762,CDM,301,RC,84157,HCPCS,Outpatient,,,37,27.75,,28.86,78,,23.088,percent of total billed charges,78% of total billed charges,4.61,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,4.84,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,24.89,67.275,,19.912,percent of total billed charges,67.275% of total billed charges,29.6,80,,23.68,percent of total billed charges,80% of total billed charges,4.04,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,29.6,80,,23.68,percent of total billed charges,80% of total billed charges,22.84,61.74,,18.272,percent of total billed charges,61.74% of total billed charges,4.7,102,,,Fee Schedule,102% of GA Medicaid Rate,4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4,33.3,
GLOBULIN,5000768,CDM,301,RC,84155,HCPCS,Outpatient,,,37,27.75,,28.86,78,,23.088,percent of total billed charges,78% of total billed charges,4.61,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,3.67,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.67,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,4.84,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,24.89,67.275,,19.912,percent of total billed charges,67.275% of total billed charges,29.6,80,,23.68,percent of total billed charges,80% of total billed charges,3.71,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,29.6,80,,23.68,percent of total billed charges,80% of total billed charges,22.84,61.74,,18.272,percent of total billed charges,61.74% of total billed charges,4.7,102,,,Fee Schedule,102% of GA Medicaid Rate,3.67,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.67,33.3,
CSF PROTEIN,5001601,CDM,301,RC,84157,HCPCS,Outpatient,,,37,27.75,,28.86,78,,23.088,percent of total billed charges,78% of total billed charges,4.61,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,4.84,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,24.89,67.275,,19.912,percent of total billed charges,67.275% of total billed charges,29.6,80,,23.68,percent of total billed charges,80% of total billed charges,4.04,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,29.6,80,,23.68,percent of total billed charges,80% of total billed charges,22.84,61.74,,18.272,percent of total billed charges,61.74% of total billed charges,4.7,102,,,Fee Schedule,102% of GA Medicaid Rate,4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4,33.3,
POTASSIUM 24 HR URINE,5001965,CDM,301,RC,84133,HCPCS,Outpatient,,,37,27.75,,28.86,78,,23.088,percent of total billed charges,78% of total billed charges,5.41,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.73,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.73,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,5.68,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,24.89,67.275,,19.912,percent of total billed charges,67.275% of total billed charges,29.6,80,,23.68,percent of total billed charges,80% of total billed charges,4.78,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,29.6,80,,23.68,percent of total billed charges,80% of total billed charges,22.84,61.74,,18.272,percent of total billed charges,61.74% of total billed charges,5.52,102,,,Fee Schedule,102% of GA Medicaid Rate,4.73,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.73,33.3,
CONTINUOUS INHALAT W/ AERO EA ADDL HR,8000006,CDM,410,RC,94645,HCPCS,Outpatient,,,37,27.75,,28.86,78,,23.088,percent of total billed charges,78% of total billed charges,23.31,63,,18.648,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,14.06,38,,11.248,percent of total billed charges,38% of total billed charges,14.06,38,,11.248,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,12.95,35,,10.36,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,29.6,80,,23.68,percent of total billed charges,80% of total billed charges,14.2,38.38,,11.36,percent of total billed charges,38.38% of total billed charges,29.6,80,,23.68,percent of total billed charges,80% of total billed charges,22.84,61.74,,18.272,percent of total billed charges,61.74% of total billed charges,37.74,102,,30.192,percent of total billed charges,102% of total billed charges,14.06,38,,11.248,percent of total billed charges,38% of total billed charges,12.95,145.93,
ANESTHESIA  CIRCUIT KIT,3004023,CDM,270,RC,,,Outpatient,,,37.17,27.88,,28.99,78,,23.192,percent of total billed charges,78% of total billed charges,23.42,63,,18.736,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,14.12,38,,11.296,percent of total billed charges,38% of total billed charges,14.12,38,,11.296,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,33.45,90,,26.76,percent of total billed charges,90% of total billed charges,13.01,35,,10.408,percent of total billed charges,35% of total billed charges,25.01,67.275,,20.008,percent of total billed charges,67.275% of total billed charges,29.74,80,,23.792,percent of total billed charges,80% of total billed charges,14.27,38.38,,11.416,percent of total billed charges,38.38% of total billed charges,29.74,80,,23.792,percent of total billed charges,80% of total billed charges,22.95,61.74,,18.36,percent of total billed charges,61.74% of total billed charges,37.91,102,,30.328,percent of total billed charges,102% of total billed charges,14.12,38,,11.296,percent of total billed charges,38% of total billed charges,13.01,37.91,
PRESSURE INFUSION 500,3001542,CDM,270,RC,,,Outpatient,,,37.5,28.13,,29.25,78,,23.4,percent of total billed charges,78% of total billed charges,23.63,63,,18.904,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,14.25,38,,11.4,percent of total billed charges,38% of total billed charges,14.25,38,,11.4,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,33.75,90,,27,percent of total billed charges,90% of total billed charges,13.13,35,,10.504,percent of total billed charges,35% of total billed charges,25.23,67.275,,20.184,percent of total billed charges,67.275% of total billed charges,30,80,,24,percent of total billed charges,80% of total billed charges,14.39,38.38,,11.512,percent of total billed charges,38.38% of total billed charges,30,80,,24,percent of total billed charges,80% of total billed charges,23.15,61.74,,18.52,percent of total billed charges,61.74% of total billed charges,38.25,102,,30.6,percent of total billed charges,102% of total billed charges,14.25,38,,11.4,percent of total billed charges,38% of total billed charges,13.13,38.25,
PRESSURE INFUSION 1000,3004013,CDM,270,RC,,,Outpatient,,,37.5,28.13,,29.25,78,,23.4,percent of total billed charges,78% of total billed charges,23.63,63,,18.904,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,14.25,38,,11.4,percent of total billed charges,38% of total billed charges,14.25,38,,11.4,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,33.75,90,,27,percent of total billed charges,90% of total billed charges,13.13,35,,10.504,percent of total billed charges,35% of total billed charges,25.23,67.275,,20.184,percent of total billed charges,67.275% of total billed charges,30,80,,24,percent of total billed charges,80% of total billed charges,14.39,38.38,,11.512,percent of total billed charges,38.38% of total billed charges,30,80,,24,percent of total billed charges,80% of total billed charges,23.15,61.74,,18.52,percent of total billed charges,61.74% of total billed charges,38.25,102,,30.6,percent of total billed charges,102% of total billed charges,14.25,38,,11.4,percent of total billed charges,38% of total billed charges,13.13,38.25,
BILE BAG 026815,3000122,CDM,270,RC,,,Outpatient,,,37.75,28.31,,29.45,78,,23.56,percent of total billed charges,78% of total billed charges,23.78,63,,19.024,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,14.35,38,,11.48,percent of total billed charges,38% of total billed charges,14.35,38,,11.48,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,33.98,90,,27.184,percent of total billed charges,90% of total billed charges,13.21,35,,10.568,percent of total billed charges,35% of total billed charges,25.4,67.275,,20.32,percent of total billed charges,67.275% of total billed charges,30.2,80,,24.16,percent of total billed charges,80% of total billed charges,14.49,38.38,,11.592,percent of total billed charges,38.38% of total billed charges,30.2,80,,24.16,percent of total billed charges,80% of total billed charges,23.31,61.74,,18.648,percent of total billed charges,61.74% of total billed charges,38.51,102,,30.808,percent of total billed charges,102% of total billed charges,14.35,38,,11.48,percent of total billed charges,38% of total billed charges,13.21,38.51,
PROLENE 3-0 FS-2 8665G,3001660,CDM,270,RC,,,Outpatient,,,37.9,28.43,,29.56,78,,23.648,percent of total billed charges,78% of total billed charges,23.88,63,,19.104,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,14.4,38,,11.52,percent of total billed charges,38% of total billed charges,14.4,38,,11.52,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,34.11,90,,27.288,percent of total billed charges,90% of total billed charges,13.27,35,,10.616,percent of total billed charges,35% of total billed charges,25.5,67.275,,20.4,percent of total billed charges,67.275% of total billed charges,30.32,80,,24.256,percent of total billed charges,80% of total billed charges,14.55,38.38,,11.64,percent of total billed charges,38.38% of total billed charges,30.32,80,,24.256,percent of total billed charges,80% of total billed charges,23.4,61.74,,18.72,percent of total billed charges,61.74% of total billed charges,38.66,102,,30.928,percent of total billed charges,102% of total billed charges,14.4,38,,11.52,percent of total billed charges,38% of total billed charges,13.27,38.66,
CALCIUM,5000715,CDM,301,RC,82310,HCPCS,Outpatient,,,38,28.5,,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,6.35,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.16,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.16,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,6.67,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,25.56,67.275,,20.448,percent of total billed charges,67.275% of total billed charges,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,5.21,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,23.46,61.74,,18.768,percent of total billed charges,61.74% of total billed charges,6.48,102,,,Fee Schedule,102% of GA Medicaid Rate,5.16,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.16,34.2,
CALCIUM TOTAL,5000717,CDM,301,RC,82310,HCPCS,Outpatient,,,38,28.5,,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,6.35,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.16,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.16,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,6.67,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,25.56,67.275,,20.448,percent of total billed charges,67.275% of total billed charges,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,5.21,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,23.46,61.74,,18.768,percent of total billed charges,61.74% of total billed charges,6.48,102,,,Fee Schedule,102% of GA Medicaid Rate,5.16,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.16,34.2,
CREATINE PHOSPH MULTIPLE,5009124,CDM,301,RC,82550,HCPCS,Outpatient,,,38,28.5,,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,6.35,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.51,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.51,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,6.67,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,25.56,67.275,,20.448,percent of total billed charges,67.275% of total billed charges,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,6.58,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,23.46,61.74,,18.768,percent of total billed charges,61.74% of total billed charges,6.48,102,,,Fee Schedule,102% of GA Medicaid Rate,6.51,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.35,34.2,
Blood test to detect heart enzymes,5009130,CDM,301,RC,82553,HCPCS,Outpatient,,,38,28.5,,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,14.52,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,11.55,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.55,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,15.25,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,25.56,67.275,,20.448,percent of total billed charges,67.275% of total billed charges,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,11.67,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,23.46,61.74,,18.768,percent of total billed charges,61.74% of total billed charges,14.81,102,,,Fee Schedule,102% of GA Medicaid Rate,11.55,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.55,34.2,
Repeated application to one or more parts of the body,9000037,CDM,420,RC,97032,HCPCS,Outpatient,,,38,28.5,,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,23.94,63,,19.152,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,14.44,38,,11.552,percent of total billed charges,38% of total billed charges,14.44,38,,11.552,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,13.3,35,,10.64,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,14.58,38.38,,11.664,percent of total billed charges,38.38% of total billed charges,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,23.46,61.74,,18.768,percent of total billed charges,61.74% of total billed charges,38.76,102,,31.008,percent of total billed charges,102% of total billed charges,14.44,38,,11.552,percent of total billed charges,38% of total billed charges,13.3,145.93,
POLYP MULTI TRAP,3000262,CDM,270,RC,,,Outpatient,,,38.38,28.79,,29.94,78,,23.952,percent of total billed charges,78% of total billed charges,24.18,63,,19.344,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,14.58,38,,11.664,percent of total billed charges,38% of total billed charges,14.58,38,,11.664,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,34.54,90,,27.632,percent of total billed charges,90% of total billed charges,13.43,35,,10.744,percent of total billed charges,35% of total billed charges,25.82,67.275,,20.656,percent of total billed charges,67.275% of total billed charges,30.7,80,,24.56,percent of total billed charges,80% of total billed charges,14.73,38.38,,11.784,percent of total billed charges,38.38% of total billed charges,30.7,80,,24.56,percent of total billed charges,80% of total billed charges,23.7,61.74,,18.96,percent of total billed charges,61.74% of total billed charges,39.15,102,,31.32,percent of total billed charges,102% of total billed charges,14.58,38,,11.664,percent of total billed charges,38% of total billed charges,13.43,39.15,
BORDER HEEL DRESSING 9X9,3001230,CDM,270,RC,,,Outpatient,,,38.44,28.83,,29.98,78,,23.984,percent of total billed charges,78% of total billed charges,24.22,63,,19.376,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,14.61,38,,11.688,percent of total billed charges,38% of total billed charges,14.61,38,,11.688,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,34.6,90,,27.68,percent of total billed charges,90% of total billed charges,13.45,35,,10.76,percent of total billed charges,35% of total billed charges,25.86,67.275,,20.688,percent of total billed charges,67.275% of total billed charges,30.75,80,,24.6,percent of total billed charges,80% of total billed charges,14.75,38.38,,11.8,percent of total billed charges,38.38% of total billed charges,30.75,80,,24.6,percent of total billed charges,80% of total billed charges,23.73,61.74,,18.984,percent of total billed charges,61.74% of total billed charges,39.21,102,,31.368,percent of total billed charges,102% of total billed charges,14.61,38,,11.688,percent of total billed charges,38% of total billed charges,13.45,39.21,
ET TUBE HOLDER,3004208,CDM,270,RC,,,Outpatient,,,38.47,28.85,,30.01,78,,24.008,percent of total billed charges,78% of total billed charges,24.24,63,,19.392,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,14.62,38,,11.696,percent of total billed charges,38% of total billed charges,14.62,38,,11.696,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,34.62,90,,27.696,percent of total billed charges,90% of total billed charges,13.46,35,,10.768,percent of total billed charges,35% of total billed charges,25.88,67.275,,20.704,percent of total billed charges,67.275% of total billed charges,30.78,80,,24.624,percent of total billed charges,80% of total billed charges,14.76,38.38,,11.808,percent of total billed charges,38.38% of total billed charges,30.78,80,,24.624,percent of total billed charges,80% of total billed charges,23.75,61.74,,19,percent of total billed charges,61.74% of total billed charges,39.24,102,,31.392,percent of total billed charges,102% of total billed charges,14.62,38,,11.696,percent of total billed charges,38% of total billed charges,13.46,39.24,
PROLENE 2-0 SH  30   8833H,3001598,CDM,270,RC,,,Outpatient,,,38.57,28.93,,30.08,78,,24.064,percent of total billed charges,78% of total billed charges,24.3,63,,19.44,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,14.66,38,,11.728,percent of total billed charges,38% of total billed charges,14.66,38,,11.728,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,34.71,90,,27.768,percent of total billed charges,90% of total billed charges,13.5,35,,10.8,percent of total billed charges,35% of total billed charges,25.95,67.275,,20.76,percent of total billed charges,67.275% of total billed charges,30.86,80,,24.688,percent of total billed charges,80% of total billed charges,14.8,38.38,,11.84,percent of total billed charges,38.38% of total billed charges,30.86,80,,24.688,percent of total billed charges,80% of total billed charges,23.81,61.74,,19.048,percent of total billed charges,61.74% of total billed charges,39.34,102,,31.472,percent of total billed charges,102% of total billed charges,14.66,38,,11.728,percent of total billed charges,38% of total billed charges,13.5,39.34,
ALKALINE PHOSPHATASE,5000755,CDM,301,RC,84075,HCPCS,Outpatient,,,39,29.25,,30.42,78,,24.336,percent of total billed charges,78% of total billed charges,6.35,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,35.1,90,,28.08,percent of total billed charges,90% of total billed charges,6.67,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,26.24,67.275,,20.992,percent of total billed charges,67.275% of total billed charges,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,5.23,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,24.08,61.74,,19.264,percent of total billed charges,61.74% of total billed charges,6.48,102,,,Fee Schedule,102% of GA Medicaid Rate,5.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.18,35.1,
ALK PHOSPHATASE BONE SPECIFIC,5000757,CDM,301,RC,84075,HCPCS,Outpatient,,,39,29.25,,30.42,78,,24.336,percent of total billed charges,78% of total billed charges,6.35,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,35.1,90,,28.08,percent of total billed charges,90% of total billed charges,6.67,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,26.24,67.275,,20.992,percent of total billed charges,67.275% of total billed charges,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,5.23,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,24.08,61.74,,19.264,percent of total billed charges,61.74% of total billed charges,6.48,102,,,Fee Schedule,102% of GA Medicaid Rate,5.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.18,35.1,
PATH PHOTO X-RAY,5003609,CDM,300,RC,,,Outpatient,,,39,29.25,,30.42,78,,24.336,percent of total billed charges,78% of total billed charges,24.57,63,,19.656,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,14.82,38,,11.856,percent of total billed charges,38% of total billed charges,14.82,38,,11.856,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,35.1,90,,28.08,percent of total billed charges,90% of total billed charges,13.65,35,,10.92,percent of total billed charges,35% of total billed charges,26.24,67.275,,20.992,percent of total billed charges,67.275% of total billed charges,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,14.97,38.38,,11.976,percent of total billed charges,38.38% of total billed charges,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,24.08,61.74,,19.264,percent of total billed charges,61.74% of total billed charges,39.78,102,,31.824,percent of total billed charges,102% of total billed charges,14.82,38,,11.856,percent of total billed charges,38% of total billed charges,13.65,39.78,
Blood test to evaluate liver function,5009147,CDM,301,RC,84460,HCPCS,Outpatient,,,39,29.25,,30.42,78,,24.336,percent of total billed charges,78% of total billed charges,6.35,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.3,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.3,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,35.1,90,,28.08,percent of total billed charges,90% of total billed charges,6.67,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,26.24,67.275,,20.992,percent of total billed charges,67.275% of total billed charges,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,5.35,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,24.08,61.74,,19.264,percent of total billed charges,61.74% of total billed charges,6.48,102,,,Fee Schedule,102% of GA Medicaid Rate,5.3,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.3,35.1,
ALKALINE PHOSHATASE MULTI,5009155,CDM,301,RC,84075,HCPCS,Outpatient,,,39,29.25,,30.42,78,,24.336,percent of total billed charges,78% of total billed charges,6.35,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,35.1,90,,28.08,percent of total billed charges,90% of total billed charges,6.67,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,26.24,67.275,,20.992,percent of total billed charges,67.275% of total billed charges,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,5.23,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,24.08,61.74,,19.264,percent of total billed charges,61.74% of total billed charges,6.48,102,,,Fee Schedule,102% of GA Medicaid Rate,5.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.18,35.1,
E-STIM UNIT FITTING,9590100,CDM,420,RC,64550,HCPCS,Outpatient,,,39,29.25,,30.42,78,,24.336,percent of total billed charges,78% of total billed charges,24.57,63,,19.656,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,14.82,38,,11.856,percent of total billed charges,38% of total billed charges,14.82,38,,11.856,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,35.1,90,,28.08,percent of total billed charges,90% of total billed charges,13.65,35,,10.92,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,14.97,38.38,,11.976,percent of total billed charges,38.38% of total billed charges,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,24.08,61.74,,19.264,percent of total billed charges,61.74% of total billed charges,39.78,102,,31.824,percent of total billed charges,102% of total billed charges,14.82,38,,11.856,percent of total billed charges,38% of total billed charges,13.65,145.93,
CATHETER 3-WAY FOLEY 20FR 30CC,3000297,CDM,270,RC,,,Outpatient,,,39.1,29.33,,30.5,78,,24.4,percent of total billed charges,78% of total billed charges,24.63,63,,19.704,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,14.86,38,,11.888,percent of total billed charges,38% of total billed charges,14.86,38,,11.888,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,35.19,90,,28.152,percent of total billed charges,90% of total billed charges,13.69,35,,10.952,percent of total billed charges,35% of total billed charges,26.3,67.275,,21.04,percent of total billed charges,67.275% of total billed charges,31.28,80,,25.024,percent of total billed charges,80% of total billed charges,15.01,38.38,,12.008,percent of total billed charges,38.38% of total billed charges,31.28,80,,25.024,percent of total billed charges,80% of total billed charges,24.14,61.74,,19.312,percent of total billed charges,61.74% of total billed charges,39.88,102,,31.904,percent of total billed charges,102% of total billed charges,14.86,38,,11.888,percent of total billed charges,38% of total billed charges,13.69,39.88,
"WOUND DRESSING, DRAWTEX, 4X4",3000572,CDM,270,RC,,,Outpatient,,,39.43,29.57,,30.76,78,,24.608,percent of total billed charges,78% of total billed charges,24.84,63,,19.872,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,14.98,38,,11.984,percent of total billed charges,38% of total billed charges,14.98,38,,11.984,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,35.49,90,,28.392,percent of total billed charges,90% of total billed charges,13.8,35,,11.04,percent of total billed charges,35% of total billed charges,26.53,67.275,,21.224,percent of total billed charges,67.275% of total billed charges,31.54,80,,25.232,percent of total billed charges,80% of total billed charges,15.13,38.38,,12.104,percent of total billed charges,38.38% of total billed charges,31.54,80,,25.232,percent of total billed charges,80% of total billed charges,24.34,61.74,,19.472,percent of total billed charges,61.74% of total billed charges,40.22,102,,32.176,percent of total billed charges,102% of total billed charges,14.98,38,,11.984,percent of total billed charges,38% of total billed charges,13.8,40.22,
PED PEAK FLOW METER,3001415,CDM,270,RC,,,Outpatient,,,39.65,29.74,,30.93,78,,24.744,percent of total billed charges,78% of total billed charges,24.98,63,,19.984,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,15.07,38,,12.056,percent of total billed charges,38% of total billed charges,15.07,38,,12.056,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,35.69,90,,28.552,percent of total billed charges,90% of total billed charges,13.88,35,,11.104,percent of total billed charges,35% of total billed charges,26.67,67.275,,21.336,percent of total billed charges,67.275% of total billed charges,31.72,80,,25.376,percent of total billed charges,80% of total billed charges,15.22,38.38,,12.176,percent of total billed charges,38.38% of total billed charges,31.72,80,,25.376,percent of total billed charges,80% of total billed charges,24.48,61.74,,19.584,percent of total billed charges,61.74% of total billed charges,40.44,102,,32.352,percent of total billed charges,102% of total billed charges,15.07,38,,12.056,percent of total billed charges,38% of total billed charges,13.88,40.44,
"Blood test, clotting time",5000012,CDM,305,RC,85610,HCPCS,Outpatient,,,40,30,,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,4.94,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.29,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.29,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.19,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,26.91,67.275,,21.528,percent of total billed charges,67.275% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,4.33,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,32,80,,25.6,percent of total billed charges,80% of total billed charges,24.7,61.74,,19.76,percent of total billed charges,61.74% of total billed charges,5.04,102,,,Fee Schedule,102% of GA Medicaid Rate,4.29,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.29,36,
"LD, PLEURAL FLUID",5000031,CDM,301,RC,83615,HCPCS,Outpatient,,,40,30,,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,6.35,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.04,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.04,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,36,90,,28.8,percent of total billed charges,90% of total billed charges,6.67,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,26.91,67.275,,21.528,percent of total billed charges,67.275% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,6.1,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,32,80,,25.6,percent of total billed charges,80% of total billed charges,24.7,61.74,,19.76,percent of total billed charges,61.74% of total billed charges,6.48,102,,,Fee Schedule,102% of GA Medicaid Rate,6.04,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.04,36,
"LD, SYNOVIAL FLUID",5000039,CDM,301,RC,83615,HCPCS,Outpatient,,,40,30,,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,6.35,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.04,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.04,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,36,90,,28.8,percent of total billed charges,90% of total billed charges,6.67,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,26.91,67.275,,21.528,percent of total billed charges,67.275% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,6.1,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,32,80,,25.6,percent of total billed charges,80% of total billed charges,24.7,61.74,,19.76,percent of total billed charges,61.74% of total billed charges,6.48,102,,,Fee Schedule,102% of GA Medicaid Rate,6.04,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.04,36,
"LDH, BODY FLUID",5000043,CDM,301,RC,83615,HCPCS,Outpatient,,,40,30,,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,6.35,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.04,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.04,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,36,90,,28.8,percent of total billed charges,90% of total billed charges,6.67,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,26.91,67.275,,21.528,percent of total billed charges,67.275% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,6.1,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,32,80,,25.6,percent of total billed charges,80% of total billed charges,24.7,61.74,,19.76,percent of total billed charges,61.74% of total billed charges,6.48,102,,,Fee Schedule,102% of GA Medicaid Rate,6.04,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.04,36,
".LD, PERITONEAL FLUID",5000063,CDM,301,RC,83615,HCPCS,Outpatient,,,40,30,,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,6.35,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.04,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.04,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,36,90,,28.8,percent of total billed charges,90% of total billed charges,6.67,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,26.91,67.275,,21.528,percent of total billed charges,67.275% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,6.1,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,32,80,,25.6,percent of total billed charges,80% of total billed charges,24.7,61.74,,19.76,percent of total billed charges,61.74% of total billed charges,6.48,102,,,Fee Schedule,102% of GA Medicaid Rate,6.04,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.04,36,
GLUCOSE  PLEURAL FLUID,5000072,CDM,301,RC,82945,HCPCS,Outpatient,,,40,30,,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,4.93,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,3.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.18,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,26.91,67.275,,21.528,percent of total billed charges,67.275% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,3.97,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,32,80,,25.6,percent of total billed charges,80% of total billed charges,24.7,61.74,,19.76,percent of total billed charges,61.74% of total billed charges,5.03,102,,,Fee Schedule,102% of GA Medicaid Rate,3.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.93,36,
"Blood test, clotting time",5000120,CDM,305,RC,85610,HCPCS,Outpatient,,,40,30,,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,4.94,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.29,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.29,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.19,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,26.91,67.275,,21.528,percent of total billed charges,67.275% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,4.33,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,32,80,,25.6,percent of total billed charges,80% of total billed charges,24.7,61.74,,19.76,percent of total billed charges,61.74% of total billed charges,5.04,102,,,Fee Schedule,102% of GA Medicaid Rate,4.29,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.29,36,
PT MIXING STUDY,5000130,CDM,305,RC,85611,HCPCS,Outpatient,,,40,30,,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,4.96,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,3.94,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.94,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.21,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,26.91,67.275,,21.528,percent of total billed charges,67.275% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,3.98,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,32,80,,25.6,percent of total billed charges,80% of total billed charges,24.7,61.74,,19.76,percent of total billed charges,61.74% of total billed charges,5.06,102,,,Fee Schedule,102% of GA Medicaid Rate,3.94,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.94,36,
LAP STAIN,5000216,CDM,300,RC,85540,HCPCS,Outpatient,,,40,30,,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,7.6,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,36,90,,28.8,percent of total billed charges,90% of total billed charges,7.98,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,26.91,67.275,,21.528,percent of total billed charges,67.275% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,8.69,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,32,80,,25.6,percent of total billed charges,80% of total billed charges,24.7,61.74,,19.76,percent of total billed charges,61.74% of total billed charges,7.75,102,,,Fee Schedule,102% of GA Medicaid Rate,8.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.6,36,
GLUCOSE SYNOVIAL FLUID,5000705,CDM,301,RC,82945,HCPCS,Outpatient,,,40,30,,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,4.93,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,3.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.18,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,26.91,67.275,,21.528,percent of total billed charges,67.275% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,3.97,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,32,80,,25.6,percent of total billed charges,80% of total billed charges,24.7,61.74,,19.76,percent of total billed charges,61.74% of total billed charges,5.03,102,,,Fee Schedule,102% of GA Medicaid Rate,3.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.93,36,
GLUCOSE BODY FLUID,5000713,CDM,301,RC,82945,HCPCS,Outpatient,,,40,30,,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,4.93,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,3.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.18,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,26.91,67.275,,21.528,percent of total billed charges,67.275% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,3.97,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,32,80,,25.6,percent of total billed charges,80% of total billed charges,24.7,61.74,,19.76,percent of total billed charges,61.74% of total billed charges,5.03,102,,,Fee Schedule,102% of GA Medicaid Rate,3.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.93,36,
LD,5000745,CDM,301,RC,83615,HCPCS,Outpatient,,,40,30,,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,6.35,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.04,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.04,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,36,90,,28.8,percent of total billed charges,90% of total billed charges,6.67,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,26.91,67.275,,21.528,percent of total billed charges,67.275% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,6.1,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,32,80,,25.6,percent of total billed charges,80% of total billed charges,24.7,61.74,,19.76,percent of total billed charges,61.74% of total billed charges,6.48,102,,,Fee Schedule,102% of GA Medicaid Rate,6.04,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.04,36,
BODY FLD GLUCOSE,5001610,CDM,301,RC,82945,HCPCS,Outpatient,,,40,30,,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,4.93,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,3.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.18,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,26.91,67.275,,21.528,percent of total billed charges,67.275% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,3.97,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,32,80,,25.6,percent of total billed charges,80% of total billed charges,24.7,61.74,,19.76,percent of total billed charges,61.74% of total billed charges,5.03,102,,,Fee Schedule,102% of GA Medicaid Rate,3.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.93,36,
"Blood test, clotting time",5009151,CDM,305,RC,85610,HCPCS,Outpatient,,,40,30,,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,4.94,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.29,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.29,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.19,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,26.91,67.275,,21.528,percent of total billed charges,67.275% of total billed charges,32,80,,25.6,percent of total billed charges,80% of total billed charges,4.33,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,32,80,,25.6,percent of total billed charges,80% of total billed charges,24.7,61.74,,19.76,percent of total billed charges,61.74% of total billed charges,5.04,102,,,Fee Schedule,102% of GA Medicaid Rate,4.29,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.29,36,
LUMBAR PUNCTURE TRAY,3001109,CDM,270,RC,,,Outpatient,,,40.05,30.04,,31.24,78,,24.992,percent of total billed charges,78% of total billed charges,25.23,63,,20.184,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,15.22,38,,12.176,percent of total billed charges,38% of total billed charges,15.22,38,,12.176,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,36.05,90,,28.84,percent of total billed charges,90% of total billed charges,14.02,35,,11.216,percent of total billed charges,35% of total billed charges,26.94,67.275,,21.552,percent of total billed charges,67.275% of total billed charges,32.04,80,,25.632,percent of total billed charges,80% of total billed charges,15.37,38.38,,12.296,percent of total billed charges,38.38% of total billed charges,32.04,80,,25.632,percent of total billed charges,80% of total billed charges,24.73,61.74,,19.784,percent of total billed charges,61.74% of total billed charges,40.85,102,,32.68,percent of total billed charges,102% of total billed charges,15.22,38,,12.176,percent of total billed charges,38% of total billed charges,14.02,40.85,
SHOULDER SLING/SWATHE - MD,3003116,CDM,270,RC,,,Outpatient,,,40.15,30.11,,31.32,78,,25.056,percent of total billed charges,78% of total billed charges,25.29,63,,20.232,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,15.26,38,,12.208,percent of total billed charges,38% of total billed charges,15.26,38,,12.208,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,36.14,90,,28.912,percent of total billed charges,90% of total billed charges,14.05,35,,11.24,percent of total billed charges,35% of total billed charges,27.01,67.275,,21.608,percent of total billed charges,67.275% of total billed charges,32.12,80,,25.696,percent of total billed charges,80% of total billed charges,15.41,38.38,,12.328,percent of total billed charges,38.38% of total billed charges,32.12,80,,25.696,percent of total billed charges,80% of total billed charges,24.79,61.74,,19.832,percent of total billed charges,61.74% of total billed charges,40.95,102,,32.76,percent of total billed charges,102% of total billed charges,15.26,38,,12.208,percent of total billed charges,38% of total billed charges,14.05,40.95,
SHOULDER SLING/SWATHE - LG,3003117,CDM,270,RC,,,Outpatient,,,40.15,30.11,,31.32,78,,25.056,percent of total billed charges,78% of total billed charges,25.29,63,,20.232,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,15.26,38,,12.208,percent of total billed charges,38% of total billed charges,15.26,38,,12.208,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,36.14,90,,28.912,percent of total billed charges,90% of total billed charges,14.05,35,,11.24,percent of total billed charges,35% of total billed charges,27.01,67.275,,21.608,percent of total billed charges,67.275% of total billed charges,32.12,80,,25.696,percent of total billed charges,80% of total billed charges,15.41,38.38,,12.328,percent of total billed charges,38.38% of total billed charges,32.12,80,,25.696,percent of total billed charges,80% of total billed charges,24.79,61.74,,19.832,percent of total billed charges,61.74% of total billed charges,40.95,102,,32.76,percent of total billed charges,102% of total billed charges,15.26,38,,12.208,percent of total billed charges,38% of total billed charges,14.05,40.95,
LMA DISP SIZE 3,3001116,CDM,270,RC,,,Outpatient,,,40.45,30.34,,31.55,78,,25.24,percent of total billed charges,78% of total billed charges,25.48,63,,20.384,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,15.37,38,,12.296,percent of total billed charges,38% of total billed charges,15.37,38,,12.296,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,36.41,90,,29.128,percent of total billed charges,90% of total billed charges,14.16,35,,11.328,percent of total billed charges,35% of total billed charges,27.21,67.275,,21.768,percent of total billed charges,67.275% of total billed charges,32.36,80,,25.888,percent of total billed charges,80% of total billed charges,15.52,38.38,,12.416,percent of total billed charges,38.38% of total billed charges,32.36,80,,25.888,percent of total billed charges,80% of total billed charges,24.97,61.74,,19.976,percent of total billed charges,61.74% of total billed charges,41.26,102,,33.008,percent of total billed charges,102% of total billed charges,15.37,38,,12.296,percent of total billed charges,38% of total billed charges,14.16,41.26,
AQUACEL 4X5,3000507,CDM,270,RC,,,Outpatient,,,40.6,30.45,,31.67,78,,25.336,percent of total billed charges,78% of total billed charges,25.58,63,,20.464,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,15.43,38,,12.344,percent of total billed charges,38% of total billed charges,15.43,38,,12.344,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,36.54,90,,29.232,percent of total billed charges,90% of total billed charges,14.21,35,,11.368,percent of total billed charges,35% of total billed charges,27.31,67.275,,21.848,percent of total billed charges,67.275% of total billed charges,32.48,80,,25.984,percent of total billed charges,80% of total billed charges,15.58,38.38,,12.464,percent of total billed charges,38.38% of total billed charges,32.48,80,,25.984,percent of total billed charges,80% of total billed charges,25.07,61.74,,20.056,percent of total billed charges,61.74% of total billed charges,41.41,102,,33.128,percent of total billed charges,102% of total billed charges,15.43,38,,12.344,percent of total billed charges,38% of total billed charges,14.21,41.41,
CHROMIC GUT 3-0 FS-2,3001587,CDM,270,RC,,,Outpatient,,,40.6,30.45,,31.67,78,,25.336,percent of total billed charges,78% of total billed charges,25.58,63,,20.464,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,15.43,38,,12.344,percent of total billed charges,38% of total billed charges,15.43,38,,12.344,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,36.54,90,,29.232,percent of total billed charges,90% of total billed charges,14.21,35,,11.368,percent of total billed charges,35% of total billed charges,27.31,67.275,,21.848,percent of total billed charges,67.275% of total billed charges,32.48,80,,25.984,percent of total billed charges,80% of total billed charges,15.58,38.38,,12.464,percent of total billed charges,38.38% of total billed charges,32.48,80,,25.984,percent of total billed charges,80% of total billed charges,25.07,61.74,,20.056,percent of total billed charges,61.74% of total billed charges,41.41,102,,33.128,percent of total billed charges,102% of total billed charges,15.43,38,,12.344,percent of total billed charges,38% of total billed charges,14.21,41.41,
"STOCKING, ANTI-EMBOLISM, THIGH - LG",3002106,CDM,270,RC,,,Outpatient,,,40.71,30.53,,31.75,78,,25.4,percent of total billed charges,78% of total billed charges,25.65,63,,20.52,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,15.47,38,,12.376,percent of total billed charges,38% of total billed charges,15.47,38,,12.376,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,36.64,90,,29.312,percent of total billed charges,90% of total billed charges,14.25,35,,11.4,percent of total billed charges,35% of total billed charges,27.39,67.275,,21.912,percent of total billed charges,67.275% of total billed charges,32.57,80,,26.056,percent of total billed charges,80% of total billed charges,15.62,38.38,,12.496,percent of total billed charges,38.38% of total billed charges,32.57,80,,26.056,percent of total billed charges,80% of total billed charges,25.13,61.74,,20.104,percent of total billed charges,61.74% of total billed charges,41.52,102,,33.216,percent of total billed charges,102% of total billed charges,15.47,38,,12.376,percent of total billed charges,38% of total billed charges,14.25,41.52,
SAFETY VEST - LG,3001607,CDM,270,RC,,,Outpatient,,,40.8,30.6,,31.82,78,,25.456,percent of total billed charges,78% of total billed charges,25.7,63,,20.56,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,15.5,38,,12.4,percent of total billed charges,38% of total billed charges,15.5,38,,12.4,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,36.72,90,,29.376,percent of total billed charges,90% of total billed charges,14.28,35,,11.424,percent of total billed charges,35% of total billed charges,27.45,67.275,,21.96,percent of total billed charges,67.275% of total billed charges,32.64,80,,26.112,percent of total billed charges,80% of total billed charges,15.66,38.38,,12.528,percent of total billed charges,38.38% of total billed charges,32.64,80,,26.112,percent of total billed charges,80% of total billed charges,25.19,61.74,,20.152,percent of total billed charges,61.74% of total billed charges,41.62,102,,33.296,percent of total billed charges,102% of total billed charges,15.5,38,,12.4,percent of total billed charges,38% of total billed charges,14.28,41.62,
SAFETY VEST- MD,3001610,CDM,270,RC,,,Outpatient,,,40.8,30.6,,31.82,78,,25.456,percent of total billed charges,78% of total billed charges,25.7,63,,20.56,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,15.5,38,,12.4,percent of total billed charges,38% of total billed charges,15.5,38,,12.4,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,36.72,90,,29.376,percent of total billed charges,90% of total billed charges,14.28,35,,11.424,percent of total billed charges,35% of total billed charges,27.45,67.275,,21.96,percent of total billed charges,67.275% of total billed charges,32.64,80,,26.112,percent of total billed charges,80% of total billed charges,15.66,38.38,,12.528,percent of total billed charges,38.38% of total billed charges,32.64,80,,26.112,percent of total billed charges,80% of total billed charges,25.19,61.74,,20.152,percent of total billed charges,61.74% of total billed charges,41.62,102,,33.296,percent of total billed charges,102% of total billed charges,15.5,38,,12.4,percent of total billed charges,38% of total billed charges,14.28,41.62,
SURGICAL STEEL 3-0 CP-1 20,3001596,CDM,270,RC,,,Outpatient,,,40.86,30.65,,31.87,78,,25.496,percent of total billed charges,78% of total billed charges,25.74,63,,20.592,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,15.53,38,,12.424,percent of total billed charges,38% of total billed charges,15.53,38,,12.424,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,36.77,90,,29.416,percent of total billed charges,90% of total billed charges,14.3,35,,11.44,percent of total billed charges,35% of total billed charges,27.49,67.275,,21.992,percent of total billed charges,67.275% of total billed charges,32.69,80,,26.152,percent of total billed charges,80% of total billed charges,15.68,38.38,,12.544,percent of total billed charges,38.38% of total billed charges,32.69,80,,26.152,percent of total billed charges,80% of total billed charges,25.23,61.74,,20.184,percent of total billed charges,61.74% of total billed charges,41.68,102,,33.344,percent of total billed charges,102% of total billed charges,15.53,38,,12.424,percent of total billed charges,38% of total billed charges,14.3,41.68,
BINDER ABD 3-panel 9  (62-74),3000123,CDM,270,RC,,,Outpatient,,,41,30.75,,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,25.83,63,,20.664,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,15.58,38,,12.464,percent of total billed charges,38% of total billed charges,15.58,38,,12.464,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,14.35,35,,11.48,percent of total billed charges,35% of total billed charges,27.58,67.275,,22.064,percent of total billed charges,67.275% of total billed charges,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,15.74,38.38,,12.592,percent of total billed charges,38.38% of total billed charges,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,25.31,61.74,,20.248,percent of total billed charges,61.74% of total billed charges,41.82,102,,33.456,percent of total billed charges,102% of total billed charges,15.58,38,,12.464,percent of total billed charges,38% of total billed charges,14.35,41.82,
Urine pregnancy test,5000325,CDM,307,RC,81025,HCPCS,Outpatient,,,41,30.75,,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,7.96,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.61,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.61,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,8.36,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,27.58,67.275,,22.064,percent of total billed charges,67.275% of total billed charges,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,8.7,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,25.31,61.74,,20.248,percent of total billed charges,61.74% of total billed charges,8.12,102,,,Fee Schedule,102% of GA Medicaid Rate,8.61,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.96,36.9,
"CELL COUNT,FLUID",5000811,CDM,309,RC,89051,HCPCS,Outpatient,,,41,30.75,,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,2.21,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,2.32,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,27.58,67.275,,22.064,percent of total billed charges,67.275% of total billed charges,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,5.66,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,25.31,61.74,,20.248,percent of total billed charges,61.74% of total billed charges,2.25,102,,,Fee Schedule,102% of GA Medicaid Rate,5.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,2.21,36.9,
"CELL COUNT, CSF",5000905,CDM,309,RC,89051,HCPCS,Outpatient,,,41,30.75,,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,2.21,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,2.32,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,27.58,67.275,,22.064,percent of total billed charges,67.275% of total billed charges,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,5.66,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,25.31,61.74,,20.248,percent of total billed charges,61.74% of total billed charges,2.25,102,,,Fee Schedule,102% of GA Medicaid Rate,5.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,2.21,36.9,
THORACENTESIS PROFILE,5001763,CDM,300,RC,89051,HCPCS,Outpatient,,,41,30.75,,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,2.21,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,2.32,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,27.58,67.275,,22.064,percent of total billed charges,67.275% of total billed charges,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,5.66,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,25.31,61.74,,20.248,percent of total billed charges,61.74% of total billed charges,2.25,102,,,Fee Schedule,102% of GA Medicaid Rate,5.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,2.21,36.9,
CELL COUNT & DIFF SYNOVIAL,5003727,CDM,309,RC,89051,HCPCS,Outpatient,,,41,30.75,,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,2.21,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,2.32,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,27.58,67.275,,22.064,percent of total billed charges,67.275% of total billed charges,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,5.66,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,25.31,61.74,,20.248,percent of total billed charges,61.74% of total billed charges,2.25,102,,,Fee Schedule,102% of GA Medicaid Rate,5.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,2.21,36.9,
EXUDERM  8X8,3001173,CDM,270,RC,,,Outpatient,,,41.1,30.83,,32.06,78,,25.648,percent of total billed charges,78% of total billed charges,25.89,63,,20.712,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,15.62,38,,12.496,percent of total billed charges,38% of total billed charges,15.62,38,,12.496,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,36.99,90,,29.592,percent of total billed charges,90% of total billed charges,14.39,35,,11.512,percent of total billed charges,35% of total billed charges,27.65,67.275,,22.12,percent of total billed charges,67.275% of total billed charges,32.88,80,,26.304,percent of total billed charges,80% of total billed charges,15.77,38.38,,12.616,percent of total billed charges,38.38% of total billed charges,32.88,80,,26.304,percent of total billed charges,80% of total billed charges,25.38,61.74,,20.304,percent of total billed charges,61.74% of total billed charges,41.92,102,,33.536,percent of total billed charges,102% of total billed charges,15.62,38,,12.496,percent of total billed charges,38% of total billed charges,14.39,41.92,
FLOW METER PEAK ADULT,3001414,CDM,270,RC,,,Outpatient,,,41.15,30.86,,32.1,78,,25.68,percent of total billed charges,78% of total billed charges,25.92,63,,20.736,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,15.64,38,,12.512,percent of total billed charges,38% of total billed charges,15.64,38,,12.512,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,37.04,90,,29.632,percent of total billed charges,90% of total billed charges,14.4,35,,11.52,percent of total billed charges,35% of total billed charges,27.68,67.275,,22.144,percent of total billed charges,67.275% of total billed charges,32.92,80,,26.336,percent of total billed charges,80% of total billed charges,15.79,38.38,,12.632,percent of total billed charges,38.38% of total billed charges,32.92,80,,26.336,percent of total billed charges,80% of total billed charges,25.41,61.74,,20.328,percent of total billed charges,61.74% of total billed charges,41.97,102,,33.576,percent of total billed charges,102% of total billed charges,15.64,38,,12.512,percent of total billed charges,38% of total billed charges,14.4,41.97,
SPLINT FOREARM SM RIGHT NON-PADDED,3002316,CDM,270,RC,,,Outpatient,,,41.2,30.9,,32.14,78,,25.712,percent of total billed charges,78% of total billed charges,25.96,63,,20.768,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,15.66,38,,12.528,percent of total billed charges,38% of total billed charges,15.66,38,,12.528,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,37.08,90,,29.664,percent of total billed charges,90% of total billed charges,14.42,35,,11.536,percent of total billed charges,35% of total billed charges,27.72,67.275,,22.176,percent of total billed charges,67.275% of total billed charges,32.96,80,,26.368,percent of total billed charges,80% of total billed charges,15.81,38.38,,12.648,percent of total billed charges,38.38% of total billed charges,32.96,80,,26.368,percent of total billed charges,80% of total billed charges,25.44,61.74,,20.352,percent of total billed charges,61.74% of total billed charges,42.02,102,,33.616,percent of total billed charges,102% of total billed charges,15.66,38,,12.528,percent of total billed charges,38% of total billed charges,14.42,42.02,
SPLINT ORTHO 4x30  PRE-CUT,3004271,CDM,270,RC,,,Outpatient,,,41.24,30.93,,32.17,78,,25.736,percent of total billed charges,78% of total billed charges,25.98,63,,20.784,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,15.67,38,,12.536,percent of total billed charges,38% of total billed charges,15.67,38,,12.536,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,37.12,90,,29.696,percent of total billed charges,90% of total billed charges,14.43,35,,11.544,percent of total billed charges,35% of total billed charges,27.74,67.275,,22.192,percent of total billed charges,67.275% of total billed charges,32.99,80,,26.392,percent of total billed charges,80% of total billed charges,15.83,38.38,,12.664,percent of total billed charges,38.38% of total billed charges,32.99,80,,26.392,percent of total billed charges,80% of total billed charges,25.46,61.74,,20.368,percent of total billed charges,61.74% of total billed charges,42.06,102,,33.648,percent of total billed charges,102% of total billed charges,15.67,38,,12.536,percent of total billed charges,38% of total billed charges,14.43,42.06,
SHOULDER SLING/SWATHE - SM,3003115,CDM,270,RC,,,Outpatient,,,41.25,30.94,,32.18,78,,25.744,percent of total billed charges,78% of total billed charges,25.99,63,,20.792,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,15.68,38,,12.544,percent of total billed charges,38% of total billed charges,15.68,38,,12.544,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,37.13,90,,29.704,percent of total billed charges,90% of total billed charges,14.44,35,,11.552,percent of total billed charges,35% of total billed charges,27.75,67.275,,22.2,percent of total billed charges,67.275% of total billed charges,33,80,,26.4,percent of total billed charges,80% of total billed charges,15.83,38.38,,12.664,percent of total billed charges,38.38% of total billed charges,33,80,,26.4,percent of total billed charges,80% of total billed charges,25.47,61.74,,20.376,percent of total billed charges,61.74% of total billed charges,42.08,102,,33.664,percent of total billed charges,102% of total billed charges,15.68,38,,12.544,percent of total billed charges,38% of total billed charges,14.44,42.08,
PHILADEL CERVICAL COL PED,3001533,CDM,270,RC,,,Outpatient,,,41.3,30.98,,32.21,78,,25.768,percent of total billed charges,78% of total billed charges,26.02,63,,20.816,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,15.69,38,,12.552,percent of total billed charges,38% of total billed charges,15.69,38,,12.552,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,37.17,90,,29.736,percent of total billed charges,90% of total billed charges,14.46,35,,11.568,percent of total billed charges,35% of total billed charges,27.78,67.275,,22.224,percent of total billed charges,67.275% of total billed charges,33.04,80,,26.432,percent of total billed charges,80% of total billed charges,15.85,38.38,,12.68,percent of total billed charges,38.38% of total billed charges,33.04,80,,26.432,percent of total billed charges,80% of total billed charges,25.5,61.74,,20.4,percent of total billed charges,61.74% of total billed charges,42.13,102,,33.704,percent of total billed charges,102% of total billed charges,15.69,38,,12.552,percent of total billed charges,38% of total billed charges,14.46,42.13,
LARYNGOSCOPE HANDLE - DISPOSABLE,3000103,CDM,270,RC,,,Outpatient,,,41.6,31.2,,32.45,78,,25.96,percent of total billed charges,78% of total billed charges,26.21,63,,20.968,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,15.81,38,,12.648,percent of total billed charges,38% of total billed charges,15.81,38,,12.648,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,37.44,90,,29.952,percent of total billed charges,90% of total billed charges,14.56,35,,11.648,percent of total billed charges,35% of total billed charges,27.99,67.275,,22.392,percent of total billed charges,67.275% of total billed charges,33.28,80,,26.624,percent of total billed charges,80% of total billed charges,15.97,38.38,,12.776,percent of total billed charges,38.38% of total billed charges,33.28,80,,26.624,percent of total billed charges,80% of total billed charges,25.68,61.74,,20.544,percent of total billed charges,61.74% of total billed charges,42.43,102,,33.944,percent of total billed charges,102% of total billed charges,15.81,38,,12.648,percent of total billed charges,38% of total billed charges,14.56,42.43,
PTT MIXING STUDY,5000131,CDM,305,RC,85732,HCPCS,Outpatient,,,42,31.5,,32.76,78,,26.208,percent of total billed charges,78% of total billed charges,8.14,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,8.55,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,28.26,67.275,,22.608,percent of total billed charges,67.275% of total billed charges,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,6.53,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,25.93,61.74,,20.744,percent of total billed charges,61.74% of total billed charges,8.3,102,,,Fee Schedule,102% of GA Medicaid Rate,6.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.47,37.8,
"EOSINOPHIL COUNT, BLOOD",5000870,CDM,305,RC,85004,HCPCS,Outpatient,,,42,31.5,,32.76,78,,26.208,percent of total billed charges,78% of total billed charges,8.14,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,8.55,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,28.26,67.275,,22.608,percent of total billed charges,67.275% of total billed charges,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,6.53,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,25.93,61.74,,20.744,percent of total billed charges,61.74% of total billed charges,8.3,102,,,Fee Schedule,102% of GA Medicaid Rate,6.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.47,37.8,
CRYOGLOBULIN,5001233,CDM,300,RC,82595,HCPCS,Outpatient,,,42,31.5,,32.76,78,,26.208,percent of total billed charges,78% of total billed charges,8.14,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,8.55,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,28.26,67.275,,22.608,percent of total billed charges,67.275% of total billed charges,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,6.53,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,25.93,61.74,,20.744,percent of total billed charges,61.74% of total billed charges,8.3,102,,,Fee Schedule,102% of GA Medicaid Rate,6.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.47,37.8,
Blood test to measure the amount of iron that is in transit in the body,5001421,CDM,301,RC,83540,HCPCS,Outpatient,,,42,31.5,,32.76,78,,26.208,percent of total billed charges,78% of total billed charges,8.15,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,8.56,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,28.26,67.275,,22.608,percent of total billed charges,67.275% of total billed charges,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,6.53,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,25.93,61.74,,20.744,percent of total billed charges,61.74% of total billed charges,8.31,102,,,Fee Schedule,102% of GA Medicaid Rate,6.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.47,37.8,
HETEROPHILE TITER,5001871,CDM,302,RC,86309,HCPCS,Outpatient,,,42,31.5,,32.76,78,,26.208,percent of total billed charges,78% of total billed charges,8.14,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,8.55,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,28.26,67.275,,22.608,percent of total billed charges,67.275% of total billed charges,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,6.53,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,25.93,61.74,,20.744,percent of total billed charges,61.74% of total billed charges,8.3,102,,,Fee Schedule,102% of GA Medicaid Rate,6.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.47,37.8,
.NUCLEIC ACID PROBE,5001957,CDM,301,RC,,,Outpatient,,,42,31.5,,32.76,78,,26.208,percent of total billed charges,78% of total billed charges,26.46,63,,21.168,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,15.96,38,,12.768,percent of total billed charges,38% of total billed charges,15.96,38,,12.768,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,14.7,35,,11.76,percent of total billed charges,35% of total billed charges,28.26,67.275,,22.608,percent of total billed charges,67.275% of total billed charges,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,16.12,38.38,,12.896,percent of total billed charges,38.38% of total billed charges,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,25.93,61.74,,20.744,percent of total billed charges,61.74% of total billed charges,42.84,102,,34.272,percent of total billed charges,102% of total billed charges,15.96,38,,12.768,percent of total billed charges,38% of total billed charges,14.7,42.84,
SPO2 HP SENSOR ADULT/PED,3001507,CDM,270,RC,,,Outpatient,,,42.2,31.65,,32.92,78,,26.336,percent of total billed charges,78% of total billed charges,26.59,63,,21.272,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,16.04,38,,12.832,percent of total billed charges,38% of total billed charges,16.04,38,,12.832,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,37.98,90,,30.384,percent of total billed charges,90% of total billed charges,14.77,35,,11.816,percent of total billed charges,35% of total billed charges,28.39,67.275,,22.712,percent of total billed charges,67.275% of total billed charges,33.76,80,,27.008,percent of total billed charges,80% of total billed charges,16.2,38.38,,12.96,percent of total billed charges,38.38% of total billed charges,33.76,80,,27.008,percent of total billed charges,80% of total billed charges,26.05,61.74,,20.84,percent of total billed charges,61.74% of total billed charges,43.04,102,,34.432,percent of total billed charges,102% of total billed charges,16.04,38,,12.832,percent of total billed charges,38% of total billed charges,14.77,43.04,
VENT CIRCUIT - EM VENTILATOR,3004037,CDM,270,RC,,,Outpatient,,,42.33,31.75,,33.02,78,,26.416,percent of total billed charges,78% of total billed charges,26.67,63,,21.336,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,16.09,38,,12.872,percent of total billed charges,38% of total billed charges,16.09,38,,12.872,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,38.1,90,,30.48,percent of total billed charges,90% of total billed charges,14.82,35,,11.856,percent of total billed charges,35% of total billed charges,28.48,67.275,,22.784,percent of total billed charges,67.275% of total billed charges,33.86,80,,27.088,percent of total billed charges,80% of total billed charges,16.25,38.38,,13,percent of total billed charges,38.38% of total billed charges,33.86,80,,27.088,percent of total billed charges,80% of total billed charges,26.13,61.74,,20.904,percent of total billed charges,61.74% of total billed charges,43.18,102,,34.544,percent of total billed charges,102% of total billed charges,16.09,38,,12.872,percent of total billed charges,38% of total billed charges,14.82,43.18,
AEROSOL TENT PED OHIO,3003014,CDM,270,RC,,,Outpatient,,,42.5,31.88,,33.15,78,,26.52,percent of total billed charges,78% of total billed charges,26.78,63,,21.424,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,16.15,38,,12.92,percent of total billed charges,38% of total billed charges,16.15,38,,12.92,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,38.25,90,,30.6,percent of total billed charges,90% of total billed charges,14.88,35,,11.904,percent of total billed charges,35% of total billed charges,28.59,67.275,,22.872,percent of total billed charges,67.275% of total billed charges,34,80,,27.2,percent of total billed charges,80% of total billed charges,16.31,38.38,,13.048,percent of total billed charges,38.38% of total billed charges,34,80,,27.2,percent of total billed charges,80% of total billed charges,26.24,61.74,,20.992,percent of total billed charges,61.74% of total billed charges,43.35,102,,34.68,percent of total billed charges,102% of total billed charges,16.15,38,,12.92,percent of total billed charges,38% of total billed charges,14.88,43.35,
BINDER ABDOMINAL 4-panel 12  (62-73),3000120,CDM,270,RC,,,Outpatient,,,42.7,32.03,,33.31,78,,26.648,percent of total billed charges,78% of total billed charges,26.9,63,,21.52,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,16.23,38,,12.984,percent of total billed charges,38% of total billed charges,16.23,38,,12.984,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,38.43,90,,30.744,percent of total billed charges,90% of total billed charges,14.95,35,,11.96,percent of total billed charges,35% of total billed charges,28.73,67.275,,22.984,percent of total billed charges,67.275% of total billed charges,34.16,80,,27.328,percent of total billed charges,80% of total billed charges,16.39,38.38,,13.112,percent of total billed charges,38.38% of total billed charges,34.16,80,,27.328,percent of total billed charges,80% of total billed charges,26.36,61.74,,21.088,percent of total billed charges,61.74% of total billed charges,43.55,102,,34.84,percent of total billed charges,102% of total billed charges,16.23,38,,12.984,percent of total billed charges,38% of total billed charges,14.95,43.55,
BAIR HUGGER UPPER,3004221,CDM,270,RC,,,Outpatient,,,42.75,32.06,,33.35,78,,26.68,percent of total billed charges,78% of total billed charges,26.93,63,,21.544,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,16.25,38,,13,percent of total billed charges,38% of total billed charges,16.25,38,,13,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,38.48,90,,30.784,percent of total billed charges,90% of total billed charges,14.96,35,,11.968,percent of total billed charges,35% of total billed charges,28.76,67.275,,23.008,percent of total billed charges,67.275% of total billed charges,34.2,80,,27.36,percent of total billed charges,80% of total billed charges,16.41,38.38,,13.128,percent of total billed charges,38.38% of total billed charges,34.2,80,,27.36,percent of total billed charges,80% of total billed charges,26.39,61.74,,21.112,percent of total billed charges,61.74% of total billed charges,43.61,102,,34.888,percent of total billed charges,102% of total billed charges,16.25,38,,13,percent of total billed charges,38% of total billed charges,14.96,43.61,
BAIR HUGGER LOWER PD1105,3004222,CDM,270,RC,,,Outpatient,,,42.75,32.06,,33.35,78,,26.68,percent of total billed charges,78% of total billed charges,26.93,63,,21.544,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,16.25,38,,13,percent of total billed charges,38% of total billed charges,16.25,38,,13,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,38.48,90,,30.784,percent of total billed charges,90% of total billed charges,14.96,35,,11.968,percent of total billed charges,35% of total billed charges,28.76,67.275,,23.008,percent of total billed charges,67.275% of total billed charges,34.2,80,,27.36,percent of total billed charges,80% of total billed charges,16.41,38.38,,13.128,percent of total billed charges,38.38% of total billed charges,34.2,80,,27.36,percent of total billed charges,80% of total billed charges,26.39,61.74,,21.112,percent of total billed charges,61.74% of total billed charges,43.61,102,,34.888,percent of total billed charges,102% of total billed charges,16.25,38,,13,percent of total billed charges,38% of total billed charges,14.96,43.61,
"CIRCUIT, NIV, W/FILTER & DEP",3002519,CDM,270,RC,,,Outpatient,,,42.9,32.18,,33.46,78,,26.768,percent of total billed charges,78% of total billed charges,27.03,63,,21.624,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,16.3,38,,13.04,percent of total billed charges,38% of total billed charges,16.3,38,,13.04,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,38.61,90,,30.888,percent of total billed charges,90% of total billed charges,15.02,35,,12.016,percent of total billed charges,35% of total billed charges,28.86,67.275,,23.088,percent of total billed charges,67.275% of total billed charges,34.32,80,,27.456,percent of total billed charges,80% of total billed charges,16.47,38.38,,13.176,percent of total billed charges,38.38% of total billed charges,34.32,80,,27.456,percent of total billed charges,80% of total billed charges,26.49,61.74,,21.192,percent of total billed charges,61.74% of total billed charges,43.76,102,,35.008,percent of total billed charges,102% of total billed charges,16.3,38,,13.04,percent of total billed charges,38% of total billed charges,15.02,43.76,
LEEP ELECTRODE PADDLE,3000143,CDM,270,RC,,,Outpatient,,,42.95,32.21,,33.5,78,,26.8,percent of total billed charges,78% of total billed charges,27.06,63,,21.648,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,16.32,38,,13.056,percent of total billed charges,38% of total billed charges,16.32,38,,13.056,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,38.66,90,,30.928,percent of total billed charges,90% of total billed charges,15.03,35,,12.024,percent of total billed charges,35% of total billed charges,28.89,67.275,,23.112,percent of total billed charges,67.275% of total billed charges,34.36,80,,27.488,percent of total billed charges,80% of total billed charges,16.48,38.38,,13.184,percent of total billed charges,38.38% of total billed charges,34.36,80,,27.488,percent of total billed charges,80% of total billed charges,26.52,61.74,,21.216,percent of total billed charges,61.74% of total billed charges,43.81,102,,35.048,percent of total billed charges,102% of total billed charges,16.32,38,,13.056,percent of total billed charges,38% of total billed charges,15.03,43.81,
FURUNCLE,1200136,CDM,981,RC,,,Outpatient,,,43,32.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,26.02,61.74,,20.816,percent of total billed charges,61.74% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,26.02,26.02,
CATHETER 3-WAY FOLEY 24FR 30CC,3000206,CDM,270,RC,,,Outpatient,,,43,32.25,,33.54,78,,26.832,percent of total billed charges,78% of total billed charges,27.09,63,,21.672,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,15.05,35,,12.04,percent of total billed charges,35% of total billed charges,28.93,67.275,,23.144,percent of total billed charges,67.275% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,16.5,38.38,,13.2,percent of total billed charges,38.38% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,26.55,61.74,,21.24,percent of total billed charges,61.74% of total billed charges,43.86,102,,35.088,percent of total billed charges,102% of total billed charges,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,15.05,43.86,
.GASTRIC ASPIRATE ACIDITY,5000454,CDM,301,RC,82926,HCPCS,Outpatient,,,43,32.25,,33.54,78,,26.832,percent of total billed charges,78% of total billed charges,27.09,63,,21.672,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,15.05,35,,12.04,percent of total billed charges,35% of total billed charges,28.93,67.275,,23.144,percent of total billed charges,67.275% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,16.5,38.38,,13.2,percent of total billed charges,38.38% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,26.55,61.74,,21.24,percent of total billed charges,61.74% of total billed charges,43.86,102,,35.088,percent of total billed charges,102% of total billed charges,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,15.05,43.86,
.PNEUMOCYSTIS CONCENTRATION,5000771,CDM,306,RC,87015,HCPCS,Outpatient,,,43,32.25,,33.54,78,,26.832,percent of total billed charges,78% of total billed charges,8.4,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.68,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.68,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,8.82,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,28.93,67.275,,23.144,percent of total billed charges,67.275% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,6.75,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,26.55,61.74,,21.24,percent of total billed charges,61.74% of total billed charges,8.57,102,,,Fee Schedule,102% of GA Medicaid Rate,6.68,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.68,38.7,
OVA AND PARSITE PROFILE,5001525,CDM,306,RC,87015,HCPCS,Outpatient,,,43,32.25,,33.54,78,,26.832,percent of total billed charges,78% of total billed charges,8.4,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.68,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.68,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,8.82,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,28.93,67.275,,23.144,percent of total billed charges,67.275% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,6.75,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,26.55,61.74,,21.24,percent of total billed charges,61.74% of total billed charges,8.57,102,,,Fee Schedule,102% of GA Medicaid Rate,6.68,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.68,38.7,
MICROSPORIDIAN SPORE DETECTION,5001661,CDM,306,RC,87015,HCPCS,Outpatient,,,43,32.25,,33.54,78,,26.832,percent of total billed charges,78% of total billed charges,8.4,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.68,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.68,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,8.82,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,28.93,67.275,,23.144,percent of total billed charges,67.275% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,6.75,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,26.55,61.74,,21.24,percent of total billed charges,61.74% of total billed charges,8.57,102,,,Fee Schedule,102% of GA Medicaid Rate,6.68,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.68,38.7,
CYCLOSPORA & ISOSPORA EXAMINATION,5001662,CDM,306,RC,87015,HCPCS,Outpatient,,,43,32.25,,33.54,78,,26.832,percent of total billed charges,78% of total billed charges,8.4,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.68,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.68,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,8.82,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,28.93,67.275,,23.144,percent of total billed charges,67.275% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,6.75,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,26.55,61.74,,21.24,percent of total billed charges,61.74% of total billed charges,8.57,102,,,Fee Schedule,102% of GA Medicaid Rate,6.68,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.68,38.7,
Radiologic examination of the ankle with 3 views,7000706,CDM,320,RC,73610,HCPCS,Outpatient,,,43,32.25,,33.54,78,,26.832,percent of total billed charges,78% of total billed charges,27.09,63,,21.672,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,15.05,35,,12.04,percent of total billed charges,35% of total billed charges,28.93,67.275,,23.144,percent of total billed charges,67.275% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,16.5,38.38,,13.2,percent of total billed charges,38.38% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,26.55,61.74,,21.24,percent of total billed charges,61.74% of total billed charges,43.86,102,,35.088,percent of total billed charges,102% of total billed charges,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,15.05,43.86,
Radiologic examination of the ankle with 3 views,7000708,CDM,320,RC,73610,HCPCS,Outpatient,,,43,32.25,,33.54,78,,26.832,percent of total billed charges,78% of total billed charges,27.09,63,,21.672,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,15.05,35,,12.04,percent of total billed charges,35% of total billed charges,28.93,67.275,,23.144,percent of total billed charges,67.275% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,16.5,38.38,,13.2,percent of total billed charges,38.38% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,26.55,61.74,,21.24,percent of total billed charges,61.74% of total billed charges,43.86,102,,35.088,percent of total billed charges,102% of total billed charges,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,15.05,43.86,
"Radiologic examination, elbow; 3 or more views",7000711,CDM,320,RC,73080,HCPCS,Outpatient,,,43,32.25,,33.54,78,,26.832,percent of total billed charges,78% of total billed charges,27.09,63,,21.672,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,15.05,35,,12.04,percent of total billed charges,35% of total billed charges,28.93,67.275,,23.144,percent of total billed charges,67.275% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,16.5,38.38,,13.2,percent of total billed charges,38.38% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,26.55,61.74,,21.24,percent of total billed charges,61.74% of total billed charges,43.86,102,,35.088,percent of total billed charges,102% of total billed charges,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,15.05,43.86,
"Radiologic examination, elbow; 3 or more views",7000717,CDM,320,RC,73080,HCPCS,Outpatient,,,43,32.25,,33.54,78,,26.832,percent of total billed charges,78% of total billed charges,27.09,63,,21.672,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,15.05,35,,12.04,percent of total billed charges,35% of total billed charges,28.93,67.275,,23.144,percent of total billed charges,67.275% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,16.5,38.38,,13.2,percent of total billed charges,38.38% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,26.55,61.74,,21.24,percent of total billed charges,61.74% of total billed charges,43.86,102,,35.088,percent of total billed charges,102% of total billed charges,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,15.05,43.86,
Up to 3 views,7000721,CDM,320,RC,73110,HCPCS,Outpatient,,,43,32.25,,33.54,78,,26.832,percent of total billed charges,78% of total billed charges,27.09,63,,21.672,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,15.05,35,,12.04,percent of total billed charges,35% of total billed charges,28.93,67.275,,23.144,percent of total billed charges,67.275% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,16.5,38.38,,13.2,percent of total billed charges,38.38% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,26.55,61.74,,21.24,percent of total billed charges,61.74% of total billed charges,43.86,102,,35.088,percent of total billed charges,102% of total billed charges,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,15.05,43.86,
Up to 3 views,7000723,CDM,320,RC,73110,HCPCS,Outpatient,,,43,32.25,,33.54,78,,26.832,percent of total billed charges,78% of total billed charges,27.09,63,,21.672,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,15.05,35,,12.04,percent of total billed charges,35% of total billed charges,28.93,67.275,,23.144,percent of total billed charges,67.275% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,16.5,38.38,,13.2,percent of total billed charges,38.38% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,26.55,61.74,,21.24,percent of total billed charges,61.74% of total billed charges,43.86,102,,35.088,percent of total billed charges,102% of total billed charges,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,15.05,43.86,
ARM MIN 2V PST RT,7000726,CDM,320,RC,73060,HCPCS,Outpatient,,,43,32.25,,33.54,78,,26.832,percent of total billed charges,78% of total billed charges,27.09,63,,21.672,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,15.05,35,,12.04,percent of total billed charges,35% of total billed charges,28.93,67.275,,23.144,percent of total billed charges,67.275% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,16.5,38.38,,13.2,percent of total billed charges,38.38% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,26.55,61.74,,21.24,percent of total billed charges,61.74% of total billed charges,43.86,102,,35.088,percent of total billed charges,102% of total billed charges,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,15.05,43.86,
ARM MIN 2V PST LT,7000728,CDM,320,RC,73060,HCPCS,Outpatient,,,43,32.25,,33.54,78,,26.832,percent of total billed charges,78% of total billed charges,27.09,63,,21.672,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,15.05,35,,12.04,percent of total billed charges,35% of total billed charges,28.93,67.275,,23.144,percent of total billed charges,67.275% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,16.5,38.38,,13.2,percent of total billed charges,38.38% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,26.55,61.74,,21.24,percent of total billed charges,61.74% of total billed charges,43.86,102,,35.088,percent of total billed charges,102% of total billed charges,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,15.05,43.86,
Radiologic examination of the forearm,7000731,CDM,320,RC,73090,HCPCS,Outpatient,,,43,32.25,,33.54,78,,26.832,percent of total billed charges,78% of total billed charges,27.09,63,,21.672,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,15.05,35,,12.04,percent of total billed charges,35% of total billed charges,28.93,67.275,,23.144,percent of total billed charges,67.275% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,16.5,38.38,,13.2,percent of total billed charges,38.38% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,26.55,61.74,,21.24,percent of total billed charges,61.74% of total billed charges,43.86,102,,35.088,percent of total billed charges,102% of total billed charges,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,15.05,43.86,
Radiologic examination of the forearm,7000733,CDM,320,RC,73090,HCPCS,Outpatient,,,43,32.25,,33.54,78,,26.832,percent of total billed charges,78% of total billed charges,27.09,63,,21.672,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,15.05,35,,12.04,percent of total billed charges,35% of total billed charges,28.93,67.275,,23.144,percent of total billed charges,67.275% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,16.5,38.38,,13.2,percent of total billed charges,38.38% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,26.55,61.74,,21.24,percent of total billed charges,61.74% of total billed charges,43.86,102,,35.088,percent of total billed charges,102% of total billed charges,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,15.05,43.86,
LEG AP/LAT POST RT,7000741,CDM,320,RC,,,Outpatient,,,43,32.25,,33.54,78,,26.832,percent of total billed charges,78% of total billed charges,27.09,63,,21.672,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,15.05,35,,12.04,percent of total billed charges,35% of total billed charges,28.93,67.275,,23.144,percent of total billed charges,67.275% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,16.5,38.38,,13.2,percent of total billed charges,38.38% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,26.55,61.74,,21.24,percent of total billed charges,61.74% of total billed charges,43.86,102,,35.088,percent of total billed charges,102% of total billed charges,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,15.05,43.86,
LEG AP/LAT POST LT,7000743,CDM,320,RC,,,Outpatient,,,43,32.25,,33.54,78,,26.832,percent of total billed charges,78% of total billed charges,27.09,63,,21.672,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,15.05,35,,12.04,percent of total billed charges,35% of total billed charges,28.93,67.275,,23.144,percent of total billed charges,67.275% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,16.5,38.38,,13.2,percent of total billed charges,38.38% of total billed charges,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,26.55,61.74,,21.24,percent of total billed charges,61.74% of total billed charges,43.86,102,,35.088,percent of total billed charges,102% of total billed charges,16.34,38,,13.072,percent of total billed charges,38% of total billed charges,15.05,43.86,
CATHETER 3-WAY FOLEY 16FR 30CC 0167V16S,3000211,CDM,270,RC,,,Outpatient,,,43.15,32.36,,33.66,78,,26.928,percent of total billed charges,78% of total billed charges,27.18,63,,21.744,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,16.4,38,,13.12,percent of total billed charges,38% of total billed charges,16.4,38,,13.12,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,38.84,90,,31.072,percent of total billed charges,90% of total billed charges,15.1,35,,12.08,percent of total billed charges,35% of total billed charges,29.03,67.275,,23.224,percent of total billed charges,67.275% of total billed charges,34.52,80,,27.616,percent of total billed charges,80% of total billed charges,16.56,38.38,,13.248,percent of total billed charges,38.38% of total billed charges,34.52,80,,27.616,percent of total billed charges,80% of total billed charges,26.64,61.74,,21.312,percent of total billed charges,61.74% of total billed charges,44.01,102,,35.208,percent of total billed charges,102% of total billed charges,16.4,38,,13.12,percent of total billed charges,38% of total billed charges,15.1,44.01,
PROFORE MULTI LAYER COMP SYSTEM,3000330,CDM,270,RC,,,Outpatient,,,43.3,32.48,,33.77,78,,27.016,percent of total billed charges,78% of total billed charges,27.28,63,,21.824,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,16.45,38,,13.16,percent of total billed charges,38% of total billed charges,16.45,38,,13.16,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,38.97,90,,31.176,percent of total billed charges,90% of total billed charges,15.16,35,,12.128,percent of total billed charges,35% of total billed charges,29.13,67.275,,23.304,percent of total billed charges,67.275% of total billed charges,34.64,80,,27.712,percent of total billed charges,80% of total billed charges,16.62,38.38,,13.296,percent of total billed charges,38.38% of total billed charges,34.64,80,,27.712,percent of total billed charges,80% of total billed charges,26.73,61.74,,21.384,percent of total billed charges,61.74% of total billed charges,44.17,102,,35.336,percent of total billed charges,102% of total billed charges,16.45,38,,13.16,percent of total billed charges,38% of total billed charges,15.16,44.17,
LMA DISP SIZE 1 - PEDIATRIC,3003097,CDM,270,RC,,,Outpatient,,,43.56,32.67,,33.98,78,,27.184,percent of total billed charges,78% of total billed charges,27.44,63,,21.952,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,16.55,38,,13.24,percent of total billed charges,38% of total billed charges,16.55,38,,13.24,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,39.2,90,,31.36,percent of total billed charges,90% of total billed charges,15.25,35,,12.2,percent of total billed charges,35% of total billed charges,29.3,67.275,,23.44,percent of total billed charges,67.275% of total billed charges,34.85,80,,27.88,percent of total billed charges,80% of total billed charges,16.72,38.38,,13.376,percent of total billed charges,38.38% of total billed charges,34.85,80,,27.88,percent of total billed charges,80% of total billed charges,26.89,61.74,,21.512,percent of total billed charges,61.74% of total billed charges,44.43,102,,35.544,percent of total billed charges,102% of total billed charges,16.55,38,,13.24,percent of total billed charges,38% of total billed charges,15.25,44.43,
CAUTERY PEN - FINE TIP,3000200,CDM,270,RC,,,Outpatient,,,43.97,32.98,,34.3,78,,27.44,percent of total billed charges,78% of total billed charges,27.7,63,,22.16,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,16.71,38,,13.368,percent of total billed charges,38% of total billed charges,16.71,38,,13.368,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,39.57,90,,31.656,percent of total billed charges,90% of total billed charges,15.39,35,,12.312,percent of total billed charges,35% of total billed charges,29.58,67.275,,23.664,percent of total billed charges,67.275% of total billed charges,35.18,80,,28.144,percent of total billed charges,80% of total billed charges,16.88,38.38,,13.504,percent of total billed charges,38.38% of total billed charges,35.18,80,,28.144,percent of total billed charges,80% of total billed charges,27.15,61.74,,21.72,percent of total billed charges,61.74% of total billed charges,44.85,102,,35.88,percent of total billed charges,102% of total billed charges,16.71,38,,13.368,percent of total billed charges,38% of total billed charges,15.39,44.85,
OP VISIT SIGNIFICANT PROC,1001026,CDM,510,RC,,,Outpatient,,,44,33,,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,27.72,63,,22.176,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,16.72,38,,13.376,percent of total billed charges,38% of total billed charges,16.72,38,,13.376,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,15.4,35,,12.32,percent of total billed charges,35% of total billed charges,133.52,67.275,,106.816,percent of total billed charges,67.275% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,16.89,38.38,,13.512,percent of total billed charges,38.38% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,27.17,61.74,,21.736,percent of total billed charges,61.74% of total billed charges,44.88,102,,35.904,percent of total billed charges,102% of total billed charges,16.72,38,,13.376,percent of total billed charges,38% of total billed charges,15.4,133.52,
Quantitative measure of glucose build up in the blood over time,5000712,CDM,301,RC,82947,HCPCS,Outpatient,,,44,33,,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,4.93,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,3.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,5.18,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,29.6,67.275,,23.68,percent of total billed charges,67.275% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,3.97,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,27.17,61.74,,21.736,percent of total billed charges,61.74% of total billed charges,5.03,102,,,Fee Schedule,102% of GA Medicaid Rate,3.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.93,39.6,
"CK, TOTAL",5000724,CDM,301,RC,82550,HCPCS,Outpatient,,,44,33,,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,6.35,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.51,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.51,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,6.67,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,29.6,67.275,,23.68,percent of total billed charges,67.275% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,6.58,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,27.17,61.74,,21.736,percent of total billed charges,61.74% of total billed charges,6.48,102,,,Fee Schedule,102% of GA Medicaid Rate,6.51,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.35,39.6,
MALARIA/BLOOD PARASITES,5001446,CDM,306,RC,87207,HCPCS,Outpatient,,,44,33,,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,7.53,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.99,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.99,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,7.91,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,29.6,67.275,,23.68,percent of total billed charges,67.275% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,6.05,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,27.17,61.74,,21.736,percent of total billed charges,61.74% of total billed charges,7.68,102,,,Fee Schedule,102% of GA Medicaid Rate,5.99,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.99,39.6,
Blood test to determine if antibodies exist for rubella,5001530,CDM,302,RC,86762,HCPCS,Outpatient,,,44,33,,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,14.63,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,15.36,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,29.6,67.275,,23.68,percent of total billed charges,67.275% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,14.53,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,27.17,61.74,,21.736,percent of total billed charges,61.74% of total billed charges,14.92,102,,,Fee Schedule,102% of GA Medicaid Rate,14.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.39,39.6,
Quantitative measure of glucose build up in the blood over time,5001600,CDM,300,RC,82947,HCPCS,Outpatient,,,44,33,,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,4.93,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,3.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,5.18,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,29.6,67.275,,23.68,percent of total billed charges,67.275% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,3.97,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,27.17,61.74,,21.736,percent of total billed charges,61.74% of total billed charges,5.03,102,,,Fee Schedule,102% of GA Medicaid Rate,3.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.93,39.6,
UREA CLEARANCE,5001882,CDM,301,RC,84545,HCPCS,Outpatient,,,44,33,,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,8.31,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,7.2,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.2,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,8.73,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,29.6,67.275,,23.68,percent of total billed charges,67.275% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,7.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,27.17,61.74,,21.736,percent of total billed charges,61.74% of total billed charges,8.48,102,,,Fee Schedule,102% of GA Medicaid Rate,7.2,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.2,39.6,
OSMOLALITY URINE,5001905,CDM,301,RC,83935,HCPCS,Outpatient,,,44,33,,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,8.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.82,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.82,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,29.6,67.275,,23.68,percent of total billed charges,67.275% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,6.89,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,27.17,61.74,,21.736,percent of total billed charges,61.74% of total billed charges,8.74,102,,,Fee Schedule,102% of GA Medicaid Rate,6.82,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.82,39.6,
"UPDRAFT SUBSEQ, RESP THERAPIST",8000008,CDM,410,RC,94640,HCPCS,Outpatient,,,44,33,,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,27.72,63,,22.176,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,16.72,38,,13.376,percent of total billed charges,38% of total billed charges,16.72,38,,13.376,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,15.4,35,,12.32,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,16.89,38.38,,13.512,percent of total billed charges,38.38% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,27.17,61.74,,21.736,percent of total billed charges,61.74% of total billed charges,44.88,102,,35.904,percent of total billed charges,102% of total billed charges,16.72,38,,13.376,percent of total billed charges,38% of total billed charges,15.4,145.93,
"SPUTUM INDUCTION SUBSEQ, EACH DAY",8000087,CDM,410,RC,94640,HCPCS,Outpatient,,,44,33,,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,27.72,63,,22.176,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,16.72,38,,13.376,percent of total billed charges,38% of total billed charges,16.72,38,,13.376,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,15.4,35,,12.32,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,16.89,38.38,,13.512,percent of total billed charges,38.38% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,27.17,61.74,,21.736,percent of total billed charges,61.74% of total billed charges,44.88,102,,35.904,percent of total billed charges,102% of total billed charges,16.72,38,,13.376,percent of total billed charges,38% of total billed charges,15.4,145.93,
PT GROUP THERAPY,9000018,CDM,420,RC,97150,HCPCS,Outpatient,,,44,33,,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,27.72,63,,22.176,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,16.72,38,,13.376,percent of total billed charges,38% of total billed charges,16.72,38,,13.376,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,15.4,35,,12.32,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,16.89,38.38,,13.512,percent of total billed charges,38.38% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,27.17,61.74,,21.736,percent of total billed charges,61.74% of total billed charges,44.88,102,,35.904,percent of total billed charges,102% of total billed charges,16.72,38,,13.376,percent of total billed charges,38% of total billed charges,15.4,145.93,
"RT GROUP THERAPY, EA 15 MIN",9000043,CDM,420,RC,97150,HCPCS,Outpatient,,,44,33,,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,27.72,63,,22.176,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,16.72,38,,13.376,percent of total billed charges,38% of total billed charges,16.72,38,,13.376,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,15.4,35,,12.32,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,16.89,38.38,,13.512,percent of total billed charges,38.38% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,27.17,61.74,,21.736,percent of total billed charges,61.74% of total billed charges,44.88,102,,35.904,percent of total billed charges,102% of total billed charges,16.72,38,,13.376,percent of total billed charges,38% of total billed charges,15.4,145.93,
"Debridement (for example, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps)",9590014,CDM,420,RC,97597,HCPCS,Outpatient,,,44,33,,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,27.72,63,,22.176,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,16.72,38,,13.376,percent of total billed charges,38% of total billed charges,16.72,38,,13.376,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,15.4,35,,12.32,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,16.89,38.38,,13.512,percent of total billed charges,38.38% of total billed charges,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,27.17,61.74,,21.736,percent of total billed charges,61.74% of total billed charges,44.88,102,,35.904,percent of total billed charges,102% of total billed charges,16.72,38,,13.376,percent of total billed charges,38% of total billed charges,15.4,145.93,
FILTER LINE SET,3000429,CDM,270,RC,,,Outpatient,,,44.3,33.23,,34.55,78,,27.64,percent of total billed charges,78% of total billed charges,27.91,63,,22.328,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,16.83,38,,13.464,percent of total billed charges,38% of total billed charges,16.83,38,,13.464,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,39.87,90,,31.896,percent of total billed charges,90% of total billed charges,15.51,35,,12.408,percent of total billed charges,35% of total billed charges,29.8,67.275,,23.84,percent of total billed charges,67.275% of total billed charges,35.44,80,,28.352,percent of total billed charges,80% of total billed charges,17,38.38,,13.6,percent of total billed charges,38.38% of total billed charges,35.44,80,,28.352,percent of total billed charges,80% of total billed charges,27.35,61.74,,21.88,percent of total billed charges,61.74% of total billed charges,45.19,102,,36.152,percent of total billed charges,102% of total billed charges,16.83,38,,13.464,percent of total billed charges,38% of total billed charges,15.51,45.19,
ORAL CARE SUCTION KIT - NON VENT,3000708,CDM,270,RC,,,Outpatient,,,44.52,33.39,,34.73,78,,27.784,percent of total billed charges,78% of total billed charges,28.05,63,,22.44,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,16.92,38,,13.536,percent of total billed charges,38% of total billed charges,16.92,38,,13.536,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,40.07,90,,32.056,percent of total billed charges,90% of total billed charges,15.58,35,,12.464,percent of total billed charges,35% of total billed charges,29.95,67.275,,23.96,percent of total billed charges,67.275% of total billed charges,35.62,80,,28.496,percent of total billed charges,80% of total billed charges,17.09,38.38,,13.672,percent of total billed charges,38.38% of total billed charges,35.62,80,,28.496,percent of total billed charges,80% of total billed charges,27.49,61.74,,21.992,percent of total billed charges,61.74% of total billed charges,45.41,102,,36.328,percent of total billed charges,102% of total billed charges,16.92,38,,13.536,percent of total billed charges,38% of total billed charges,15.58,45.41,
VICRYL 2-0 ON CT-2    X411,3001559,CDM,270,RC,,,Outpatient,,,44.65,33.49,,34.83,78,,27.864,percent of total billed charges,78% of total billed charges,28.13,63,,22.504,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,16.97,38,,13.576,percent of total billed charges,38% of total billed charges,16.97,38,,13.576,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,40.19,90,,32.152,percent of total billed charges,90% of total billed charges,15.63,35,,12.504,percent of total billed charges,35% of total billed charges,30.04,67.275,,24.032,percent of total billed charges,67.275% of total billed charges,35.72,80,,28.576,percent of total billed charges,80% of total billed charges,17.14,38.38,,13.712,percent of total billed charges,38.38% of total billed charges,35.72,80,,28.576,percent of total billed charges,80% of total billed charges,27.57,61.74,,22.056,percent of total billed charges,61.74% of total billed charges,45.54,102,,36.432,percent of total billed charges,102% of total billed charges,16.97,38,,13.576,percent of total billed charges,38% of total billed charges,15.63,45.54,
FDP,5000122,CDM,305,RC,85362,HCPCS,Outpatient,,,45,33.75,,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,8.66,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.89,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.89,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,9.09,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,30.27,67.275,,24.216,percent of total billed charges,67.275% of total billed charges,36,80,,28.8,percent of total billed charges,80% of total billed charges,6.96,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,36,80,,28.8,percent of total billed charges,80% of total billed charges,27.78,61.74,,22.224,percent of total billed charges,61.74% of total billed charges,8.83,102,,,Fee Schedule,102% of GA Medicaid Rate,6.89,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.89,40.5,
Blood test to evaluate liver function,5000747,CDM,301,RC,84460,HCPCS,Outpatient,,,45,33.75,,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,6.35,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.3,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.3,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,6.67,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,30.27,67.275,,24.216,percent of total billed charges,67.275% of total billed charges,36,80,,28.8,percent of total billed charges,80% of total billed charges,5.35,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,36,80,,28.8,percent of total billed charges,80% of total billed charges,27.78,61.74,,22.224,percent of total billed charges,61.74% of total billed charges,6.48,102,,,Fee Schedule,102% of GA Medicaid Rate,5.3,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.3,40.5,
VOLUME MEASUREMENT,5001864,CDM,301,RC,81050,HCPCS,Outpatient,,,45,33.75,,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,3.77,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,3.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,3.96,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,30.27,67.275,,24.216,percent of total billed charges,67.275% of total billed charges,36,80,,28.8,percent of total billed charges,80% of total billed charges,3.68,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,36,80,,28.8,percent of total billed charges,80% of total billed charges,27.78,61.74,,22.224,percent of total billed charges,61.74% of total billed charges,3.85,102,,,Fee Schedule,102% of GA Medicaid Rate,3.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.64,40.5,
LIPASE,5001915,CDM,301,RC,83690,HCPCS,Outpatient,,,45,33.75,,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,8.66,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.89,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.89,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,9.09,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,30.27,67.275,,24.216,percent of total billed charges,67.275% of total billed charges,36,80,,28.8,percent of total billed charges,80% of total billed charges,6.96,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,36,80,,28.8,percent of total billed charges,80% of total billed charges,27.78,61.74,,22.224,percent of total billed charges,61.74% of total billed charges,8.83,102,,,Fee Schedule,102% of GA Medicaid Rate,6.89,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.89,40.5,
NASAL SMEAR FOR EOSINEPHI,5001953,CDM,305,RC,89190,HCPCS,Outpatient,,,45,33.75,,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,5.98,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.79,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.79,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,6.28,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,30.27,67.275,,24.216,percent of total billed charges,67.275% of total billed charges,36,80,,28.8,percent of total billed charges,80% of total billed charges,5.85,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,36,80,,28.8,percent of total billed charges,80% of total billed charges,27.78,61.74,,22.224,percent of total billed charges,61.74% of total billed charges,6.1,102,,,Fee Schedule,102% of GA Medicaid Rate,5.79,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.79,40.5,
PT WHIRLPOOL,9000602,CDM,420,RC,97022,HCPCS,Outpatient,,,45,33.75,,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,17.1,38,,13.68,percent of total billed charges,38% of total billed charges,17.1,38,,13.68,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,15.75,35,,12.6,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,36,80,,28.8,percent of total billed charges,80% of total billed charges,17.27,38.38,,13.816,percent of total billed charges,38.38% of total billed charges,36,80,,28.8,percent of total billed charges,80% of total billed charges,27.78,61.74,,22.224,percent of total billed charges,61.74% of total billed charges,45.9,102,,36.72,percent of total billed charges,102% of total billed charges,17.1,38,,13.68,percent of total billed charges,38% of total billed charges,15.75,145.93,
TRANSPAC IV MONITORING KIT,3004240,CDM,270,RC,,,Outpatient,,,45.65,34.24,,35.61,78,,28.488,percent of total billed charges,78% of total billed charges,28.76,63,,23.008,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,17.35,38,,13.88,percent of total billed charges,38% of total billed charges,17.35,38,,13.88,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,41.09,90,,32.872,percent of total billed charges,90% of total billed charges,15.98,35,,12.784,percent of total billed charges,35% of total billed charges,30.71,67.275,,24.568,percent of total billed charges,67.275% of total billed charges,36.52,80,,29.216,percent of total billed charges,80% of total billed charges,17.52,38.38,,14.016,percent of total billed charges,38.38% of total billed charges,36.52,80,,29.216,percent of total billed charges,80% of total billed charges,28.18,61.74,,22.544,percent of total billed charges,61.74% of total billed charges,46.56,102,,37.248,percent of total billed charges,102% of total billed charges,17.35,38,,13.88,percent of total billed charges,38% of total billed charges,15.98,46.56,
MAXORB SILVER ALG 4X5,3000566,CDM,270,RC,,,Outpatient,,,45.79,34.34,,35.72,78,,28.576,percent of total billed charges,78% of total billed charges,28.85,63,,23.08,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,17.4,38,,13.92,percent of total billed charges,38% of total billed charges,17.4,38,,13.92,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,41.21,90,,32.968,percent of total billed charges,90% of total billed charges,16.03,35,,12.824,percent of total billed charges,35% of total billed charges,30.81,67.275,,24.648,percent of total billed charges,67.275% of total billed charges,36.63,80,,29.304,percent of total billed charges,80% of total billed charges,17.57,38.38,,14.056,percent of total billed charges,38.38% of total billed charges,36.63,80,,29.304,percent of total billed charges,80% of total billed charges,28.27,61.74,,22.616,percent of total billed charges,61.74% of total billed charges,46.71,102,,37.368,percent of total billed charges,102% of total billed charges,17.4,38,,13.92,percent of total billed charges,38% of total billed charges,16.03,46.71,
DRAIN/DEBRIDE/TRIM NAILS,1001172,CDM,450,RC,,,Outpatient,,,46,34.5,,35.88,78,,28.704,percent of total billed charges,78% of total billed charges,28.98,63,,23.184,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,17.48,38,,13.984,percent of total billed charges,38% of total billed charges,17.48,38,,13.984,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,16.1,35,,12.88,percent of total billed charges,35% of total billed charges,30.95,67.275,,24.76,percent of total billed charges,67.275% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,17.65,38.38,,14.12,percent of total billed charges,38.38% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,28.4,61.74,,22.72,percent of total billed charges,61.74% of total billed charges,46.92,102,,37.536,percent of total billed charges,102% of total billed charges,17.48,38,,13.984,percent of total billed charges,38% of total billed charges,16.1,46.92,
STREP SCREEN RAPID,5000230,CDM,300,RC,86317,HCPCS,Outpatient,,,46,34.5,,35.88,78,,28.704,percent of total billed charges,78% of total billed charges,15.09,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.99,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.99,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,15.84,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,30.95,67.275,,24.76,percent of total billed charges,67.275% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,15.14,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,28.4,61.74,,22.72,percent of total billed charges,61.74% of total billed charges,15.39,102,,,Fee Schedule,102% of GA Medicaid Rate,14.99,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.99,41.4,
FEBRILE AGGLUTINATION,5000340,CDM,302,RC,86000,HCPCS,Outpatient,,,46,34.5,,35.88,78,,28.704,percent of total billed charges,78% of total billed charges,8.78,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,9.22,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,30.95,67.275,,24.76,percent of total billed charges,67.275% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,7.05,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,28.4,61.74,,22.72,percent of total billed charges,61.74% of total billed charges,8.96,102,,,Fee Schedule,102% of GA Medicaid Rate,6.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.98,41.4,
Manual urinalysis test with examination with or without using microscope,5000645,CDM,307,RC,81001,HCPCS,Outpatient,,,46,34.5,,35.88,78,,28.704,percent of total billed charges,78% of total billed charges,3.99,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,3.17,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.17,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,4.19,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,30.95,67.275,,24.76,percent of total billed charges,67.275% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,3.2,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,28.4,61.74,,22.72,percent of total billed charges,61.74% of total billed charges,4.07,102,,,Fee Schedule,102% of GA Medicaid Rate,3.17,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.17,41.4,
STREP  PNEU IGG AB,5001690,CDM,306,RC,86317,HCPCS,Outpatient,,,46,34.5,,35.88,78,,28.704,percent of total billed charges,78% of total billed charges,15.09,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.99,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.99,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,15.84,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,30.95,67.275,,24.76,percent of total billed charges,67.275% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,15.14,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,28.4,61.74,,22.72,percent of total billed charges,61.74% of total billed charges,15.39,102,,,Fee Schedule,102% of GA Medicaid Rate,14.99,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.99,41.4,
ANTI-STREPTOLYSIN O,5001870,CDM,302,RC,86060,HCPCS,Outpatient,,,46,34.5,,35.88,78,,28.704,percent of total billed charges,78% of total billed charges,8.79,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,7.3,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.3,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,9.23,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,30.95,67.275,,24.76,percent of total billed charges,67.275% of total billed charges,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,7.37,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,28.4,61.74,,22.72,percent of total billed charges,61.74% of total billed charges,8.97,102,,,Fee Schedule,102% of GA Medicaid Rate,7.3,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.3,41.4,
CATHETER FOLEY SILICONE 10FR,3000269,CDM,270,RC,,,Outpatient,,,46.2,34.65,,36.04,78,,28.832,percent of total billed charges,78% of total billed charges,29.11,63,,23.288,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,17.56,38,,14.048,percent of total billed charges,38% of total billed charges,17.56,38,,14.048,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,41.58,90,,33.264,percent of total billed charges,90% of total billed charges,16.17,35,,12.936,percent of total billed charges,35% of total billed charges,31.08,67.275,,24.864,percent of total billed charges,67.275% of total billed charges,36.96,80,,29.568,percent of total billed charges,80% of total billed charges,17.73,38.38,,14.184,percent of total billed charges,38.38% of total billed charges,36.96,80,,29.568,percent of total billed charges,80% of total billed charges,28.52,61.74,,22.816,percent of total billed charges,61.74% of total billed charges,47.12,102,,37.696,percent of total billed charges,102% of total billed charges,17.56,38,,14.048,percent of total billed charges,38% of total billed charges,16.17,47.12,
CIRCUIT PATIENT ASSEMBLY ADULT RESP,3002518,CDM,270,RC,,,Outpatient,,,46.27,34.7,,36.09,78,,28.872,percent of total billed charges,78% of total billed charges,29.15,63,,23.32,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,17.58,38,,14.064,percent of total billed charges,38% of total billed charges,17.58,38,,14.064,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,41.64,90,,33.312,percent of total billed charges,90% of total billed charges,16.19,35,,12.952,percent of total billed charges,35% of total billed charges,31.13,67.275,,24.904,percent of total billed charges,67.275% of total billed charges,37.02,80,,29.616,percent of total billed charges,80% of total billed charges,17.76,38.38,,14.208,percent of total billed charges,38.38% of total billed charges,37.02,80,,29.616,percent of total billed charges,80% of total billed charges,28.57,61.74,,22.856,percent of total billed charges,61.74% of total billed charges,47.2,102,,37.76,percent of total billed charges,102% of total billed charges,17.58,38,,14.064,percent of total billed charges,38% of total billed charges,16.19,47.2,
GGT,5000746,CDM,301,RC,82977,HCPCS,Outpatient,,,47,35.25,,36.66,78,,29.328,percent of total billed charges,78% of total billed charges,6.35,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,7.2,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.2,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,6.67,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,31.62,67.275,,25.296,percent of total billed charges,67.275% of total billed charges,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,7.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,29.02,61.74,,23.216,percent of total billed charges,61.74% of total billed charges,6.48,102,,,Fee Schedule,102% of GA Medicaid Rate,7.2,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.35,42.3,
MAGNESIUM,5001445,CDM,301,RC,83735,HCPCS,Outpatient,,,47,35.25,,36.66,78,,29.328,percent of total billed charges,78% of total billed charges,8.42,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.7,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.7,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,8.84,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,31.62,67.275,,25.296,percent of total billed charges,67.275% of total billed charges,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,6.77,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,29.02,61.74,,23.216,percent of total billed charges,61.74% of total billed charges,8.59,102,,,Fee Schedule,102% of GA Medicaid Rate,6.7,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.7,42.3,
MAGNESIUM RBC,5001447,CDM,301,RC,83735,HCPCS,Outpatient,,,47,35.25,,36.66,78,,29.328,percent of total billed charges,78% of total billed charges,8.42,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.7,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.7,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,8.84,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,31.62,67.275,,25.296,percent of total billed charges,67.275% of total billed charges,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,6.77,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,29.02,61.74,,23.216,percent of total billed charges,61.74% of total billed charges,8.59,102,,,Fee Schedule,102% of GA Medicaid Rate,6.7,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.7,42.3,
MAGNESIUM 24 HR URINE W/O CREATININE,5001448,CDM,301,RC,83735,HCPCS,Outpatient,,,47,35.25,,36.66,78,,29.328,percent of total billed charges,78% of total billed charges,8.42,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.7,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.7,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,8.84,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,31.62,67.275,,25.296,percent of total billed charges,67.275% of total billed charges,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,6.77,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,29.02,61.74,,23.216,percent of total billed charges,61.74% of total billed charges,8.59,102,,,Fee Schedule,102% of GA Medicaid Rate,6.7,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.7,42.3,
"MAGNESIUM, URINE",5001455,CDM,301,RC,83735,HCPCS,Outpatient,,,47,35.25,,36.66,78,,29.328,percent of total billed charges,78% of total billed charges,8.42,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.7,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.7,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,8.84,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,31.62,67.275,,25.296,percent of total billed charges,67.275% of total billed charges,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,6.77,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,29.02,61.74,,23.216,percent of total billed charges,61.74% of total billed charges,8.59,102,,,Fee Schedule,102% of GA Medicaid Rate,6.7,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.7,42.3,
ASSAY OF SIROLIMUS,5080195,CDM,301,RC,80195,HCPCS,Outpatient,,,47,35.25,,36.66,78,,29.328,percent of total billed charges,78% of total billed charges,17.25,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.73,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.73,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,18.11,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,31.62,67.275,,25.296,percent of total billed charges,67.275% of total billed charges,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,13.87,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,29.02,61.74,,23.216,percent of total billed charges,61.74% of total billed charges,17.6,102,,,Fee Schedule,102% of GA Medicaid Rate,13.73,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.73,42.3,
CO2 DETECTOR PEDICAP,3004213,CDM,270,RC,,,Outpatient,,,47.25,35.44,,36.86,78,,29.488,percent of total billed charges,78% of total billed charges,29.77,63,,23.816,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,17.96,38,,14.368,percent of total billed charges,38% of total billed charges,17.96,38,,14.368,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,42.53,90,,34.024,percent of total billed charges,90% of total billed charges,16.54,35,,13.232,percent of total billed charges,35% of total billed charges,31.79,67.275,,25.432,percent of total billed charges,67.275% of total billed charges,37.8,80,,30.24,percent of total billed charges,80% of total billed charges,18.13,38.38,,14.504,percent of total billed charges,38.38% of total billed charges,37.8,80,,30.24,percent of total billed charges,80% of total billed charges,29.17,61.74,,23.336,percent of total billed charges,61.74% of total billed charges,48.2,102,,38.56,percent of total billed charges,102% of total billed charges,17.96,38,,14.368,percent of total billed charges,38% of total billed charges,16.54,48.2,
BUR 4 X 8 MM - OVAL,3003199,CDM,270,RC,,,Outpatient,,,47.5,35.63,,37.05,78,,29.64,percent of total billed charges,78% of total billed charges,29.93,63,,23.944,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,18.05,38,,14.44,percent of total billed charges,38% of total billed charges,18.05,38,,14.44,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,42.75,90,,34.2,percent of total billed charges,90% of total billed charges,16.63,35,,13.304,percent of total billed charges,35% of total billed charges,31.96,67.275,,25.568,percent of total billed charges,67.275% of total billed charges,38,80,,30.4,percent of total billed charges,80% of total billed charges,18.23,38.38,,14.584,percent of total billed charges,38.38% of total billed charges,38,80,,30.4,percent of total billed charges,80% of total billed charges,29.33,61.74,,23.464,percent of total billed charges,61.74% of total billed charges,48.45,102,,38.76,percent of total billed charges,102% of total billed charges,18.05,38,,14.44,percent of total billed charges,38% of total billed charges,16.63,48.45,
SKIN AFFIX,3004004,CDM,270,RC,,,Outpatient,,,47.5,35.63,,37.05,78,,29.64,percent of total billed charges,78% of total billed charges,29.93,63,,23.944,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,18.05,38,,14.44,percent of total billed charges,38% of total billed charges,18.05,38,,14.44,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,42.75,90,,34.2,percent of total billed charges,90% of total billed charges,16.63,35,,13.304,percent of total billed charges,35% of total billed charges,31.96,67.275,,25.568,percent of total billed charges,67.275% of total billed charges,38,80,,30.4,percent of total billed charges,80% of total billed charges,18.23,38.38,,14.584,percent of total billed charges,38.38% of total billed charges,38,80,,30.4,percent of total billed charges,80% of total billed charges,29.33,61.74,,23.464,percent of total billed charges,61.74% of total billed charges,48.45,102,,38.76,percent of total billed charges,102% of total billed charges,18.05,38,,14.44,percent of total billed charges,38% of total billed charges,16.63,48.45,
SILK C013D,3002344,CDM,270,RC,,,Outpatient,,,47.75,35.81,,37.25,78,,29.8,percent of total billed charges,78% of total billed charges,30.08,63,,24.064,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,18.15,38,,14.52,percent of total billed charges,38% of total billed charges,18.15,38,,14.52,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,42.98,90,,34.384,percent of total billed charges,90% of total billed charges,16.71,35,,13.368,percent of total billed charges,35% of total billed charges,32.12,67.275,,25.696,percent of total billed charges,67.275% of total billed charges,38.2,80,,30.56,percent of total billed charges,80% of total billed charges,18.33,38.38,,14.664,percent of total billed charges,38.38% of total billed charges,38.2,80,,30.56,percent of total billed charges,80% of total billed charges,29.48,61.74,,23.584,percent of total billed charges,61.74% of total billed charges,48.71,102,,38.968,percent of total billed charges,102% of total billed charges,18.15,38,,14.52,percent of total billed charges,38% of total billed charges,16.71,48.71,
Immunization administration in children <18,1001280,CDM,450,RC,90460,HCPCS,Outpatient,,,48,36,,37.44,78,,29.952,percent of total billed charges,78% of total billed charges,30.24,63,,24.192,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,18.24,38,,14.592,percent of total billed charges,38% of total billed charges,18.24,38,,14.592,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,16.8,35,,13.44,percent of total billed charges,35% of total billed charges,32.29,67.275,,25.832,percent of total billed charges,67.275% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,18.42,38.38,,14.736,percent of total billed charges,38.38% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,29.64,61.74,,23.712,percent of total billed charges,61.74% of total billed charges,48.96,102,,39.168,percent of total billed charges,102% of total billed charges,18.24,38,,14.592,percent of total billed charges,38% of total billed charges,16.8,48.96,
REFLEX CHLAMYDIA-CONFIRM,5000227,CDM,306,RC,87490,HCPCS,Outpatient,,,48,36,,37.44,78,,29.952,percent of total billed charges,78% of total billed charges,24.8,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,22.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,22.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,26.04,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,32.29,67.275,,25.832,percent of total billed charges,67.275% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,22.98,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,29.64,61.74,,23.712,percent of total billed charges,61.74% of total billed charges,25.3,102,,,Fee Schedule,102% of GA Medicaid Rate,22.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,22.75,43.2,
REFLEX GC- CONFIRM POS,5000228,CDM,306,RC,87590,HCPCS,Outpatient,,,48,36,,37.44,78,,29.952,percent of total billed charges,78% of total billed charges,30.24,63,,24.192,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,26.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,26.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,16.8,35,,13.44,percent of total billed charges,35% of total billed charges,32.29,67.275,,25.832,percent of total billed charges,67.275% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,27.15,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,29.64,61.74,,23.712,percent of total billed charges,61.74% of total billed charges,48.96,102,,39.168,percent of total billed charges,102% of total billed charges,26.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.8,48.96,
ACID PHOSPHATASE,5001715,CDM,301,RC,84060,HCPCS,Outpatient,,,48,36,,37.44,78,,29.952,percent of total billed charges,78% of total billed charges,9.29,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,7.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,9.75,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,32.29,67.275,,25.832,percent of total billed charges,67.275% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,7.72,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,29.64,61.74,,23.712,percent of total billed charges,61.74% of total billed charges,9.48,102,,,Fee Schedule,102% of GA Medicaid Rate,7.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.64,43.2,
"GI,THIN,W/SMALL INT,SERIAL",7000635,CDM,320,RC,74245,HCPCS,Outpatient,,,48,36,,37.44,78,,29.952,percent of total billed charges,78% of total billed charges,30.24,63,,24.192,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,18.24,38,,14.592,percent of total billed charges,38% of total billed charges,18.24,38,,14.592,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,16.8,35,,13.44,percent of total billed charges,35% of total billed charges,32.29,67.275,,25.832,percent of total billed charges,67.275% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,18.42,38.38,,14.736,percent of total billed charges,38.38% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,29.64,61.74,,23.712,percent of total billed charges,61.74% of total billed charges,48.96,102,,39.168,percent of total billed charges,102% of total billed charges,18.24,38,,14.592,percent of total billed charges,38% of total billed charges,16.8,48.96,
"OT DEV OF COGNITIVE SKILLS, EA 15 MIN",9000222,CDM,430,RC,97532,HCPCS,Outpatient,,,48,36,,37.44,78,,29.952,percent of total billed charges,78% of total billed charges,30.24,63,,24.192,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,18.24,38,,14.592,percent of total billed charges,38% of total billed charges,18.24,38,,14.592,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,16.8,35,,13.44,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,18.42,38.38,,14.736,percent of total billed charges,38.38% of total billed charges,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,29.64,61.74,,23.712,percent of total billed charges,61.74% of total billed charges,48.96,102,,39.168,percent of total billed charges,102% of total billed charges,18.24,38,,14.592,percent of total billed charges,38% of total billed charges,16.8,145.93,
BIOPSY FORCEP W/FENST NEEDLE,3004044,CDM,270,RC,,,Outpatient,,,48.5,36.38,,37.83,78,,30.264,percent of total billed charges,78% of total billed charges,30.56,63,,24.448,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,18.43,38,,14.744,percent of total billed charges,38% of total billed charges,18.43,38,,14.744,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,43.65,90,,34.92,percent of total billed charges,90% of total billed charges,16.98,35,,13.584,percent of total billed charges,35% of total billed charges,32.63,67.275,,26.104,percent of total billed charges,67.275% of total billed charges,38.8,80,,31.04,percent of total billed charges,80% of total billed charges,18.61,38.38,,14.888,percent of total billed charges,38.38% of total billed charges,38.8,80,,31.04,percent of total billed charges,80% of total billed charges,29.94,61.74,,23.952,percent of total billed charges,61.74% of total billed charges,49.47,102,,39.576,percent of total billed charges,102% of total billed charges,18.43,38,,14.744,percent of total billed charges,38% of total billed charges,16.98,49.47,
COUDE FOLEY SILICONE 20FR,3000274,CDM,270,RC,,,Outpatient,,,48.75,36.56,,38.03,78,,30.424,percent of total billed charges,78% of total billed charges,30.71,63,,24.568,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,18.53,38,,14.824,percent of total billed charges,38% of total billed charges,18.53,38,,14.824,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,43.88,90,,35.104,percent of total billed charges,90% of total billed charges,17.06,35,,13.648,percent of total billed charges,35% of total billed charges,32.8,67.275,,26.24,percent of total billed charges,67.275% of total billed charges,39,80,,31.2,percent of total billed charges,80% of total billed charges,18.71,38.38,,14.968,percent of total billed charges,38.38% of total billed charges,39,80,,31.2,percent of total billed charges,80% of total billed charges,30.1,61.74,,24.08,percent of total billed charges,61.74% of total billed charges,49.73,102,,39.784,percent of total billed charges,102% of total billed charges,18.53,38,,14.824,percent of total billed charges,38% of total billed charges,17.06,49.73,
REMOVE/DEBRIDE NAIL PLATE,1001174,CDM,450,RC,,,Outpatient,,,49,36.75,,38.22,78,,30.576,percent of total billed charges,78% of total billed charges,30.87,63,,24.696,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,18.62,38,,14.896,percent of total billed charges,38% of total billed charges,18.62,38,,14.896,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,17.15,35,,13.72,percent of total billed charges,35% of total billed charges,32.96,67.275,,26.368,percent of total billed charges,67.275% of total billed charges,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,18.81,38.38,,15.048,percent of total billed charges,38.38% of total billed charges,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,30.25,61.74,,24.2,percent of total billed charges,61.74% of total billed charges,49.98,102,,39.984,percent of total billed charges,102% of total billed charges,18.62,38,,14.896,percent of total billed charges,38% of total billed charges,17.15,49.98,
INFUSION CONCURRENT,1001278,CDM,450,RC,96368,HCPCS,Outpatient,,,49,36.75,,38.22,78,,30.576,percent of total billed charges,78% of total billed charges,30.87,63,,24.696,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,18.62,38,,14.896,percent of total billed charges,38% of total billed charges,18.62,38,,14.896,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,17.15,35,,13.72,percent of total billed charges,35% of total billed charges,32.96,67.275,,26.368,percent of total billed charges,67.275% of total billed charges,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,18.81,38.38,,15.048,percent of total billed charges,38.38% of total billed charges,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,30.25,61.74,,24.2,percent of total billed charges,61.74% of total billed charges,49.98,102,,39.984,percent of total billed charges,102% of total billed charges,18.62,38,,14.896,percent of total billed charges,38% of total billed charges,17.15,49.98,
PARASITE ID EXTERNAL,5001522,CDM,306,RC,87169,HCPCS,Outpatient,,,49,36.75,,38.22,78,,30.576,percent of total billed charges,78% of total billed charges,5.36,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.31,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.31,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,5.63,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,32.96,67.275,,26.368,percent of total billed charges,67.275% of total billed charges,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,4.35,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,30.25,61.74,,24.2,percent of total billed charges,61.74% of total billed charges,5.47,102,,,Fee Schedule,102% of GA Medicaid Rate,4.31,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.31,44.1,
Chemical test of the blood to measure presence or concentration of a substance in the blood,5001686,CDM,301,RC,83516,HCPCS,Outpatient,,,49,36.75,,38.22,78,,30.576,percent of total billed charges,78% of total billed charges,13.45,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,11.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,14.12,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,32.96,67.275,,26.368,percent of total billed charges,67.275% of total billed charges,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,11.65,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,30.25,61.74,,24.2,percent of total billed charges,61.74% of total billed charges,13.72,102,,,Fee Schedule,102% of GA Medicaid Rate,11.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.53,44.1,
Coagulation assessment blood test,5009111,CDM,305,RC,85730,HCPCS,Outpatient,,,49,36.75,,38.22,78,,30.576,percent of total billed charges,78% of total billed charges,7.54,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.01,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.01,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,7.92,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,32.96,67.275,,26.368,percent of total billed charges,67.275% of total billed charges,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,6.07,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,30.25,61.74,,24.2,percent of total billed charges,61.74% of total billed charges,7.69,102,,,Fee Schedule,102% of GA Medicaid Rate,6.01,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.01,44.1,
Radiologic examination of the foot with 3 or more views,7000751,CDM,320,RC,73630,HCPCS,Outpatient,,,49,36.75,,38.22,78,,30.576,percent of total billed charges,78% of total billed charges,30.87,63,,24.696,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,18.62,38,,14.896,percent of total billed charges,38% of total billed charges,18.62,38,,14.896,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,17.15,35,,13.72,percent of total billed charges,35% of total billed charges,32.96,67.275,,26.368,percent of total billed charges,67.275% of total billed charges,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,18.81,38.38,,15.048,percent of total billed charges,38.38% of total billed charges,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,30.25,61.74,,24.2,percent of total billed charges,61.74% of total billed charges,49.98,102,,39.984,percent of total billed charges,102% of total billed charges,18.62,38,,14.896,percent of total billed charges,38% of total billed charges,17.15,49.98,
Radiologic examination of the foot with 3 or more views,7000753,CDM,320,RC,73630,HCPCS,Outpatient,,,49,36.75,,38.22,78,,30.576,percent of total billed charges,78% of total billed charges,30.87,63,,24.696,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,18.62,38,,14.896,percent of total billed charges,38% of total billed charges,18.62,38,,14.896,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,17.15,35,,13.72,percent of total billed charges,35% of total billed charges,32.96,67.275,,26.368,percent of total billed charges,67.275% of total billed charges,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,18.81,38.38,,15.048,percent of total billed charges,38.38% of total billed charges,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,30.25,61.74,,24.2,percent of total billed charges,61.74% of total billed charges,49.98,102,,39.984,percent of total billed charges,102% of total billed charges,18.62,38,,14.896,percent of total billed charges,38% of total billed charges,17.15,49.98,
Radiologic examination of the toe(s),7000767,CDM,320,RC,73660,HCPCS,Outpatient,,,49,36.75,,38.22,78,,30.576,percent of total billed charges,78% of total billed charges,30.87,63,,24.696,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,18.62,38,,14.896,percent of total billed charges,38% of total billed charges,18.62,38,,14.896,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,17.15,35,,13.72,percent of total billed charges,35% of total billed charges,32.96,67.275,,26.368,percent of total billed charges,67.275% of total billed charges,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,18.81,38.38,,15.048,percent of total billed charges,38.38% of total billed charges,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,30.25,61.74,,24.2,percent of total billed charges,61.74% of total billed charges,49.98,102,,39.984,percent of total billed charges,102% of total billed charges,18.62,38,,14.896,percent of total billed charges,38% of total billed charges,17.15,49.98,
Radiologic examination of the toe(s),7000768,CDM,320,RC,73660,HCPCS,Outpatient,,,49,36.75,,38.22,78,,30.576,percent of total billed charges,78% of total billed charges,30.87,63,,24.696,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,18.62,38,,14.896,percent of total billed charges,38% of total billed charges,18.62,38,,14.896,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,17.15,35,,13.72,percent of total billed charges,35% of total billed charges,32.96,67.275,,26.368,percent of total billed charges,67.275% of total billed charges,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,18.81,38.38,,15.048,percent of total billed charges,38.38% of total billed charges,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,30.25,61.74,,24.2,percent of total billed charges,61.74% of total billed charges,49.98,102,,39.984,percent of total billed charges,102% of total billed charges,18.62,38,,14.896,percent of total billed charges,38% of total billed charges,17.15,49.98,
SUSPENSORY MEDIUM,3004507,CDM,270,RC,,,Outpatient,,,49.1,36.83,,38.3,78,,30.64,percent of total billed charges,78% of total billed charges,30.93,63,,24.744,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,18.66,38,,14.928,percent of total billed charges,38% of total billed charges,18.66,38,,14.928,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,44.19,90,,35.352,percent of total billed charges,90% of total billed charges,17.19,35,,13.752,percent of total billed charges,35% of total billed charges,33.03,67.275,,26.424,percent of total billed charges,67.275% of total billed charges,39.28,80,,31.424,percent of total billed charges,80% of total billed charges,18.84,38.38,,15.072,percent of total billed charges,38.38% of total billed charges,39.28,80,,31.424,percent of total billed charges,80% of total billed charges,30.31,61.74,,24.248,percent of total billed charges,61.74% of total billed charges,50.08,102,,40.064,percent of total billed charges,102% of total billed charges,18.66,38,,14.928,percent of total billed charges,38% of total billed charges,17.19,50.08,
SUSPENSORY LARGE,3005002,CDM,270,RC,,,Outpatient,,,49.15,36.86,,38.34,78,,30.672,percent of total billed charges,78% of total billed charges,30.96,63,,24.768,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,18.68,38,,14.944,percent of total billed charges,38% of total billed charges,18.68,38,,14.944,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,44.24,90,,35.392,percent of total billed charges,90% of total billed charges,17.2,35,,13.76,percent of total billed charges,35% of total billed charges,33.07,67.275,,26.456,percent of total billed charges,67.275% of total billed charges,39.32,80,,31.456,percent of total billed charges,80% of total billed charges,18.86,38.38,,15.088,percent of total billed charges,38.38% of total billed charges,39.32,80,,31.456,percent of total billed charges,80% of total billed charges,30.35,61.74,,24.28,percent of total billed charges,61.74% of total billed charges,50.13,102,,40.104,percent of total billed charges,102% of total billed charges,18.68,38,,14.944,percent of total billed charges,38% of total billed charges,17.2,50.13,
CHEST TUBE INSERTION TRAY,3005003,CDM,270,RC,,,Outpatient,,,49.15,36.86,,38.34,78,,30.672,percent of total billed charges,78% of total billed charges,30.96,63,,24.768,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,18.68,38,,14.944,percent of total billed charges,38% of total billed charges,18.68,38,,14.944,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,44.24,90,,35.392,percent of total billed charges,90% of total billed charges,17.2,35,,13.76,percent of total billed charges,35% of total billed charges,33.07,67.275,,26.456,percent of total billed charges,67.275% of total billed charges,39.32,80,,31.456,percent of total billed charges,80% of total billed charges,18.86,38.38,,15.088,percent of total billed charges,38.38% of total billed charges,39.32,80,,31.456,percent of total billed charges,80% of total billed charges,30.35,61.74,,24.28,percent of total billed charges,61.74% of total billed charges,50.13,102,,40.104,percent of total billed charges,102% of total billed charges,18.68,38,,14.944,percent of total billed charges,38% of total billed charges,17.2,50.13,
BOTTLE VACUUM,3006021,CDM,270,RC,,,Outpatient,,,49.75,37.31,,38.81,78,,31.048,percent of total billed charges,78% of total billed charges,31.34,63,,25.072,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,18.91,38,,15.128,percent of total billed charges,38% of total billed charges,18.91,38,,15.128,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,44.78,90,,35.824,percent of total billed charges,90% of total billed charges,17.41,35,,13.928,percent of total billed charges,35% of total billed charges,33.47,67.275,,26.776,percent of total billed charges,67.275% of total billed charges,39.8,80,,31.84,percent of total billed charges,80% of total billed charges,19.09,38.38,,15.272,percent of total billed charges,38.38% of total billed charges,39.8,80,,31.84,percent of total billed charges,80% of total billed charges,30.72,61.74,,24.576,percent of total billed charges,61.74% of total billed charges,50.75,102,,40.6,percent of total billed charges,102% of total billed charges,18.91,38,,15.128,percent of total billed charges,38% of total billed charges,17.41,50.75,
"STYLET - LG - GLIDESCOPE, DISP",3004652,CDM,270,RC,,,Outpatient,,,50,37.5,,39,78,,31.2,percent of total billed charges,78% of total billed charges,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,19,38,,15.2,percent of total billed charges,38% of total billed charges,19,38,,15.2,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,45,90,,36,percent of total billed charges,90% of total billed charges,17.5,35,,14,percent of total billed charges,35% of total billed charges,33.64,67.275,,26.912,percent of total billed charges,67.275% of total billed charges,40,80,,32,percent of total billed charges,80% of total billed charges,19.19,38.38,,15.352,percent of total billed charges,38.38% of total billed charges,40,80,,32,percent of total billed charges,80% of total billed charges,30.87,61.74,,24.696,percent of total billed charges,61.74% of total billed charges,51,102,,40.8,percent of total billed charges,102% of total billed charges,19,38,,15.2,percent of total billed charges,38% of total billed charges,17.5,51,
A procedure used to determine if fungi are present in an area of the body,5000229,CDM,306,RC,87101,HCPCS,Outpatient,,,50,37.5,,39,78,,31.2,percent of total billed charges,78% of total billed charges,9.69,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,7.71,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.71,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,45,90,,36,percent of total billed charges,90% of total billed charges,10.17,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,33.64,67.275,,26.912,percent of total billed charges,67.275% of total billed charges,40,80,,32,percent of total billed charges,80% of total billed charges,7.79,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,40,80,,32,percent of total billed charges,80% of total billed charges,30.87,61.74,,24.696,percent of total billed charges,61.74% of total billed charges,9.88,102,,,Fee Schedule,102% of GA Medicaid Rate,7.71,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.71,45,
CULTURE CHLAMYDIA,5000259,CDM,306,RC,87140,HCPCS,Outpatient,,,50,37.5,,39,78,,31.2,percent of total billed charges,78% of total billed charges,7.01,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,45,90,,36,percent of total billed charges,90% of total billed charges,7.36,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,33.64,67.275,,26.912,percent of total billed charges,67.275% of total billed charges,40,80,,32,percent of total billed charges,80% of total billed charges,5.63,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,40,80,,32,percent of total billed charges,80% of total billed charges,30.87,61.74,,24.696,percent of total billed charges,61.74% of total billed charges,7.15,102,,,Fee Schedule,102% of GA Medicaid Rate,5.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.57,45,
SPERM COUNT POST VAS,5000320,CDM,309,RC,89321,HCPCS,Outpatient,,,50,37.5,,39,78,,31.2,percent of total billed charges,78% of total billed charges,7.25,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,45,90,,36,percent of total billed charges,90% of total billed charges,7.61,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,33.64,67.275,,26.912,percent of total billed charges,67.275% of total billed charges,40,80,,32,percent of total billed charges,80% of total billed charges,12.17,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,40,80,,32,percent of total billed charges,80% of total billed charges,30.87,61.74,,24.696,percent of total billed charges,61.74% of total billed charges,7.4,102,,,Fee Schedule,102% of GA Medicaid Rate,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.25,45,
PNEUMOSLIDE AGG,5000908,CDM,306,RC,87140,HCPCS,Outpatient,,,50,37.5,,39,78,,31.2,percent of total billed charges,78% of total billed charges,7.01,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,45,90,,36,percent of total billed charges,90% of total billed charges,7.36,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,33.64,67.275,,26.912,percent of total billed charges,67.275% of total billed charges,40,80,,32,percent of total billed charges,80% of total billed charges,5.63,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,40,80,,32,percent of total billed charges,80% of total billed charges,30.87,61.74,,24.696,percent of total billed charges,61.74% of total billed charges,7.15,102,,,Fee Schedule,102% of GA Medicaid Rate,5.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.57,45,
Psychiatric treatment in which seizures are electrically induced in patients to provide relief from mental disorders,9000024,CDM,420,RC,97033,HCPCS,Outpatient,,,50,37.5,,39,78,,31.2,percent of total billed charges,78% of total billed charges,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,19,38,,15.2,percent of total billed charges,38% of total billed charges,19,38,,15.2,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,45,90,,36,percent of total billed charges,90% of total billed charges,17.5,35,,14,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,40,80,,32,percent of total billed charges,80% of total billed charges,19.19,38.38,,15.352,percent of total billed charges,38.38% of total billed charges,40,80,,32,percent of total billed charges,80% of total billed charges,30.87,61.74,,24.696,percent of total billed charges,61.74% of total billed charges,51,102,,40.8,percent of total billed charges,102% of total billed charges,19,38,,15.2,percent of total billed charges,38% of total billed charges,17.5,145.93,
PT DEBRIDEMENT WOUND > 20 CM,9590013,CDM,420,RC,97598,HCPCS,Outpatient,,,50,37.5,,39,78,,31.2,percent of total billed charges,78% of total billed charges,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,19,38,,15.2,percent of total billed charges,38% of total billed charges,19,38,,15.2,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,45,90,,36,percent of total billed charges,90% of total billed charges,17.5,35,,14,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,40,80,,32,percent of total billed charges,80% of total billed charges,19.19,38.38,,15.352,percent of total billed charges,38.38% of total billed charges,40,80,,32,percent of total billed charges,80% of total billed charges,30.87,61.74,,24.696,percent of total billed charges,61.74% of total billed charges,51,102,,40.8,percent of total billed charges,102% of total billed charges,19,38,,15.2,percent of total billed charges,38% of total billed charges,17.5,145.93,
JAMSHIDI BIOPSY NEEDLE SHORT,3000902,CDM,270,RC,,,Outpatient,,,50.05,37.54,,39.04,78,,31.232,percent of total billed charges,78% of total billed charges,31.53,63,,25.224,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,19.02,38,,15.216,percent of total billed charges,38% of total billed charges,19.02,38,,15.216,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,45.05,90,,36.04,percent of total billed charges,90% of total billed charges,17.52,35,,14.016,percent of total billed charges,35% of total billed charges,33.67,67.275,,26.936,percent of total billed charges,67.275% of total billed charges,40.04,80,,32.032,percent of total billed charges,80% of total billed charges,19.21,38.38,,15.368,percent of total billed charges,38.38% of total billed charges,40.04,80,,32.032,percent of total billed charges,80% of total billed charges,30.9,61.74,,24.72,percent of total billed charges,61.74% of total billed charges,51.05,102,,40.84,percent of total billed charges,102% of total billed charges,19.02,38,,15.216,percent of total billed charges,38% of total billed charges,17.52,51.05,
BINDER ABDOMINAL 4-panel 12  (74-85),3000121,CDM,270,RC,,,Outpatient,,,50.75,38.06,,39.59,78,,31.672,percent of total billed charges,78% of total billed charges,31.97,63,,25.576,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,19.29,38,,15.432,percent of total billed charges,38% of total billed charges,19.29,38,,15.432,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,45.68,90,,36.544,percent of total billed charges,90% of total billed charges,17.76,35,,14.208,percent of total billed charges,35% of total billed charges,34.14,67.275,,27.312,percent of total billed charges,67.275% of total billed charges,40.6,80,,32.48,percent of total billed charges,80% of total billed charges,19.48,38.38,,15.584,percent of total billed charges,38.38% of total billed charges,40.6,80,,32.48,percent of total billed charges,80% of total billed charges,31.33,61.74,,25.064,percent of total billed charges,61.74% of total billed charges,51.77,102,,41.416,percent of total billed charges,102% of total billed charges,19.29,38,,15.432,percent of total billed charges,38% of total billed charges,17.76,51.77,
GASTRIC LAVAGE,1200211,CDM,981,RC,91105,HCPCS,Outpatient,,,51,38.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,30.86,61.74,,24.688,percent of total billed charges,61.74% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,30.86,30.86,
Blood test to screen for bacteria in the blood,5000215,CDM,306,RC,87040,HCPCS,Outpatient,,,51,38.25,,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,12.98,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,10.32,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.32,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,13.63,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,34.31,67.275,,27.448,percent of total billed charges,67.275% of total billed charges,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,10.42,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,31.49,61.74,,25.192,percent of total billed charges,61.74% of total billed charges,13.24,102,,,Fee Schedule,102% of GA Medicaid Rate,10.32,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.32,45.9,
GLUCOSE-6-PD QUANT,5001638,CDM,301,RC,82955,HCPCS,Outpatient,,,51,38.25,,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,9.82,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,9.7,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,9.7,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,10.31,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,34.31,67.275,,27.448,percent of total billed charges,67.275% of total billed charges,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,9.8,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,31.49,61.74,,25.192,percent of total billed charges,61.74% of total billed charges,10.02,102,,,Fee Schedule,102% of GA Medicaid Rate,9.7,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,9.7,45.9,
X-ray of the hand with 3 or more views,7000746,CDM,320,RC,73130,HCPCS,Outpatient,,,51,38.25,,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,32.13,63,,25.704,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,19.38,38,,15.504,percent of total billed charges,38% of total billed charges,19.38,38,,15.504,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,17.85,35,,14.28,percent of total billed charges,35% of total billed charges,34.31,67.275,,27.448,percent of total billed charges,67.275% of total billed charges,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,19.57,38.38,,15.656,percent of total billed charges,38.38% of total billed charges,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,31.49,61.74,,25.192,percent of total billed charges,61.74% of total billed charges,52.02,102,,41.616,percent of total billed charges,102% of total billed charges,19.38,38,,15.504,percent of total billed charges,38% of total billed charges,17.85,52.02,
X-ray of the hand with 3 or more views,7000748,CDM,320,RC,73130,HCPCS,Outpatient,,,51,38.25,,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,32.13,63,,25.704,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,19.38,38,,15.504,percent of total billed charges,38% of total billed charges,19.38,38,,15.504,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,17.85,35,,14.28,percent of total billed charges,35% of total billed charges,34.31,67.275,,27.448,percent of total billed charges,67.275% of total billed charges,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,19.57,38.38,,15.656,percent of total billed charges,38.38% of total billed charges,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,31.49,61.74,,25.192,percent of total billed charges,61.74% of total billed charges,52.02,102,,41.616,percent of total billed charges,102% of total billed charges,19.38,38,,15.504,percent of total billed charges,38% of total billed charges,17.85,52.02,
SPLINT ORTHO 5X30  PRE-CUT,3004274,CDM,270,RC,,,Outpatient,,,51.85,38.89,,40.44,78,,32.352,percent of total billed charges,78% of total billed charges,32.67,63,,26.136,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,19.7,38,,15.76,percent of total billed charges,38% of total billed charges,19.7,38,,15.76,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,46.67,90,,37.336,percent of total billed charges,90% of total billed charges,18.15,35,,14.52,percent of total billed charges,35% of total billed charges,34.88,67.275,,27.904,percent of total billed charges,67.275% of total billed charges,41.48,80,,33.184,percent of total billed charges,80% of total billed charges,19.9,38.38,,15.92,percent of total billed charges,38.38% of total billed charges,41.48,80,,33.184,percent of total billed charges,80% of total billed charges,32.01,61.74,,25.608,percent of total billed charges,61.74% of total billed charges,52.89,102,,42.312,percent of total billed charges,102% of total billed charges,19.7,38,,15.76,percent of total billed charges,38% of total billed charges,18.15,52.89,
CUCUMBER IGG,5000044,CDM,302,RC,86001,HCPCS,Outpatient,,,52,39,,40.56,78,,32.448,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,7.82,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.82,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,34.98,67.275,,27.984,percent of total billed charges,67.275% of total billed charges,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,7.9,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,32.1,61.74,,25.68,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,7.82,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.57,46.8,
CORTISOL SALIVA,5001689,CDM,301,RC,82530,HCPCS,Outpatient,,,52,39,,40.56,78,,32.448,percent of total billed charges,78% of total billed charges,21.02,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.71,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.71,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,22.07,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,34.98,67.275,,27.984,percent of total billed charges,67.275% of total billed charges,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,16.88,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,32.1,61.74,,25.68,percent of total billed charges,61.74% of total billed charges,21.44,102,,,Fee Schedule,102% of GA Medicaid Rate,16.71,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.71,46.8,
IGG SUBCLASS I,5001979,CDM,301,RC,82787,HCPCS,Outpatient,,,52,39,,40.56,78,,32.448,percent of total billed charges,78% of total billed charges,10.08,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,10.58,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,34.98,67.275,,27.984,percent of total billed charges,67.275% of total billed charges,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,8.1,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,32.1,61.74,,25.68,percent of total billed charges,61.74% of total billed charges,10.28,102,,,Fee Schedule,102% of GA Medicaid Rate,8.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.02,46.8,
IGG SUBCLASS II,5001980,CDM,301,RC,82787,HCPCS,Outpatient,,,52,39,,40.56,78,,32.448,percent of total billed charges,78% of total billed charges,10.08,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,10.58,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,34.98,67.275,,27.984,percent of total billed charges,67.275% of total billed charges,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,8.1,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,32.1,61.74,,25.68,percent of total billed charges,61.74% of total billed charges,10.28,102,,,Fee Schedule,102% of GA Medicaid Rate,8.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.02,46.8,
IGG SUBCLASS III,5001981,CDM,301,RC,82787,HCPCS,Outpatient,,,52,39,,40.56,78,,32.448,percent of total billed charges,78% of total billed charges,10.08,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,10.58,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,34.98,67.275,,27.984,percent of total billed charges,67.275% of total billed charges,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,8.1,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,32.1,61.74,,25.68,percent of total billed charges,61.74% of total billed charges,10.28,102,,,Fee Schedule,102% of GA Medicaid Rate,8.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.02,46.8,
IGG SUBCLASS IV,5001982,CDM,301,RC,82787,HCPCS,Outpatient,,,52,39,,40.56,78,,32.448,percent of total billed charges,78% of total billed charges,10.08,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,10.58,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,34.98,67.275,,27.984,percent of total billed charges,67.275% of total billed charges,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,8.1,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,32.1,61.74,,25.68,percent of total billed charges,61.74% of total billed charges,10.28,102,,,Fee Schedule,102% of GA Medicaid Rate,8.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.02,46.8,
IgA1 SUBCLASS,5002044,CDM,301,RC,82787,HCPCS,Outpatient,,,52,39,,40.56,78,,32.448,percent of total billed charges,78% of total billed charges,10.08,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,10.58,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,34.98,67.275,,27.984,percent of total billed charges,67.275% of total billed charges,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,8.1,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,32.1,61.74,,25.68,percent of total billed charges,61.74% of total billed charges,10.28,102,,,Fee Schedule,102% of GA Medicaid Rate,8.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.02,46.8,
IgA2 SUBCLASS,5002045,CDM,301,RC,82787,HCPCS,Outpatient,,,52,39,,40.56,78,,32.448,percent of total billed charges,78% of total billed charges,10.08,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,10.58,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,34.98,67.275,,27.984,percent of total billed charges,67.275% of total billed charges,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,8.1,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,32.1,61.74,,25.68,percent of total billed charges,61.74% of total billed charges,10.28,102,,,Fee Schedule,102% of GA Medicaid Rate,8.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.02,46.8,
ALLERGEN SPECIFIC IG6 QUAN,5086001,CDM,300,RC,86001,HCPCS,Outpatient,,,52,39,,40.56,78,,32.448,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,7.82,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.82,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,34.98,67.275,,27.984,percent of total billed charges,67.275% of total billed charges,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,7.9,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,32.1,61.74,,25.68,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,7.82,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.57,46.8,
A type of physical therapy,9590009,CDM,420,RC,97116,HCPCS,Outpatient,,,52,39,,40.56,78,,32.448,percent of total billed charges,78% of total billed charges,32.76,63,,26.208,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,19.76,38,,15.808,percent of total billed charges,38% of total billed charges,19.76,38,,15.808,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,18.2,35,,14.56,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,19.96,38.38,,15.968,percent of total billed charges,38.38% of total billed charges,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,32.1,61.74,,25.68,percent of total billed charges,61.74% of total billed charges,53.04,102,,42.432,percent of total billed charges,102% of total billed charges,19.76,38,,15.808,percent of total billed charges,38% of total billed charges,18.2,145.93,
DERMABOND,3004000,CDM,270,RC,,,Outpatient,,,52.47,39.35,,40.93,78,,32.744,percent of total billed charges,78% of total billed charges,33.06,63,,26.448,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,19.94,38,,15.952,percent of total billed charges,38% of total billed charges,19.94,38,,15.952,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,47.22,90,,37.776,percent of total billed charges,90% of total billed charges,18.36,35,,14.688,percent of total billed charges,35% of total billed charges,35.3,67.275,,28.24,percent of total billed charges,67.275% of total billed charges,41.98,80,,33.584,percent of total billed charges,80% of total billed charges,20.14,38.38,,16.112,percent of total billed charges,38.38% of total billed charges,41.98,80,,33.584,percent of total billed charges,80% of total billed charges,32.39,61.74,,25.912,percent of total billed charges,61.74% of total billed charges,53.52,102,,42.816,percent of total billed charges,102% of total billed charges,19.94,38,,15.952,percent of total billed charges,38% of total billed charges,18.36,53.52,
CRUTCH MEDIUM ADULT,3004207,CDM,270,RC,,,Outpatient,,,52.89,39.67,,41.25,78,,33,percent of total billed charges,78% of total billed charges,33.32,63,,26.656,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,20.1,38,,16.08,percent of total billed charges,38% of total billed charges,20.1,38,,16.08,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,47.6,90,,38.08,percent of total billed charges,90% of total billed charges,18.51,35,,14.808,percent of total billed charges,35% of total billed charges,35.58,67.275,,28.464,percent of total billed charges,67.275% of total billed charges,42.31,80,,33.848,percent of total billed charges,80% of total billed charges,20.3,38.38,,16.24,percent of total billed charges,38.38% of total billed charges,42.31,80,,33.848,percent of total billed charges,80% of total billed charges,32.65,61.74,,26.12,percent of total billed charges,61.74% of total billed charges,53.95,102,,43.16,percent of total billed charges,102% of total billed charges,20.1,38,,16.08,percent of total billed charges,38% of total billed charges,18.51,53.95,
Test of a wound for type of bacterial infection,5000222,CDM,306,RC,87077,HCPCS,Outpatient,,,53,39.75,,41.34,78,,33.072,percent of total billed charges,78% of total billed charges,10.16,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,10.67,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,35.66,67.275,,28.528,percent of total billed charges,67.275% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,8.16,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,32.72,61.74,,26.176,percent of total billed charges,61.74% of total billed charges,10.36,102,,,Fee Schedule,102% of GA Medicaid Rate,8.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.08,47.7,
Test of a wound for type of bacterial infection,5000501,CDM,306,RC,87077,HCPCS,Outpatient,,,53,39.75,,41.34,78,,33.072,percent of total billed charges,78% of total billed charges,10.16,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,10.67,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,35.66,67.275,,28.528,percent of total billed charges,67.275% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,8.16,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,32.72,61.74,,26.176,percent of total billed charges,61.74% of total billed charges,10.36,102,,,Fee Schedule,102% of GA Medicaid Rate,8.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.08,47.7,
Blood test to measure the level of lipoproteins in the blood,5000720,CDM,301,RC,83718,HCPCS,Outpatient,,,53,39.75,,41.34,78,,33.072,percent of total billed charges,78% of total billed charges,10.3,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.19,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.19,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,10.82,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,35.66,67.275,,28.528,percent of total billed charges,67.275% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,8.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,32.72,61.74,,26.176,percent of total billed charges,61.74% of total billed charges,10.51,102,,,Fee Schedule,102% of GA Medicaid Rate,8.19,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.19,47.7,
Blood test to measure the level of lipoproteins in the blood,5000726,CDM,301,RC,83718,HCPCS,Outpatient,,,53,39.75,,41.34,78,,33.072,percent of total billed charges,78% of total billed charges,10.3,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.19,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.19,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,10.82,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,35.66,67.275,,28.528,percent of total billed charges,67.275% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,8.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,32.72,61.74,,26.176,percent of total billed charges,61.74% of total billed charges,10.51,102,,,Fee Schedule,102% of GA Medicaid Rate,8.19,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.19,47.7,
Test of a wound for type of bacterial infection,5000895,CDM,306,RC,87077,HCPCS,Outpatient,,,53,39.75,,41.34,78,,33.072,percent of total billed charges,78% of total billed charges,10.16,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,10.67,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,35.66,67.275,,28.528,percent of total billed charges,67.275% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,8.16,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,32.72,61.74,,26.176,percent of total billed charges,61.74% of total billed charges,10.36,102,,,Fee Schedule,102% of GA Medicaid Rate,8.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.08,47.7,
Test of a wound for type of bacterial infection,5000904,CDM,306,RC,87077,HCPCS,Outpatient,,,53,39.75,,41.34,78,,33.072,percent of total billed charges,78% of total billed charges,10.16,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,10.67,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,35.66,67.275,,28.528,percent of total billed charges,67.275% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,8.16,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,32.72,61.74,,26.176,percent of total billed charges,61.74% of total billed charges,10.36,102,,,Fee Schedule,102% of GA Medicaid Rate,8.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.08,47.7,
TICK (ARTHROPOD) ID,5001521,CDM,306,RC,87168,HCPCS,Outpatient,,,53,39.75,,41.34,78,,33.072,percent of total billed charges,78% of total billed charges,5.36,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,5.63,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,35.66,67.275,,28.528,percent of total billed charges,67.275% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,4.31,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,32.72,61.74,,26.176,percent of total billed charges,61.74% of total billed charges,5.47,102,,,Fee Schedule,102% of GA Medicaid Rate,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.27,47.7,
COLD AGGLUTININ TITER,5001720,CDM,302,RC,86157,HCPCS,Outpatient,,,53,39.75,,41.34,78,,33.072,percent of total billed charges,78% of total billed charges,10.14,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.06,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.06,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,10.65,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,35.66,67.275,,28.528,percent of total billed charges,67.275% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,8.14,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,32.72,61.74,,26.176,percent of total billed charges,61.74% of total billed charges,10.34,102,,,Fee Schedule,102% of GA Medicaid Rate,8.06,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.06,47.7,
PATH SURGICAL BLANK,5003041,CDM,312,RC,88311,HCPCS,Outpatient,,,53,39.75,,41.34,78,,33.072,percent of total billed charges,78% of total billed charges,15.45,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,20.14,38,,16.112,percent of total billed charges,38% of total billed charges,20.14,38,,16.112,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,16.22,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,35.66,67.275,,28.528,percent of total billed charges,67.275% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,20.34,38.38,,16.272,percent of total billed charges,38.38% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,32.72,61.74,,26.176,percent of total billed charges,61.74% of total billed charges,15.76,102,,,Fee Schedule,102% of GA Medicaid Rate,20.14,38,,16.112,percent of total billed charges,38% of total billed charges,15.45,47.7,
PATH DECAL,5003110,CDM,312,RC,88311,HCPCS,Outpatient,,,53,39.75,,41.34,78,,33.072,percent of total billed charges,78% of total billed charges,15.45,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,20.14,38,,16.112,percent of total billed charges,38% of total billed charges,20.14,38,,16.112,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,16.22,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,35.66,67.275,,28.528,percent of total billed charges,67.275% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,20.34,38.38,,16.272,percent of total billed charges,38.38% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,32.72,61.74,,26.176,percent of total billed charges,61.74% of total billed charges,15.76,102,,,Fee Schedule,102% of GA Medicaid Rate,20.14,38,,16.112,percent of total billed charges,38% of total billed charges,15.45,47.7,
HAEMOPHILUS INFLUENZA ANTIBODY,5003903,CDM,302,RC,86684,HCPCS,Outpatient,,,53,39.75,,41.34,78,,33.072,percent of total billed charges,78% of total billed charges,19.93,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,15.84,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.84,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,20.93,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,35.66,67.275,,28.528,percent of total billed charges,67.275% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,16,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,32.72,61.74,,26.176,percent of total billed charges,61.74% of total billed charges,20.33,102,,,Fee Schedule,102% of GA Medicaid Rate,15.84,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.84,47.7,
BILE ACIDS TOTAL,5003906,CDM,301,RC,82239,HCPCS,Outpatient,,,53,39.75,,41.34,78,,33.072,percent of total billed charges,78% of total billed charges,21.55,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,17.12,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.12,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,22.63,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,35.66,67.275,,28.528,percent of total billed charges,67.275% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,17.29,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,32.72,61.74,,26.176,percent of total billed charges,61.74% of total billed charges,21.98,102,,,Fee Schedule,102% of GA Medicaid Rate,17.12,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.12,47.7,
AMYLASE-MULTIPLE,5009106,CDM,301,RC,82150,HCPCS,Outpatient,,,53,39.75,,41.34,78,,33.072,percent of total billed charges,78% of total billed charges,8.15,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.48,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.48,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,8.56,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,35.66,67.275,,28.528,percent of total billed charges,67.275% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,6.54,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,32.72,61.74,,26.176,percent of total billed charges,61.74% of total billed charges,8.31,102,,,Fee Schedule,102% of GA Medicaid Rate,6.48,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.48,47.7,
PT SENSORY INTEGR & BAL STIM,9590025,CDM,420,RC,97533,HCPCS,Outpatient,,,53,39.75,,41.34,78,,33.072,percent of total billed charges,78% of total billed charges,33.39,63,,26.712,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,20.14,38,,16.112,percent of total billed charges,38% of total billed charges,20.14,38,,16.112,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,18.55,35,,14.84,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,20.34,38.38,,16.272,percent of total billed charges,38.38% of total billed charges,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,32.72,61.74,,26.176,percent of total billed charges,61.74% of total billed charges,54.06,102,,43.248,percent of total billed charges,102% of total billed charges,20.14,38,,16.112,percent of total billed charges,38% of total billed charges,18.55,145.93,
ETHILON 4-0 PS-2,3001543,CDM,270,RC,,,Outpatient,,,53.45,40.09,,41.69,78,,33.352,percent of total billed charges,78% of total billed charges,33.67,63,,26.936,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,20.31,38,,16.248,percent of total billed charges,38% of total billed charges,20.31,38,,16.248,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,48.11,90,,38.488,percent of total billed charges,90% of total billed charges,18.71,35,,14.968,percent of total billed charges,35% of total billed charges,35.96,67.275,,28.768,percent of total billed charges,67.275% of total billed charges,42.76,80,,34.208,percent of total billed charges,80% of total billed charges,20.51,38.38,,16.408,percent of total billed charges,38.38% of total billed charges,42.76,80,,34.208,percent of total billed charges,80% of total billed charges,33,61.74,,26.4,percent of total billed charges,61.74% of total billed charges,54.52,102,,43.616,percent of total billed charges,102% of total billed charges,20.31,38,,16.248,percent of total billed charges,38% of total billed charges,18.71,54.52,
DISPOSABLE SNARE SD-210U-25,3003057,CDM,270,RC,,,Outpatient,,,53.63,40.22,,41.83,78,,33.464,percent of total billed charges,78% of total billed charges,33.79,63,,27.032,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,20.38,38,,16.304,percent of total billed charges,38% of total billed charges,20.38,38,,16.304,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,48.27,90,,38.616,percent of total billed charges,90% of total billed charges,18.77,35,,15.016,percent of total billed charges,35% of total billed charges,36.08,67.275,,28.864,percent of total billed charges,67.275% of total billed charges,42.9,80,,34.32,percent of total billed charges,80% of total billed charges,20.58,38.38,,16.464,percent of total billed charges,38.38% of total billed charges,42.9,80,,34.32,percent of total billed charges,80% of total billed charges,33.11,61.74,,26.488,percent of total billed charges,61.74% of total billed charges,54.7,102,,43.76,percent of total billed charges,102% of total billed charges,20.38,38,,16.304,percent of total billed charges,38% of total billed charges,18.77,54.7,
ANKLE BRACE SUPPORT,3000007,CDM,270,RC,,,Outpatient,,,53.9,40.43,,42.04,78,,33.632,percent of total billed charges,78% of total billed charges,33.96,63,,27.168,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,20.48,38,,16.384,percent of total billed charges,38% of total billed charges,20.48,38,,16.384,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,48.51,90,,38.808,percent of total billed charges,90% of total billed charges,18.87,35,,15.096,percent of total billed charges,35% of total billed charges,36.26,67.275,,29.008,percent of total billed charges,67.275% of total billed charges,43.12,80,,34.496,percent of total billed charges,80% of total billed charges,20.69,38.38,,16.552,percent of total billed charges,38.38% of total billed charges,43.12,80,,34.496,percent of total billed charges,80% of total billed charges,33.28,61.74,,26.624,percent of total billed charges,61.74% of total billed charges,54.98,102,,43.984,percent of total billed charges,102% of total billed charges,20.48,38,,16.384,percent of total billed charges,38% of total billed charges,18.87,54.98,
CERVICAL COLLAR - PATRIOT LOW,3000202,CDM,270,RC,,,Outpatient,,,54,40.5,,42.12,78,,33.696,percent of total billed charges,78% of total billed charges,34.02,63,,27.216,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,20.52,38,,16.416,percent of total billed charges,38% of total billed charges,20.52,38,,16.416,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,18.9,35,,15.12,percent of total billed charges,35% of total billed charges,36.33,67.275,,29.064,percent of total billed charges,67.275% of total billed charges,43.2,80,,34.56,percent of total billed charges,80% of total billed charges,20.73,38.38,,16.584,percent of total billed charges,38.38% of total billed charges,43.2,80,,34.56,percent of total billed charges,80% of total billed charges,33.34,61.74,,26.672,percent of total billed charges,61.74% of total billed charges,55.08,102,,44.064,percent of total billed charges,102% of total billed charges,20.52,38,,16.416,percent of total billed charges,38% of total billed charges,18.9,55.08,
BLEEDING TIME,5000105,CDM,305,RC,85002,HCPCS,Outpatient,,,54,40.5,,42.12,78,,33.696,percent of total billed charges,78% of total billed charges,5.66,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.82,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.82,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,5.94,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,36.33,67.275,,29.064,percent of total billed charges,67.275% of total billed charges,43.2,80,,34.56,percent of total billed charges,80% of total billed charges,4.87,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,43.2,80,,34.56,percent of total billed charges,80% of total billed charges,33.34,61.74,,26.672,percent of total billed charges,61.74% of total billed charges,5.77,102,,,Fee Schedule,102% of GA Medicaid Rate,4.82,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.82,48.6,
MDI THERAPY TREATMENT EA  ADDL,8094641,CDM,410,RC,94640,HCPCS,Outpatient,,,54,40.5,,42.12,78,,33.696,percent of total billed charges,78% of total billed charges,34.02,63,,27.216,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,20.52,38,,16.416,percent of total billed charges,38% of total billed charges,20.52,38,,16.416,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,18.9,35,,15.12,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,43.2,80,,34.56,percent of total billed charges,80% of total billed charges,20.73,38.38,,16.584,percent of total billed charges,38.38% of total billed charges,43.2,80,,34.56,percent of total billed charges,80% of total billed charges,33.34,61.74,,26.672,percent of total billed charges,61.74% of total billed charges,55.08,102,,44.064,percent of total billed charges,102% of total billed charges,20.52,38,,16.416,percent of total billed charges,38% of total billed charges,18.9,145.93,
Manipulation of 1 or more regions of the body,9590026,CDM,420,RC,97140,HCPCS,Outpatient,,,54,40.5,,42.12,78,,33.696,percent of total billed charges,78% of total billed charges,34.02,63,,27.216,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,20.52,38,,16.416,percent of total billed charges,38% of total billed charges,20.52,38,,16.416,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,18.9,35,,15.12,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,43.2,80,,34.56,percent of total billed charges,80% of total billed charges,20.73,38.38,,16.584,percent of total billed charges,38.38% of total billed charges,43.2,80,,34.56,percent of total billed charges,80% of total billed charges,33.34,61.74,,26.672,percent of total billed charges,61.74% of total billed charges,55.08,102,,44.064,percent of total billed charges,102% of total billed charges,20.52,38,,16.416,percent of total billed charges,38% of total billed charges,18.9,145.93,
SPO2 SENSOR ADULT DISP - MINDRAY,3000134,CDM,270,RC,,,Outpatient,,,54.99,41.24,,42.89,78,,34.312,percent of total billed charges,78% of total billed charges,34.64,63,,27.712,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,20.9,38,,16.72,percent of total billed charges,38% of total billed charges,20.9,38,,16.72,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,49.49,90,,39.592,percent of total billed charges,90% of total billed charges,19.25,35,,15.4,percent of total billed charges,35% of total billed charges,36.99,67.275,,29.592,percent of total billed charges,67.275% of total billed charges,43.99,80,,35.192,percent of total billed charges,80% of total billed charges,21.11,38.38,,16.888,percent of total billed charges,38.38% of total billed charges,43.99,80,,35.192,percent of total billed charges,80% of total billed charges,33.95,61.74,,27.16,percent of total billed charges,61.74% of total billed charges,56.09,102,,44.872,percent of total billed charges,102% of total billed charges,20.9,38,,16.72,percent of total billed charges,38% of total billed charges,19.25,56.09,
FIBRINOGEN,5000112,CDM,305,RC,85384,HCPCS,Outpatient,,,55,41.25,,42.9,78,,34.32,percent of total billed charges,78% of total billed charges,10.68,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,9.72,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,9.72,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,11.21,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,37,67.275,,29.6,percent of total billed charges,67.275% of total billed charges,44,80,,35.2,percent of total billed charges,80% of total billed charges,9.82,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,44,80,,35.2,percent of total billed charges,80% of total billed charges,33.96,61.74,,27.168,percent of total billed charges,61.74% of total billed charges,10.89,102,,,Fee Schedule,102% of GA Medicaid Rate,9.72,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,9.72,49.5,
"PORPHOBILINOGEN, QUANT",5001231,CDM,301,RC,84110,HCPCS,Outpatient,,,55,41.25,,42.9,78,,34.32,percent of total billed charges,78% of total billed charges,10.62,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.44,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.44,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,11.15,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,37,67.275,,29.6,percent of total billed charges,67.275% of total billed charges,44,80,,35.2,percent of total billed charges,80% of total billed charges,8.52,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,44,80,,35.2,percent of total billed charges,80% of total billed charges,33.96,61.74,,27.168,percent of total billed charges,61.74% of total billed charges,10.83,102,,,Fee Schedule,102% of GA Medicaid Rate,8.44,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.44,49.5,
HEXAGONAL PHOSPHOLIPID REFLEX TEST,5003900,CDM,300,RC,85598,HCPCS,Outpatient,,,55,41.25,,42.9,78,,34.32,percent of total billed charges,78% of total billed charges,20.24,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,17.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,21.25,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,37,67.275,,29.6,percent of total billed charges,67.275% of total billed charges,44,80,,35.2,percent of total billed charges,80% of total billed charges,18.16,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,44,80,,35.2,percent of total billed charges,80% of total billed charges,33.96,61.74,,27.168,percent of total billed charges,61.74% of total billed charges,20.64,102,,,Fee Schedule,102% of GA Medicaid Rate,17.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.98,49.5,
GIGLI WIRE 20,3004314,CDM,270,RC,,,Outpatient,,,55.25,41.44,,43.1,78,,34.48,percent of total billed charges,78% of total billed charges,34.81,63,,27.848,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,21,38,,16.8,percent of total billed charges,38% of total billed charges,21,38,,16.8,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,49.73,90,,39.784,percent of total billed charges,90% of total billed charges,19.34,35,,15.472,percent of total billed charges,35% of total billed charges,37.17,67.275,,29.736,percent of total billed charges,67.275% of total billed charges,44.2,80,,35.36,percent of total billed charges,80% of total billed charges,21.2,38.38,,16.96,percent of total billed charges,38.38% of total billed charges,44.2,80,,35.36,percent of total billed charges,80% of total billed charges,34.11,61.74,,27.288,percent of total billed charges,61.74% of total billed charges,56.36,102,,45.088,percent of total billed charges,102% of total billed charges,21,38,,16.8,percent of total billed charges,38% of total billed charges,19.34,56.36,
AIR CUSHION WHEELCHAIR - RING,3005070,CDM,270,RC,,,Outpatient,,,55.41,41.56,,43.22,78,,34.576,percent of total billed charges,78% of total billed charges,34.91,63,,27.928,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,21.06,38,,16.848,percent of total billed charges,38% of total billed charges,21.06,38,,16.848,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,49.87,90,,39.896,percent of total billed charges,90% of total billed charges,19.39,35,,15.512,percent of total billed charges,35% of total billed charges,37.28,67.275,,29.824,percent of total billed charges,67.275% of total billed charges,44.33,80,,35.464,percent of total billed charges,80% of total billed charges,21.27,38.38,,17.016,percent of total billed charges,38.38% of total billed charges,44.33,80,,35.464,percent of total billed charges,80% of total billed charges,34.21,61.74,,27.368,percent of total billed charges,61.74% of total billed charges,56.52,102,,45.216,percent of total billed charges,102% of total billed charges,21.06,38,,16.848,percent of total billed charges,38% of total billed charges,19.39,56.52,
LEEP ELECTRODE PADDLE 20 x 10,3006019,CDM,270,RC,,,Outpatient,,,55.5,41.63,,43.29,78,,34.632,percent of total billed charges,78% of total billed charges,34.97,63,,27.976,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,21.09,38,,16.872,percent of total billed charges,38% of total billed charges,21.09,38,,16.872,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,49.95,90,,39.96,percent of total billed charges,90% of total billed charges,19.43,35,,15.544,percent of total billed charges,35% of total billed charges,37.34,67.275,,29.872,percent of total billed charges,67.275% of total billed charges,44.4,80,,35.52,percent of total billed charges,80% of total billed charges,21.3,38.38,,17.04,percent of total billed charges,38.38% of total billed charges,44.4,80,,35.52,percent of total billed charges,80% of total billed charges,34.27,61.74,,27.416,percent of total billed charges,61.74% of total billed charges,56.61,102,,45.288,percent of total billed charges,102% of total billed charges,21.09,38,,16.872,percent of total billed charges,38% of total billed charges,19.43,56.61,
CATH FOLEY TRAY SILVER 14 FR,3000420,CDM,270,RC,,,Outpatient,,,55.6,41.7,,43.37,78,,34.696,percent of total billed charges,78% of total billed charges,35.03,63,,28.024,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,21.13,38,,16.904,percent of total billed charges,38% of total billed charges,21.13,38,,16.904,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,50.04,90,,40.032,percent of total billed charges,90% of total billed charges,19.46,35,,15.568,percent of total billed charges,35% of total billed charges,37.4,67.275,,29.92,percent of total billed charges,67.275% of total billed charges,44.48,80,,35.584,percent of total billed charges,80% of total billed charges,21.34,38.38,,17.072,percent of total billed charges,38.38% of total billed charges,44.48,80,,35.584,percent of total billed charges,80% of total billed charges,34.33,61.74,,27.464,percent of total billed charges,61.74% of total billed charges,56.71,102,,45.368,percent of total billed charges,102% of total billed charges,21.13,38,,16.904,percent of total billed charges,38% of total billed charges,19.46,56.71,
DUO DERM SIGNAL 8 X 8,3000319,CDM,270,RC,,,Outpatient,,,55.73,41.8,,43.47,78,,34.776,percent of total billed charges,78% of total billed charges,35.11,63,,28.088,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,21.18,38,,16.944,percent of total billed charges,38% of total billed charges,21.18,38,,16.944,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,50.16,90,,40.128,percent of total billed charges,90% of total billed charges,19.51,35,,15.608,percent of total billed charges,35% of total billed charges,37.49,67.275,,29.992,percent of total billed charges,67.275% of total billed charges,44.58,80,,35.664,percent of total billed charges,80% of total billed charges,21.39,38.38,,17.112,percent of total billed charges,38.38% of total billed charges,44.58,80,,35.664,percent of total billed charges,80% of total billed charges,34.41,61.74,,27.528,percent of total billed charges,61.74% of total billed charges,56.84,102,,45.472,percent of total billed charges,102% of total billed charges,21.18,38,,16.944,percent of total billed charges,38% of total billed charges,19.51,56.84,
OXY TIP SENSOR,3001413,CDM,270,RC,,,Outpatient,,,55.95,41.96,,43.64,78,,34.912,percent of total billed charges,78% of total billed charges,35.25,63,,28.2,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,21.26,38,,17.008,percent of total billed charges,38% of total billed charges,21.26,38,,17.008,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,50.36,90,,40.288,percent of total billed charges,90% of total billed charges,19.58,35,,15.664,percent of total billed charges,35% of total billed charges,37.64,67.275,,30.112,percent of total billed charges,67.275% of total billed charges,44.76,80,,35.808,percent of total billed charges,80% of total billed charges,21.47,38.38,,17.176,percent of total billed charges,38.38% of total billed charges,44.76,80,,35.808,percent of total billed charges,80% of total billed charges,34.54,61.74,,27.632,percent of total billed charges,61.74% of total billed charges,57.07,102,,45.656,percent of total billed charges,102% of total billed charges,21.26,38,,17.008,percent of total billed charges,38% of total billed charges,19.58,57.07,
A lab test used to detect bacteria or fungi in a sample taken from the site of a suspected infection,500020,CDM,306,RC,87205,HCPCS,Outpatient,,,56,42,,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,2.95,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,3.1,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,37.67,67.275,,30.136,percent of total billed charges,67.275% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,4.31,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,34.57,61.74,,27.656,percent of total billed charges,61.74% of total billed charges,3.01,102,,,Fee Schedule,102% of GA Medicaid Rate,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,2.95,50.4,
Test of body fluid other than blood to assess for bacteria,5000019,CDM,306,RC,87070,HCPCS,Outpatient,,,56,42,,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,10.83,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,11.37,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,37.67,67.275,,30.136,percent of total billed charges,67.275% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,8.71,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,34.57,61.74,,27.656,percent of total billed charges,61.74% of total billed charges,11.05,102,,,Fee Schedule,102% of GA Medicaid Rate,8.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.62,50.4,
Test of body fluid other than blood to assess for bacteria,5000021,CDM,306,RC,87070,HCPCS,Outpatient,,,56,42,,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,10.83,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,11.37,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,37.67,67.275,,30.136,percent of total billed charges,67.275% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,8.71,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,34.57,61.74,,27.656,percent of total billed charges,61.74% of total billed charges,11.05,102,,,Fee Schedule,102% of GA Medicaid Rate,8.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.62,50.4,
Coagulation assessment blood test,5000110,CDM,305,RC,85730,HCPCS,Outpatient,,,56,42,,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,7.54,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.01,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.01,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,7.92,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,37.67,67.275,,30.136,percent of total billed charges,67.275% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,6.07,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,34.57,61.74,,27.656,percent of total billed charges,61.74% of total billed charges,7.69,102,,,Fee Schedule,102% of GA Medicaid Rate,6.01,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.01,50.4,
Coagulation assessment blood test,5000111,CDM,305,RC,85730,HCPCS,Outpatient,,,56,42,,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,7.54,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.01,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.01,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,7.92,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,37.67,67.275,,30.136,percent of total billed charges,67.275% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,6.07,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,34.57,61.74,,27.656,percent of total billed charges,61.74% of total billed charges,7.69,102,,,Fee Schedule,102% of GA Medicaid Rate,6.01,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.01,50.4,
A lab test used to detect bacteria or fungi in a sample taken from the site of a suspected infection,5000141,CDM,300,RC,87205,HCPCS,Outpatient,,,56,42,,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,2.95,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,3.1,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,37.67,67.275,,30.136,percent of total billed charges,67.275% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,4.31,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,34.57,61.74,,27.656,percent of total billed charges,61.74% of total billed charges,3.01,102,,,Fee Schedule,102% of GA Medicaid Rate,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,2.95,50.4,
A test used to determine which medications work on bacteria for fungi,5000183,CDM,306,RC,87186,HCPCS,Outpatient,,,56,42,,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,10.87,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.65,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.65,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,11.41,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,37.67,67.275,,30.136,percent of total billed charges,67.275% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,8.74,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,34.57,61.74,,27.656,percent of total billed charges,61.74% of total billed charges,11.09,102,,,Fee Schedule,102% of GA Medicaid Rate,8.65,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.65,50.4,
Test of body fluid other than blood to assess for bacteria,5000200,CDM,306,RC,87070,HCPCS,Outpatient,,,56,42,,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,10.83,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,11.37,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,37.67,67.275,,30.136,percent of total billed charges,67.275% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,8.71,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,34.57,61.74,,27.656,percent of total billed charges,61.74% of total billed charges,11.05,102,,,Fee Schedule,102% of GA Medicaid Rate,8.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.62,50.4,
Test of body fluid other than blood to assess for bacteria,5000201,CDM,306,RC,87070,HCPCS,Outpatient,,,56,42,,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,10.83,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,11.37,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,37.67,67.275,,30.136,percent of total billed charges,67.275% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,8.71,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,34.57,61.74,,27.656,percent of total billed charges,61.74% of total billed charges,11.05,102,,,Fee Schedule,102% of GA Medicaid Rate,8.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.62,50.4,
Test of body fluid other than blood to assess for bacteria,5000203,CDM,306,RC,87070,HCPCS,Outpatient,,,56,42,,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,10.83,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,11.37,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,37.67,67.275,,30.136,percent of total billed charges,67.275% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,8.71,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,34.57,61.74,,27.656,percent of total billed charges,61.74% of total billed charges,11.05,102,,,Fee Schedule,102% of GA Medicaid Rate,8.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.62,50.4,
Test of body fluid other than blood to assess for bacteria,5000204,CDM,306,RC,87070,HCPCS,Outpatient,,,56,42,,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,10.83,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,11.37,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,37.67,67.275,,30.136,percent of total billed charges,67.275% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,8.71,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,34.57,61.74,,27.656,percent of total billed charges,61.74% of total billed charges,11.05,102,,,Fee Schedule,102% of GA Medicaid Rate,8.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.62,50.4,
Test of body fluid other than blood to assess for bacteria,5000207,CDM,306,RC,87070,HCPCS,Outpatient,,,56,42,,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,10.83,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,11.37,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,37.67,67.275,,30.136,percent of total billed charges,67.275% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,8.71,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,34.57,61.74,,27.656,percent of total billed charges,61.74% of total billed charges,11.05,102,,,Fee Schedule,102% of GA Medicaid Rate,8.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.62,50.4,
Test of body fluid other than blood to assess for bacteria,5000208,CDM,306,RC,87070,HCPCS,Outpatient,,,56,42,,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,10.83,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,11.37,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,37.67,67.275,,30.136,percent of total billed charges,67.275% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,8.71,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,34.57,61.74,,27.656,percent of total billed charges,61.74% of total billed charges,11.05,102,,,Fee Schedule,102% of GA Medicaid Rate,8.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.62,50.4,
Test of body fluid other than blood to assess for bacteria,5000209,CDM,306,RC,87070,HCPCS,Outpatient,,,56,42,,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,10.83,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,11.37,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,37.67,67.275,,30.136,percent of total billed charges,67.275% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,8.71,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,34.57,61.74,,27.656,percent of total billed charges,61.74% of total billed charges,11.05,102,,,Fee Schedule,102% of GA Medicaid Rate,8.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.62,50.4,
A lab test used to detect bacteria or fungi in a sample taken from the site of a suspected infection,5000210,CDM,306,RC,87205,HCPCS,Outpatient,,,56,42,,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,2.95,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,3.1,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,37.67,67.275,,30.136,percent of total billed charges,67.275% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,4.31,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,34.57,61.74,,27.656,percent of total billed charges,61.74% of total billed charges,3.01,102,,,Fee Schedule,102% of GA Medicaid Rate,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,2.95,50.4,
A lab test used to detect bacteria or fungi in a sample taken from the site of a suspected infection,5000220,CDM,306,RC,87205,HCPCS,Outpatient,,,56,42,,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,2.95,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,3.1,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,37.67,67.275,,30.136,percent of total billed charges,67.275% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,4.31,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,34.57,61.74,,27.656,percent of total billed charges,61.74% of total billed charges,3.01,102,,,Fee Schedule,102% of GA Medicaid Rate,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,2.95,50.4,
HEMOCCULT SC 1st SPECIMEN,5000510,CDM,301,RC,82270,HCPCS,Outpatient,,,56,42,,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,4.04,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.38,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.38,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,4.24,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,37.67,67.275,,30.136,percent of total billed charges,67.275% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,4.42,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,34.57,61.74,,27.656,percent of total billed charges,61.74% of total billed charges,4.12,102,,,Fee Schedule,102% of GA Medicaid Rate,4.38,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.04,50.4,
SODIUM (FECES),5000753,CDM,309,RC,84302,HCPCS,Outpatient,,,56,42,,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,4.35,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.86,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.86,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,4.57,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,37.67,67.275,,30.136,percent of total billed charges,67.275% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,4.91,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,34.57,61.74,,27.656,percent of total billed charges,61.74% of total billed charges,4.44,102,,,Fee Schedule,102% of GA Medicaid Rate,4.86,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.35,50.4,
A lab test used to detect bacteria or fungi in a sample taken from the site of a suspected infection,5000856,CDM,300,RC,87205,HCPCS,Outpatient,,,56,42,,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,2.95,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,3.1,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,37.67,67.275,,30.136,percent of total billed charges,67.275% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,4.31,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,34.57,61.74,,27.656,percent of total billed charges,61.74% of total billed charges,3.01,102,,,Fee Schedule,102% of GA Medicaid Rate,4.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,2.95,50.4,
A test used to determine which medications work on bacteria for fungi,5000900,CDM,306,RC,87186,HCPCS,Outpatient,,,56,42,,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,10.87,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.65,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.65,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,11.41,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,37.67,67.275,,30.136,percent of total billed charges,67.275% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,8.74,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,34.57,61.74,,27.656,percent of total billed charges,61.74% of total billed charges,11.09,102,,,Fee Schedule,102% of GA Medicaid Rate,8.65,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.65,50.4,
Test of body fluid other than blood to assess for bacteria,5000910,CDM,306,RC,87070,HCPCS,Outpatient,,,56,42,,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,10.83,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,11.37,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,37.67,67.275,,30.136,percent of total billed charges,67.275% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,8.71,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,34.57,61.74,,27.656,percent of total billed charges,61.74% of total billed charges,11.05,102,,,Fee Schedule,102% of GA Medicaid Rate,8.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.62,50.4,
Urine test to measure albumin,5001407,CDM,301,RC,82043,HCPCS,Outpatient,,,56,42,,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,7.28,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.78,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.78,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,7.64,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,37.67,67.275,,30.136,percent of total billed charges,67.275% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,5.84,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,34.57,61.74,,27.656,percent of total billed charges,61.74% of total billed charges,7.43,102,,,Fee Schedule,102% of GA Medicaid Rate,5.78,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.78,50.4,
Urine test to measure albumin,5001426,CDM,301,RC,82043,HCPCS,Outpatient,,,56,42,,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,7.28,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.78,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.78,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,7.64,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,37.67,67.275,,30.136,percent of total billed charges,67.275% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,5.84,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,34.57,61.74,,27.656,percent of total billed charges,61.74% of total billed charges,7.43,102,,,Fee Schedule,102% of GA Medicaid Rate,5.78,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.78,50.4,
Urine test to measure albumin,5001427,CDM,301,RC,82043,HCPCS,Outpatient,,,56,42,,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,7.28,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.78,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.78,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,7.64,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,37.67,67.275,,30.136,percent of total billed charges,67.275% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,5.84,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,34.57,61.74,,27.656,percent of total billed charges,61.74% of total billed charges,7.43,102,,,Fee Schedule,102% of GA Medicaid Rate,5.78,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.78,50.4,
Urine test to measure albumin,5001429,CDM,301,RC,82043,HCPCS,Outpatient,,,56,42,,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,7.28,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.78,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.78,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,7.64,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,37.67,67.275,,30.136,percent of total billed charges,67.275% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,5.84,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,34.57,61.74,,27.656,percent of total billed charges,61.74% of total billed charges,7.43,102,,,Fee Schedule,102% of GA Medicaid Rate,5.78,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.78,50.4,
HEMOGLOBIN A2,5001829,CDM,301,RC,83021,HCPCS,Outpatient,,,56,42,,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,7.55,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.06,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.06,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,7.93,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,37.67,67.275,,30.136,percent of total billed charges,67.275% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,18.24,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,34.57,61.74,,27.656,percent of total billed charges,61.74% of total billed charges,7.7,102,,,Fee Schedule,102% of GA Medicaid Rate,18.06,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.55,50.4,
A test used to determine which medications work on bacteria for fungi,5002079,CDM,306,RC,87186,HCPCS,Outpatient,,,56,42,,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,10.87,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.65,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.65,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,11.41,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,37.67,67.275,,30.136,percent of total billed charges,67.275% of total billed charges,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,8.74,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,34.57,61.74,,27.656,percent of total billed charges,61.74% of total billed charges,11.09,102,,,Fee Schedule,102% of GA Medicaid Rate,8.65,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.65,50.4,
CENTRAL LINE DRESSING TRAY,3004211,CDM,270,RC,,,Outpatient,,,56.27,42.2,,43.89,78,,35.112,percent of total billed charges,78% of total billed charges,35.45,63,,28.36,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,21.38,38,,17.104,percent of total billed charges,38% of total billed charges,21.38,38,,17.104,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,50.64,90,,40.512,percent of total billed charges,90% of total billed charges,19.69,35,,15.752,percent of total billed charges,35% of total billed charges,37.86,67.275,,30.288,percent of total billed charges,67.275% of total billed charges,45.02,80,,36.016,percent of total billed charges,80% of total billed charges,21.6,38.38,,17.28,percent of total billed charges,38.38% of total billed charges,45.02,80,,36.016,percent of total billed charges,80% of total billed charges,34.74,61.74,,27.792,percent of total billed charges,61.74% of total billed charges,57.4,102,,45.92,percent of total billed charges,102% of total billed charges,21.38,38,,17.104,percent of total billed charges,38% of total billed charges,19.69,57.4,
DUO DERM CGF 8X8,3001172,CDM,270,RC,,,Outpatient,,,56.51,42.38,,44.08,78,,35.264,percent of total billed charges,78% of total billed charges,35.6,63,,28.48,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,21.47,38,,17.176,percent of total billed charges,38% of total billed charges,21.47,38,,17.176,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,50.86,90,,40.688,percent of total billed charges,90% of total billed charges,19.78,35,,15.824,percent of total billed charges,35% of total billed charges,38.02,67.275,,30.416,percent of total billed charges,67.275% of total billed charges,45.21,80,,36.168,percent of total billed charges,80% of total billed charges,21.69,38.38,,17.352,percent of total billed charges,38.38% of total billed charges,45.21,80,,36.168,percent of total billed charges,80% of total billed charges,34.89,61.74,,27.912,percent of total billed charges,61.74% of total billed charges,57.64,102,,46.112,percent of total billed charges,102% of total billed charges,21.47,38,,17.176,percent of total billed charges,38% of total billed charges,19.78,57.64,
KNEE DRESSING 16  - Universal,3001026,CDM,270,RC,,,Outpatient,,,56.9,42.68,,44.38,78,,35.504,percent of total billed charges,78% of total billed charges,35.85,63,,28.68,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,21.62,38,,17.296,percent of total billed charges,38% of total billed charges,21.62,38,,17.296,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,51.21,90,,40.968,percent of total billed charges,90% of total billed charges,19.92,35,,15.936,percent of total billed charges,35% of total billed charges,38.28,67.275,,30.624,percent of total billed charges,67.275% of total billed charges,45.52,80,,36.416,percent of total billed charges,80% of total billed charges,21.84,38.38,,17.472,percent of total billed charges,38.38% of total billed charges,45.52,80,,36.416,percent of total billed charges,80% of total billed charges,35.13,61.74,,28.104,percent of total billed charges,61.74% of total billed charges,58.04,102,,46.432,percent of total billed charges,102% of total billed charges,21.62,38,,17.296,percent of total billed charges,38% of total billed charges,19.92,58.04,
Prostate cancer screening; prostate specific antigen test (psa),5001719,CDM,301,RC,G0103,HCPCS,Outpatient,,,57,42.75,,44.46,78,,35.568,percent of total billed charges,78% of total billed charges,25.7,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,19.31,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,19.31,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,26.99,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,38.35,67.275,,30.68,percent of total billed charges,67.275% of total billed charges,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,19.5,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,35.19,61.74,,28.152,percent of total billed charges,61.74% of total billed charges,26.21,102,,,Fee Schedule,102% of GA Medicaid Rate,19.31,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,19.31,51.3,
LIPOPROTEIN ELECTROPHORES,5001782,CDM,301,RC,83700,HCPCS,Outpatient,,,57,42.75,,44.46,78,,35.568,percent of total billed charges,78% of total billed charges,11,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,11.26,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.26,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,11.55,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,38.35,67.275,,30.68,percent of total billed charges,67.275% of total billed charges,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,11.37,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,35.19,61.74,,28.152,percent of total billed charges,61.74% of total billed charges,11.22,102,,,Fee Schedule,102% of GA Medicaid Rate,11.26,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11,51.3,
"Use of sound waves to treat medical problems, especially musculoskeletal problems like inflammation from injuries",9000016,CDM,420,RC,97035,HCPCS,Outpatient,,,57,42.75,,44.46,78,,35.568,percent of total billed charges,78% of total billed charges,35.91,63,,28.728,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,21.66,38,,17.328,percent of total billed charges,38% of total billed charges,21.66,38,,17.328,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,19.95,35,,15.96,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,21.88,38.38,,17.504,percent of total billed charges,38.38% of total billed charges,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,35.19,61.74,,28.152,percent of total billed charges,61.74% of total billed charges,58.14,102,,46.512,percent of total billed charges,102% of total billed charges,21.66,38,,17.328,percent of total billed charges,38% of total billed charges,19.95,145.93,
BAIR WARM GOWN,3004279,CDM,270,RC,,,Outpatient,,,57.91,43.43,,45.17,78,,36.136,percent of total billed charges,78% of total billed charges,36.48,63,,29.184,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,22.01,38,,17.608,percent of total billed charges,38% of total billed charges,22.01,38,,17.608,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,52.12,90,,41.696,percent of total billed charges,90% of total billed charges,20.27,35,,16.216,percent of total billed charges,35% of total billed charges,38.96,67.275,,31.168,percent of total billed charges,67.275% of total billed charges,46.33,80,,37.064,percent of total billed charges,80% of total billed charges,22.23,38.38,,17.784,percent of total billed charges,38.38% of total billed charges,46.33,80,,37.064,percent of total billed charges,80% of total billed charges,35.75,61.74,,28.6,percent of total billed charges,61.74% of total billed charges,59.07,102,,47.256,percent of total billed charges,102% of total billed charges,22.01,38,,17.608,percent of total billed charges,38% of total billed charges,20.27,59.07,
"REDUCING SUBSTANCES, FECES",5000519,CDM,302,RC,84376,HCPCS,Outpatient,,,58,43.5,,45.24,78,,36.192,percent of total billed charges,78% of total billed charges,6.92,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.5,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.5,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,7.27,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,39.02,67.275,,31.216,percent of total billed charges,67.275% of total billed charges,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,5.56,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,35.81,61.74,,28.648,percent of total billed charges,61.74% of total billed charges,7.06,102,,,Fee Schedule,102% of GA Medicaid Rate,5.5,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.5,52.2,
BRUCELLA AB,5001938,CDM,302,RC,86622,HCPCS,Outpatient,,,58,43.5,,45.24,78,,36.192,percent of total billed charges,78% of total billed charges,11.23,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,11.79,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,39.02,67.275,,31.216,percent of total billed charges,67.275% of total billed charges,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,9.02,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,35.81,61.74,,28.648,percent of total billed charges,61.74% of total billed charges,11.45,102,,,Fee Schedule,102% of GA Medicaid Rate,8.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.93,52.2,
BB AUTOLOGOUS UNIT ARC ADM C,5200020,CDM,300,RC,86999,HCPCS,Outpatient,,,58,43.5,,45.24,78,,36.192,percent of total billed charges,78% of total billed charges,36.54,63,,29.232,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,22.04,38,,17.632,percent of total billed charges,38% of total billed charges,22.04,38,,17.632,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,20.3,35,,16.24,percent of total billed charges,35% of total billed charges,39.02,67.275,,31.216,percent of total billed charges,67.275% of total billed charges,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,22.26,38.38,,17.808,percent of total billed charges,38.38% of total billed charges,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,35.81,61.74,,28.648,percent of total billed charges,61.74% of total billed charges,59.16,102,,47.328,percent of total billed charges,102% of total billed charges,22.04,38,,17.632,percent of total billed charges,38% of total billed charges,20.3,59.16,
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",9590012,CDM,420,RC,97110,HCPCS,Outpatient,,,58,43.5,,45.24,78,,36.192,percent of total billed charges,78% of total billed charges,36.54,63,,29.232,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,22.04,38,,17.632,percent of total billed charges,38% of total billed charges,22.04,38,,17.632,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,20.3,35,,16.24,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,22.26,38.38,,17.808,percent of total billed charges,38.38% of total billed charges,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,35.81,61.74,,28.648,percent of total billed charges,61.74% of total billed charges,59.16,102,,47.328,percent of total billed charges,102% of total billed charges,22.04,38,,17.632,percent of total billed charges,38% of total billed charges,20.3,145.93,
CERV COLLAR PHILADELPHIA MED,3001319,CDM,270,RC,,,Outpatient,,,58.25,43.69,,45.44,78,,36.352,percent of total billed charges,78% of total billed charges,36.7,63,,29.36,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,22.14,38,,17.712,percent of total billed charges,38% of total billed charges,22.14,38,,17.712,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,52.43,90,,41.944,percent of total billed charges,90% of total billed charges,20.39,35,,16.312,percent of total billed charges,35% of total billed charges,39.19,67.275,,31.352,percent of total billed charges,67.275% of total billed charges,46.6,80,,37.28,percent of total billed charges,80% of total billed charges,22.36,38.38,,17.888,percent of total billed charges,38.38% of total billed charges,46.6,80,,37.28,percent of total billed charges,80% of total billed charges,35.96,61.74,,28.768,percent of total billed charges,61.74% of total billed charges,59.42,102,,47.536,percent of total billed charges,102% of total billed charges,22.14,38,,17.712,percent of total billed charges,38% of total billed charges,20.39,59.42,
KNEE DRESSING 16  79-80420,3001009,CDM,270,RC,,,Outpatient,,,58.3,43.73,,45.47,78,,36.376,percent of total billed charges,78% of total billed charges,36.73,63,,29.384,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,22.15,38,,17.72,percent of total billed charges,38% of total billed charges,22.15,38,,17.72,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,52.47,90,,41.976,percent of total billed charges,90% of total billed charges,20.41,35,,16.328,percent of total billed charges,35% of total billed charges,39.22,67.275,,31.376,percent of total billed charges,67.275% of total billed charges,46.64,80,,37.312,percent of total billed charges,80% of total billed charges,22.38,38.38,,17.904,percent of total billed charges,38.38% of total billed charges,46.64,80,,37.312,percent of total billed charges,80% of total billed charges,35.99,61.74,,28.792,percent of total billed charges,61.74% of total billed charges,59.47,102,,47.576,percent of total billed charges,102% of total billed charges,22.15,38,,17.72,percent of total billed charges,38% of total billed charges,20.41,59.47,
CULTURE FUNGUS BLOOD,5000217,CDM,306,RC,87103,HCPCS,Outpatient,,,59,44.25,,46.02,78,,36.816,percent of total billed charges,78% of total billed charges,11.34,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,20.46,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.46,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,11.91,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,39.69,67.275,,31.752,percent of total billed charges,67.275% of total billed charges,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,20.66,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,36.43,61.74,,29.144,percent of total billed charges,61.74% of total billed charges,11.57,102,,,Fee Schedule,102% of GA Medicaid Rate,20.46,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.34,53.1,
Psychiatric treatment in which seizures are electrically induced in patients to provide relief from mental disorders,9590024,CDM,420,RC,97033,HCPCS,Outpatient,,,59,44.25,,46.02,78,,36.816,percent of total billed charges,78% of total billed charges,37.17,63,,29.736,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,22.42,38,,17.936,percent of total billed charges,38% of total billed charges,22.42,38,,17.936,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,20.65,35,,16.52,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,22.64,38.38,,18.112,percent of total billed charges,38.38% of total billed charges,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,36.43,61.74,,29.144,percent of total billed charges,61.74% of total billed charges,60.18,102,,48.144,percent of total billed charges,102% of total billed charges,22.42,38,,17.936,percent of total billed charges,38% of total billed charges,20.65,145.93,
ETHILON 5-0 PC-3 1965G,3004007,CDM,270,RC,,,Outpatient,,,59.25,44.44,,46.22,78,,36.976,percent of total billed charges,78% of total billed charges,37.33,63,,29.864,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,22.52,38,,18.016,percent of total billed charges,38% of total billed charges,22.52,38,,18.016,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,53.33,90,,42.664,percent of total billed charges,90% of total billed charges,20.74,35,,16.592,percent of total billed charges,35% of total billed charges,39.86,67.275,,31.888,percent of total billed charges,67.275% of total billed charges,47.4,80,,37.92,percent of total billed charges,80% of total billed charges,22.74,38.38,,18.192,percent of total billed charges,38.38% of total billed charges,47.4,80,,37.92,percent of total billed charges,80% of total billed charges,36.58,61.74,,29.264,percent of total billed charges,61.74% of total billed charges,60.44,102,,48.352,percent of total billed charges,102% of total billed charges,22.52,38,,18.016,percent of total billed charges,38% of total billed charges,20.74,60.44,
CRUTCH TALL,3004204,CDM,270,RC,,,Outpatient,,,59.97,44.98,,46.78,78,,37.424,percent of total billed charges,78% of total billed charges,37.78,63,,30.224,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,22.79,38,,18.232,percent of total billed charges,38% of total billed charges,22.79,38,,18.232,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,53.97,90,,43.176,percent of total billed charges,90% of total billed charges,20.99,35,,16.792,percent of total billed charges,35% of total billed charges,40.34,67.275,,32.272,percent of total billed charges,67.275% of total billed charges,47.98,80,,38.384,percent of total billed charges,80% of total billed charges,23.02,38.38,,18.416,percent of total billed charges,38.38% of total billed charges,47.98,80,,38.384,percent of total billed charges,80% of total billed charges,37.03,61.74,,29.624,percent of total billed charges,61.74% of total billed charges,61.17,102,,48.936,percent of total billed charges,102% of total billed charges,22.79,38,,18.232,percent of total billed charges,38% of total billed charges,20.99,61.17,
"K-WIRE 9  X .062 , one-ended",3005123,CDM,270,RC,,,Outpatient,,,60,45,,46.8,78,,37.44,percent of total billed charges,78% of total billed charges,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,22.8,38,,18.24,percent of total billed charges,38% of total billed charges,22.8,38,,18.24,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,54,90,,43.2,percent of total billed charges,90% of total billed charges,21,35,,16.8,percent of total billed charges,35% of total billed charges,40.37,67.275,,32.296,percent of total billed charges,67.275% of total billed charges,48,80,,38.4,percent of total billed charges,80% of total billed charges,23.03,38.38,,18.424,percent of total billed charges,38.38% of total billed charges,48,80,,38.4,percent of total billed charges,80% of total billed charges,37.04,61.74,,29.632,percent of total billed charges,61.74% of total billed charges,61.2,102,,48.96,percent of total billed charges,102% of total billed charges,22.8,38,,18.24,percent of total billed charges,38% of total billed charges,21,61.2,
CAROTENE,5002018,CDM,301,RC,82380,HCPCS,Outpatient,,,60,45,,46.8,78,,37.44,percent of total billed charges,78% of total billed charges,11.6,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,9.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,9.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,54,90,,43.2,percent of total billed charges,90% of total billed charges,12.18,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,40.37,67.275,,32.296,percent of total billed charges,67.275% of total billed charges,48,80,,38.4,percent of total billed charges,80% of total billed charges,9.31,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,48,80,,38.4,percent of total billed charges,80% of total billed charges,37.04,61.74,,29.632,percent of total billed charges,61.74% of total billed charges,11.83,102,,,Fee Schedule,102% of GA Medicaid Rate,9.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,9.22,54,
IN-LINE CLOSED SUCT - ENDOTRACHEAL,3003001,CDM,270,RC,,,Outpatient,,,60.38,45.29,,47.1,78,,37.68,percent of total billed charges,78% of total billed charges,38.04,63,,30.432,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,22.94,38,,18.352,percent of total billed charges,38% of total billed charges,22.94,38,,18.352,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,54.34,90,,43.472,percent of total billed charges,90% of total billed charges,21.13,35,,16.904,percent of total billed charges,35% of total billed charges,40.62,67.275,,32.496,percent of total billed charges,67.275% of total billed charges,48.3,80,,38.64,percent of total billed charges,80% of total billed charges,23.17,38.38,,18.536,percent of total billed charges,38.38% of total billed charges,48.3,80,,38.64,percent of total billed charges,80% of total billed charges,37.28,61.74,,29.824,percent of total billed charges,61.74% of total billed charges,61.59,102,,49.272,percent of total billed charges,102% of total billed charges,22.94,38,,18.352,percent of total billed charges,38% of total billed charges,21.13,61.59,
IN-LINE CLOSED SUCT - TRACHEOSTOMY,3003022,CDM,270,RC,,,Outpatient,,,60.38,45.29,,47.1,78,,37.68,percent of total billed charges,78% of total billed charges,38.04,63,,30.432,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,22.94,38,,18.352,percent of total billed charges,38% of total billed charges,22.94,38,,18.352,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,54.34,90,,43.472,percent of total billed charges,90% of total billed charges,21.13,35,,16.904,percent of total billed charges,35% of total billed charges,40.62,67.275,,32.496,percent of total billed charges,67.275% of total billed charges,48.3,80,,38.64,percent of total billed charges,80% of total billed charges,23.17,38.38,,18.536,percent of total billed charges,38.38% of total billed charges,48.3,80,,38.64,percent of total billed charges,80% of total billed charges,37.28,61.74,,29.824,percent of total billed charges,61.74% of total billed charges,61.59,102,,49.272,percent of total billed charges,102% of total billed charges,22.94,38,,18.352,percent of total billed charges,38% of total billed charges,21.13,61.59,
SPO2 DISP NURSING SERVICE,3004502,CDM,270,RC,,,Outpatient,,,60.75,45.56,,47.39,78,,37.912,percent of total billed charges,78% of total billed charges,38.27,63,,30.616,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,23.09,38,,18.472,percent of total billed charges,38% of total billed charges,23.09,38,,18.472,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,54.68,90,,43.744,percent of total billed charges,90% of total billed charges,21.26,35,,17.008,percent of total billed charges,35% of total billed charges,40.87,67.275,,32.696,percent of total billed charges,67.275% of total billed charges,48.6,80,,38.88,percent of total billed charges,80% of total billed charges,23.32,38.38,,18.656,percent of total billed charges,38.38% of total billed charges,48.6,80,,38.88,percent of total billed charges,80% of total billed charges,37.51,61.74,,30.008,percent of total billed charges,61.74% of total billed charges,61.97,102,,49.576,percent of total billed charges,102% of total billed charges,23.09,38,,18.472,percent of total billed charges,38% of total billed charges,21.26,61.97,
PT FUNCTIONAL EVALUATION,9590010,CDM,420,RC,97750,HCPCS,Outpatient,,,61,45.75,,47.58,78,,38.064,percent of total billed charges,78% of total billed charges,38.43,63,,30.744,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,23.18,38,,18.544,percent of total billed charges,38% of total billed charges,23.18,38,,18.544,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,21.35,35,,17.08,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,23.41,38.38,,18.728,percent of total billed charges,38.38% of total billed charges,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,37.66,61.74,,30.128,percent of total billed charges,61.74% of total billed charges,62.22,102,,49.776,percent of total billed charges,102% of total billed charges,23.18,38,,18.544,percent of total billed charges,38% of total billed charges,21.35,145.93,
A technique used by physical therapists to restore normal body movement patterns,9590021,CDM,420,RC,97112,HCPCS,Outpatient,,,61,45.75,,47.58,78,,38.064,percent of total billed charges,78% of total billed charges,38.43,63,,30.744,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,23.18,38,,18.544,percent of total billed charges,38% of total billed charges,23.18,38,,18.544,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,21.35,35,,17.08,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,23.41,38.38,,18.728,percent of total billed charges,38.38% of total billed charges,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,37.66,61.74,,30.128,percent of total billed charges,61.74% of total billed charges,62.22,102,,49.776,percent of total billed charges,102% of total billed charges,23.18,38,,18.544,percent of total billed charges,38% of total billed charges,21.35,145.93,
PT PROSTH TRAINING,9590030,CDM,420,RC,97761,HCPCS,Outpatient,,,61,45.75,,47.58,78,,38.064,percent of total billed charges,78% of total billed charges,38.43,63,,30.744,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,23.18,38,,18.544,percent of total billed charges,38% of total billed charges,23.18,38,,18.544,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,21.35,35,,17.08,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,23.41,38.38,,18.728,percent of total billed charges,38.38% of total billed charges,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,37.66,61.74,,30.128,percent of total billed charges,61.74% of total billed charges,62.22,102,,49.776,percent of total billed charges,102% of total billed charges,23.18,38,,18.544,percent of total billed charges,38% of total billed charges,21.35,145.93,
MEPILEX TRANSFER AG 4X5,3000561,CDM,270,RC,,,Outpatient,,,61.2,45.9,,47.74,78,,38.192,percent of total billed charges,78% of total billed charges,38.56,63,,30.848,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,23.26,38,,18.608,percent of total billed charges,38% of total billed charges,23.26,38,,18.608,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,55.08,90,,44.064,percent of total billed charges,90% of total billed charges,21.42,35,,17.136,percent of total billed charges,35% of total billed charges,41.17,67.275,,32.936,percent of total billed charges,67.275% of total billed charges,48.96,80,,39.168,percent of total billed charges,80% of total billed charges,23.49,38.38,,18.792,percent of total billed charges,38.38% of total billed charges,48.96,80,,39.168,percent of total billed charges,80% of total billed charges,37.78,61.74,,30.224,percent of total billed charges,61.74% of total billed charges,62.42,102,,49.936,percent of total billed charges,102% of total billed charges,23.26,38,,18.608,percent of total billed charges,38% of total billed charges,21.42,62.42,
NEEDLE VERRES 150MM INSUFFLATION,3003074,CDM,270,RC,,,Outpatient,,,61.75,46.31,,48.17,78,,38.536,percent of total billed charges,78% of total billed charges,38.9,63,,31.12,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,23.47,38,,18.776,percent of total billed charges,38% of total billed charges,23.47,38,,18.776,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,55.58,90,,44.464,percent of total billed charges,90% of total billed charges,21.61,35,,17.288,percent of total billed charges,35% of total billed charges,41.54,67.275,,33.232,percent of total billed charges,67.275% of total billed charges,49.4,80,,39.52,percent of total billed charges,80% of total billed charges,23.7,38.38,,18.96,percent of total billed charges,38.38% of total billed charges,49.4,80,,39.52,percent of total billed charges,80% of total billed charges,38.12,61.74,,30.496,percent of total billed charges,61.74% of total billed charges,62.99,102,,50.392,percent of total billed charges,102% of total billed charges,23.47,38,,18.776,percent of total billed charges,38% of total billed charges,21.61,62.99,
MODULE O2 PURPLE,3000036,CDM,270,RC,,,Outpatient,,,61.92,46.44,,48.3,78,,38.64,percent of total billed charges,78% of total billed charges,39.01,63,,31.208,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,23.53,38,,18.824,percent of total billed charges,38% of total billed charges,23.53,38,,18.824,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,55.73,90,,44.584,percent of total billed charges,90% of total billed charges,21.67,35,,17.336,percent of total billed charges,35% of total billed charges,41.66,67.275,,33.328,percent of total billed charges,67.275% of total billed charges,49.54,80,,39.632,percent of total billed charges,80% of total billed charges,23.76,38.38,,19.008,percent of total billed charges,38.38% of total billed charges,49.54,80,,39.632,percent of total billed charges,80% of total billed charges,38.23,61.74,,30.584,percent of total billed charges,61.74% of total billed charges,63.16,102,,50.528,percent of total billed charges,102% of total billed charges,23.53,38,,18.824,percent of total billed charges,38% of total billed charges,21.67,63.16,
Blood test to identify bacteria that may be contributing to symptoms in the gastrointestinal tract,5000224,CDM,306,RC,87046,HCPCS,Outpatient,,,62,46.5,,48.36,78,,38.688,percent of total billed charges,78% of total billed charges,2.97,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,9.44,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,9.44,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,3.12,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,41.71,67.275,,33.368,percent of total billed charges,67.275% of total billed charges,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,9.53,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,38.28,61.74,,30.624,percent of total billed charges,61.74% of total billed charges,3.03,102,,,Fee Schedule,102% of GA Medicaid Rate,9.44,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,2.97,55.8,
Blood test to identify bacteria that may be contributing to symptoms in the gastrointestinal tract,5000225,CDM,306,RC,87046,HCPCS,Outpatient,,,62,46.5,,48.36,78,,38.688,percent of total billed charges,78% of total billed charges,2.97,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,9.44,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,9.44,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,3.12,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,41.71,67.275,,33.368,percent of total billed charges,67.275% of total billed charges,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,9.53,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,38.28,61.74,,30.624,percent of total billed charges,61.74% of total billed charges,3.03,102,,,Fee Schedule,102% of GA Medicaid Rate,9.44,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,2.97,55.8,
.CULTURE STOOL SAL SHIG,5000499,CDM,306,RC,87045,HCPCS,Outpatient,,,62,46.5,,48.36,78,,38.688,percent of total billed charges,78% of total billed charges,39.06,63,,31.248,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,9.44,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,9.44,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,21.7,35,,17.36,percent of total billed charges,35% of total billed charges,41.71,67.275,,33.368,percent of total billed charges,67.275% of total billed charges,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,9.53,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,38.28,61.74,,30.624,percent of total billed charges,61.74% of total billed charges,63.24,102,,50.592,percent of total billed charges,102% of total billed charges,9.44,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,9.44,63.24,
Blood test to identify bacteria that may be contributing to symptoms in the gastrointestinal tract,5000509,CDM,306,RC,87046,HCPCS,Outpatient,,,62,46.5,,48.36,78,,38.688,percent of total billed charges,78% of total billed charges,2.97,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,9.44,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,9.44,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,3.12,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,41.71,67.275,,33.368,percent of total billed charges,67.275% of total billed charges,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,9.53,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,38.28,61.74,,30.624,percent of total billed charges,61.74% of total billed charges,3.03,102,,,Fee Schedule,102% of GA Medicaid Rate,9.44,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,2.97,55.8,
Blood test to identify bacteria that may be contributing to symptoms in the gastrointestinal tract,5001504,CDM,306,RC,87046,HCPCS,Outpatient,,,62,46.5,,48.36,78,,38.688,percent of total billed charges,78% of total billed charges,2.97,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,9.44,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,9.44,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,3.12,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,41.71,67.275,,33.368,percent of total billed charges,67.275% of total billed charges,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,9.53,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,38.28,61.74,,30.624,percent of total billed charges,61.74% of total billed charges,3.03,102,,,Fee Schedule,102% of GA Medicaid Rate,9.44,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,2.97,55.8,
RUSSELL VIPER VENOM-DILUT,5001929,CDM,300,RC,85613,HCPCS,Outpatient,,,62,46.5,,48.36,78,,38.688,percent of total billed charges,78% of total billed charges,12.03,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,9.58,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,9.58,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,12.63,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,41.71,67.275,,33.368,percent of total billed charges,67.275% of total billed charges,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,9.68,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,38.28,61.74,,30.624,percent of total billed charges,61.74% of total billed charges,12.27,102,,,Fee Schedule,102% of GA Medicaid Rate,9.58,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,9.58,55.8,
SPO2 SENSOR PEDIATRIC DISP - MINDRAY,3004173,CDM,270,RC,,,Outpatient,,,62.04,46.53,,48.39,78,,38.712,percent of total billed charges,78% of total billed charges,39.09,63,,31.272,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,23.58,38,,18.864,percent of total billed charges,38% of total billed charges,23.58,38,,18.864,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,55.84,90,,44.672,percent of total billed charges,90% of total billed charges,21.71,35,,17.368,percent of total billed charges,35% of total billed charges,41.74,67.275,,33.392,percent of total billed charges,67.275% of total billed charges,49.63,80,,39.704,percent of total billed charges,80% of total billed charges,23.81,38.38,,19.048,percent of total billed charges,38.38% of total billed charges,49.63,80,,39.704,percent of total billed charges,80% of total billed charges,38.3,61.74,,30.64,percent of total billed charges,61.74% of total billed charges,63.28,102,,50.624,percent of total billed charges,102% of total billed charges,23.58,38,,18.864,percent of total billed charges,38% of total billed charges,21.71,63.28,
IN-LINE CLOSED SUCT -dbl swivel - Endo,3003032,CDM,270,RC,,,Outpatient,,,62.06,46.55,,48.41,78,,38.728,percent of total billed charges,78% of total billed charges,39.1,63,,31.28,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,23.58,38,,18.864,percent of total billed charges,38% of total billed charges,23.58,38,,18.864,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,55.85,90,,44.68,percent of total billed charges,90% of total billed charges,21.72,35,,17.376,percent of total billed charges,35% of total billed charges,41.75,67.275,,33.4,percent of total billed charges,67.275% of total billed charges,49.65,80,,39.72,percent of total billed charges,80% of total billed charges,23.82,38.38,,19.056,percent of total billed charges,38.38% of total billed charges,49.65,80,,39.72,percent of total billed charges,80% of total billed charges,38.32,61.74,,30.656,percent of total billed charges,61.74% of total billed charges,63.3,102,,50.64,percent of total billed charges,102% of total billed charges,23.58,38,,18.864,percent of total billed charges,38% of total billed charges,21.72,63.3,
NASAL PACKING - SMALL,3002102,CDM,270,RC,,,Outpatient,,,62.1,46.58,,48.44,78,,38.752,percent of total billed charges,78% of total billed charges,39.12,63,,31.296,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,23.6,38,,18.88,percent of total billed charges,38% of total billed charges,23.6,38,,18.88,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,55.89,90,,44.712,percent of total billed charges,90% of total billed charges,21.74,35,,17.392,percent of total billed charges,35% of total billed charges,41.78,67.275,,33.424,percent of total billed charges,67.275% of total billed charges,49.68,80,,39.744,percent of total billed charges,80% of total billed charges,23.83,38.38,,19.064,percent of total billed charges,38.38% of total billed charges,49.68,80,,39.744,percent of total billed charges,80% of total billed charges,38.34,61.74,,30.672,percent of total billed charges,61.74% of total billed charges,63.34,102,,50.672,percent of total billed charges,102% of total billed charges,23.6,38,,18.88,percent of total billed charges,38% of total billed charges,21.74,63.34,
SPLINT ORTHO 3X35  PRE-CUT,3004501,CDM,270,RC,,,Outpatient,,,62.15,46.61,,48.48,78,,38.784,percent of total billed charges,78% of total billed charges,39.15,63,,31.32,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,23.62,38,,18.896,percent of total billed charges,38% of total billed charges,23.62,38,,18.896,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,55.94,90,,44.752,percent of total billed charges,90% of total billed charges,21.75,35,,17.4,percent of total billed charges,35% of total billed charges,41.81,67.275,,33.448,percent of total billed charges,67.275% of total billed charges,49.72,80,,39.776,percent of total billed charges,80% of total billed charges,23.85,38.38,,19.08,percent of total billed charges,38.38% of total billed charges,49.72,80,,39.776,percent of total billed charges,80% of total billed charges,38.37,61.74,,30.696,percent of total billed charges,61.74% of total billed charges,63.39,102,,50.712,percent of total billed charges,102% of total billed charges,23.62,38,,18.896,percent of total billed charges,38% of total billed charges,21.75,63.39,
KNEE DRESSING 24  UNIV,3001007,CDM,270,RC,,,Outpatient,,,62.35,46.76,,48.63,78,,38.904,percent of total billed charges,78% of total billed charges,39.28,63,,31.424,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,23.69,38,,18.952,percent of total billed charges,38% of total billed charges,23.69,38,,18.952,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,56.12,90,,44.896,percent of total billed charges,90% of total billed charges,21.82,35,,17.456,percent of total billed charges,35% of total billed charges,41.95,67.275,,33.56,percent of total billed charges,67.275% of total billed charges,49.88,80,,39.904,percent of total billed charges,80% of total billed charges,23.93,38.38,,19.144,percent of total billed charges,38.38% of total billed charges,49.88,80,,39.904,percent of total billed charges,80% of total billed charges,38.49,61.74,,30.792,percent of total billed charges,61.74% of total billed charges,63.6,102,,50.88,percent of total billed charges,102% of total billed charges,23.69,38,,18.952,percent of total billed charges,38% of total billed charges,21.82,63.6,
FOLEY CATH 5CC 22FR,3000304,CDM,270,RC,,,Outpatient,,,62.5,46.88,,48.75,78,,39,percent of total billed charges,78% of total billed charges,39.38,63,,31.504,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,23.75,38,,19,percent of total billed charges,38% of total billed charges,23.75,38,,19,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,56.25,90,,45,percent of total billed charges,90% of total billed charges,21.88,35,,17.504,percent of total billed charges,35% of total billed charges,42.05,67.275,,33.64,percent of total billed charges,67.275% of total billed charges,50,80,,40,percent of total billed charges,80% of total billed charges,23.99,38.38,,19.192,percent of total billed charges,38.38% of total billed charges,50,80,,40,percent of total billed charges,80% of total billed charges,38.59,61.74,,30.872,percent of total billed charges,61.74% of total billed charges,63.75,102,,51,percent of total billed charges,102% of total billed charges,23.75,38,,19,percent of total billed charges,38% of total billed charges,21.88,63.75,
FOLEY CATH 5CC 16FR,3000305,CDM,270,RC,,,Outpatient,,,62.5,46.88,,48.75,78,,39,percent of total billed charges,78% of total billed charges,39.38,63,,31.504,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,23.75,38,,19,percent of total billed charges,38% of total billed charges,23.75,38,,19,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,56.25,90,,45,percent of total billed charges,90% of total billed charges,21.88,35,,17.504,percent of total billed charges,35% of total billed charges,42.05,67.275,,33.64,percent of total billed charges,67.275% of total billed charges,50,80,,40,percent of total billed charges,80% of total billed charges,23.99,38.38,,19.192,percent of total billed charges,38.38% of total billed charges,50,80,,40,percent of total billed charges,80% of total billed charges,38.59,61.74,,30.872,percent of total billed charges,61.74% of total billed charges,63.75,102,,51,percent of total billed charges,102% of total billed charges,23.75,38,,19,percent of total billed charges,38% of total billed charges,21.88,63.75,
FOLEY CATH 5CC 20FR,3000321,CDM,270,RC,,,Outpatient,,,62.5,46.88,,48.75,78,,39,percent of total billed charges,78% of total billed charges,39.38,63,,31.504,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,23.75,38,,19,percent of total billed charges,38% of total billed charges,23.75,38,,19,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,56.25,90,,45,percent of total billed charges,90% of total billed charges,21.88,35,,17.504,percent of total billed charges,35% of total billed charges,42.05,67.275,,33.64,percent of total billed charges,67.275% of total billed charges,50,80,,40,percent of total billed charges,80% of total billed charges,23.99,38.38,,19.192,percent of total billed charges,38.38% of total billed charges,50,80,,40,percent of total billed charges,80% of total billed charges,38.59,61.74,,30.872,percent of total billed charges,61.74% of total billed charges,63.75,102,,51,percent of total billed charges,102% of total billed charges,23.75,38,,19,percent of total billed charges,38% of total billed charges,21.88,63.75,
FOLEY CATH 5CC 24FR,3000332,CDM,270,RC,,,Outpatient,,,62.5,46.88,,48.75,78,,39,percent of total billed charges,78% of total billed charges,39.38,63,,31.504,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,23.75,38,,19,percent of total billed charges,38% of total billed charges,23.75,38,,19,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,56.25,90,,45,percent of total billed charges,90% of total billed charges,21.88,35,,17.504,percent of total billed charges,35% of total billed charges,42.05,67.275,,33.64,percent of total billed charges,67.275% of total billed charges,50,80,,40,percent of total billed charges,80% of total billed charges,23.99,38.38,,19.192,percent of total billed charges,38.38% of total billed charges,50,80,,40,percent of total billed charges,80% of total billed charges,38.59,61.74,,30.872,percent of total billed charges,61.74% of total billed charges,63.75,102,,51,percent of total billed charges,102% of total billed charges,23.75,38,,19,percent of total billed charges,38% of total billed charges,21.88,63.75,
CLEAR OUTER EAR CANAL,1001224,CDM,450,RC,,,Outpatient,,,63,47.25,,49.14,78,,39.312,percent of total billed charges,78% of total billed charges,39.69,63,,31.752,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,23.94,38,,19.152,percent of total billed charges,38% of total billed charges,23.94,38,,19.152,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,22.05,35,,17.64,percent of total billed charges,35% of total billed charges,42.38,67.275,,33.904,percent of total billed charges,67.275% of total billed charges,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,24.18,38.38,,19.344,percent of total billed charges,38.38% of total billed charges,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,38.9,61.74,,31.12,percent of total billed charges,61.74% of total billed charges,64.26,102,,51.408,percent of total billed charges,102% of total billed charges,23.94,38,,19.152,percent of total billed charges,38% of total billed charges,22.05,64.26,
PROSTATIC ACID PHOSPHATASE,5001716,CDM,301,RC,84066,HCPCS,Outpatient,,,63,47.25,,49.14,78,,39.312,percent of total billed charges,78% of total billed charges,12.15,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,9.66,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,9.66,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,12.76,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,42.38,67.275,,33.904,percent of total billed charges,67.275% of total billed charges,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,9.76,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,38.9,61.74,,31.12,percent of total billed charges,61.74% of total billed charges,12.39,102,,,Fee Schedule,102% of GA Medicaid Rate,9.66,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,9.66,56.7,
ALDOLASE,5001802,CDM,301,RC,82085,HCPCS,Outpatient,,,63,47.25,,49.14,78,,39.312,percent of total billed charges,78% of total billed charges,12.2,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,9.71,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,9.71,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,12.81,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,42.38,67.275,,33.904,percent of total billed charges,67.275% of total billed charges,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,9.81,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,38.9,61.74,,31.12,percent of total billed charges,61.74% of total billed charges,12.44,102,,,Fee Schedule,102% of GA Medicaid Rate,9.71,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,9.71,56.7,
Blood test to measure average blood glucose levels for past 2-3 months,5001828,CDM,301,RC,83036,HCPCS,Outpatient,,,63,47.25,,49.14,78,,39.312,percent of total billed charges,78% of total billed charges,12.2,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,9.71,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,9.71,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,12.81,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,42.38,67.275,,33.904,percent of total billed charges,67.275% of total billed charges,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,9.81,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,38.9,61.74,,31.12,percent of total billed charges,61.74% of total billed charges,12.44,102,,,Fee Schedule,102% of GA Medicaid Rate,9.71,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,9.71,56.7,
Blood test to measure average blood glucose levels for past 2-3 months,5002030,CDM,301,RC,83036,HCPCS,Outpatient,,,63,47.25,,49.14,78,,39.312,percent of total billed charges,78% of total billed charges,12.2,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,9.71,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,9.71,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,12.81,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,42.38,67.275,,33.904,percent of total billed charges,67.275% of total billed charges,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,9.81,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,38.9,61.74,,31.12,percent of total billed charges,61.74% of total billed charges,12.44,102,,,Fee Schedule,102% of GA Medicaid Rate,9.71,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,9.71,56.7,
DILANTIN MULTIPLE,5009114,CDM,301,RC,80185,HCPCS,Outpatient,,,63,47.25,,49.14,78,,39.312,percent of total billed charges,78% of total billed charges,16.67,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,17.5,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,42.38,67.275,,33.904,percent of total billed charges,67.275% of total billed charges,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,13.38,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,38.9,61.74,,31.12,percent of total billed charges,61.74% of total billed charges,17,102,,,Fee Schedule,102% of GA Medicaid Rate,13.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.25,56.7,
Occupational therapy,9590011,CDM,420,RC,97535,HCPCS,Outpatient,,,63,47.25,,49.14,78,,39.312,percent of total billed charges,78% of total billed charges,39.69,63,,31.752,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,23.94,38,,19.152,percent of total billed charges,38% of total billed charges,23.94,38,,19.152,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,22.05,35,,17.64,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,24.18,38.38,,19.344,percent of total billed charges,38.38% of total billed charges,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,38.9,61.74,,31.12,percent of total billed charges,61.74% of total billed charges,64.26,102,,51.408,percent of total billed charges,102% of total billed charges,23.94,38,,19.152,percent of total billed charges,38% of total billed charges,22.05,145.93,
"Incorporates the use of multiple parameters, such as balance, strength, and range of motion, for a functional activity",9590022,CDM,420,RC,97530,HCPCS,Outpatient,,,63,47.25,,49.14,78,,39.312,percent of total billed charges,78% of total billed charges,39.69,63,,31.752,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,23.94,38,,19.152,percent of total billed charges,38% of total billed charges,23.94,38,,19.152,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,22.05,35,,17.64,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,24.18,38.38,,19.344,percent of total billed charges,38.38% of total billed charges,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,38.9,61.74,,31.12,percent of total billed charges,61.74% of total billed charges,64.26,102,,51.408,percent of total billed charges,102% of total billed charges,23.94,38,,19.152,percent of total billed charges,38% of total billed charges,22.05,145.93,
FOUR FLEX,3000571,CDM,270,RC,,,Outpatient,,,63.24,47.43,,49.33,78,,39.464,percent of total billed charges,78% of total billed charges,39.84,63,,31.872,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,24.03,38,,19.224,percent of total billed charges,38% of total billed charges,24.03,38,,19.224,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,56.92,90,,45.536,percent of total billed charges,90% of total billed charges,22.13,35,,17.704,percent of total billed charges,35% of total billed charges,42.54,67.275,,34.032,percent of total billed charges,67.275% of total billed charges,50.59,80,,40.472,percent of total billed charges,80% of total billed charges,24.27,38.38,,19.416,percent of total billed charges,38.38% of total billed charges,50.59,80,,40.472,percent of total billed charges,80% of total billed charges,39.04,61.74,,31.232,percent of total billed charges,61.74% of total billed charges,64.5,102,,51.6,percent of total billed charges,102% of total billed charges,24.03,38,,19.224,percent of total billed charges,38% of total billed charges,22.13,64.5,
HEAD REST PILLOW   RT INTUBATION,3005044,CDM,270,RC,,,Outpatient,,,63.65,47.74,,49.65,78,,39.72,percent of total billed charges,78% of total billed charges,40.1,63,,32.08,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,24.19,38,,19.352,percent of total billed charges,38% of total billed charges,24.19,38,,19.352,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,57.29,90,,45.832,percent of total billed charges,90% of total billed charges,22.28,35,,17.824,percent of total billed charges,35% of total billed charges,42.82,67.275,,34.256,percent of total billed charges,67.275% of total billed charges,50.92,80,,40.736,percent of total billed charges,80% of total billed charges,24.43,38.38,,19.544,percent of total billed charges,38.38% of total billed charges,50.92,80,,40.736,percent of total billed charges,80% of total billed charges,39.3,61.74,,31.44,percent of total billed charges,61.74% of total billed charges,64.92,102,,51.936,percent of total billed charges,102% of total billed charges,24.19,38,,19.352,percent of total billed charges,38% of total billed charges,22.28,64.92,
KNEE DRESSING 20  79-80170,3001006,CDM,270,RC,,,Outpatient,,,63.7,47.78,,49.69,78,,39.752,percent of total billed charges,78% of total billed charges,40.13,63,,32.104,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,24.21,38,,19.368,percent of total billed charges,38% of total billed charges,24.21,38,,19.368,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,57.33,90,,45.864,percent of total billed charges,90% of total billed charges,22.3,35,,17.84,percent of total billed charges,35% of total billed charges,42.85,67.275,,34.28,percent of total billed charges,67.275% of total billed charges,50.96,80,,40.768,percent of total billed charges,80% of total billed charges,24.45,38.38,,19.56,percent of total billed charges,38.38% of total billed charges,50.96,80,,40.768,percent of total billed charges,80% of total billed charges,39.33,61.74,,31.464,percent of total billed charges,61.74% of total billed charges,64.97,102,,51.976,percent of total billed charges,102% of total billed charges,24.21,38,,19.368,percent of total billed charges,38% of total billed charges,22.3,64.97,
CRUTCH YOUTH,3004205,CDM,270,RC,,,Outpatient,,,63.8,47.85,,49.76,78,,39.808,percent of total billed charges,78% of total billed charges,40.19,63,,32.152,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,24.24,38,,19.392,percent of total billed charges,38% of total billed charges,24.24,38,,19.392,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,57.42,90,,45.936,percent of total billed charges,90% of total billed charges,22.33,35,,17.864,percent of total billed charges,35% of total billed charges,42.92,67.275,,34.336,percent of total billed charges,67.275% of total billed charges,51.04,80,,40.832,percent of total billed charges,80% of total billed charges,24.49,38.38,,19.592,percent of total billed charges,38.38% of total billed charges,51.04,80,,40.832,percent of total billed charges,80% of total billed charges,39.39,61.74,,31.512,percent of total billed charges,61.74% of total billed charges,65.08,102,,52.064,percent of total billed charges,102% of total billed charges,24.24,38,,19.392,percent of total billed charges,38% of total billed charges,22.33,65.08,
"TRAY, FOLEY CATH 18FR - BARD",3005086,CDM,270,RC,,,Outpatient,,,63.84,47.88,,49.8,78,,39.84,percent of total billed charges,78% of total billed charges,40.22,63,,32.176,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,24.26,38,,19.408,percent of total billed charges,38% of total billed charges,24.26,38,,19.408,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,57.46,90,,45.968,percent of total billed charges,90% of total billed charges,22.34,35,,17.872,percent of total billed charges,35% of total billed charges,42.95,67.275,,34.36,percent of total billed charges,67.275% of total billed charges,51.07,80,,40.856,percent of total billed charges,80% of total billed charges,24.5,38.38,,19.6,percent of total billed charges,38.38% of total billed charges,51.07,80,,40.856,percent of total billed charges,80% of total billed charges,39.41,61.74,,31.528,percent of total billed charges,61.74% of total billed charges,65.12,102,,52.096,percent of total billed charges,102% of total billed charges,24.26,38,,19.408,percent of total billed charges,38% of total billed charges,22.34,65.12,
B-HYDROXYBUTYRATE,5000247,CDM,301,RC,84311,HCPCS,Outpatient,,,64,48,,49.92,78,,39.936,percent of total billed charges,78% of total billed charges,8.79,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.1,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.1,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,9.23,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,43.06,67.275,,34.448,percent of total billed charges,67.275% of total billed charges,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,8.18,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,39.51,61.74,,31.608,percent of total billed charges,61.74% of total billed charges,8.97,102,,,Fee Schedule,102% of GA Medicaid Rate,8.1,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.1,57.6,
AMYLASE,5000706,CDM,301,RC,82150,HCPCS,Outpatient,,,64,48,,49.92,78,,39.936,percent of total billed charges,78% of total billed charges,8.15,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.48,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.48,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,8.56,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,43.06,67.275,,34.448,percent of total billed charges,67.275% of total billed charges,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,6.54,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,39.51,61.74,,31.608,percent of total billed charges,61.74% of total billed charges,8.31,102,,,Fee Schedule,102% of GA Medicaid Rate,6.48,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.48,57.6,
AMYLASE 2 HR URINE,5000708,CDM,301,RC,82150,HCPCS,Outpatient,,,64,48,,49.92,78,,39.936,percent of total billed charges,78% of total billed charges,8.15,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.48,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.48,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,8.56,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,43.06,67.275,,34.448,percent of total billed charges,67.275% of total billed charges,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,6.54,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,39.51,61.74,,31.608,percent of total billed charges,61.74% of total billed charges,8.31,102,,,Fee Schedule,102% of GA Medicaid Rate,6.48,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.48,57.6,
POTASSIUM (FECES),5000750,CDM,309,RC,84311,HCPCS,Outpatient,,,64,48,,49.92,78,,39.936,percent of total billed charges,78% of total billed charges,8.79,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.1,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.1,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,9.23,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,43.06,67.275,,34.448,percent of total billed charges,67.275% of total billed charges,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,8.18,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,39.51,61.74,,31.608,percent of total billed charges,61.74% of total billed charges,8.97,102,,,Fee Schedule,102% of GA Medicaid Rate,8.1,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.1,57.6,
"CHOLESTEROL, PLEURAL FLUID",5001687,CDM,301,RC,84311,HCPCS,Outpatient,,,64,48,,49.92,78,,39.936,percent of total billed charges,78% of total billed charges,8.79,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.1,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.1,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,9.23,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,43.06,67.275,,34.448,percent of total billed charges,67.275% of total billed charges,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,8.18,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,39.51,61.74,,31.608,percent of total billed charges,61.74% of total billed charges,8.97,102,,,Fee Schedule,102% of GA Medicaid Rate,8.1,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.1,57.6,
"ADENOSINE DEAMINASE, PLEURAL FLUID",5002042,CDM,301,RC,84311,HCPCS,Outpatient,,,64,48,,49.92,78,,39.936,percent of total billed charges,78% of total billed charges,8.79,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.1,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.1,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,9.23,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,43.06,67.275,,34.448,percent of total billed charges,67.275% of total billed charges,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,8.18,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,39.51,61.74,,31.608,percent of total billed charges,61.74% of total billed charges,8.97,102,,,Fee Schedule,102% of GA Medicaid Rate,8.1,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.1,57.6,
"TRAY, FOLEY CATH  16FR - BARD",3005085,CDM,270,RC,,,Outpatient,,,64.58,48.44,,50.37,78,,40.296,percent of total billed charges,78% of total billed charges,40.69,63,,32.552,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,24.54,38,,19.632,percent of total billed charges,38% of total billed charges,24.54,38,,19.632,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,58.12,90,,46.496,percent of total billed charges,90% of total billed charges,22.6,35,,18.08,percent of total billed charges,35% of total billed charges,43.45,67.275,,34.76,percent of total billed charges,67.275% of total billed charges,51.66,80,,41.328,percent of total billed charges,80% of total billed charges,24.79,38.38,,19.832,percent of total billed charges,38.38% of total billed charges,51.66,80,,41.328,percent of total billed charges,80% of total billed charges,39.87,61.74,,31.896,percent of total billed charges,61.74% of total billed charges,65.87,102,,52.696,percent of total billed charges,102% of total billed charges,24.54,38,,19.632,percent of total billed charges,38% of total billed charges,22.6,65.87,
"RIB, EACH",1200149,CDM,981,RC,,,Outpatient,,,65,48.75,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.33,61.74,,31.464,percent of total billed charges,61.74% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.33,39.33,
AMMONIA,5001770,CDM,301,RC,82140,HCPCS,Outpatient,,,65,48.75,,50.7,78,,40.56,percent of total billed charges,78% of total billed charges,12.44,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,13.06,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,43.73,67.275,,34.984,percent of total billed charges,67.275% of total billed charges,52,80,,41.6,percent of total billed charges,80% of total billed charges,14.72,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,52,80,,41.6,percent of total billed charges,80% of total billed charges,40.13,61.74,,32.104,percent of total billed charges,61.74% of total billed charges,12.69,102,,,Fee Schedule,102% of GA Medicaid Rate,14.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.44,58.5,
MATURATION INDEX,5002016,CDM,311,RC,88155,HCPCS,Outpatient,,,65,48.75,,50.7,78,,40.56,percent of total billed charges,78% of total billed charges,7.53,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.65,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.65,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,7.91,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,43.73,67.275,,34.984,percent of total billed charges,67.275% of total billed charges,52,80,,41.6,percent of total billed charges,80% of total billed charges,14.8,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,52,80,,41.6,percent of total billed charges,80% of total billed charges,40.13,61.74,,32.104,percent of total billed charges,61.74% of total billed charges,7.68,102,,,Fee Schedule,102% of GA Medicaid Rate,14.65,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.53,58.5,
IN-LINE CLOSED SUCT - 6FR PEDS,3003006,CDM,270,RC,,,Outpatient,,,65.85,49.39,,51.36,78,,41.088,percent of total billed charges,78% of total billed charges,41.49,63,,33.192,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,25.02,38,,20.016,percent of total billed charges,38% of total billed charges,25.02,38,,20.016,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,59.27,90,,47.416,percent of total billed charges,90% of total billed charges,23.05,35,,18.44,percent of total billed charges,35% of total billed charges,44.3,67.275,,35.44,percent of total billed charges,67.275% of total billed charges,52.68,80,,42.144,percent of total billed charges,80% of total billed charges,25.27,38.38,,20.216,percent of total billed charges,38.38% of total billed charges,52.68,80,,42.144,percent of total billed charges,80% of total billed charges,40.66,61.74,,32.528,percent of total billed charges,61.74% of total billed charges,67.17,102,,53.736,percent of total billed charges,102% of total billed charges,25.02,38,,20.016,percent of total billed charges,38% of total billed charges,23.05,67.17,
CO2 DETECTORS,3000227,CDM,270,RC,,,Outpatient,,,65.9,49.43,,51.4,78,,41.12,percent of total billed charges,78% of total billed charges,41.52,63,,33.216,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,25.04,38,,20.032,percent of total billed charges,38% of total billed charges,25.04,38,,20.032,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,59.31,90,,47.448,percent of total billed charges,90% of total billed charges,23.07,35,,18.456,percent of total billed charges,35% of total billed charges,44.33,67.275,,35.464,percent of total billed charges,67.275% of total billed charges,52.72,80,,42.176,percent of total billed charges,80% of total billed charges,25.29,38.38,,20.232,percent of total billed charges,38.38% of total billed charges,52.72,80,,42.176,percent of total billed charges,80% of total billed charges,40.69,61.74,,32.552,percent of total billed charges,61.74% of total billed charges,67.22,102,,53.776,percent of total billed charges,102% of total billed charges,25.04,38,,20.032,percent of total billed charges,38% of total billed charges,23.07,67.22,
LARYNGOSCOPY DIAGNOSTIC,1001210,CDM,450,RC,,,Outpatient,,,66,49.5,,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,41.58,63,,33.264,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,25.08,38,,20.064,percent of total billed charges,38% of total billed charges,25.08,38,,20.064,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,23.1,35,,18.48,percent of total billed charges,35% of total billed charges,44.4,67.275,,35.52,percent of total billed charges,67.275% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,25.33,38.38,,20.264,percent of total billed charges,38.38% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,40.75,61.74,,32.6,percent of total billed charges,61.74% of total billed charges,67.32,102,,53.856,percent of total billed charges,102% of total billed charges,25.08,38,,20.064,percent of total billed charges,38% of total billed charges,23.1,67.32,
LARYNGOSCOPY REMOVE FB,1001212,CDM,450,RC,,,Outpatient,,,66,49.5,,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,41.58,63,,33.264,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,25.08,38,,20.064,percent of total billed charges,38% of total billed charges,25.08,38,,20.064,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,23.1,35,,18.48,percent of total billed charges,35% of total billed charges,44.4,67.275,,35.52,percent of total billed charges,67.275% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,25.33,38.38,,20.264,percent of total billed charges,38.38% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,40.75,61.74,,32.6,percent of total billed charges,61.74% of total billed charges,67.32,102,,53.856,percent of total billed charges,102% of total billed charges,25.08,38,,20.064,percent of total billed charges,38% of total billed charges,23.1,67.32,
CULTURE AFB,5001510,CDM,306,RC,87116,HCPCS,Outpatient,,,66,49.5,,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,41.58,63,,33.264,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,10.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,23.1,35,,18.48,percent of total billed charges,35% of total billed charges,44.4,67.275,,35.52,percent of total billed charges,67.275% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,10.91,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,40.75,61.74,,32.6,percent of total billed charges,61.74% of total billed charges,67.32,102,,53.856,percent of total billed charges,102% of total billed charges,10.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.8,67.32,
"CULTURE FUNGUS, OTHER",5001515,CDM,300,RC,87102,HCPCS,Outpatient,,,66,49.5,,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,10.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.41,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.41,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,11.1,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,44.4,67.275,,35.52,percent of total billed charges,67.275% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,8.49,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,40.75,61.74,,32.6,percent of total billed charges,61.74% of total billed charges,10.78,102,,,Fee Schedule,102% of GA Medicaid Rate,8.41,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.41,59.4,
"MYCOBACTERIUM, BLOOD CULTURE",5002086,CDM,306,RC,87116,HCPCS,Outpatient,,,66,49.5,,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,41.58,63,,33.264,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,10.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,23.1,35,,18.48,percent of total billed charges,35% of total billed charges,44.4,67.275,,35.52,percent of total billed charges,67.275% of total billed charges,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,10.91,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,40.75,61.74,,32.6,percent of total billed charges,61.74% of total billed charges,67.32,102,,53.856,percent of total billed charges,102% of total billed charges,10.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.8,67.32,
BUR 4MM ROUND,3003102,CDM,270,RC,,,Outpatient,,,66.15,49.61,,51.6,78,,41.28,percent of total billed charges,78% of total billed charges,41.67,63,,33.336,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,25.14,38,,20.112,percent of total billed charges,38% of total billed charges,25.14,38,,20.112,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,59.54,90,,47.632,percent of total billed charges,90% of total billed charges,23.15,35,,18.52,percent of total billed charges,35% of total billed charges,44.5,67.275,,35.6,percent of total billed charges,67.275% of total billed charges,52.92,80,,42.336,percent of total billed charges,80% of total billed charges,25.39,38.38,,20.312,percent of total billed charges,38.38% of total billed charges,52.92,80,,42.336,percent of total billed charges,80% of total billed charges,40.84,61.74,,32.672,percent of total billed charges,61.74% of total billed charges,67.47,102,,53.976,percent of total billed charges,102% of total billed charges,25.14,38,,20.112,percent of total billed charges,38% of total billed charges,23.15,67.47,
CULTURE FUNGUS ID,5000113,CDM,306,RC,87106,HCPCS,Outpatient,,,67,50.25,,52.26,78,,41.808,percent of total billed charges,78% of total billed charges,12.98,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,10.32,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.32,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,13.63,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,45.07,67.275,,36.056,percent of total billed charges,67.275% of total billed charges,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,10.42,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,41.37,61.74,,33.096,percent of total billed charges,61.74% of total billed charges,13.24,102,,,Fee Schedule,102% of GA Medicaid Rate,10.32,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.32,60.3,
.CULTURE FUNGUS ID- MOLD,5000114,CDM,306,RC,87107,HCPCS,Outpatient,,,67,50.25,,52.26,78,,41.808,percent of total billed charges,78% of total billed charges,12.98,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,10.32,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.32,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,13.63,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,45.07,67.275,,36.056,percent of total billed charges,67.275% of total billed charges,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,10.42,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,41.37,61.74,,33.096,percent of total billed charges,61.74% of total billed charges,13.24,102,,,Fee Schedule,102% of GA Medicaid Rate,10.32,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.32,60.3,
METHEMOGLOBIN,5001806,CDM,301,RC,83050,HCPCS,Outpatient,,,67,50.25,,52.26,78,,41.808,percent of total billed charges,78% of total billed charges,9.21,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.2,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.2,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,9.67,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,45.07,67.275,,36.056,percent of total billed charges,67.275% of total billed charges,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,8.28,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,41.37,61.74,,33.096,percent of total billed charges,61.74% of total billed charges,9.39,102,,,Fee Schedule,102% of GA Medicaid Rate,8.2,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.2,60.3,
BB RH PHENOTYPE,5200026,CDM,300,RC,86906,HCPCS,Outpatient,,,67,50.25,,52.26,78,,41.808,percent of total billed charges,78% of total billed charges,9.75,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,7.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,10.24,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,45.07,67.275,,36.056,percent of total billed charges,67.275% of total billed charges,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,7.83,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,41.37,61.74,,33.096,percent of total billed charges,61.74% of total billed charges,9.95,102,,,Fee Schedule,102% of GA Medicaid Rate,7.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.75,60.3,
BB AG SCREEN W/ PT SERUM,5200031,CDM,300,RC,86904,HCPCS,Outpatient,,,67,50.25,,52.26,78,,41.808,percent of total billed charges,78% of total billed charges,11.95,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.34,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.34,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,12.55,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,45.07,67.275,,36.056,percent of total billed charges,67.275% of total billed charges,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,16.5,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,41.37,61.74,,33.096,percent of total billed charges,61.74% of total billed charges,12.19,102,,,Fee Schedule,102% of GA Medicaid Rate,16.34,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.95,60.3,
BB DIRECT COOMBS,5200410,CDM,300,RC,86880,HCPCS,Outpatient,,,67,50.25,,52.26,78,,41.808,percent of total billed charges,78% of total billed charges,6.75,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,7.09,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,45.07,67.275,,36.056,percent of total billed charges,67.275% of total billed charges,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,5.44,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,41.37,61.74,,33.096,percent of total billed charges,61.74% of total billed charges,6.89,102,,,Fee Schedule,102% of GA Medicaid Rate,5.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.39,60.3,
BB RH TYPE,5200435,CDM,300,RC,86901,HCPCS,Outpatient,,,67,50.25,,52.26,78,,41.808,percent of total billed charges,78% of total billed charges,14.51,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,2.99,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,2.99,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,15.24,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,45.07,67.275,,36.056,percent of total billed charges,67.275% of total billed charges,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,3.02,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,41.37,61.74,,33.096,percent of total billed charges,61.74% of total billed charges,14.8,102,,,Fee Schedule,102% of GA Medicaid Rate,2.99,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,2.99,60.3,
Manipulation of 1 or more regions of the body,9000026,CDM,420,RC,97140,HCPCS,Outpatient,,,67,50.25,,52.26,78,,41.808,percent of total billed charges,78% of total billed charges,42.21,63,,33.768,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,25.46,38,,20.368,percent of total billed charges,38% of total billed charges,25.46,38,,20.368,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,23.45,35,,18.76,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,25.71,38.38,,20.568,percent of total billed charges,38.38% of total billed charges,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,41.37,61.74,,33.096,percent of total billed charges,61.74% of total billed charges,68.34,102,,54.672,percent of total billed charges,102% of total billed charges,25.46,38,,20.368,percent of total billed charges,38% of total billed charges,23.45,145.93,
Manipulation of 1 or more regions of the body,9000210,CDM,430,RC,97140,HCPCS,Outpatient,,,67,50.25,,52.26,78,,41.808,percent of total billed charges,78% of total billed charges,42.21,63,,33.768,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,25.46,38,,20.368,percent of total billed charges,38% of total billed charges,25.46,38,,20.368,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,23.45,35,,18.76,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,25.71,38.38,,20.568,percent of total billed charges,38.38% of total billed charges,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,41.37,61.74,,33.096,percent of total billed charges,61.74% of total billed charges,68.34,102,,54.672,percent of total billed charges,102% of total billed charges,25.46,38,,20.368,percent of total billed charges,38% of total billed charges,23.45,145.93,
XEMG H REFLEX; OTHER THAN GASTROC,9600021,CDM,922,RC,95936,HCPCS,Outpatient,,,67,50.25,,52.26,78,,41.808,percent of total billed charges,78% of total billed charges,42.21,63,,33.768,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,25.46,38,,20.368,percent of total billed charges,38% of total billed charges,25.46,38,,20.368,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,23.45,35,,18.76,percent of total billed charges,35% of total billed charges,45.07,67.275,,36.056,percent of total billed charges,67.275% of total billed charges,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,25.71,38.38,,20.568,percent of total billed charges,38.38% of total billed charges,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,41.37,61.74,,33.096,percent of total billed charges,61.74% of total billed charges,68.34,102,,54.672,percent of total billed charges,102% of total billed charges,25.46,38,,20.368,percent of total billed charges,38% of total billed charges,23.45,68.34,
GUIDE WIRE HYPROCURE,3006042,CDM,270,RC,,,Outpatient,,,67.5,50.63,,52.65,78,,42.12,percent of total billed charges,78% of total billed charges,42.53,63,,34.024,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,25.65,38,,20.52,percent of total billed charges,38% of total billed charges,25.65,38,,20.52,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,60.75,90,,48.6,percent of total billed charges,90% of total billed charges,23.63,35,,18.904,percent of total billed charges,35% of total billed charges,45.41,67.275,,36.328,percent of total billed charges,67.275% of total billed charges,54,80,,43.2,percent of total billed charges,80% of total billed charges,25.91,38.38,,20.728,percent of total billed charges,38.38% of total billed charges,54,80,,43.2,percent of total billed charges,80% of total billed charges,41.67,61.74,,33.336,percent of total billed charges,61.74% of total billed charges,68.85,102,,55.08,percent of total billed charges,102% of total billed charges,25.65,38,,20.52,percent of total billed charges,38% of total billed charges,23.63,68.85,
DUO-THERM PAD,3004227,CDM,270,RC,,,Outpatient,,,68,51,,53.04,78,,42.432,percent of total billed charges,78% of total billed charges,42.84,63,,34.272,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,25.84,38,,20.672,percent of total billed charges,38% of total billed charges,25.84,38,,20.672,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,23.8,35,,19.04,percent of total billed charges,35% of total billed charges,45.75,67.275,,36.6,percent of total billed charges,67.275% of total billed charges,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,26.1,38.38,,20.88,percent of total billed charges,38.38% of total billed charges,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,41.98,61.74,,33.584,percent of total billed charges,61.74% of total billed charges,69.36,102,,55.488,percent of total billed charges,102% of total billed charges,25.84,38,,20.672,percent of total billed charges,38% of total billed charges,23.8,69.36,
"Blood test, thyroid stimulating hormone (TSH)",5001400,CDM,300,RC,84443,HCPCS,Outpatient,,,68,51,,53.04,78,,42.432,percent of total billed charges,78% of total billed charges,21.12,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,22.18,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,45.75,67.275,,36.6,percent of total billed charges,67.275% of total billed charges,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,16.97,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,41.98,61.74,,33.584,percent of total billed charges,61.74% of total billed charges,21.54,102,,,Fee Schedule,102% of GA Medicaid Rate,16.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.8,61.2,
"Blood test, thyroid stimulating hormone (TSH)",5001404,CDM,300,RC,84443,HCPCS,Outpatient,,,68,51,,53.04,78,,42.432,percent of total billed charges,78% of total billed charges,21.12,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,22.18,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,45.75,67.275,,36.6,percent of total billed charges,67.275% of total billed charges,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,16.97,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,41.98,61.74,,33.584,percent of total billed charges,61.74% of total billed charges,21.54,102,,,Fee Schedule,102% of GA Medicaid Rate,16.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.8,61.2,
"Blood test, thyroid stimulating hormone (TSH)",5001615,CDM,301,RC,84443,HCPCS,Outpatient,,,68,51,,53.04,78,,42.432,percent of total billed charges,78% of total billed charges,21.12,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,22.18,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,45.75,67.275,,36.6,percent of total billed charges,67.275% of total billed charges,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,16.97,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,41.98,61.74,,33.584,percent of total billed charges,61.74% of total billed charges,21.54,102,,,Fee Schedule,102% of GA Medicaid Rate,16.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.8,61.2,
TULAREMIA,5001761,CDM,300,RC,86668,HCPCS,Outpatient,,,68,51,,53.04,78,,42.432,percent of total billed charges,78% of total billed charges,13.08,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.16,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.16,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,13.73,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,45.75,67.275,,36.6,percent of total billed charges,67.275% of total billed charges,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,14.3,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,41.98,61.74,,33.584,percent of total billed charges,61.74% of total billed charges,13.34,102,,,Fee Schedule,102% of GA Medicaid Rate,14.16,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.08,61.2,
"Blood test, thyroid stimulating hormone (TSH)",5001839,CDM,301,RC,84443,HCPCS,Outpatient,,,68,51,,53.04,78,,42.432,percent of total billed charges,78% of total billed charges,21.12,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,22.18,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,45.75,67.275,,36.6,percent of total billed charges,67.275% of total billed charges,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,16.97,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,41.98,61.74,,33.584,percent of total billed charges,61.74% of total billed charges,21.54,102,,,Fee Schedule,102% of GA Medicaid Rate,16.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.8,61.2,
GELFOAM 12-7 MM,3000634,CDM,270,RC,,,Outpatient,,,68.25,51.19,,53.24,78,,42.592,percent of total billed charges,78% of total billed charges,43,63,,34.4,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,25.94,38,,20.752,percent of total billed charges,38% of total billed charges,25.94,38,,20.752,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,61.43,90,,49.144,percent of total billed charges,90% of total billed charges,23.89,35,,19.112,percent of total billed charges,35% of total billed charges,45.92,67.275,,36.736,percent of total billed charges,67.275% of total billed charges,54.6,80,,43.68,percent of total billed charges,80% of total billed charges,26.19,38.38,,20.952,percent of total billed charges,38.38% of total billed charges,54.6,80,,43.68,percent of total billed charges,80% of total billed charges,42.14,61.74,,33.712,percent of total billed charges,61.74% of total billed charges,69.62,102,,55.696,percent of total billed charges,102% of total billed charges,25.94,38,,20.752,percent of total billed charges,38% of total billed charges,23.89,69.62,
DSP BIOPSY FORCEP,3004045,CDM,270,RC,,,Outpatient,,,68.48,51.36,,53.41,78,,42.728,percent of total billed charges,78% of total billed charges,43.14,63,,34.512,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,26.02,38,,20.816,percent of total billed charges,38% of total billed charges,26.02,38,,20.816,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,61.63,90,,49.304,percent of total billed charges,90% of total billed charges,23.97,35,,19.176,percent of total billed charges,35% of total billed charges,46.07,67.275,,36.856,percent of total billed charges,67.275% of total billed charges,54.78,80,,43.824,percent of total billed charges,80% of total billed charges,26.28,38.38,,21.024,percent of total billed charges,38.38% of total billed charges,54.78,80,,43.824,percent of total billed charges,80% of total billed charges,42.28,61.74,,33.824,percent of total billed charges,61.74% of total billed charges,69.85,102,,55.88,percent of total billed charges,102% of total billed charges,26.02,38,,20.816,percent of total billed charges,38% of total billed charges,23.97,69.85,
AIR CUSHION WHEELCHAIR - WAFFLE,3002348,CDM,270,RC,,,Outpatient,,,68.77,51.58,,53.64,78,,42.912,percent of total billed charges,78% of total billed charges,43.33,63,,34.664,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,26.13,38,,20.904,percent of total billed charges,38% of total billed charges,26.13,38,,20.904,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,61.89,90,,49.512,percent of total billed charges,90% of total billed charges,24.07,35,,19.256,percent of total billed charges,35% of total billed charges,46.27,67.275,,37.016,percent of total billed charges,67.275% of total billed charges,55.02,80,,44.016,percent of total billed charges,80% of total billed charges,26.39,38.38,,21.112,percent of total billed charges,38.38% of total billed charges,55.02,80,,44.016,percent of total billed charges,80% of total billed charges,42.46,61.74,,33.968,percent of total billed charges,61.74% of total billed charges,70.15,102,,56.12,percent of total billed charges,102% of total billed charges,26.13,38,,20.904,percent of total billed charges,38% of total billed charges,24.07,70.15,
SYNTHETIC CANNABINOIDS QL,5000522,CDM,301,RC,80352,HCPCS,Outpatient,,,69,51.75,,53.82,78,,43.056,percent of total billed charges,78% of total billed charges,43.47,63,,34.776,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,26.22,38,,20.976,percent of total billed charges,38% of total billed charges,26.22,38,,20.976,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,62.1,90,,49.68,percent of total billed charges,90% of total billed charges,24.15,35,,19.32,percent of total billed charges,35% of total billed charges,46.42,67.275,,37.136,percent of total billed charges,67.275% of total billed charges,55.2,80,,44.16,percent of total billed charges,80% of total billed charges,26.48,38.38,,21.184,percent of total billed charges,38.38% of total billed charges,55.2,80,,44.16,percent of total billed charges,80% of total billed charges,42.6,61.74,,34.08,percent of total billed charges,61.74% of total billed charges,70.38,102,,56.304,percent of total billed charges,102% of total billed charges,26.22,38,,20.976,percent of total billed charges,38% of total billed charges,24.15,70.38,
Test to determine level of iron in the blood,5001750,CDM,301,RC,82728,HCPCS,Outpatient,,,69,51.75,,53.82,78,,43.056,percent of total billed charges,78% of total billed charges,17.13,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.63,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.63,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,62.1,90,,49.68,percent of total billed charges,90% of total billed charges,17.99,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,46.42,67.275,,37.136,percent of total billed charges,67.275% of total billed charges,55.2,80,,44.16,percent of total billed charges,80% of total billed charges,13.77,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,55.2,80,,44.16,percent of total billed charges,80% of total billed charges,42.6,61.74,,34.08,percent of total billed charges,61.74% of total billed charges,17.47,102,,,Fee Schedule,102% of GA Medicaid Rate,13.63,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.63,62.1,
"Complete blood count, automated",5000088,CDM,305,RC,85027,HCPCS,Outpatient,,,70,52.5,,54.6,78,,43.68,percent of total billed charges,78% of total billed charges,8.14,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,63,90,,50.4,percent of total billed charges,90% of total billed charges,8.55,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,47.09,67.275,,37.672,percent of total billed charges,67.275% of total billed charges,56,80,,44.8,percent of total billed charges,80% of total billed charges,6.53,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,56,80,,44.8,percent of total billed charges,80% of total billed charges,43.22,61.74,,34.576,percent of total billed charges,61.74% of total billed charges,8.3,102,,,Fee Schedule,102% of GA Medicaid Rate,6.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.47,63,
FOLATE,5001418,CDM,301,RC,82746,HCPCS,Outpatient,,,70,52.5,,54.6,78,,43.68,percent of total billed charges,78% of total billed charges,18.49,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.7,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.7,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,63,90,,50.4,percent of total billed charges,90% of total billed charges,19.41,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,47.09,67.275,,37.672,percent of total billed charges,67.275% of total billed charges,56,80,,44.8,percent of total billed charges,80% of total billed charges,14.85,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,56,80,,44.8,percent of total billed charges,80% of total billed charges,43.22,61.74,,34.576,percent of total billed charges,61.74% of total billed charges,18.86,102,,,Fee Schedule,102% of GA Medicaid Rate,14.7,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.7,63,
"ALCOHOL (B), COC",5001633,CDM,300,RC,80320,HCPCS,Outpatient,,,70,52.5,,54.6,78,,43.68,percent of total billed charges,78% of total billed charges,13.59,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,26.6,38,,21.28,percent of total billed charges,38% of total billed charges,26.6,38,,21.28,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,63,90,,50.4,percent of total billed charges,90% of total billed charges,14.27,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,47.09,67.275,,37.672,percent of total billed charges,67.275% of total billed charges,56,80,,44.8,percent of total billed charges,80% of total billed charges,26.87,38.38,,21.496,percent of total billed charges,38.38% of total billed charges,56,80,,44.8,percent of total billed charges,80% of total billed charges,43.22,61.74,,34.576,percent of total billed charges,61.74% of total billed charges,13.86,102,,,Fee Schedule,102% of GA Medicaid Rate,26.6,38,,21.28,percent of total billed charges,38% of total billed charges,13.59,63,
ALCOHOL-MEDICAL,5001636,CDM,300,RC,80320,HCPCS,Outpatient,,,70,52.5,,54.6,78,,43.68,percent of total billed charges,78% of total billed charges,13.59,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,26.6,38,,21.28,percent of total billed charges,38% of total billed charges,26.6,38,,21.28,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,63,90,,50.4,percent of total billed charges,90% of total billed charges,14.27,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,47.09,67.275,,37.672,percent of total billed charges,67.275% of total billed charges,56,80,,44.8,percent of total billed charges,80% of total billed charges,26.87,38.38,,21.496,percent of total billed charges,38.38% of total billed charges,56,80,,44.8,percent of total billed charges,80% of total billed charges,43.22,61.74,,34.576,percent of total billed charges,61.74% of total billed charges,13.86,102,,,Fee Schedule,102% of GA Medicaid Rate,26.6,38,,21.28,percent of total billed charges,38% of total billed charges,13.59,63,
Chemical test of the blood to measure presence or concentration of a substance in the blood,5001707,CDM,301,RC,83516,HCPCS,Outpatient,,,70,52.5,,54.6,78,,43.68,percent of total billed charges,78% of total billed charges,13.45,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,11.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,63,90,,50.4,percent of total billed charges,90% of total billed charges,14.12,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,47.09,67.275,,37.672,percent of total billed charges,67.275% of total billed charges,56,80,,44.8,percent of total billed charges,80% of total billed charges,11.65,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,56,80,,44.8,percent of total billed charges,80% of total billed charges,43.22,61.74,,34.576,percent of total billed charges,61.74% of total billed charges,13.72,102,,,Fee Schedule,102% of GA Medicaid Rate,11.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.53,63,
ALCOHOL-(B) PAT REQUESTED; SPECIAL PRICE,5001835,CDM,301,RC,80320,HCPCS,Outpatient,,,70,52.5,,54.6,78,,43.68,percent of total billed charges,78% of total billed charges,13.59,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,26.6,38,,21.28,percent of total billed charges,38% of total billed charges,26.6,38,,21.28,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,63,90,,50.4,percent of total billed charges,90% of total billed charges,14.27,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,47.09,67.275,,37.672,percent of total billed charges,67.275% of total billed charges,56,80,,44.8,percent of total billed charges,80% of total billed charges,26.87,38.38,,21.496,percent of total billed charges,38.38% of total billed charges,56,80,,44.8,percent of total billed charges,80% of total billed charges,43.22,61.74,,34.576,percent of total billed charges,61.74% of total billed charges,13.86,102,,,Fee Schedule,102% of GA Medicaid Rate,26.6,38,,21.28,percent of total billed charges,38% of total billed charges,13.59,63,
PT ORTHOTIC MGMT & TRAINING,9590029,CDM,420,RC,97760,HCPCS,Outpatient,,,70,52.5,,54.6,78,,43.68,percent of total billed charges,78% of total billed charges,44.1,63,,35.28,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,26.6,38,,21.28,percent of total billed charges,38% of total billed charges,26.6,38,,21.28,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,63,90,,50.4,percent of total billed charges,90% of total billed charges,24.5,35,,19.6,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,56,80,,44.8,percent of total billed charges,80% of total billed charges,26.87,38.38,,21.496,percent of total billed charges,38.38% of total billed charges,56,80,,44.8,percent of total billed charges,80% of total billed charges,43.22,61.74,,34.576,percent of total billed charges,61.74% of total billed charges,71.4,102,,57.12,percent of total billed charges,102% of total billed charges,26.6,38,,21.28,percent of total billed charges,38% of total billed charges,24.5,145.93,
EAKIN FISTULA 6.9X4.3 OSTOMY,3001511,CDM,270,RC,,,Outpatient,,,70.25,52.69,,54.8,78,,43.84,percent of total billed charges,78% of total billed charges,44.26,63,,35.408,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,26.7,38,,21.36,percent of total billed charges,38% of total billed charges,26.7,38,,21.36,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,63.23,90,,50.584,percent of total billed charges,90% of total billed charges,24.59,35,,19.672,percent of total billed charges,35% of total billed charges,47.26,67.275,,37.808,percent of total billed charges,67.275% of total billed charges,56.2,80,,44.96,percent of total billed charges,80% of total billed charges,26.96,38.38,,21.568,percent of total billed charges,38.38% of total billed charges,56.2,80,,44.96,percent of total billed charges,80% of total billed charges,43.37,61.74,,34.696,percent of total billed charges,61.74% of total billed charges,71.66,102,,57.328,percent of total billed charges,102% of total billed charges,26.7,38,,21.36,percent of total billed charges,38% of total billed charges,24.59,71.66,
BULB SUCTION RESV 2160,3000107,CDM,270,RC,,,Outpatient,,,70.9,53.18,,55.3,78,,44.24,percent of total billed charges,78% of total billed charges,44.67,63,,35.736,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,26.94,38,,21.552,percent of total billed charges,38% of total billed charges,26.94,38,,21.552,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,63.81,90,,51.048,percent of total billed charges,90% of total billed charges,24.82,35,,19.856,percent of total billed charges,35% of total billed charges,47.7,67.275,,38.16,percent of total billed charges,67.275% of total billed charges,56.72,80,,45.376,percent of total billed charges,80% of total billed charges,27.21,38.38,,21.768,percent of total billed charges,38.38% of total billed charges,56.72,80,,45.376,percent of total billed charges,80% of total billed charges,43.77,61.74,,35.016,percent of total billed charges,61.74% of total billed charges,72.32,102,,57.856,percent of total billed charges,102% of total billed charges,26.94,38,,21.552,percent of total billed charges,38% of total billed charges,24.82,72.32,
XRAY MRI SYRINGE,3004272,CDM,270,RC,,,Outpatient,,,70.9,53.18,,55.3,78,,44.24,percent of total billed charges,78% of total billed charges,44.67,63,,35.736,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,26.94,38,,21.552,percent of total billed charges,38% of total billed charges,26.94,38,,21.552,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,63.81,90,,51.048,percent of total billed charges,90% of total billed charges,24.82,35,,19.856,percent of total billed charges,35% of total billed charges,47.7,67.275,,38.16,percent of total billed charges,67.275% of total billed charges,56.72,80,,45.376,percent of total billed charges,80% of total billed charges,27.21,38.38,,21.768,percent of total billed charges,38.38% of total billed charges,56.72,80,,45.376,percent of total billed charges,80% of total billed charges,43.77,61.74,,35.016,percent of total billed charges,61.74% of total billed charges,72.32,102,,57.856,percent of total billed charges,102% of total billed charges,26.94,38,,21.552,percent of total billed charges,38% of total billed charges,24.82,72.32,
OFFLOADING SHOE - MD,3001800,CDM,270,RC,,,Outpatient,,,70.95,53.21,,55.34,78,,44.272,percent of total billed charges,78% of total billed charges,44.7,63,,35.76,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,26.96,38,,21.568,percent of total billed charges,38% of total billed charges,26.96,38,,21.568,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,63.86,90,,51.088,percent of total billed charges,90% of total billed charges,24.83,35,,19.864,percent of total billed charges,35% of total billed charges,47.73,67.275,,38.184,percent of total billed charges,67.275% of total billed charges,56.76,80,,45.408,percent of total billed charges,80% of total billed charges,27.23,38.38,,21.784,percent of total billed charges,38.38% of total billed charges,56.76,80,,45.408,percent of total billed charges,80% of total billed charges,43.8,61.74,,35.04,percent of total billed charges,61.74% of total billed charges,72.37,102,,57.896,percent of total billed charges,102% of total billed charges,26.96,38,,21.568,percent of total billed charges,38% of total billed charges,24.83,72.37,
BETA LACTAMASE,5000902,CDM,306,RC,87185,HCPCS,Outpatient,,,71,53.25,,55.38,78,,44.304,percent of total billed charges,78% of total billed charges,5.98,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,6.28,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,47.77,67.275,,38.216,percent of total billed charges,67.275% of total billed charges,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,4.8,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,43.84,61.74,,35.072,percent of total billed charges,61.74% of total billed charges,6.1,102,,,Fee Schedule,102% of GA Medicaid Rate,4.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.75,63.9,
PROTEIN ELECTROPHORESIS,5001411,CDM,301,RC,84165,HCPCS,Outpatient,,,71,53.25,,55.38,78,,44.304,percent of total billed charges,78% of total billed charges,13.51,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,10.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,14.19,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,47.77,67.275,,38.216,percent of total billed charges,67.275% of total billed charges,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,10.85,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,43.84,61.74,,35.072,percent of total billed charges,61.74% of total billed charges,13.78,102,,,Fee Schedule,102% of GA Medicaid Rate,10.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.74,63.9,
HEPATITIS B SURF AB,5001737,CDM,302,RC,86706,HCPCS,Outpatient,,,71,53.25,,55.38,78,,44.304,percent of total billed charges,78% of total billed charges,13.51,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,10.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,14.19,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,47.77,67.275,,38.216,percent of total billed charges,67.275% of total billed charges,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,10.85,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,43.84,61.74,,35.072,percent of total billed charges,61.74% of total billed charges,13.78,102,,,Fee Schedule,102% of GA Medicaid Rate,10.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.74,63.9,
BIOPSY TRAY SAFE-T,3005017,CDM,270,RC,,,Outpatient,,,71.75,53.81,,55.97,78,,44.776,percent of total billed charges,78% of total billed charges,45.2,63,,36.16,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,27.27,38,,21.816,percent of total billed charges,38% of total billed charges,27.27,38,,21.816,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,64.58,90,,51.664,percent of total billed charges,90% of total billed charges,25.11,35,,20.088,percent of total billed charges,35% of total billed charges,48.27,67.275,,38.616,percent of total billed charges,67.275% of total billed charges,57.4,80,,45.92,percent of total billed charges,80% of total billed charges,27.54,38.38,,22.032,percent of total billed charges,38.38% of total billed charges,57.4,80,,45.92,percent of total billed charges,80% of total billed charges,44.3,61.74,,35.44,percent of total billed charges,61.74% of total billed charges,73.19,102,,58.552,percent of total billed charges,102% of total billed charges,27.27,38,,21.816,percent of total billed charges,38% of total billed charges,25.11,73.19,
LEG LIFT,3004115,CDM,270,RC,,,Outpatient,,,72,54,,56.16,78,,44.928,percent of total billed charges,78% of total billed charges,45.36,63,,36.288,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,27.36,38,,21.888,percent of total billed charges,38% of total billed charges,27.36,38,,21.888,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,64.8,90,,51.84,percent of total billed charges,90% of total billed charges,25.2,35,,20.16,percent of total billed charges,35% of total billed charges,48.44,67.275,,38.752,percent of total billed charges,67.275% of total billed charges,57.6,80,,46.08,percent of total billed charges,80% of total billed charges,27.63,38.38,,22.104,percent of total billed charges,38.38% of total billed charges,57.6,80,,46.08,percent of total billed charges,80% of total billed charges,44.45,61.74,,35.56,percent of total billed charges,61.74% of total billed charges,73.44,102,,58.752,percent of total billed charges,102% of total billed charges,27.36,38,,21.888,percent of total billed charges,38% of total billed charges,25.2,73.44,
LITHIUM LEVEL,5001785,CDM,301,RC,80178,HCPCS,Outpatient,,,72,54,,56.16,78,,44.928,percent of total billed charges,78% of total billed charges,8.32,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.61,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.61,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,64.8,90,,51.84,percent of total billed charges,90% of total billed charges,8.74,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,48.44,67.275,,38.752,percent of total billed charges,67.275% of total billed charges,57.6,80,,46.08,percent of total billed charges,80% of total billed charges,6.68,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,57.6,80,,46.08,percent of total billed charges,80% of total billed charges,44.45,61.74,,35.56,percent of total billed charges,61.74% of total billed charges,8.49,102,,,Fee Schedule,102% of GA Medicaid Rate,6.61,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.61,64.8,
DEFIB MONITOR PADS- PED,3000313,CDM,270,RC,,,Outpatient,,,72.5,54.38,,56.55,78,,45.24,percent of total billed charges,78% of total billed charges,45.68,63,,36.544,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,27.55,38,,22.04,percent of total billed charges,38% of total billed charges,27.55,38,,22.04,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,65.25,90,,52.2,percent of total billed charges,90% of total billed charges,25.38,35,,20.304,percent of total billed charges,35% of total billed charges,48.77,67.275,,39.016,percent of total billed charges,67.275% of total billed charges,58,80,,46.4,percent of total billed charges,80% of total billed charges,27.83,38.38,,22.264,percent of total billed charges,38.38% of total billed charges,58,80,,46.4,percent of total billed charges,80% of total billed charges,44.76,61.74,,35.808,percent of total billed charges,61.74% of total billed charges,73.95,102,,59.16,percent of total billed charges,102% of total billed charges,27.55,38,,22.04,percent of total billed charges,38% of total billed charges,25.38,73.95,
"MITT, HAND/BINDER, PADDED",3000518,CDM,270,RC,,,Outpatient,,,72.75,54.56,,56.75,78,,45.4,percent of total billed charges,78% of total billed charges,45.83,63,,36.664,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,27.65,38,,22.12,percent of total billed charges,38% of total billed charges,27.65,38,,22.12,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,65.48,90,,52.384,percent of total billed charges,90% of total billed charges,25.46,35,,20.368,percent of total billed charges,35% of total billed charges,48.94,67.275,,39.152,percent of total billed charges,67.275% of total billed charges,58.2,80,,46.56,percent of total billed charges,80% of total billed charges,27.92,38.38,,22.336,percent of total billed charges,38.38% of total billed charges,58.2,80,,46.56,percent of total billed charges,80% of total billed charges,44.92,61.74,,35.936,percent of total billed charges,61.74% of total billed charges,74.21,102,,59.368,percent of total billed charges,102% of total billed charges,27.65,38,,22.12,percent of total billed charges,38% of total billed charges,25.46,74.21,
5' NUCLEOTIDASE,5000108,CDM,301,RC,83915,HCPCS,Outpatient,,,73,54.75,,56.94,78,,45.552,percent of total billed charges,78% of total billed charges,14.02,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,11.15,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.15,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,14.72,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,49.11,67.275,,39.288,percent of total billed charges,67.275% of total billed charges,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,11.26,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,45.07,61.74,,36.056,percent of total billed charges,61.74% of total billed charges,14.3,102,,,Fee Schedule,102% of GA Medicaid Rate,11.15,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.15,65.7,
SODIUM,5000751,CDM,301,RC,84295,HCPCS,Outpatient,,,73,54.75,,56.94,78,,45.552,percent of total billed charges,78% of total billed charges,6.05,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,6.35,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,49.11,67.275,,39.288,percent of total billed charges,67.275% of total billed charges,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,4.86,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,45.07,61.74,,36.056,percent of total billed charges,61.74% of total billed charges,6.17,102,,,Fee Schedule,102% of GA Medicaid Rate,4.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.81,65.7,
Blood test to determine autoimmune disorders,5001454,CDM,302,RC,86039,HCPCS,Outpatient,,,73,54.75,,56.94,78,,45.552,percent of total billed charges,78% of total billed charges,14.04,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,11.16,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.16,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,14.74,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,49.11,67.275,,39.288,percent of total billed charges,67.275% of total billed charges,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,11.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,45.07,61.74,,36.056,percent of total billed charges,61.74% of total billed charges,14.32,102,,,Fee Schedule,102% of GA Medicaid Rate,11.16,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.16,65.7,
HEPATITIS A IGM ANTIBODY,5001734,CDM,300,RC,86709,HCPCS,Outpatient,,,73,54.75,,56.94,78,,45.552,percent of total billed charges,78% of total billed charges,14.16,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,11.26,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.26,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,14.87,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,49.11,67.275,,39.288,percent of total billed charges,67.275% of total billed charges,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,11.37,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,45.07,61.74,,36.056,percent of total billed charges,61.74% of total billed charges,14.44,102,,,Fee Schedule,102% of GA Medicaid Rate,11.26,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.26,65.7,
A type of physical therapy,9000009,CDM,420,RC,97116,HCPCS,Outpatient,,,73,54.75,,56.94,78,,45.552,percent of total billed charges,78% of total billed charges,45.99,63,,36.792,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,27.74,38,,22.192,percent of total billed charges,38% of total billed charges,27.74,38,,22.192,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,25.55,35,,20.44,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,28.02,38.38,,22.416,percent of total billed charges,38.38% of total billed charges,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,45.07,61.74,,36.056,percent of total billed charges,61.74% of total billed charges,74.46,102,,59.568,percent of total billed charges,102% of total billed charges,27.74,38,,22.192,percent of total billed charges,38% of total billed charges,25.55,145.93,
Use of massage,9000017,CDM,420,RC,97124,HCPCS,Outpatient,,,73,54.75,,56.94,78,,45.552,percent of total billed charges,78% of total billed charges,45.99,63,,36.792,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,27.74,38,,22.192,percent of total billed charges,38% of total billed charges,27.74,38,,22.192,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,25.55,35,,20.44,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,28.02,38.38,,22.416,percent of total billed charges,38.38% of total billed charges,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,45.07,61.74,,36.056,percent of total billed charges,61.74% of total billed charges,74.46,102,,59.568,percent of total billed charges,102% of total billed charges,27.74,38,,22.192,percent of total billed charges,38% of total billed charges,25.55,145.93,
Use of massage,9000208,CDM,430,RC,97124,HCPCS,Outpatient,,,73,54.75,,56.94,78,,45.552,percent of total billed charges,78% of total billed charges,45.99,63,,36.792,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,27.74,38,,22.192,percent of total billed charges,38% of total billed charges,27.74,38,,22.192,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,25.55,35,,20.44,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,28.02,38.38,,22.416,percent of total billed charges,38.38% of total billed charges,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,45.07,61.74,,36.056,percent of total billed charges,61.74% of total billed charges,74.46,102,,59.568,percent of total billed charges,102% of total billed charges,27.74,38,,22.192,percent of total billed charges,38% of total billed charges,25.55,145.93,
CATH FOLEY TRAY SILVER 16FR,3000203,CDM,270,RC,,,Outpatient,,,73.1,54.83,,57.02,78,,45.616,percent of total billed charges,78% of total billed charges,46.05,63,,36.84,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,27.78,38,,22.224,percent of total billed charges,38% of total billed charges,27.78,38,,22.224,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,65.79,90,,52.632,percent of total billed charges,90% of total billed charges,25.59,35,,20.472,percent of total billed charges,35% of total billed charges,49.18,67.275,,39.344,percent of total billed charges,67.275% of total billed charges,58.48,80,,46.784,percent of total billed charges,80% of total billed charges,28.06,38.38,,22.448,percent of total billed charges,38.38% of total billed charges,58.48,80,,46.784,percent of total billed charges,80% of total billed charges,45.13,61.74,,36.104,percent of total billed charges,61.74% of total billed charges,74.56,102,,59.648,percent of total billed charges,102% of total billed charges,27.78,38,,22.224,percent of total billed charges,38% of total billed charges,25.59,74.56,
CATH FOLEY TRAY SILVER 18FR,3000413,CDM,270,RC,,,Outpatient,,,73.1,54.83,,57.02,78,,45.616,percent of total billed charges,78% of total billed charges,46.05,63,,36.84,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,27.78,38,,22.224,percent of total billed charges,38% of total billed charges,27.78,38,,22.224,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,65.79,90,,52.632,percent of total billed charges,90% of total billed charges,25.59,35,,20.472,percent of total billed charges,35% of total billed charges,49.18,67.275,,39.344,percent of total billed charges,67.275% of total billed charges,58.48,80,,46.784,percent of total billed charges,80% of total billed charges,28.06,38.38,,22.448,percent of total billed charges,38.38% of total billed charges,58.48,80,,46.784,percent of total billed charges,80% of total billed charges,45.13,61.74,,36.104,percent of total billed charges,61.74% of total billed charges,74.56,102,,59.648,percent of total billed charges,102% of total billed charges,27.78,38,,22.224,percent of total billed charges,38% of total billed charges,25.59,74.56,
MASK PANDA SMALL,3003061,CDM,270,RC,,,Outpatient,,,73.1,54.83,,57.02,78,,45.616,percent of total billed charges,78% of total billed charges,46.05,63,,36.84,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,27.78,38,,22.224,percent of total billed charges,38% of total billed charges,27.78,38,,22.224,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,65.79,90,,52.632,percent of total billed charges,90% of total billed charges,25.59,35,,20.472,percent of total billed charges,35% of total billed charges,49.18,67.275,,39.344,percent of total billed charges,67.275% of total billed charges,58.48,80,,46.784,percent of total billed charges,80% of total billed charges,28.06,38.38,,22.448,percent of total billed charges,38.38% of total billed charges,58.48,80,,46.784,percent of total billed charges,80% of total billed charges,45.13,61.74,,36.104,percent of total billed charges,61.74% of total billed charges,74.56,102,,59.648,percent of total billed charges,102% of total billed charges,27.78,38,,22.224,percent of total billed charges,38% of total billed charges,25.59,74.56,
SILVASORB 4X4  MSC9344Z,3000528,CDM,270,RC,,,Outpatient,,,73.25,54.94,,57.14,78,,45.712,percent of total billed charges,78% of total billed charges,46.15,63,,36.92,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,27.84,38,,22.272,percent of total billed charges,38% of total billed charges,27.84,38,,22.272,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,65.93,90,,52.744,percent of total billed charges,90% of total billed charges,25.64,35,,20.512,percent of total billed charges,35% of total billed charges,49.28,67.275,,39.424,percent of total billed charges,67.275% of total billed charges,58.6,80,,46.88,percent of total billed charges,80% of total billed charges,28.11,38.38,,22.488,percent of total billed charges,38.38% of total billed charges,58.6,80,,46.88,percent of total billed charges,80% of total billed charges,45.22,61.74,,36.176,percent of total billed charges,61.74% of total billed charges,74.72,102,,59.776,percent of total billed charges,102% of total billed charges,27.84,38,,22.272,percent of total billed charges,38% of total billed charges,25.64,74.72,
"THUMB SPLINT, SPICA, UNIVERSAL - SUB",3001775,CDM,270,RC,,,Outpatient,,,73.65,55.24,,57.45,78,,45.96,percent of total billed charges,78% of total billed charges,46.4,63,,37.12,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,27.99,38,,22.392,percent of total billed charges,38% of total billed charges,27.99,38,,22.392,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,66.29,90,,53.032,percent of total billed charges,90% of total billed charges,25.78,35,,20.624,percent of total billed charges,35% of total billed charges,49.55,67.275,,39.64,percent of total billed charges,67.275% of total billed charges,58.92,80,,47.136,percent of total billed charges,80% of total billed charges,28.27,38.38,,22.616,percent of total billed charges,38.38% of total billed charges,58.92,80,,47.136,percent of total billed charges,80% of total billed charges,45.47,61.74,,36.376,percent of total billed charges,61.74% of total billed charges,75.12,102,,60.096,percent of total billed charges,102% of total billed charges,27.99,38,,22.392,percent of total billed charges,38% of total billed charges,25.78,75.12,
BUN,5000763,CDM,301,RC,84520,HCPCS,Outpatient,,,74,55.5,,57.72,78,,46.176,percent of total billed charges,78% of total billed charges,4.96,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,3.95,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.95,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,5.21,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,49.78,67.275,,39.824,percent of total billed charges,67.275% of total billed charges,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,3.99,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,45.69,61.74,,36.552,percent of total billed charges,61.74% of total billed charges,5.06,102,,,Fee Schedule,102% of GA Medicaid Rate,3.95,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.95,66.6,
ALLG SPEC IGE CRUDE EA,5086003,CDM,301,RC,86003,HCPCS,Outpatient,,,74,55.5,,57.72,78,,46.176,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,49.78,67.275,,39.824,percent of total billed charges,67.275% of total billed charges,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,5.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,45.69,61.74,,36.552,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,66.6,
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",9000012,CDM,420,RC,97110,HCPCS,Outpatient,,,74,55.5,,57.72,78,,46.176,percent of total billed charges,78% of total billed charges,46.62,63,,37.296,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,28.12,38,,22.496,percent of total billed charges,38% of total billed charges,28.12,38,,22.496,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,25.9,35,,20.72,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,28.4,38.38,,22.72,percent of total billed charges,38.38% of total billed charges,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,45.69,61.74,,36.552,percent of total billed charges,61.74% of total billed charges,75.48,102,,60.384,percent of total billed charges,102% of total billed charges,28.12,38,,22.496,percent of total billed charges,38% of total billed charges,25.9,145.93,
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",9000044,CDM,420,RC,97110,HCPCS,Outpatient,,,74,55.5,,57.72,78,,46.176,percent of total billed charges,78% of total billed charges,46.62,63,,37.296,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,28.12,38,,22.496,percent of total billed charges,38% of total billed charges,28.12,38,,22.496,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,25.9,35,,20.72,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,28.4,38.38,,22.72,percent of total billed charges,38.38% of total billed charges,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,45.69,61.74,,36.552,percent of total billed charges,61.74% of total billed charges,75.48,102,,60.384,percent of total billed charges,102% of total billed charges,28.12,38,,22.496,percent of total billed charges,38% of total billed charges,25.9,145.93,
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",9000204,CDM,430,RC,97110,HCPCS,Outpatient,,,74,55.5,,57.72,78,,46.176,percent of total billed charges,78% of total billed charges,46.62,63,,37.296,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,28.12,38,,22.496,percent of total billed charges,38% of total billed charges,28.12,38,,22.496,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,25.9,35,,20.72,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,28.4,38.38,,22.72,percent of total billed charges,38.38% of total billed charges,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,45.69,61.74,,36.552,percent of total billed charges,61.74% of total billed charges,75.48,102,,60.384,percent of total billed charges,102% of total billed charges,28.12,38,,22.496,percent of total billed charges,38% of total billed charges,25.9,145.93,
CERV COLLAR PHILADELPHIA LARGE,3001532,CDM,270,RC,,,Outpatient,,,74.2,55.65,,57.88,78,,46.304,percent of total billed charges,78% of total billed charges,46.75,63,,37.4,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,28.2,38,,22.56,percent of total billed charges,38% of total billed charges,28.2,38,,22.56,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,66.78,90,,53.424,percent of total billed charges,90% of total billed charges,25.97,35,,20.776,percent of total billed charges,35% of total billed charges,49.92,67.275,,39.936,percent of total billed charges,67.275% of total billed charges,59.36,80,,47.488,percent of total billed charges,80% of total billed charges,28.48,38.38,,22.784,percent of total billed charges,38.38% of total billed charges,59.36,80,,47.488,percent of total billed charges,80% of total billed charges,45.81,61.74,,36.648,percent of total billed charges,61.74% of total billed charges,75.68,102,,60.544,percent of total billed charges,102% of total billed charges,28.2,38,,22.56,percent of total billed charges,38% of total billed charges,25.97,75.68,
WASHER SLOTTED,3006013,CDM,270,RC,,,Outpatient,,,75,56.25,,58.5,78,,46.8,percent of total billed charges,78% of total billed charges,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,28.5,38,,22.8,percent of total billed charges,38% of total billed charges,28.5,38,,22.8,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,67.5,90,,54,percent of total billed charges,90% of total billed charges,26.25,35,,21,percent of total billed charges,35% of total billed charges,50.46,67.275,,40.368,percent of total billed charges,67.275% of total billed charges,60,80,,48,percent of total billed charges,80% of total billed charges,28.79,38.38,,23.032,percent of total billed charges,38.38% of total billed charges,60,80,,48,percent of total billed charges,80% of total billed charges,46.31,61.74,,37.048,percent of total billed charges,61.74% of total billed charges,76.5,102,,61.2,percent of total billed charges,102% of total billed charges,28.5,38,,22.8,percent of total billed charges,38% of total billed charges,26.25,76.5,
K-WIRE SINGLE TROCAR 1.1,3008002,CDM,270,RC,,,Outpatient,,,75,56.25,,58.5,78,,46.8,percent of total billed charges,78% of total billed charges,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,28.5,38,,22.8,percent of total billed charges,38% of total billed charges,28.5,38,,22.8,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,67.5,90,,54,percent of total billed charges,90% of total billed charges,26.25,35,,21,percent of total billed charges,35% of total billed charges,50.46,67.275,,40.368,percent of total billed charges,67.275% of total billed charges,60,80,,48,percent of total billed charges,80% of total billed charges,28.79,38.38,,23.032,percent of total billed charges,38.38% of total billed charges,60,80,,48,percent of total billed charges,80% of total billed charges,46.31,61.74,,37.048,percent of total billed charges,61.74% of total billed charges,76.5,102,,61.2,percent of total billed charges,102% of total billed charges,28.5,38,,22.8,percent of total billed charges,38% of total billed charges,26.25,76.5,
"ALCOHOL, SALIVA",5001634,CDM,300,RC,82075,HCPCS,Outpatient,,,75,56.25,,58.5,78,,46.8,percent of total billed charges,78% of total billed charges,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,30,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,30,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,67.5,90,,54,percent of total billed charges,90% of total billed charges,26.25,35,,21,percent of total billed charges,35% of total billed charges,50.46,67.275,,40.368,percent of total billed charges,67.275% of total billed charges,60,80,,48,percent of total billed charges,80% of total billed charges,30.3,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,60,80,,48,percent of total billed charges,80% of total billed charges,46.31,61.74,,37.048,percent of total billed charges,61.74% of total billed charges,76.5,102,,61.2,percent of total billed charges,102% of total billed charges,30,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,26.25,76.5,
WEST NILE IGG-SERUM,5000027,CDM,302,RC,86789,HCPCS,Outpatient,,,76,57,,59.28,78,,47.424,percent of total billed charges,78% of total billed charges,14.63,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,15.36,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,51.13,67.275,,40.904,percent of total billed charges,67.275% of total billed charges,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,14.53,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,46.92,61.74,,37.536,percent of total billed charges,61.74% of total billed charges,14.92,102,,,Fee Schedule,102% of GA Medicaid Rate,14.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.39,68.4,
.WEST NILE IGG,5000037,CDM,302,RC,86789,HCPCS,Outpatient,,,76,57,,59.28,78,,47.424,percent of total billed charges,78% of total billed charges,14.63,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,15.36,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,51.13,67.275,,40.904,percent of total billed charges,67.275% of total billed charges,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,14.53,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,46.92,61.74,,37.536,percent of total billed charges,61.74% of total billed charges,14.92,102,,,Fee Schedule,102% of GA Medicaid Rate,14.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.39,68.4,
PROTEIN S ACTIVITY,5000452,CDM,301,RC,85305,HCPCS,Outpatient,,,76,57,,59.28,78,,47.424,percent of total billed charges,78% of total billed charges,14.58,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,11.61,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.61,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,15.31,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,51.13,67.275,,40.904,percent of total billed charges,67.275% of total billed charges,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,11.73,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,46.92,61.74,,37.536,percent of total billed charges,61.74% of total billed charges,14.87,102,,,Fee Schedule,102% of GA Medicaid Rate,11.61,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.61,68.4,
CHLORIDE,5000721,CDM,301,RC,82435,HCPCS,Outpatient,,,76,57,,59.28,78,,47.424,percent of total billed charges,78% of total billed charges,5.78,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,6.07,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,51.13,67.275,,40.904,percent of total billed charges,67.275% of total billed charges,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,4.65,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,46.92,61.74,,37.536,percent of total billed charges,61.74% of total billed charges,5.9,102,,,Fee Schedule,102% of GA Medicaid Rate,4.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.6,68.4,
THYROXIN BINDING GLOBULIN (TBG),5001234,CDM,300,RC,84442,HCPCS,Outpatient,,,76,57,,59.28,78,,47.424,percent of total billed charges,78% of total billed charges,14.63,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.78,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.78,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,15.36,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,51.13,67.275,,40.904,percent of total billed charges,67.275% of total billed charges,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,14.93,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,46.92,61.74,,37.536,percent of total billed charges,61.74% of total billed charges,14.92,102,,,Fee Schedule,102% of GA Medicaid Rate,14.78,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.63,68.4,
LDH ISOENZYME,5001431,CDM,301,RC,83625,HCPCS,Outpatient,,,76,57,,59.28,78,,47.424,percent of total billed charges,78% of total billed charges,14.55,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.79,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.79,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,15.28,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,51.13,67.275,,40.904,percent of total billed charges,67.275% of total billed charges,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,12.92,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,46.92,61.74,,37.536,percent of total billed charges,61.74% of total billed charges,14.84,102,,,Fee Schedule,102% of GA Medicaid Rate,12.79,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.79,68.4,
HEP BE ANTIBODY,5001762,CDM,302,RC,86707,HCPCS,Outpatient,,,76,57,,59.28,78,,47.424,percent of total billed charges,78% of total billed charges,14.54,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,11.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,15.27,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,51.13,67.275,,40.904,percent of total billed charges,67.275% of total billed charges,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,11.69,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,46.92,61.74,,37.536,percent of total billed charges,61.74% of total billed charges,14.83,102,,,Fee Schedule,102% of GA Medicaid Rate,11.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.57,68.4,
Blood test to monitor for cytomegalovirus,5001805,CDM,302,RC,86644,HCPCS,Outpatient,,,76,57,,59.28,78,,47.424,percent of total billed charges,78% of total billed charges,14.63,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,15.36,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,51.13,67.275,,40.904,percent of total billed charges,67.275% of total billed charges,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,14.53,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,46.92,61.74,,37.536,percent of total billed charges,61.74% of total billed charges,14.92,102,,,Fee Schedule,102% of GA Medicaid Rate,14.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.39,68.4,
HERPES SIMPLEX ANTIBODY,5001913,CDM,302,RC,86694,HCPCS,Outpatient,,,76,57,,59.28,78,,47.424,percent of total billed charges,78% of total billed charges,14.63,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,15.36,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,51.13,67.275,,40.904,percent of total billed charges,67.275% of total billed charges,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,14.53,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,46.92,61.74,,37.536,percent of total billed charges,61.74% of total billed charges,14.92,102,,,Fee Schedule,102% of GA Medicaid Rate,14.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.39,68.4,
Blood test to monitor for cytomegalovirus,5001971,CDM,302,RC,86644,HCPCS,Outpatient,,,76,57,,59.28,78,,47.424,percent of total billed charges,78% of total billed charges,14.63,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,15.36,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,51.13,67.275,,40.904,percent of total billed charges,67.275% of total billed charges,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,14.53,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,46.92,61.74,,37.536,percent of total billed charges,61.74% of total billed charges,14.92,102,,,Fee Schedule,102% of GA Medicaid Rate,14.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.39,68.4,
HSV IgM WITH REFLEX TITER,5008405,CDM,302,RC,86694,HCPCS,Outpatient,,,76,57,,59.28,78,,47.424,percent of total billed charges,78% of total billed charges,14.63,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,15.36,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,51.13,67.275,,40.904,percent of total billed charges,67.275% of total billed charges,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,14.53,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,46.92,61.74,,37.536,percent of total billed charges,61.74% of total billed charges,14.92,102,,,Fee Schedule,102% of GA Medicaid Rate,14.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.39,68.4,
XEMG SENSORY OR MIXED NERVE STUDY,9600019,CDM,922,RC,95904,HCPCS,Outpatient,,,76,57,,59.28,78,,47.424,percent of total billed charges,78% of total billed charges,47.88,63,,38.304,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,28.88,38,,23.104,percent of total billed charges,38% of total billed charges,28.88,38,,23.104,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,26.6,35,,21.28,percent of total billed charges,35% of total billed charges,51.13,67.275,,40.904,percent of total billed charges,67.275% of total billed charges,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,29.17,38.38,,23.336,percent of total billed charges,38.38% of total billed charges,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,46.92,61.74,,37.536,percent of total billed charges,61.74% of total billed charges,77.52,102,,62.016,percent of total billed charges,102% of total billed charges,28.88,38,,23.104,percent of total billed charges,38% of total billed charges,26.6,77.52,
CAST UPPER EXTREMITY,1001082,CDM,450,RC,,,Outpatient,,,77,57.75,,60.06,78,,48.048,percent of total billed charges,78% of total billed charges,48.51,63,,38.808,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,29.26,38,,23.408,percent of total billed charges,38% of total billed charges,29.26,38,,23.408,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,26.95,35,,21.56,percent of total billed charges,35% of total billed charges,51.8,67.275,,41.44,percent of total billed charges,67.275% of total billed charges,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,29.55,38.38,,23.64,percent of total billed charges,38.38% of total billed charges,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,47.54,61.74,,38.032,percent of total billed charges,61.74% of total billed charges,78.54,102,,62.832,percent of total billed charges,102% of total billed charges,29.26,38,,23.408,percent of total billed charges,38% of total billed charges,26.95,78.54,
STRAPPING UPPER EXTREMITY,1001090,CDM,450,RC,,,Outpatient,,,77,57.75,,60.06,78,,48.048,percent of total billed charges,78% of total billed charges,48.51,63,,38.808,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,29.26,38,,23.408,percent of total billed charges,38% of total billed charges,29.26,38,,23.408,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,26.95,35,,21.56,percent of total billed charges,35% of total billed charges,51.8,67.275,,41.44,percent of total billed charges,67.275% of total billed charges,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,29.55,38.38,,23.64,percent of total billed charges,38.38% of total billed charges,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,47.54,61.74,,38.032,percent of total billed charges,61.74% of total billed charges,78.54,102,,62.832,percent of total billed charges,102% of total billed charges,29.26,38,,23.408,percent of total billed charges,38% of total billed charges,26.95,78.54,
COMPREHENSIVE CONSULTATIO,1200111,CDM,981,RC,,,Outpatient,,,77,57.75,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.59,61.74,,37.272,percent of total billed charges,61.74% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.59,46.59,
CREATININE BLOOD,5000727,CDM,301,RC,82565,HCPCS,Outpatient,,,77,57.75,,60.06,78,,48.048,percent of total billed charges,78% of total billed charges,6.35,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.12,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.12,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,6.67,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,51.8,67.275,,41.44,percent of total billed charges,67.275% of total billed charges,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,5.17,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,47.54,61.74,,38.032,percent of total billed charges,61.74% of total billed charges,6.48,102,,,Fee Schedule,102% of GA Medicaid Rate,5.12,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.12,69.3,
HEP B-CORE IgM Ab,5001654,CDM,300,RC,86705,HCPCS,Outpatient,,,77,57.75,,60.06,78,,48.048,percent of total billed charges,78% of total billed charges,14.8,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,11.77,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.77,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,15.54,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,51.8,67.275,,41.44,percent of total billed charges,67.275% of total billed charges,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,11.89,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,47.54,61.74,,38.032,percent of total billed charges,61.74% of total billed charges,15.1,102,,,Fee Schedule,102% of GA Medicaid Rate,11.77,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.77,69.3,
.GLOMERULAR FILTRATION RATE,5001711,CDM,301,RC,82565,HCPCS,Outpatient,,,77,57.75,,60.06,78,,48.048,percent of total billed charges,78% of total billed charges,6.35,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.12,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.12,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,6.67,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,51.8,67.275,,41.44,percent of total billed charges,67.275% of total billed charges,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,5.17,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,47.54,61.74,,38.032,percent of total billed charges,61.74% of total billed charges,6.48,102,,,Fee Schedule,102% of GA Medicaid Rate,5.12,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.12,69.3,
PT RE-EVALUATION,9590020,CDM,420,RC,,,Outpatient,,,77,57.75,,60.06,78,,48.048,percent of total billed charges,78% of total billed charges,48.51,63,,38.808,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,29.26,38,,23.408,percent of total billed charges,38% of total billed charges,29.26,38,,23.408,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,26.95,35,,21.56,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,29.55,38.38,,23.64,percent of total billed charges,38.38% of total billed charges,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,47.54,61.74,,38.032,percent of total billed charges,61.74% of total billed charges,78.54,102,,62.832,percent of total billed charges,102% of total billed charges,29.26,38,,23.408,percent of total billed charges,38% of total billed charges,26.95,145.93,
MODULE O2 ORANGE,3000041,CDM,270,RC,,,Outpatient,,,77.4,58.05,,60.37,78,,48.296,percent of total billed charges,78% of total billed charges,48.76,63,,39.008,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,29.41,38,,23.528,percent of total billed charges,38% of total billed charges,29.41,38,,23.528,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,69.66,90,,55.728,percent of total billed charges,90% of total billed charges,27.09,35,,21.672,percent of total billed charges,35% of total billed charges,52.07,67.275,,41.656,percent of total billed charges,67.275% of total billed charges,61.92,80,,49.536,percent of total billed charges,80% of total billed charges,29.71,38.38,,23.768,percent of total billed charges,38.38% of total billed charges,61.92,80,,49.536,percent of total billed charges,80% of total billed charges,47.79,61.74,,38.232,percent of total billed charges,61.74% of total billed charges,78.95,102,,63.16,percent of total billed charges,102% of total billed charges,29.41,38,,23.528,percent of total billed charges,38% of total billed charges,27.09,78.95,
MODULE O2 YELLOW,3000044,CDM,270,RC,,,Outpatient,,,77.4,58.05,,60.37,78,,48.296,percent of total billed charges,78% of total billed charges,48.76,63,,39.008,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,29.41,38,,23.528,percent of total billed charges,38% of total billed charges,29.41,38,,23.528,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,69.66,90,,55.728,percent of total billed charges,90% of total billed charges,27.09,35,,21.672,percent of total billed charges,35% of total billed charges,52.07,67.275,,41.656,percent of total billed charges,67.275% of total billed charges,61.92,80,,49.536,percent of total billed charges,80% of total billed charges,29.71,38.38,,23.768,percent of total billed charges,38.38% of total billed charges,61.92,80,,49.536,percent of total billed charges,80% of total billed charges,47.79,61.74,,38.232,percent of total billed charges,61.74% of total billed charges,78.95,102,,63.16,percent of total billed charges,102% of total billed charges,29.41,38,,23.528,percent of total billed charges,38% of total billed charges,27.09,78.95,
MODULE O2 WHITE,3000047,CDM,270,RC,,,Outpatient,,,77.4,58.05,,60.37,78,,48.296,percent of total billed charges,78% of total billed charges,48.76,63,,39.008,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,29.41,38,,23.528,percent of total billed charges,38% of total billed charges,29.41,38,,23.528,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,69.66,90,,55.728,percent of total billed charges,90% of total billed charges,27.09,35,,21.672,percent of total billed charges,35% of total billed charges,52.07,67.275,,41.656,percent of total billed charges,67.275% of total billed charges,61.92,80,,49.536,percent of total billed charges,80% of total billed charges,29.71,38.38,,23.768,percent of total billed charges,38.38% of total billed charges,61.92,80,,49.536,percent of total billed charges,80% of total billed charges,47.79,61.74,,38.232,percent of total billed charges,61.74% of total billed charges,78.95,102,,63.16,percent of total billed charges,102% of total billed charges,29.41,38,,23.528,percent of total billed charges,38% of total billed charges,27.09,78.95,
MODULE O2 BLUE,3000051,CDM,270,RC,,,Outpatient,,,77.4,58.05,,60.37,78,,48.296,percent of total billed charges,78% of total billed charges,48.76,63,,39.008,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,29.41,38,,23.528,percent of total billed charges,38% of total billed charges,29.41,38,,23.528,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,69.66,90,,55.728,percent of total billed charges,90% of total billed charges,27.09,35,,21.672,percent of total billed charges,35% of total billed charges,52.07,67.275,,41.656,percent of total billed charges,67.275% of total billed charges,61.92,80,,49.536,percent of total billed charges,80% of total billed charges,29.71,38.38,,23.768,percent of total billed charges,38.38% of total billed charges,61.92,80,,49.536,percent of total billed charges,80% of total billed charges,47.79,61.74,,38.232,percent of total billed charges,61.74% of total billed charges,78.95,102,,63.16,percent of total billed charges,102% of total billed charges,29.41,38,,23.528,percent of total billed charges,38% of total billed charges,27.09,78.95,
MODULE O2 GREEN,3000055,CDM,270,RC,,,Outpatient,,,77.4,58.05,,60.37,78,,48.296,percent of total billed charges,78% of total billed charges,48.76,63,,39.008,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,29.41,38,,23.528,percent of total billed charges,38% of total billed charges,29.41,38,,23.528,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,69.66,90,,55.728,percent of total billed charges,90% of total billed charges,27.09,35,,21.672,percent of total billed charges,35% of total billed charges,52.07,67.275,,41.656,percent of total billed charges,67.275% of total billed charges,61.92,80,,49.536,percent of total billed charges,80% of total billed charges,29.71,38.38,,23.768,percent of total billed charges,38.38% of total billed charges,61.92,80,,49.536,percent of total billed charges,80% of total billed charges,47.79,61.74,,38.232,percent of total billed charges,61.74% of total billed charges,78.95,102,,63.16,percent of total billed charges,102% of total billed charges,29.41,38,,23.528,percent of total billed charges,38% of total billed charges,27.09,78.95,
MODULE O2 PINK/RED,3000058,CDM,270,RC,,,Outpatient,,,77.4,58.05,,60.37,78,,48.296,percent of total billed charges,78% of total billed charges,48.76,63,,39.008,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,29.41,38,,23.528,percent of total billed charges,38% of total billed charges,29.41,38,,23.528,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,69.66,90,,55.728,percent of total billed charges,90% of total billed charges,27.09,35,,21.672,percent of total billed charges,35% of total billed charges,52.07,67.275,,41.656,percent of total billed charges,67.275% of total billed charges,61.92,80,,49.536,percent of total billed charges,80% of total billed charges,29.71,38.38,,23.768,percent of total billed charges,38.38% of total billed charges,61.92,80,,49.536,percent of total billed charges,80% of total billed charges,47.79,61.74,,38.232,percent of total billed charges,61.74% of total billed charges,78.95,102,,63.16,percent of total billed charges,102% of total billed charges,29.41,38,,23.528,percent of total billed charges,38% of total billed charges,27.09,78.95,
AMBU BAG W/PEEP,3004028,CDM,270,RC,,,Outpatient,,,77.65,58.24,,60.57,78,,48.456,percent of total billed charges,78% of total billed charges,48.92,63,,39.136,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,29.51,38,,23.608,percent of total billed charges,38% of total billed charges,29.51,38,,23.608,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,69.89,90,,55.912,percent of total billed charges,90% of total billed charges,27.18,35,,21.744,percent of total billed charges,35% of total billed charges,52.24,67.275,,41.792,percent of total billed charges,67.275% of total billed charges,62.12,80,,49.696,percent of total billed charges,80% of total billed charges,29.8,38.38,,23.84,percent of total billed charges,38.38% of total billed charges,62.12,80,,49.696,percent of total billed charges,80% of total billed charges,47.94,61.74,,38.352,percent of total billed charges,61.74% of total billed charges,79.2,102,,63.36,percent of total billed charges,102% of total billed charges,29.51,38,,23.608,percent of total billed charges,38% of total billed charges,27.18,79.2,
IMMUNIZATION ADMIN; INFLUENZA M'CARE,1001148,CDM,450,RC,G0008,HCPCS,Outpatient,,,78,58.5,,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,49.14,63,,39.312,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,29.64,38,,23.712,percent of total billed charges,38% of total billed charges,29.64,38,,23.712,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,27.3,35,,21.84,percent of total billed charges,35% of total billed charges,52.47,67.275,,41.976,percent of total billed charges,67.275% of total billed charges,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,29.94,38.38,,23.952,percent of total billed charges,38.38% of total billed charges,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,48.16,61.74,,38.528,percent of total billed charges,61.74% of total billed charges,79.56,102,,63.648,percent of total billed charges,102% of total billed charges,29.64,38,,23.712,percent of total billed charges,38% of total billed charges,27.3,79.56,
IMMUNIZATION ADMIN; PNEUMOCOCCAL M'CARE,1001149,CDM,450,RC,G0009,HCPCS,Outpatient,,,78,58.5,,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,49.14,63,,39.312,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,29.64,38,,23.712,percent of total billed charges,38% of total billed charges,29.64,38,,23.712,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,27.3,35,,21.84,percent of total billed charges,35% of total billed charges,52.47,67.275,,41.976,percent of total billed charges,67.275% of total billed charges,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,29.94,38.38,,23.952,percent of total billed charges,38.38% of total billed charges,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,48.16,61.74,,38.528,percent of total billed charges,61.74% of total billed charges,79.56,102,,63.648,percent of total billed charges,102% of total billed charges,29.64,38,,23.712,percent of total billed charges,38% of total billed charges,27.3,79.56,
MISC ALLER SPEC IGE,5000036,CDM,302,RC,86003,HCPCS,Outpatient,,,78,58.5,,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,6.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,6.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,52.47,67.275,,41.976,percent of total billed charges,67.275% of total billed charges,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,5.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,48.16,61.74,,38.528,percent of total billed charges,61.74% of total billed charges,6.7,102,,,Fee Schedule,102% of GA Medicaid Rate,5.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.22,70.2,
URINE PROTEIN RANDOM,5000307,CDM,301,RC,84156,HCPCS,Outpatient,,,78,58.5,,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,4.61,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,3.67,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.67,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,4.84,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,52.47,67.275,,41.976,percent of total billed charges,67.275% of total billed charges,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,3.71,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,48.16,61.74,,38.528,percent of total billed charges,61.74% of total billed charges,4.7,102,,,Fee Schedule,102% of GA Medicaid Rate,3.67,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.67,70.2,
PROTEIN 24 HR URINE,5001850,CDM,301,RC,84156,HCPCS,Outpatient,,,78,58.5,,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,4.61,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,3.67,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.67,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,4.84,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,52.47,67.275,,41.976,percent of total billed charges,67.275% of total billed charges,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,3.71,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,48.16,61.74,,38.528,percent of total billed charges,61.74% of total billed charges,4.7,102,,,Fee Schedule,102% of GA Medicaid Rate,3.67,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.67,70.2,
PROTEIN/CREAT RATIO,5001935,CDM,301,RC,84156,HCPCS,Outpatient,,,78,58.5,,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,4.61,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,3.67,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.67,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,4.84,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,52.47,67.275,,41.976,percent of total billed charges,67.275% of total billed charges,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,3.71,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,48.16,61.74,,38.528,percent of total billed charges,61.74% of total billed charges,4.7,102,,,Fee Schedule,102% of GA Medicaid Rate,3.67,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.67,70.2,
.RSV DFA,5001966,CDM,306,RC,87280,HCPCS,Outpatient,,,78,58.5,,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,15.08,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.42,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.42,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,15.83,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,52.47,67.275,,41.976,percent of total billed charges,67.275% of total billed charges,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,13.55,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,48.16,61.74,,38.528,percent of total billed charges,61.74% of total billed charges,15.38,102,,,Fee Schedule,102% of GA Medicaid Rate,13.42,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.42,70.2,
DIGOXIN-MULTIPLE,5009149,CDM,301,RC,80162,HCPCS,Outpatient,,,78,58.5,,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,16.7,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.28,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.28,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,17.54,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,52.47,67.275,,41.976,percent of total billed charges,67.275% of total billed charges,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,13.41,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,48.16,61.74,,38.528,percent of total billed charges,61.74% of total billed charges,17.03,102,,,Fee Schedule,102% of GA Medicaid Rate,13.28,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.28,70.2,
DARCO ORTHOWEDGE SHOE - MD,3005101,CDM,270,RC,,,Outpatient,,,78.5,58.88,,61.23,78,,48.984,percent of total billed charges,78% of total billed charges,49.46,63,,39.568,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,29.83,38,,23.864,percent of total billed charges,38% of total billed charges,29.83,38,,23.864,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,70.65,90,,56.52,percent of total billed charges,90% of total billed charges,27.48,35,,21.984,percent of total billed charges,35% of total billed charges,52.81,67.275,,42.248,percent of total billed charges,67.275% of total billed charges,62.8,80,,50.24,percent of total billed charges,80% of total billed charges,30.13,38.38,,24.104,percent of total billed charges,38.38% of total billed charges,62.8,80,,50.24,percent of total billed charges,80% of total billed charges,48.47,61.74,,38.776,percent of total billed charges,61.74% of total billed charges,80.07,102,,64.056,percent of total billed charges,102% of total billed charges,29.83,38,,23.864,percent of total billed charges,38% of total billed charges,27.48,80.07,
.NEUTROPHIL CYTOPLASM ABC,5000513,CDM,302,RC,86255,HCPCS,Outpatient,,,79,59.25,,61.62,78,,49.296,percent of total billed charges,78% of total billed charges,15.16,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,15.92,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,53.15,67.275,,42.52,percent of total billed charges,67.275% of total billed charges,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,12.17,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,48.77,61.74,,39.016,percent of total billed charges,61.74% of total billed charges,15.46,102,,,Fee Schedule,102% of GA Medicaid Rate,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.05,71.1,
.NEUTROPHIL CYTOPLASM ABP,5000514,CDM,302,RC,86255,HCPCS,Outpatient,,,79,59.25,,61.62,78,,49.296,percent of total billed charges,78% of total billed charges,15.16,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,15.92,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,53.15,67.275,,42.52,percent of total billed charges,67.275% of total billed charges,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,12.17,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,48.77,61.74,,39.016,percent of total billed charges,61.74% of total billed charges,15.46,102,,,Fee Schedule,102% of GA Medicaid Rate,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.05,71.1,
CENTROMERE B ANTIBODY,5001219,CDM,302,RC,86038,HCPCS,Outpatient,,,79,59.25,,61.62,78,,49.296,percent of total billed charges,78% of total billed charges,15.2,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,15.96,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,53.15,67.275,,42.52,percent of total billed charges,67.275% of total billed charges,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,12.21,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,48.77,61.74,,39.016,percent of total billed charges,61.74% of total billed charges,15.5,102,,,Fee Schedule,102% of GA Medicaid Rate,12.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.09,71.1,
ANA SCREEN W/REFLEX TO TITER IFA,5001405,CDM,302,RC,86038,HCPCS,Outpatient,,,79,59.25,,61.62,78,,49.296,percent of total billed charges,78% of total billed charges,15.2,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,15.96,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,53.15,67.275,,42.52,percent of total billed charges,67.275% of total billed charges,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,12.21,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,48.77,61.74,,39.016,percent of total billed charges,61.74% of total billed charges,15.5,102,,,Fee Schedule,102% of GA Medicaid Rate,12.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.09,71.1,
ALUMINUM,5001692,CDM,301,RC,82108,HCPCS,Outpatient,,,79,59.25,,61.62,78,,49.296,percent of total billed charges,78% of total billed charges,21.2,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,25.48,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,25.48,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,22.26,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,53.15,67.275,,42.52,percent of total billed charges,67.275% of total billed charges,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,25.73,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,48.77,61.74,,39.016,percent of total billed charges,61.74% of total billed charges,21.62,102,,,Fee Schedule,102% of GA Medicaid Rate,25.48,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,21.2,71.1,
SELENIUM,5001693,CDM,301,RC,84255,HCPCS,Outpatient,,,79,59.25,,61.62,78,,49.296,percent of total billed charges,78% of total billed charges,32.1,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,25.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,25.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,33.71,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,53.15,67.275,,42.52,percent of total billed charges,67.275% of total billed charges,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,25.79,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,48.77,61.74,,39.016,percent of total billed charges,61.74% of total billed charges,32.74,102,,,Fee Schedule,102% of GA Medicaid Rate,25.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,25.53,71.1,
ENDOMYSIAL AB IgA WITH REFLEX,5001767,CDM,302,RC,86255,HCPCS,Outpatient,,,79,59.25,,61.62,78,,49.296,percent of total billed charges,78% of total billed charges,15.16,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,15.92,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,53.15,67.275,,42.52,percent of total billed charges,67.275% of total billed charges,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,12.17,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,48.77,61.74,,39.016,percent of total billed charges,61.74% of total billed charges,15.46,102,,,Fee Schedule,102% of GA Medicaid Rate,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.05,71.1,
Blood test to determine the concentration of lead in the blood,5001775,CDM,301,RC,83655,HCPCS,Outpatient,,,79,59.25,,61.62,78,,49.296,percent of total billed charges,78% of total billed charges,10,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.11,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.11,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,10.5,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,53.15,67.275,,42.52,percent of total billed charges,67.275% of total billed charges,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,12.23,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,48.77,61.74,,39.016,percent of total billed charges,61.74% of total billed charges,10.2,102,,,Fee Schedule,102% of GA Medicaid Rate,12.11,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10,71.1,
STRIATED MUSCLE AB,5001834,CDM,302,RC,86255,HCPCS,Outpatient,,,79,59.25,,61.62,78,,49.296,percent of total billed charges,78% of total billed charges,15.16,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,15.92,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,53.15,67.275,,42.52,percent of total billed charges,67.275% of total billed charges,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,12.17,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,48.77,61.74,,39.016,percent of total billed charges,61.74% of total billed charges,15.46,102,,,Fee Schedule,102% of GA Medicaid Rate,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.05,71.1,
ANTI-MITOCHANDRIAL AB,5001840,CDM,302,RC,86255,HCPCS,Outpatient,,,79,59.25,,61.62,78,,49.296,percent of total billed charges,78% of total billed charges,15.16,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,15.92,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,53.15,67.275,,42.52,percent of total billed charges,67.275% of total billed charges,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,12.17,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,48.77,61.74,,39.016,percent of total billed charges,61.74% of total billed charges,15.46,102,,,Fee Schedule,102% of GA Medicaid Rate,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.05,71.1,
ANTI MYOCARDIAL ANTIBODY,5001845,CDM,302,RC,86255,HCPCS,Outpatient,,,79,59.25,,61.62,78,,49.296,percent of total billed charges,78% of total billed charges,15.16,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,15.92,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,53.15,67.275,,42.52,percent of total billed charges,67.275% of total billed charges,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,12.17,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,48.77,61.74,,39.016,percent of total billed charges,61.74% of total billed charges,15.46,102,,,Fee Schedule,102% of GA Medicaid Rate,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.05,71.1,
Blood test to determine the concentration of lead in the blood,5001857,CDM,301,RC,83655,HCPCS,Outpatient,,,79,59.25,,61.62,78,,49.296,percent of total billed charges,78% of total billed charges,10,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.11,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.11,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,10.5,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,53.15,67.275,,42.52,percent of total billed charges,67.275% of total billed charges,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,12.23,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,48.77,61.74,,39.016,percent of total billed charges,61.74% of total billed charges,10.2,102,,,Fee Schedule,102% of GA Medicaid Rate,12.11,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10,71.1,
ADRENAL ANTIBODY TITER,5001998,CDM,302,RC,86255,HCPCS,Outpatient,,,79,59.25,,61.62,78,,49.296,percent of total billed charges,78% of total billed charges,15.16,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,15.92,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,53.15,67.275,,42.52,percent of total billed charges,67.275% of total billed charges,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,12.17,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,48.77,61.74,,39.016,percent of total billed charges,61.74% of total billed charges,15.46,102,,,Fee Schedule,102% of GA Medicaid Rate,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.05,71.1,
Blood test to determine the concentration of lead in the blood,5002023,CDM,301,RC,83655,HCPCS,Outpatient,,,79,59.25,,61.62,78,,49.296,percent of total billed charges,78% of total billed charges,10,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.11,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.11,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,10.5,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,53.15,67.275,,42.52,percent of total billed charges,67.275% of total billed charges,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,12.23,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,48.77,61.74,,39.016,percent of total billed charges,61.74% of total billed charges,10.2,102,,,Fee Schedule,102% of GA Medicaid Rate,12.11,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10,71.1,
"RI AB TITER, REFLEX",5002031,CDM,302,RC,86255,HCPCS,Outpatient,,,79,59.25,,61.62,78,,49.296,percent of total billed charges,78% of total billed charges,15.16,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,15.92,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,53.15,67.275,,42.52,percent of total billed charges,67.275% of total billed charges,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,12.17,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,48.77,61.74,,39.016,percent of total billed charges,61.74% of total billed charges,15.46,102,,,Fee Schedule,102% of GA Medicaid Rate,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.05,71.1,
VARIAX K-WIRE SMOOTH 1.4MM x 100MM,3004020,CDM,270,RC,,,Outpatient,,,79.75,59.81,,62.21,78,,49.768,percent of total billed charges,78% of total billed charges,50.24,63,,40.192,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,30.31,38,,24.248,percent of total billed charges,38% of total billed charges,30.31,38,,24.248,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,71.78,90,,57.424,percent of total billed charges,90% of total billed charges,27.91,35,,22.328,percent of total billed charges,35% of total billed charges,53.65,67.275,,42.92,percent of total billed charges,67.275% of total billed charges,63.8,80,,51.04,percent of total billed charges,80% of total billed charges,30.61,38.38,,24.488,percent of total billed charges,38.38% of total billed charges,63.8,80,,51.04,percent of total billed charges,80% of total billed charges,49.24,61.74,,39.392,percent of total billed charges,61.74% of total billed charges,81.35,102,,65.08,percent of total billed charges,102% of total billed charges,30.31,38,,24.248,percent of total billed charges,38% of total billed charges,27.91,81.35,
STRYKER 1.4X100MM K WIRE,3005055,CDM,270,RC,,,Outpatient,,,79.75,59.81,,62.21,78,,49.768,percent of total billed charges,78% of total billed charges,50.24,63,,40.192,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,30.31,38,,24.248,percent of total billed charges,38% of total billed charges,30.31,38,,24.248,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,71.78,90,,57.424,percent of total billed charges,90% of total billed charges,27.91,35,,22.328,percent of total billed charges,35% of total billed charges,53.65,67.275,,42.92,percent of total billed charges,67.275% of total billed charges,63.8,80,,51.04,percent of total billed charges,80% of total billed charges,30.61,38.38,,24.488,percent of total billed charges,38.38% of total billed charges,63.8,80,,51.04,percent of total billed charges,80% of total billed charges,49.24,61.74,,39.392,percent of total billed charges,61.74% of total billed charges,81.35,102,,65.08,percent of total billed charges,102% of total billed charges,30.31,38,,24.248,percent of total billed charges,38% of total billed charges,27.91,81.35,
TROCAR SLEEVE 5MM CTS02,3004069,CDM,270,RC,,,Outpatient,,,80,60,,62.4,78,,49.92,percent of total billed charges,78% of total billed charges,50.4,63,,40.32,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,30.4,38,,24.32,percent of total billed charges,38% of total billed charges,30.4,38,,24.32,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,72,90,,57.6,percent of total billed charges,90% of total billed charges,28,35,,22.4,percent of total billed charges,35% of total billed charges,53.82,67.275,,43.056,percent of total billed charges,67.275% of total billed charges,64,80,,51.2,percent of total billed charges,80% of total billed charges,30.7,38.38,,24.56,percent of total billed charges,38.38% of total billed charges,64,80,,51.2,percent of total billed charges,80% of total billed charges,49.39,61.74,,39.512,percent of total billed charges,61.74% of total billed charges,81.6,102,,65.28,percent of total billed charges,102% of total billed charges,30.4,38,,24.32,percent of total billed charges,38% of total billed charges,28,81.6,
GVL 3 STAT GLIDESCOPE,3004262,CDM,270,RC,,,Outpatient,,,80,60,,62.4,78,,49.92,percent of total billed charges,78% of total billed charges,50.4,63,,40.32,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,30.4,38,,24.32,percent of total billed charges,38% of total billed charges,30.4,38,,24.32,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,72,90,,57.6,percent of total billed charges,90% of total billed charges,28,35,,22.4,percent of total billed charges,35% of total billed charges,53.82,67.275,,43.056,percent of total billed charges,67.275% of total billed charges,64,80,,51.2,percent of total billed charges,80% of total billed charges,30.7,38.38,,24.56,percent of total billed charges,38.38% of total billed charges,64,80,,51.2,percent of total billed charges,80% of total billed charges,49.39,61.74,,39.512,percent of total billed charges,61.74% of total billed charges,81.6,102,,65.28,percent of total billed charges,102% of total billed charges,30.4,38,,24.32,percent of total billed charges,38% of total billed charges,28,81.6,
H FLU SENSITIVITY,5000180,CDM,306,RC,87184,HCPCS,Outpatient,,,80,60,,62.4,78,,49.92,percent of total billed charges,78% of total billed charges,8.67,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,7.48,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.48,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,72,90,,57.6,percent of total billed charges,90% of total billed charges,9.1,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,53.82,67.275,,43.056,percent of total billed charges,67.275% of total billed charges,64,80,,51.2,percent of total billed charges,80% of total billed charges,7.55,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,64,80,,51.2,percent of total billed charges,80% of total billed charges,49.39,61.74,,39.512,percent of total billed charges,61.74% of total billed charges,8.84,102,,,Fee Schedule,102% of GA Medicaid Rate,7.48,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.48,72,
INFLAM BOWEL DIS PANEL,5000515,CDM,302,RC,86671,HCPCS,Outpatient,,,80,60,,62.4,78,,49.92,percent of total billed charges,78% of total billed charges,15.42,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,72,90,,57.6,percent of total billed charges,90% of total billed charges,16.19,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,53.82,67.275,,43.056,percent of total billed charges,67.275% of total billed charges,64,80,,51.2,percent of total billed charges,80% of total billed charges,12.37,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,64,80,,51.2,percent of total billed charges,80% of total billed charges,49.39,61.74,,39.512,percent of total billed charges,61.74% of total billed charges,15.73,102,,,Fee Schedule,102% of GA Medicaid Rate,12.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.25,72,
Manual urinalysis test with examination using microscope,5000630,CDM,307,RC,81000,HCPCS,Outpatient,,,80,60,,62.4,78,,49.92,percent of total billed charges,78% of total billed charges,3.99,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,72,90,,57.6,percent of total billed charges,90% of total billed charges,4.19,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,53.82,67.275,,43.056,percent of total billed charges,67.275% of total billed charges,64,80,,51.2,percent of total billed charges,80% of total billed charges,4.06,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,64,80,,51.2,percent of total billed charges,80% of total billed charges,49.39,61.74,,39.512,percent of total billed charges,61.74% of total billed charges,4.07,102,,,Fee Schedule,102% of GA Medicaid Rate,4.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.99,72,
DISK DIFFUSION,5000901,CDM,306,RC,87184,HCPCS,Outpatient,,,80,60,,62.4,78,,49.92,percent of total billed charges,78% of total billed charges,8.67,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,7.48,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.48,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,72,90,,57.6,percent of total billed charges,90% of total billed charges,9.1,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,53.82,67.275,,43.056,percent of total billed charges,67.275% of total billed charges,64,80,,51.2,percent of total billed charges,80% of total billed charges,7.55,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,64,80,,51.2,percent of total billed charges,80% of total billed charges,49.39,61.74,,39.512,percent of total billed charges,61.74% of total billed charges,8.84,102,,,Fee Schedule,102% of GA Medicaid Rate,7.48,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.48,72,
D-TEST CLINDAMYCIN RESISTANCE TEST,5001511,CDM,306,RC,87184,HCPCS,Outpatient,,,80,60,,62.4,78,,49.92,percent of total billed charges,78% of total billed charges,8.67,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,7.48,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.48,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,72,90,,57.6,percent of total billed charges,90% of total billed charges,9.1,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,53.82,67.275,,43.056,percent of total billed charges,67.275% of total billed charges,64,80,,51.2,percent of total billed charges,80% of total billed charges,7.55,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,64,80,,51.2,percent of total billed charges,80% of total billed charges,49.39,61.74,,39.512,percent of total billed charges,61.74% of total billed charges,8.84,102,,,Fee Schedule,102% of GA Medicaid Rate,7.48,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.48,72,
ASCA IgA,5001682,CDM,302,RC,86671,HCPCS,Outpatient,,,80,60,,62.4,78,,49.92,percent of total billed charges,78% of total billed charges,15.42,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,72,90,,57.6,percent of total billed charges,90% of total billed charges,16.19,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,53.82,67.275,,43.056,percent of total billed charges,67.275% of total billed charges,64,80,,51.2,percent of total billed charges,80% of total billed charges,12.37,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,64,80,,51.2,percent of total billed charges,80% of total billed charges,49.39,61.74,,39.512,percent of total billed charges,61.74% of total billed charges,15.73,102,,,Fee Schedule,102% of GA Medicaid Rate,12.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.25,72,
ASCA IgG,5001683,CDM,302,RC,86671,HCPCS,Outpatient,,,80,60,,62.4,78,,49.92,percent of total billed charges,78% of total billed charges,15.42,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,72,90,,57.6,percent of total billed charges,90% of total billed charges,16.19,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,53.82,67.275,,43.056,percent of total billed charges,67.275% of total billed charges,64,80,,51.2,percent of total billed charges,80% of total billed charges,12.37,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,64,80,,51.2,percent of total billed charges,80% of total billed charges,49.39,61.74,,39.512,percent of total billed charges,61.74% of total billed charges,15.73,102,,,Fee Schedule,102% of GA Medicaid Rate,12.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.25,72,
LYSOZYME MURAMIDASE,5003743,CDM,300,RC,85549,HCPCS,Outpatient,,,80,60,,62.4,78,,49.92,percent of total billed charges,78% of total billed charges,23.59,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,72,90,,57.6,percent of total billed charges,90% of total billed charges,24.77,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,53.82,67.275,,43.056,percent of total billed charges,67.275% of total billed charges,64,80,,51.2,percent of total billed charges,80% of total billed charges,18.94,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,64,80,,51.2,percent of total billed charges,80% of total billed charges,49.39,61.74,,39.512,percent of total billed charges,61.74% of total billed charges,24.06,102,,,Fee Schedule,102% of GA Medicaid Rate,18.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.75,72,
OVA & PARASITE -MULTIPLE,5009153,CDM,306,RC,87015,HCPCS,Outpatient,,,80,60,,62.4,78,,49.92,percent of total billed charges,78% of total billed charges,8.4,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.68,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.68,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,72,90,,57.6,percent of total billed charges,90% of total billed charges,8.82,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,53.82,67.275,,43.056,percent of total billed charges,67.275% of total billed charges,64,80,,51.2,percent of total billed charges,80% of total billed charges,6.75,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,64,80,,51.2,percent of total billed charges,80% of total billed charges,49.39,61.74,,39.512,percent of total billed charges,61.74% of total billed charges,8.57,102,,,Fee Schedule,102% of GA Medicaid Rate,6.68,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.68,72,
"REC THERAPY COMM/WORK INTEGR, EA 15 MIN",9000042,CDM,420,RC,97537,HCPCS,Outpatient,,,80,60,,62.4,78,,49.92,percent of total billed charges,78% of total billed charges,50.4,63,,40.32,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,30.4,38,,24.32,percent of total billed charges,38% of total billed charges,30.4,38,,24.32,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,72,90,,57.6,percent of total billed charges,90% of total billed charges,28,35,,22.4,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,64,80,,51.2,percent of total billed charges,80% of total billed charges,30.7,38.38,,24.56,percent of total billed charges,38.38% of total billed charges,64,80,,51.2,percent of total billed charges,80% of total billed charges,49.39,61.74,,39.512,percent of total billed charges,61.74% of total billed charges,81.6,102,,65.28,percent of total billed charges,102% of total billed charges,30.4,38,,24.32,percent of total billed charges,38% of total billed charges,28,145.93,
XEMG H REFLEX; RECORDED FROM GASTROC,9600020,CDM,922,RC,95934,HCPCS,Outpatient,,,80,60,,62.4,78,,49.92,percent of total billed charges,78% of total billed charges,50.4,63,,40.32,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,30.4,38,,24.32,percent of total billed charges,38% of total billed charges,30.4,38,,24.32,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,72,90,,57.6,percent of total billed charges,90% of total billed charges,28,35,,22.4,percent of total billed charges,35% of total billed charges,53.82,67.275,,43.056,percent of total billed charges,67.275% of total billed charges,64,80,,51.2,percent of total billed charges,80% of total billed charges,30.7,38.38,,24.56,percent of total billed charges,38.38% of total billed charges,64,80,,51.2,percent of total billed charges,80% of total billed charges,49.39,61.74,,39.512,percent of total billed charges,61.74% of total billed charges,81.6,102,,65.28,percent of total billed charges,102% of total billed charges,30.4,38,,24.32,percent of total billed charges,38% of total billed charges,28,81.6,
"COPPER, 24-HR URINE",5000182,CDM,301,RC,82525,HCPCS,Outpatient,,,81,60.75,,63.18,78,,50.544,percent of total billed charges,78% of total billed charges,15.61,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.41,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.41,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,16.39,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,54.49,67.275,,43.592,percent of total billed charges,67.275% of total billed charges,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,12.53,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,50.01,61.74,,40.008,percent of total billed charges,61.74% of total billed charges,15.92,102,,,Fee Schedule,102% of GA Medicaid Rate,12.41,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.41,72.9,
COPPER SERUM,5000238,CDM,301,RC,82525,HCPCS,Outpatient,,,81,60.75,,63.18,78,,50.544,percent of total billed charges,78% of total billed charges,15.61,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.41,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.41,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,16.39,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,54.49,67.275,,43.592,percent of total billed charges,67.275% of total billed charges,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,12.53,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,50.01,61.74,,40.008,percent of total billed charges,61.74% of total billed charges,15.92,102,,,Fee Schedule,102% of GA Medicaid Rate,12.41,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.41,72.9,
ENTAMOEBA HISTOLYTICIA IgG,5001524,CDM,302,RC,86753,HCPCS,Outpatient,,,81,60.75,,63.18,78,,50.544,percent of total billed charges,78% of total billed charges,15.59,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,16.37,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,54.49,67.275,,43.592,percent of total billed charges,67.275% of total billed charges,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,12.51,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,50.01,61.74,,40.008,percent of total billed charges,61.74% of total billed charges,15.9,102,,,Fee Schedule,102% of GA Medicaid Rate,12.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.39,72.9,
Blood test indicating infection with Hepatitis A,5001733,CDM,302,RC,86708,HCPCS,Outpatient,,,81,60.75,,63.18,78,,50.544,percent of total billed charges,78% of total billed charges,15.58,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,16.36,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,54.49,67.275,,43.592,percent of total billed charges,67.275% of total billed charges,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,12.51,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,50.01,61.74,,40.008,percent of total billed charges,61.74% of total billed charges,15.89,102,,,Fee Schedule,102% of GA Medicaid Rate,12.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.39,72.9,
.DRUG SCREEN UR W/ALC,5001746,CDM,301,RC,80100,HCPCS,Outpatient,,,81,60.75,,63.18,78,,50.544,percent of total billed charges,78% of total billed charges,51.03,63,,40.824,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,30.78,38,,24.624,percent of total billed charges,38% of total billed charges,30.78,38,,24.624,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,28.35,35,,22.68,percent of total billed charges,35% of total billed charges,54.49,67.275,,43.592,percent of total billed charges,67.275% of total billed charges,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,31.09,38.38,,24.872,percent of total billed charges,38.38% of total billed charges,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,50.01,61.74,,40.008,percent of total billed charges,61.74% of total billed charges,82.62,102,,66.096,percent of total billed charges,102% of total billed charges,30.78,38,,24.624,percent of total billed charges,38% of total billed charges,28.35,82.62,
Chemical test of the blood to measure presence or concentration of a substance in the blood,5001771,CDM,302,RC,83516,HCPCS,Outpatient,,,81,60.75,,63.18,78,,50.544,percent of total billed charges,78% of total billed charges,13.45,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,11.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,14.12,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,54.49,67.275,,43.592,percent of total billed charges,67.275% of total billed charges,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,11.65,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,50.01,61.74,,40.008,percent of total billed charges,61.74% of total billed charges,13.72,102,,,Fee Schedule,102% of GA Medicaid Rate,11.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.53,72.9,
RAPID RHINO - 7.5 CM,3001536,CDM,270,RC,,,Outpatient,,,81.24,60.93,,63.37,78,,50.696,percent of total billed charges,78% of total billed charges,51.18,63,,40.944,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,30.87,38,,24.696,percent of total billed charges,38% of total billed charges,30.87,38,,24.696,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,73.12,90,,58.496,percent of total billed charges,90% of total billed charges,28.43,35,,22.744,percent of total billed charges,35% of total billed charges,54.65,67.275,,43.72,percent of total billed charges,67.275% of total billed charges,64.99,80,,51.992,percent of total billed charges,80% of total billed charges,31.18,38.38,,24.944,percent of total billed charges,38.38% of total billed charges,64.99,80,,51.992,percent of total billed charges,80% of total billed charges,50.16,61.74,,40.128,percent of total billed charges,61.74% of total billed charges,82.86,102,,66.288,percent of total billed charges,102% of total billed charges,30.87,38,,24.696,percent of total billed charges,38% of total billed charges,28.43,82.86,
ETCO2 DRYLINE WATER TRAP,3003019,CDM,270,RC,,,Outpatient,,,81.43,61.07,,63.52,78,,50.816,percent of total billed charges,78% of total billed charges,51.3,63,,41.04,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,30.94,38,,24.752,percent of total billed charges,38% of total billed charges,30.94,38,,24.752,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,73.29,90,,58.632,percent of total billed charges,90% of total billed charges,28.5,35,,22.8,percent of total billed charges,35% of total billed charges,54.78,67.275,,43.824,percent of total billed charges,67.275% of total billed charges,65.14,80,,52.112,percent of total billed charges,80% of total billed charges,31.25,38.38,,25,percent of total billed charges,38.38% of total billed charges,65.14,80,,52.112,percent of total billed charges,80% of total billed charges,50.27,61.74,,40.216,percent of total billed charges,61.74% of total billed charges,83.06,102,,66.448,percent of total billed charges,102% of total billed charges,30.94,38,,24.752,percent of total billed charges,38% of total billed charges,28.5,83.06,
JAMSHIDINEEDLE (LONG),3000901,CDM,270,RC,,,Outpatient,,,81.7,61.28,,63.73,78,,50.984,percent of total billed charges,78% of total billed charges,51.47,63,,41.176,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,31.05,38,,24.84,percent of total billed charges,38% of total billed charges,31.05,38,,24.84,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,73.53,90,,58.824,percent of total billed charges,90% of total billed charges,28.6,35,,22.88,percent of total billed charges,35% of total billed charges,54.96,67.275,,43.968,percent of total billed charges,67.275% of total billed charges,65.36,80,,52.288,percent of total billed charges,80% of total billed charges,31.36,38.38,,25.088,percent of total billed charges,38.38% of total billed charges,65.36,80,,52.288,percent of total billed charges,80% of total billed charges,50.44,61.74,,40.352,percent of total billed charges,61.74% of total billed charges,83.33,102,,66.664,percent of total billed charges,102% of total billed charges,31.05,38,,24.84,percent of total billed charges,38% of total billed charges,28.6,83.33,
17-KETOSTEROIDS 24 HR URI,5001860,CDM,301,RC,83586,HCPCS,Outpatient,,,82,61.5,,63.96,78,,51.168,percent of total billed charges,78% of total billed charges,15.8,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,16.59,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,55.17,67.275,,44.136,percent of total billed charges,67.275% of total billed charges,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,12.93,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,50.63,61.74,,40.504,percent of total billed charges,61.74% of total billed charges,16.12,102,,,Fee Schedule,102% of GA Medicaid Rate,12.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.8,73.8,
.HISTOPLASMA ANTIBODY,5001942,CDM,302,RC,86698,HCPCS,Outpatient,,,82,61.5,,63.96,78,,51.168,percent of total billed charges,78% of total billed charges,15.71,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.79,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.79,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,16.5,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,55.17,67.275,,44.136,percent of total billed charges,67.275% of total billed charges,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,13.93,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,50.63,61.74,,40.504,percent of total billed charges,61.74% of total billed charges,16.02,102,,,Fee Schedule,102% of GA Medicaid Rate,13.79,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.79,73.8,
HISTOPLASMA AB,5001945,CDM,302,RC,86698,HCPCS,Outpatient,,,82,61.5,,63.96,78,,51.168,percent of total billed charges,78% of total billed charges,15.71,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.79,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.79,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,16.5,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,55.17,67.275,,44.136,percent of total billed charges,67.275% of total billed charges,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,13.93,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,50.63,61.74,,40.504,percent of total billed charges,61.74% of total billed charges,16.02,102,,,Fee Schedule,102% of GA Medicaid Rate,13.79,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.79,73.8,
PT SENSORY INTEGR & BAL STIM,9000025,CDM,420,RC,97533,HCPCS,Outpatient,,,82,61.5,,63.96,78,,51.168,percent of total billed charges,78% of total billed charges,51.66,63,,41.328,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,31.16,38,,24.928,percent of total billed charges,38% of total billed charges,31.16,38,,24.928,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,28.7,35,,22.96,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,31.47,38.38,,25.176,percent of total billed charges,38.38% of total billed charges,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,50.63,61.74,,40.504,percent of total billed charges,61.74% of total billed charges,83.64,102,,66.912,percent of total billed charges,102% of total billed charges,31.16,38,,24.928,percent of total billed charges,38% of total billed charges,28.7,145.93,
"OT SENSORY INTEGRATIVE TECH, EA 15 MIN",9000224,CDM,430,RC,97533,HCPCS,Outpatient,,,82,61.5,,63.96,78,,51.168,percent of total billed charges,78% of total billed charges,51.66,63,,41.328,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,31.16,38,,24.928,percent of total billed charges,38% of total billed charges,31.16,38,,24.928,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,28.7,35,,22.96,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,31.47,38.38,,25.176,percent of total billed charges,38.38% of total billed charges,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,50.63,61.74,,40.504,percent of total billed charges,61.74% of total billed charges,83.64,102,,66.912,percent of total billed charges,102% of total billed charges,31.16,38,,24.928,percent of total billed charges,38% of total billed charges,28.7,145.93,
DARCO ORTHOWEDGE SHOE - SM,3005097,CDM,270,RC,,,Outpatient,,,82.3,61.73,,64.19,78,,51.352,percent of total billed charges,78% of total billed charges,51.85,63,,41.48,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,31.27,38,,25.016,percent of total billed charges,38% of total billed charges,31.27,38,,25.016,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,74.07,90,,59.256,percent of total billed charges,90% of total billed charges,28.81,35,,23.048,percent of total billed charges,35% of total billed charges,55.37,67.275,,44.296,percent of total billed charges,67.275% of total billed charges,65.84,80,,52.672,percent of total billed charges,80% of total billed charges,31.59,38.38,,25.272,percent of total billed charges,38.38% of total billed charges,65.84,80,,52.672,percent of total billed charges,80% of total billed charges,50.81,61.74,,40.648,percent of total billed charges,61.74% of total billed charges,83.95,102,,67.16,percent of total billed charges,102% of total billed charges,31.27,38,,25.016,percent of total billed charges,38% of total billed charges,28.81,83.95,
BIOPSY TRAY BASIC,3001520,CDM,270,RC,,,Outpatient,,,82.4,61.8,,64.27,78,,51.416,percent of total billed charges,78% of total billed charges,51.91,63,,41.528,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,31.31,38,,25.048,percent of total billed charges,38% of total billed charges,31.31,38,,25.048,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,74.16,90,,59.328,percent of total billed charges,90% of total billed charges,28.84,35,,23.072,percent of total billed charges,35% of total billed charges,55.43,67.275,,44.344,percent of total billed charges,67.275% of total billed charges,65.92,80,,52.736,percent of total billed charges,80% of total billed charges,31.63,38.38,,25.304,percent of total billed charges,38.38% of total billed charges,65.92,80,,52.736,percent of total billed charges,80% of total billed charges,50.87,61.74,,40.696,percent of total billed charges,61.74% of total billed charges,84.05,102,,67.24,percent of total billed charges,102% of total billed charges,31.31,38,,25.048,percent of total billed charges,38% of total billed charges,28.84,84.05,
AIRWAY ADAPTER PED TO ADULT,3004012,CDM,270,RC,,,Outpatient,,,82.9,62.18,,64.66,78,,51.728,percent of total billed charges,78% of total billed charges,52.23,63,,41.784,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,31.5,38,,25.2,percent of total billed charges,38% of total billed charges,31.5,38,,25.2,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,74.61,90,,59.688,percent of total billed charges,90% of total billed charges,29.02,35,,23.216,percent of total billed charges,35% of total billed charges,55.77,67.275,,44.616,percent of total billed charges,67.275% of total billed charges,66.32,80,,53.056,percent of total billed charges,80% of total billed charges,31.82,38.38,,25.456,percent of total billed charges,38.38% of total billed charges,66.32,80,,53.056,percent of total billed charges,80% of total billed charges,51.18,61.74,,40.944,percent of total billed charges,61.74% of total billed charges,84.56,102,,67.648,percent of total billed charges,102% of total billed charges,31.5,38,,25.2,percent of total billed charges,38% of total billed charges,29.02,84.56,
FLU SCREEN A & B,5000198,CDM,306,RC,87449,HCPCS,Outpatient,,,83,62.25,,64.74,78,,51.792,percent of total billed charges,78% of total billed charges,15.08,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,11.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,15.83,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,55.84,67.275,,44.672,percent of total billed charges,67.275% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,12.1,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,51.24,61.74,,40.992,percent of total billed charges,61.74% of total billed charges,15.38,102,,,Fee Schedule,102% of GA Medicaid Rate,11.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.98,74.7,
TRANSFERRIN,5000767,CDM,301,RC,84466,HCPCS,Outpatient,,,83,62.25,,64.74,78,,51.792,percent of total billed charges,78% of total billed charges,16.06,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.76,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.76,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,16.86,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,55.84,67.275,,44.672,percent of total billed charges,67.275% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,12.89,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,51.24,61.74,,40.992,percent of total billed charges,61.74% of total billed charges,16.38,102,,,Fee Schedule,102% of GA Medicaid Rate,12.76,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.76,74.7,
".MOLECULAR EXTRATION, DNA OR RNA",5001956,CDM,301,RC,83890,HCPCS,Outpatient,,,83,62.25,,64.74,78,,51.792,percent of total billed charges,78% of total billed charges,52.29,63,,41.832,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,31.54,38,,25.232,percent of total billed charges,38% of total billed charges,31.54,38,,25.232,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,29.05,35,,23.24,percent of total billed charges,35% of total billed charges,55.84,67.275,,44.672,percent of total billed charges,67.275% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,31.86,38.38,,25.488,percent of total billed charges,38.38% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,51.24,61.74,,40.992,percent of total billed charges,61.74% of total billed charges,84.66,102,,67.728,percent of total billed charges,102% of total billed charges,31.54,38,,25.232,percent of total billed charges,38% of total billed charges,29.05,84.66,
.NUCLEIC ACID PCR,5001958,CDM,301,RC,,,Outpatient,,,83,62.25,,64.74,78,,51.792,percent of total billed charges,78% of total billed charges,52.29,63,,41.832,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,31.54,38,,25.232,percent of total billed charges,38% of total billed charges,31.54,38,,25.232,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,29.05,35,,23.24,percent of total billed charges,35% of total billed charges,55.84,67.275,,44.672,percent of total billed charges,67.275% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,31.86,38.38,,25.488,percent of total billed charges,38.38% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,51.24,61.74,,40.992,percent of total billed charges,61.74% of total billed charges,84.66,102,,67.728,percent of total billed charges,102% of total billed charges,31.54,38,,25.232,percent of total billed charges,38% of total billed charges,29.05,84.66,
Occupational therapy,9000011,CDM,420,RC,97535,HCPCS,Outpatient,,,83,62.25,,64.74,78,,51.792,percent of total billed charges,78% of total billed charges,52.29,63,,41.832,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,31.54,38,,25.232,percent of total billed charges,38% of total billed charges,31.54,38,,25.232,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,29.05,35,,23.24,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,31.86,38.38,,25.488,percent of total billed charges,38.38% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,51.24,61.74,,40.992,percent of total billed charges,61.74% of total billed charges,84.66,102,,67.728,percent of total billed charges,102% of total billed charges,31.54,38,,25.232,percent of total billed charges,38% of total billed charges,29.05,145.93,
Occupational therapy,9000041,CDM,420,RC,97535,HCPCS,Outpatient,,,83,62.25,,64.74,78,,51.792,percent of total billed charges,78% of total billed charges,52.29,63,,41.832,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,31.54,38,,25.232,percent of total billed charges,38% of total billed charges,31.54,38,,25.232,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,29.05,35,,23.24,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,31.86,38.38,,25.488,percent of total billed charges,38.38% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,51.24,61.74,,40.992,percent of total billed charges,61.74% of total billed charges,84.66,102,,67.728,percent of total billed charges,102% of total billed charges,31.54,38,,25.232,percent of total billed charges,38% of total billed charges,29.05,145.93,
Occupational therapy,9000202,CDM,430,RC,97535,HCPCS,Outpatient,,,83,62.25,,64.74,78,,51.792,percent of total billed charges,78% of total billed charges,52.29,63,,41.832,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,31.54,38,,25.232,percent of total billed charges,38% of total billed charges,31.54,38,,25.232,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,29.05,35,,23.24,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,31.86,38.38,,25.488,percent of total billed charges,38.38% of total billed charges,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,51.24,61.74,,40.992,percent of total billed charges,61.74% of total billed charges,84.66,102,,67.728,percent of total billed charges,102% of total billed charges,31.54,38,,25.232,percent of total billed charges,38% of total billed charges,29.05,145.93,
"OPTIFLOW+ ADULT CANNULA, MD",3000025,CDM,270,RC,,,Outpatient,,,83.2,62.4,,64.9,78,,51.92,percent of total billed charges,78% of total billed charges,52.42,63,,41.936,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,31.62,38,,25.296,percent of total billed charges,38% of total billed charges,31.62,38,,25.296,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,74.88,90,,59.904,percent of total billed charges,90% of total billed charges,29.12,35,,23.296,percent of total billed charges,35% of total billed charges,55.97,67.275,,44.776,percent of total billed charges,67.275% of total billed charges,66.56,80,,53.248,percent of total billed charges,80% of total billed charges,31.93,38.38,,25.544,percent of total billed charges,38.38% of total billed charges,66.56,80,,53.248,percent of total billed charges,80% of total billed charges,51.37,61.74,,41.096,percent of total billed charges,61.74% of total billed charges,84.86,102,,67.888,percent of total billed charges,102% of total billed charges,31.62,38,,25.296,percent of total billed charges,38% of total billed charges,29.12,84.86,
LAP ELECTRODE WITH SUCTION L-HOOK,3004067,CDM,270,RC,,,Outpatient,,,83.65,62.74,,65.25,78,,52.2,percent of total billed charges,78% of total billed charges,52.7,63,,42.16,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,31.79,38,,25.432,percent of total billed charges,38% of total billed charges,31.79,38,,25.432,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,75.29,90,,60.232,percent of total billed charges,90% of total billed charges,29.28,35,,23.424,percent of total billed charges,35% of total billed charges,56.28,67.275,,45.024,percent of total billed charges,67.275% of total billed charges,66.92,80,,53.536,percent of total billed charges,80% of total billed charges,32.1,38.38,,25.68,percent of total billed charges,38.38% of total billed charges,66.92,80,,53.536,percent of total billed charges,80% of total billed charges,51.65,61.74,,41.32,percent of total billed charges,61.74% of total billed charges,85.32,102,,68.256,percent of total billed charges,102% of total billed charges,31.79,38,,25.432,percent of total billed charges,38% of total billed charges,29.28,85.32,
SCREW CANCELLOUS 4.0MMX18MM,3006028,CDM,270,RC,,,Outpatient,,,84,63,,65.52,78,,52.416,percent of total billed charges,78% of total billed charges,52.92,63,,42.336,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,31.92,38,,25.536,percent of total billed charges,38% of total billed charges,31.92,38,,25.536,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,29.4,35,,23.52,percent of total billed charges,35% of total billed charges,56.51,67.275,,45.208,percent of total billed charges,67.275% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,32.24,38.38,,25.792,percent of total billed charges,38.38% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,51.86,61.74,,41.488,percent of total billed charges,61.74% of total billed charges,85.68,102,,68.544,percent of total billed charges,102% of total billed charges,31.92,38,,25.536,percent of total billed charges,38% of total billed charges,29.4,85.68,
LUPUS ANTICOAGULANT EVALUATION W/REFLEX,5000107,CDM,300,RC,,,Outpatient,,,84,63,,65.52,78,,52.416,percent of total billed charges,78% of total billed charges,52.92,63,,42.336,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,31.92,38,,25.536,percent of total billed charges,38% of total billed charges,31.92,38,,25.536,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,29.4,35,,23.52,percent of total billed charges,35% of total billed charges,56.51,67.275,,45.208,percent of total billed charges,67.275% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,32.24,38.38,,25.792,percent of total billed charges,38.38% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,51.86,61.74,,41.488,percent of total billed charges,61.74% of total billed charges,85.68,102,,68.544,percent of total billed charges,102% of total billed charges,31.92,38,,25.536,percent of total billed charges,38% of total billed charges,29.4,85.68,
Test that detects Chlamydia,5000226,CDM,306,RC,87491,HCPCS,Outpatient,,,84,63,,65.52,78,,52.416,percent of total billed charges,78% of total billed charges,24.67,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,25.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,56.51,67.275,,45.208,percent of total billed charges,67.275% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,35.44,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,51.86,61.74,,41.488,percent of total billed charges,61.74% of total billed charges,25.16,102,,,Fee Schedule,102% of GA Medicaid Rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,24.67,75.6,
Blood test for an STD,5000233,CDM,306,RC,87591,HCPCS,Outpatient,,,84,63,,65.52,78,,52.416,percent of total billed charges,78% of total billed charges,21.42,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,22.49,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,56.51,67.275,,45.208,percent of total billed charges,67.275% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,35.44,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,51.86,61.74,,41.488,percent of total billed charges,61.74% of total billed charges,21.85,102,,,Fee Schedule,102% of GA Medicaid Rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,21.42,75.6,
RABIES TITER,5000256,CDM,302,RC,86790,HCPCS,Outpatient,,,84,63,,65.52,78,,52.416,percent of total billed charges,78% of total billed charges,16.2,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,17.01,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,56.51,67.275,,45.208,percent of total billed charges,67.275% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,13.01,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,51.86,61.74,,41.488,percent of total billed charges,61.74% of total billed charges,16.52,102,,,Fee Schedule,102% of GA Medicaid Rate,12.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.88,75.6,
RSV ANTIBODY TITER,5000459,CDM,302,RC,86756,HCPCS,Outpatient,,,84,63,,65.52,78,,52.416,percent of total billed charges,78% of total billed charges,16.21,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,15.89,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.89,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,17.02,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,56.51,67.275,,45.208,percent of total billed charges,67.275% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,16.05,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,51.86,61.74,,41.488,percent of total billed charges,61.74% of total billed charges,16.53,102,,,Fee Schedule,102% of GA Medicaid Rate,15.89,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.89,75.6,
STREP ID,5000898,CDM,306,RC,87430,HCPCS,Outpatient,,,84,63,,65.52,78,,52.416,percent of total billed charges,78% of total billed charges,15.08,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,15.83,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,56.51,67.275,,45.208,percent of total billed charges,67.275% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,16.98,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,51.86,61.74,,41.488,percent of total billed charges,61.74% of total billed charges,15.38,102,,,Fee Schedule,102% of GA Medicaid Rate,16.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.08,75.6,
MYOGLOBIN QUAL (URINE),5001731,CDM,301,RC,83874,HCPCS,Outpatient,,,84,63,,65.52,78,,52.416,percent of total billed charges,78% of total billed charges,16.24,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.92,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.92,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,17.05,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,56.51,67.275,,45.208,percent of total billed charges,67.275% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,13.05,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,51.86,61.74,,41.488,percent of total billed charges,61.74% of total billed charges,16.56,102,,,Fee Schedule,102% of GA Medicaid Rate,12.92,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.92,75.6,
MYOGLOBIN SERUM(OLD),5001741,CDM,301,RC,83874,HCPCS,Outpatient,,,84,63,,65.52,78,,52.416,percent of total billed charges,78% of total billed charges,16.24,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.92,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.92,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,17.05,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,56.51,67.275,,45.208,percent of total billed charges,67.275% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,13.05,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,51.86,61.74,,41.488,percent of total billed charges,61.74% of total billed charges,16.56,102,,,Fee Schedule,102% of GA Medicaid Rate,12.92,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.92,75.6,
ADENOVIRUS AB,5001807,CDM,302,RC,86603,HCPCS,Outpatient,,,84,63,,65.52,78,,52.416,percent of total billed charges,78% of total billed charges,16.18,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,16.99,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,56.51,67.275,,45.208,percent of total billed charges,67.275% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,13,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,51.86,61.74,,41.488,percent of total billed charges,61.74% of total billed charges,16.5,102,,,Fee Schedule,102% of GA Medicaid Rate,12.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.87,75.6,
Blood test to determine if antibodies exist for measles,5001818,CDM,302,RC,86765,HCPCS,Outpatient,,,84,63,,65.52,78,,52.416,percent of total billed charges,78% of total billed charges,16.2,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,17.01,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,56.51,67.275,,45.208,percent of total billed charges,67.275% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,13.01,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,51.86,61.74,,41.488,percent of total billed charges,61.74% of total billed charges,16.52,102,,,Fee Schedule,102% of GA Medicaid Rate,12.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.88,75.6,
OXALATE 24 HR URINE,5001854,CDM,301,RC,83945,HCPCS,Outpatient,,,84,63,,65.52,78,,52.416,percent of total billed charges,78% of total billed charges,16.19,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,17,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,56.51,67.275,,45.208,percent of total billed charges,67.275% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,14.59,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,51.86,61.74,,41.488,percent of total billed charges,61.74% of total billed charges,16.51,102,,,Fee Schedule,102% of GA Medicaid Rate,14.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.45,75.6,
KIDNEY STONE ANALYSIS,5001885,CDM,301,RC,82360,HCPCS,Outpatient,,,84,63,,65.52,78,,52.416,percent of total billed charges,78% of total billed charges,16.19,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,17,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,56.51,67.275,,45.208,percent of total billed charges,67.275% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,13,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,51.86,61.74,,41.488,percent of total billed charges,61.74% of total billed charges,16.51,102,,,Fee Schedule,102% of GA Medicaid Rate,12.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.87,75.6,
SEROTONIN METABO 5HIAA,5001892,CDM,301,RC,83497,HCPCS,Outpatient,,,84,63,,65.52,78,,52.416,percent of total billed charges,78% of total billed charges,16.21,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.9,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.9,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,17.02,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,56.51,67.275,,45.208,percent of total billed charges,67.275% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,13.03,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,51.86,61.74,,41.488,percent of total billed charges,61.74% of total billed charges,16.53,102,,,Fee Schedule,102% of GA Medicaid Rate,12.9,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.9,75.6,
"WEST NILE AB (IGG,IGM)",5001988,CDM,302,RC,86790,HCPCS,Outpatient,,,84,63,,65.52,78,,52.416,percent of total billed charges,78% of total billed charges,16.2,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,17.01,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,56.51,67.275,,45.208,percent of total billed charges,67.275% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,13.01,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,51.86,61.74,,41.488,percent of total billed charges,61.74% of total billed charges,16.52,102,,,Fee Schedule,102% of GA Medicaid Rate,12.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.88,75.6,
TYPHUS FEVER ANTIBODY,5001992,CDM,300,RC,86609,HCPCS,Outpatient,,,84,63,,65.52,78,,52.416,percent of total billed charges,78% of total billed charges,16.2,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,17.01,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,56.51,67.275,,45.208,percent of total billed charges,67.275% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,13.01,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,51.86,61.74,,41.488,percent of total billed charges,61.74% of total billed charges,16.52,102,,,Fee Schedule,102% of GA Medicaid Rate,12.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.88,75.6,
MAG AB (IgM),5003907,CDM,301,RC,84181,HCPCS,Outpatient,,,84,63,,65.52,78,,52.416,percent of total billed charges,78% of total billed charges,21.42,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,17.03,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.03,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,22.49,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,56.51,67.275,,45.208,percent of total billed charges,67.275% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,17.2,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,51.86,61.74,,41.488,percent of total billed charges,61.74% of total billed charges,21.85,102,,,Fee Schedule,102% of GA Medicaid Rate,17.03,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.03,75.6,
MYOGLOBIN SERUM,5009141,CDM,301,RC,83874,HCPCS,Outpatient,,,84,63,,65.52,78,,52.416,percent of total billed charges,78% of total billed charges,16.24,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.92,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.92,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,17.05,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,56.51,67.275,,45.208,percent of total billed charges,67.275% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,13.05,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,51.86,61.74,,41.488,percent of total billed charges,61.74% of total billed charges,16.56,102,,,Fee Schedule,102% of GA Medicaid Rate,12.92,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.92,75.6,
A technique used by physical therapists to restore normal body movement patterns,9000021,CDM,420,RC,97112,HCPCS,Outpatient,,,84,63,,65.52,78,,52.416,percent of total billed charges,78% of total billed charges,52.92,63,,42.336,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,31.92,38,,25.536,percent of total billed charges,38% of total billed charges,31.92,38,,25.536,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,29.4,35,,23.52,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,32.24,38.38,,25.792,percent of total billed charges,38.38% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,51.86,61.74,,41.488,percent of total billed charges,61.74% of total billed charges,85.68,102,,68.544,percent of total billed charges,102% of total billed charges,31.92,38,,25.536,percent of total billed charges,38% of total billed charges,29.4,145.93,
A technique used by physical therapists to restore normal body movement patterns,9000206,CDM,430,RC,97112,HCPCS,Outpatient,,,84,63,,65.52,78,,52.416,percent of total billed charges,78% of total billed charges,52.92,63,,42.336,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,31.92,38,,25.536,percent of total billed charges,38% of total billed charges,31.92,38,,25.536,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,29.4,35,,23.52,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,32.24,38.38,,25.792,percent of total billed charges,38.38% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,51.86,61.74,,41.488,percent of total billed charges,61.74% of total billed charges,85.68,102,,68.544,percent of total billed charges,102% of total billed charges,31.92,38,,25.536,percent of total billed charges,38% of total billed charges,29.4,145.93,
EMG THORACIC PARASPINALS,9600023,CDM,922,RC,95869,HCPCS,Outpatient,,,84,63,,65.52,78,,52.416,percent of total billed charges,78% of total billed charges,52.92,63,,42.336,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,31.92,38,,25.536,percent of total billed charges,38% of total billed charges,31.92,38,,25.536,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,29.4,35,,23.52,percent of total billed charges,35% of total billed charges,56.51,67.275,,45.208,percent of total billed charges,67.275% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,32.24,38.38,,25.792,percent of total billed charges,38.38% of total billed charges,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,51.86,61.74,,41.488,percent of total billed charges,61.74% of total billed charges,85.68,102,,68.544,percent of total billed charges,102% of total billed charges,31.92,38,,25.536,percent of total billed charges,38% of total billed charges,29.4,85.68,
CERVICAL COLLAR - ADULT TALL,3000256,CDM,270,RC,,,Outpatient,,,84.05,63.04,,65.56,78,,52.448,percent of total billed charges,78% of total billed charges,52.95,63,,42.36,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,31.94,38,,25.552,percent of total billed charges,38% of total billed charges,31.94,38,,25.552,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,75.65,90,,60.52,percent of total billed charges,90% of total billed charges,29.42,35,,23.536,percent of total billed charges,35% of total billed charges,56.54,67.275,,45.232,percent of total billed charges,67.275% of total billed charges,67.24,80,,53.792,percent of total billed charges,80% of total billed charges,32.26,38.38,,25.808,percent of total billed charges,38.38% of total billed charges,67.24,80,,53.792,percent of total billed charges,80% of total billed charges,51.89,61.74,,41.512,percent of total billed charges,61.74% of total billed charges,85.73,102,,68.584,percent of total billed charges,102% of total billed charges,31.94,38,,25.552,percent of total billed charges,38% of total billed charges,29.42,85.73,
CERVICAL COLLAR - ADULT REG,3000266,CDM,270,RC,,,Outpatient,,,84.05,63.04,,65.56,78,,52.448,percent of total billed charges,78% of total billed charges,52.95,63,,42.36,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,31.94,38,,25.552,percent of total billed charges,38% of total billed charges,31.94,38,,25.552,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,75.65,90,,60.52,percent of total billed charges,90% of total billed charges,29.42,35,,23.536,percent of total billed charges,35% of total billed charges,56.54,67.275,,45.232,percent of total billed charges,67.275% of total billed charges,67.24,80,,53.792,percent of total billed charges,80% of total billed charges,32.26,38.38,,25.808,percent of total billed charges,38.38% of total billed charges,67.24,80,,53.792,percent of total billed charges,80% of total billed charges,51.89,61.74,,41.512,percent of total billed charges,61.74% of total billed charges,85.73,102,,68.584,percent of total billed charges,102% of total billed charges,31.94,38,,25.552,percent of total billed charges,38% of total billed charges,29.42,85.73,
ABDOMINAL PARCENTESIS,1200202,CDM,981,RC,49080,HCPCS,Outpatient,,,85,63.75,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.43,61.74,,41.144,percent of total billed charges,61.74% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.43,51.43,
"SPLINT,SPICA THUMB LEFT SMALL",3001777,CDM,270,RC,,,Outpatient,,,85,63.75,,66.3,78,,53.04,percent of total billed charges,78% of total billed charges,53.55,63,,42.84,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,32.3,38,,25.84,percent of total billed charges,38% of total billed charges,32.3,38,,25.84,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,29.75,35,,23.8,percent of total billed charges,35% of total billed charges,57.18,67.275,,45.744,percent of total billed charges,67.275% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,32.62,38.38,,26.096,percent of total billed charges,38.38% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,52.48,61.74,,41.984,percent of total billed charges,61.74% of total billed charges,86.7,102,,69.36,percent of total billed charges,102% of total billed charges,32.3,38,,25.84,percent of total billed charges,38% of total billed charges,29.75,86.7,
"SPLINT,SPICA THUMB LEFT MEDIUM",3001778,CDM,270,RC,,,Outpatient,,,85,63.75,,66.3,78,,53.04,percent of total billed charges,78% of total billed charges,53.55,63,,42.84,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,32.3,38,,25.84,percent of total billed charges,38% of total billed charges,32.3,38,,25.84,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,29.75,35,,23.8,percent of total billed charges,35% of total billed charges,57.18,67.275,,45.744,percent of total billed charges,67.275% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,32.62,38.38,,26.096,percent of total billed charges,38.38% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,52.48,61.74,,41.984,percent of total billed charges,61.74% of total billed charges,86.7,102,,69.36,percent of total billed charges,102% of total billed charges,32.3,38,,25.84,percent of total billed charges,38% of total billed charges,29.75,86.7,
"SPLINT,SPICA THUMB LEFT LARGE",3001779,CDM,270,RC,,,Outpatient,,,85,63.75,,66.3,78,,53.04,percent of total billed charges,78% of total billed charges,53.55,63,,42.84,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,32.3,38,,25.84,percent of total billed charges,38% of total billed charges,32.3,38,,25.84,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,29.75,35,,23.8,percent of total billed charges,35% of total billed charges,57.18,67.275,,45.744,percent of total billed charges,67.275% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,32.62,38.38,,26.096,percent of total billed charges,38.38% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,52.48,61.74,,41.984,percent of total billed charges,61.74% of total billed charges,86.7,102,,69.36,percent of total billed charges,102% of total billed charges,32.3,38,,25.84,percent of total billed charges,38% of total billed charges,29.75,86.7,
SPLINT SPICA THUMB RIGHT SMALL 6,3001781,CDM,270,RC,,,Outpatient,,,85,63.75,,66.3,78,,53.04,percent of total billed charges,78% of total billed charges,53.55,63,,42.84,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,32.3,38,,25.84,percent of total billed charges,38% of total billed charges,32.3,38,,25.84,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,29.75,35,,23.8,percent of total billed charges,35% of total billed charges,57.18,67.275,,45.744,percent of total billed charges,67.275% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,32.62,38.38,,26.096,percent of total billed charges,38.38% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,52.48,61.74,,41.984,percent of total billed charges,61.74% of total billed charges,86.7,102,,69.36,percent of total billed charges,102% of total billed charges,32.3,38,,25.84,percent of total billed charges,38% of total billed charges,29.75,86.7,
SPLINT SPICA THUMB RIGHT LARGE 6,3001782,CDM,270,RC,,,Outpatient,,,85,63.75,,66.3,78,,53.04,percent of total billed charges,78% of total billed charges,53.55,63,,42.84,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,32.3,38,,25.84,percent of total billed charges,38% of total billed charges,32.3,38,,25.84,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,29.75,35,,23.8,percent of total billed charges,35% of total billed charges,57.18,67.275,,45.744,percent of total billed charges,67.275% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,32.62,38.38,,26.096,percent of total billed charges,38.38% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,52.48,61.74,,41.984,percent of total billed charges,61.74% of total billed charges,86.7,102,,69.36,percent of total billed charges,102% of total billed charges,32.3,38,,25.84,percent of total billed charges,38% of total billed charges,29.75,86.7,
SPLINT SPICA THUMB RIGHT LARGE 8,3001783,CDM,270,RC,,,Outpatient,,,85,63.75,,66.3,78,,53.04,percent of total billed charges,78% of total billed charges,53.55,63,,42.84,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,32.3,38,,25.84,percent of total billed charges,38% of total billed charges,32.3,38,,25.84,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,29.75,35,,23.8,percent of total billed charges,35% of total billed charges,57.18,67.275,,45.744,percent of total billed charges,67.275% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,32.62,38.38,,26.096,percent of total billed charges,38.38% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,52.48,61.74,,41.984,percent of total billed charges,61.74% of total billed charges,86.7,102,,69.36,percent of total billed charges,102% of total billed charges,32.3,38,,25.84,percent of total billed charges,38% of total billed charges,29.75,86.7,
MONO TEST,5000310,CDM,302,RC,86308,HCPCS,Outpatient,,,85,63.75,,66.3,78,,53.04,percent of total billed charges,78% of total billed charges,6.51,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,6.84,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,57.18,67.275,,45.744,percent of total billed charges,67.275% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,5.23,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,68,80,,54.4,percent of total billed charges,80% of total billed charges,52.48,61.74,,41.984,percent of total billed charges,61.74% of total billed charges,6.64,102,,,Fee Schedule,102% of GA Medicaid Rate,5.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.18,76.5,
INTERFERON-BETA AB IgG,5000738,CDM,301,RC,83520,HCPCS,Outpatient,,,85,63.75,,66.3,78,,53.04,percent of total billed charges,78% of total billed charges,16.28,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,17.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,17.09,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,57.18,67.275,,45.744,percent of total billed charges,67.275% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,17.44,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,68,80,,54.4,percent of total billed charges,80% of total billed charges,52.48,61.74,,41.984,percent of total billed charges,61.74% of total billed charges,16.61,102,,,Fee Schedule,102% of GA Medicaid Rate,17.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.28,76.5,
SOLUBLE TRANSFERRIN RECEP,5000769,CDM,301,RC,83520,HCPCS,Outpatient,,,85,63.75,,66.3,78,,53.04,percent of total billed charges,78% of total billed charges,16.28,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,17.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,17.09,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,57.18,67.275,,45.744,percent of total billed charges,67.275% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,17.44,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,68,80,,54.4,percent of total billed charges,80% of total billed charges,52.48,61.74,,41.984,percent of total billed charges,61.74% of total billed charges,16.61,102,,,Fee Schedule,102% of GA Medicaid Rate,17.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.28,76.5,
TELOPEPTIDE (OSTEOMARK),5001648,CDM,300,RC,83520,HCPCS,Outpatient,,,85,63.75,,66.3,78,,53.04,percent of total billed charges,78% of total billed charges,16.28,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,17.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,17.09,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,57.18,67.275,,45.744,percent of total billed charges,67.275% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,17.44,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,68,80,,54.4,percent of total billed charges,80% of total billed charges,52.48,61.74,,41.984,percent of total billed charges,61.74% of total billed charges,16.61,102,,,Fee Schedule,102% of GA Medicaid Rate,17.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.28,76.5,
GLOMERULAR BASEMENT MEMBRANE AB IGG,5001712,CDM,301,RC,83520,HCPCS,Outpatient,,,85,63.75,,66.3,78,,53.04,percent of total billed charges,78% of total billed charges,16.28,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,17.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,17.09,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,57.18,67.275,,45.744,percent of total billed charges,67.275% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,17.44,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,68,80,,54.4,percent of total billed charges,80% of total billed charges,52.48,61.74,,41.984,percent of total billed charges,61.74% of total billed charges,16.61,102,,,Fee Schedule,102% of GA Medicaid Rate,17.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.28,76.5,
FACTOR II ACTIVITY,5001774,CDM,305,RC,85210,HCPCS,Outpatient,,,85,63.75,,66.3,78,,53.04,percent of total billed charges,78% of total billed charges,16.33,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,17.15,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,57.18,67.275,,45.744,percent of total billed charges,67.275% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,13.11,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,68,80,,54.4,percent of total billed charges,80% of total billed charges,52.48,61.74,,41.984,percent of total billed charges,61.74% of total billed charges,16.66,102,,,Fee Schedule,102% of GA Medicaid Rate,12.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.98,76.5,
LIPOPROTEIN (A),5001783,CDM,301,RC,83695,HCPCS,Outpatient,,,85,63.75,,66.3,78,,53.04,percent of total billed charges,78% of total billed charges,16.28,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.32,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.32,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,17.09,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,57.18,67.275,,45.744,percent of total billed charges,67.275% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,14.46,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,68,80,,54.4,percent of total billed charges,80% of total billed charges,52.48,61.74,,41.984,percent of total billed charges,61.74% of total billed charges,16.61,102,,,Fee Schedule,102% of GA Medicaid Rate,14.32,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.32,76.5,
.INFLUENZA VIRUS ANTIBODIE,5001808,CDM,302,RC,86171,HCPCS,Outpatient,,,85,63.75,,66.3,78,,53.04,percent of total billed charges,78% of total billed charges,8.79,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,10.01,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.01,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,9.23,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,57.18,67.275,,45.744,percent of total billed charges,67.275% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,10.11,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,68,80,,54.4,percent of total billed charges,80% of total billed charges,52.48,61.74,,41.984,percent of total billed charges,61.74% of total billed charges,8.97,102,,,Fee Schedule,102% of GA Medicaid Rate,10.01,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.79,76.5,
HERPES TITER (CF),5001810,CDM,306,RC,86171,HCPCS,Outpatient,,,85,63.75,,66.3,78,,53.04,percent of total billed charges,78% of total billed charges,8.79,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,10.01,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.01,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,9.23,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,57.18,67.275,,45.744,percent of total billed charges,67.275% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,10.11,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,68,80,,54.4,percent of total billed charges,80% of total billed charges,52.48,61.74,,41.984,percent of total billed charges,61.74% of total billed charges,8.97,102,,,Fee Schedule,102% of GA Medicaid Rate,10.01,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.79,76.5,
Chemical test of the blood to measure presence or concentration of a substance in the blood,5001873,CDM,301,RC,83516,HCPCS,Outpatient,,,85,63.75,,66.3,78,,53.04,percent of total billed charges,78% of total billed charges,13.45,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,11.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,14.12,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,57.18,67.275,,45.744,percent of total billed charges,67.275% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,11.65,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,68,80,,54.4,percent of total billed charges,80% of total billed charges,52.48,61.74,,41.984,percent of total billed charges,61.74% of total billed charges,13.72,102,,,Fee Schedule,102% of GA Medicaid Rate,11.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.53,76.5,
.ANTI CCP IGG,5001932,CDM,301,RC,83520,HCPCS,Outpatient,,,85,63.75,,66.3,78,,53.04,percent of total billed charges,78% of total billed charges,16.28,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,17.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,17.09,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,57.18,67.275,,45.744,percent of total billed charges,67.275% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,17.44,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,68,80,,54.4,percent of total billed charges,80% of total billed charges,52.48,61.74,,41.984,percent of total billed charges,61.74% of total billed charges,16.61,102,,,Fee Schedule,102% of GA Medicaid Rate,17.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.28,76.5,
CARDIO CRP,5001968,CDM,302,RC,86141,HCPCS,Outpatient,,,85,63.75,,66.3,78,,53.04,percent of total billed charges,78% of total billed charges,16.28,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.95,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.95,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,17.09,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,57.18,67.275,,45.744,percent of total billed charges,67.275% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,13.08,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,68,80,,54.4,percent of total billed charges,80% of total billed charges,52.48,61.74,,41.984,percent of total billed charges,61.74% of total billed charges,16.61,102,,,Fee Schedule,102% of GA Medicaid Rate,12.95,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.95,76.5,
TRYPTASE,5001994,CDM,301,RC,83520,HCPCS,Outpatient,,,85,63.75,,66.3,78,,53.04,percent of total billed charges,78% of total billed charges,16.28,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,17.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,17.09,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,57.18,67.275,,45.744,percent of total billed charges,67.275% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,17.44,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,68,80,,54.4,percent of total billed charges,80% of total billed charges,52.48,61.74,,41.984,percent of total billed charges,61.74% of total billed charges,16.61,102,,,Fee Schedule,102% of GA Medicaid Rate,17.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.28,76.5,
Blood test to diagnose rheumatoid arthritis,5001995,CDM,302,RC,86200,HCPCS,Outpatient,,,85,63.75,,66.3,78,,53.04,percent of total billed charges,78% of total billed charges,16.28,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.95,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.95,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,17.09,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,57.18,67.275,,45.744,percent of total billed charges,67.275% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,13.08,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,68,80,,54.4,percent of total billed charges,80% of total billed charges,52.48,61.74,,41.984,percent of total billed charges,61.74% of total billed charges,16.61,102,,,Fee Schedule,102% of GA Medicaid Rate,12.95,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.95,76.5,
ANTI-MULLERIAN HORMONE,5002050,CDM,300,RC,83520,HCPCS,Outpatient,,,85,63.75,,66.3,78,,53.04,percent of total billed charges,78% of total billed charges,16.28,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,17.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,17.09,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,57.18,67.275,,45.744,percent of total billed charges,67.275% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,17.44,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,68,80,,54.4,percent of total billed charges,80% of total billed charges,52.48,61.74,,41.984,percent of total billed charges,61.74% of total billed charges,16.61,102,,,Fee Schedule,102% of GA Medicaid Rate,17.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.28,76.5,
Mammography of both breasts-2 or more views,7601111,CDM,403,RC,77067,HCPCS,Outpatient,,,85,63.75,,66.3,78,,53.04,percent of total billed charges,78% of total billed charges,53.55,63,,42.84,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,32.3,38,,25.84,percent of total billed charges,38% of total billed charges,32.3,38,,25.84,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,29.75,35,,23.8,percent of total billed charges,35% of total billed charges,57.18,67.275,,45.744,percent of total billed charges,67.275% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,32.62,38.38,,26.096,percent of total billed charges,38.38% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,52.48,61.74,,41.984,percent of total billed charges,61.74% of total billed charges,86.7,102,,69.36,percent of total billed charges,102% of total billed charges,32.3,38,,25.84,percent of total billed charges,38% of total billed charges,29.75,86.7,
OXYGEN THERAPY SHORT STAY,8000053,CDM,270,RC,,,Outpatient,,,85,63.75,,66.3,78,,53.04,percent of total billed charges,78% of total billed charges,53.55,63,,42.84,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,32.3,38,,25.84,percent of total billed charges,38% of total billed charges,32.3,38,,25.84,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,29.75,35,,23.8,percent of total billed charges,35% of total billed charges,57.18,67.275,,45.744,percent of total billed charges,67.275% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,32.62,38.38,,26.096,percent of total billed charges,38.38% of total billed charges,68,80,,54.4,percent of total billed charges,80% of total billed charges,52.48,61.74,,41.984,percent of total billed charges,61.74% of total billed charges,86.7,102,,69.36,percent of total billed charges,102% of total billed charges,32.3,38,,25.84,percent of total billed charges,38% of total billed charges,29.75,86.7,
CHAIR ALARM  PRESSURE PAD,3001175,CDM,270,RC,,,Outpatient,,,85.2,63.9,,66.46,78,,53.168,percent of total billed charges,78% of total billed charges,53.68,63,,42.944,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,32.38,38,,25.904,percent of total billed charges,38% of total billed charges,32.38,38,,25.904,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,76.68,90,,61.344,percent of total billed charges,90% of total billed charges,29.82,35,,23.856,percent of total billed charges,35% of total billed charges,57.32,67.275,,45.856,percent of total billed charges,67.275% of total billed charges,68.16,80,,54.528,percent of total billed charges,80% of total billed charges,32.7,38.38,,26.16,percent of total billed charges,38.38% of total billed charges,68.16,80,,54.528,percent of total billed charges,80% of total billed charges,52.6,61.74,,42.08,percent of total billed charges,61.74% of total billed charges,86.9,102,,69.52,percent of total billed charges,102% of total billed charges,32.38,38,,25.904,percent of total billed charges,38% of total billed charges,29.82,86.9,
STRYKER CORTICAL SCREW - 2.7X18,3000126,CDM,270,RC,,,Outpatient,,,85.4,64.05,,66.61,78,,53.288,percent of total billed charges,78% of total billed charges,53.8,63,,43.04,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,32.45,38,,25.96,percent of total billed charges,38% of total billed charges,32.45,38,,25.96,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,76.86,90,,61.488,percent of total billed charges,90% of total billed charges,29.89,35,,23.912,percent of total billed charges,35% of total billed charges,57.45,67.275,,45.96,percent of total billed charges,67.275% of total billed charges,68.32,80,,54.656,percent of total billed charges,80% of total billed charges,32.78,38.38,,26.224,percent of total billed charges,38.38% of total billed charges,68.32,80,,54.656,percent of total billed charges,80% of total billed charges,52.73,61.74,,42.184,percent of total billed charges,61.74% of total billed charges,87.11,102,,69.688,percent of total billed charges,102% of total billed charges,32.45,38,,25.96,percent of total billed charges,38% of total billed charges,29.89,87.11,
STRYKER CORTICAL SCREW - 2.7X20,3000236,CDM,270,RC,,,Outpatient,,,85.4,64.05,,66.61,78,,53.288,percent of total billed charges,78% of total billed charges,53.8,63,,43.04,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,32.45,38,,25.96,percent of total billed charges,38% of total billed charges,32.45,38,,25.96,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,76.86,90,,61.488,percent of total billed charges,90% of total billed charges,29.89,35,,23.912,percent of total billed charges,35% of total billed charges,57.45,67.275,,45.96,percent of total billed charges,67.275% of total billed charges,68.32,80,,54.656,percent of total billed charges,80% of total billed charges,32.78,38.38,,26.224,percent of total billed charges,38.38% of total billed charges,68.32,80,,54.656,percent of total billed charges,80% of total billed charges,52.73,61.74,,42.184,percent of total billed charges,61.74% of total billed charges,87.11,102,,69.688,percent of total billed charges,102% of total billed charges,32.45,38,,25.96,percent of total billed charges,38% of total billed charges,29.89,87.11,
STRYKER CORTICAL SCREW - 2.7X22,3000309,CDM,270,RC,,,Outpatient,,,85.4,64.05,,66.61,78,,53.288,percent of total billed charges,78% of total billed charges,53.8,63,,43.04,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,32.45,38,,25.96,percent of total billed charges,38% of total billed charges,32.45,38,,25.96,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,76.86,90,,61.488,percent of total billed charges,90% of total billed charges,29.89,35,,23.912,percent of total billed charges,35% of total billed charges,57.45,67.275,,45.96,percent of total billed charges,67.275% of total billed charges,68.32,80,,54.656,percent of total billed charges,80% of total billed charges,32.78,38.38,,26.224,percent of total billed charges,38.38% of total billed charges,68.32,80,,54.656,percent of total billed charges,80% of total billed charges,52.73,61.74,,42.184,percent of total billed charges,61.74% of total billed charges,87.11,102,,69.688,percent of total billed charges,102% of total billed charges,32.45,38,,25.96,percent of total billed charges,38% of total billed charges,29.89,87.11,
STRYKER CORTICAL SCREW - 2.7X8,3000315,CDM,270,RC,,,Outpatient,,,85.4,64.05,,66.61,78,,53.288,percent of total billed charges,78% of total billed charges,53.8,63,,43.04,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,32.45,38,,25.96,percent of total billed charges,38% of total billed charges,32.45,38,,25.96,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,76.86,90,,61.488,percent of total billed charges,90% of total billed charges,29.89,35,,23.912,percent of total billed charges,35% of total billed charges,57.45,67.275,,45.96,percent of total billed charges,67.275% of total billed charges,68.32,80,,54.656,percent of total billed charges,80% of total billed charges,32.78,38.38,,26.224,percent of total billed charges,38.38% of total billed charges,68.32,80,,54.656,percent of total billed charges,80% of total billed charges,52.73,61.74,,42.184,percent of total billed charges,61.74% of total billed charges,87.11,102,,69.688,percent of total billed charges,102% of total billed charges,32.45,38,,25.96,percent of total billed charges,38% of total billed charges,29.89,87.11,
STRYKER CORTICAL SCREW - 2.7X10,3000317,CDM,270,RC,,,Outpatient,,,85.4,64.05,,66.61,78,,53.288,percent of total billed charges,78% of total billed charges,53.8,63,,43.04,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,32.45,38,,25.96,percent of total billed charges,38% of total billed charges,32.45,38,,25.96,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,76.86,90,,61.488,percent of total billed charges,90% of total billed charges,29.89,35,,23.912,percent of total billed charges,35% of total billed charges,57.45,67.275,,45.96,percent of total billed charges,67.275% of total billed charges,68.32,80,,54.656,percent of total billed charges,80% of total billed charges,32.78,38.38,,26.224,percent of total billed charges,38.38% of total billed charges,68.32,80,,54.656,percent of total billed charges,80% of total billed charges,52.73,61.74,,42.184,percent of total billed charges,61.74% of total billed charges,87.11,102,,69.688,percent of total billed charges,102% of total billed charges,32.45,38,,25.96,percent of total billed charges,38% of total billed charges,29.89,87.11,
STRYKER CORTICAL SCREW - 2.7X12,3000322,CDM,270,RC,,,Outpatient,,,85.4,64.05,,66.61,78,,53.288,percent of total billed charges,78% of total billed charges,53.8,63,,43.04,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,32.45,38,,25.96,percent of total billed charges,38% of total billed charges,32.45,38,,25.96,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,76.86,90,,61.488,percent of total billed charges,90% of total billed charges,29.89,35,,23.912,percent of total billed charges,35% of total billed charges,57.45,67.275,,45.96,percent of total billed charges,67.275% of total billed charges,68.32,80,,54.656,percent of total billed charges,80% of total billed charges,32.78,38.38,,26.224,percent of total billed charges,38.38% of total billed charges,68.32,80,,54.656,percent of total billed charges,80% of total billed charges,52.73,61.74,,42.184,percent of total billed charges,61.74% of total billed charges,87.11,102,,69.688,percent of total billed charges,102% of total billed charges,32.45,38,,25.96,percent of total billed charges,38% of total billed charges,29.89,87.11,
STRYKER CORTICAL SCREW - 2.7X14,3000324,CDM,270,RC,,,Outpatient,,,85.4,64.05,,66.61,78,,53.288,percent of total billed charges,78% of total billed charges,53.8,63,,43.04,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,32.45,38,,25.96,percent of total billed charges,38% of total billed charges,32.45,38,,25.96,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,76.86,90,,61.488,percent of total billed charges,90% of total billed charges,29.89,35,,23.912,percent of total billed charges,35% of total billed charges,57.45,67.275,,45.96,percent of total billed charges,67.275% of total billed charges,68.32,80,,54.656,percent of total billed charges,80% of total billed charges,32.78,38.38,,26.224,percent of total billed charges,38.38% of total billed charges,68.32,80,,54.656,percent of total billed charges,80% of total billed charges,52.73,61.74,,42.184,percent of total billed charges,61.74% of total billed charges,87.11,102,,69.688,percent of total billed charges,102% of total billed charges,32.45,38,,25.96,percent of total billed charges,38% of total billed charges,29.89,87.11,
STRYKER CORTICAL SCREW - 2.7X24,3000325,CDM,270,RC,,,Outpatient,,,85.4,64.05,,66.61,78,,53.288,percent of total billed charges,78% of total billed charges,53.8,63,,43.04,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,32.45,38,,25.96,percent of total billed charges,38% of total billed charges,32.45,38,,25.96,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,76.86,90,,61.488,percent of total billed charges,90% of total billed charges,29.89,35,,23.912,percent of total billed charges,35% of total billed charges,57.45,67.275,,45.96,percent of total billed charges,67.275% of total billed charges,68.32,80,,54.656,percent of total billed charges,80% of total billed charges,32.78,38.38,,26.224,percent of total billed charges,38.38% of total billed charges,68.32,80,,54.656,percent of total billed charges,80% of total billed charges,52.73,61.74,,42.184,percent of total billed charges,61.74% of total billed charges,87.11,102,,69.688,percent of total billed charges,102% of total billed charges,32.45,38,,25.96,percent of total billed charges,38% of total billed charges,29.89,87.11,
STRYKER CORTICAL SCREW - 2.7X26,3000326,CDM,270,RC,,,Outpatient,,,85.4,64.05,,66.61,78,,53.288,percent of total billed charges,78% of total billed charges,53.8,63,,43.04,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,32.45,38,,25.96,percent of total billed charges,38% of total billed charges,32.45,38,,25.96,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,76.86,90,,61.488,percent of total billed charges,90% of total billed charges,29.89,35,,23.912,percent of total billed charges,35% of total billed charges,57.45,67.275,,45.96,percent of total billed charges,67.275% of total billed charges,68.32,80,,54.656,percent of total billed charges,80% of total billed charges,32.78,38.38,,26.224,percent of total billed charges,38.38% of total billed charges,68.32,80,,54.656,percent of total billed charges,80% of total billed charges,52.73,61.74,,42.184,percent of total billed charges,61.74% of total billed charges,87.11,102,,69.688,percent of total billed charges,102% of total billed charges,32.45,38,,25.96,percent of total billed charges,38% of total billed charges,29.89,87.11,
STRYKER CORTICAL SCREW - 2.7X28,3000327,CDM,270,RC,,,Outpatient,,,85.4,64.05,,66.61,78,,53.288,percent of total billed charges,78% of total billed charges,53.8,63,,43.04,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,32.45,38,,25.96,percent of total billed charges,38% of total billed charges,32.45,38,,25.96,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,76.86,90,,61.488,percent of total billed charges,90% of total billed charges,29.89,35,,23.912,percent of total billed charges,35% of total billed charges,57.45,67.275,,45.96,percent of total billed charges,67.275% of total billed charges,68.32,80,,54.656,percent of total billed charges,80% of total billed charges,32.78,38.38,,26.224,percent of total billed charges,38.38% of total billed charges,68.32,80,,54.656,percent of total billed charges,80% of total billed charges,52.73,61.74,,42.184,percent of total billed charges,61.74% of total billed charges,87.11,102,,69.688,percent of total billed charges,102% of total billed charges,32.45,38,,25.96,percent of total billed charges,38% of total billed charges,29.89,87.11,
STRYKER CORTICAL SCREW - 2.7x16,3003036,CDM,270,RC,,,Outpatient,,,85.4,64.05,,66.61,78,,53.288,percent of total billed charges,78% of total billed charges,53.8,63,,43.04,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,32.45,38,,25.96,percent of total billed charges,38% of total billed charges,32.45,38,,25.96,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,76.86,90,,61.488,percent of total billed charges,90% of total billed charges,29.89,35,,23.912,percent of total billed charges,35% of total billed charges,57.45,67.275,,45.96,percent of total billed charges,67.275% of total billed charges,68.32,80,,54.656,percent of total billed charges,80% of total billed charges,32.78,38.38,,26.224,percent of total billed charges,38.38% of total billed charges,68.32,80,,54.656,percent of total billed charges,80% of total billed charges,52.73,61.74,,42.184,percent of total billed charges,61.74% of total billed charges,87.11,102,,69.688,percent of total billed charges,102% of total billed charges,32.45,38,,25.96,percent of total billed charges,38% of total billed charges,29.89,87.11,
"HEEL GUARD BOOT, PILLOW",3000719,CDM,270,RC,,,Outpatient,,,85.47,64.1,,66.67,78,,53.336,percent of total billed charges,78% of total billed charges,53.85,63,,43.08,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,32.48,38,,25.984,percent of total billed charges,38% of total billed charges,32.48,38,,25.984,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,76.92,90,,61.536,percent of total billed charges,90% of total billed charges,29.91,35,,23.928,percent of total billed charges,35% of total billed charges,57.5,67.275,,46,percent of total billed charges,67.275% of total billed charges,68.38,80,,54.704,percent of total billed charges,80% of total billed charges,32.8,38.38,,26.24,percent of total billed charges,38.38% of total billed charges,68.38,80,,54.704,percent of total billed charges,80% of total billed charges,52.77,61.74,,42.216,percent of total billed charges,61.74% of total billed charges,87.18,102,,69.744,percent of total billed charges,102% of total billed charges,32.48,38,,25.984,percent of total billed charges,38% of total billed charges,29.91,87.18,
OPTIFOAM AG 3.5 X 6 STRIP,3000509,CDM,270,RC,,,Outpatient,,,85.6,64.2,,66.77,78,,53.416,percent of total billed charges,78% of total billed charges,53.93,63,,43.144,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,32.53,38,,26.024,percent of total billed charges,38% of total billed charges,32.53,38,,26.024,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,77.04,90,,61.632,percent of total billed charges,90% of total billed charges,29.96,35,,23.968,percent of total billed charges,35% of total billed charges,57.59,67.275,,46.072,percent of total billed charges,67.275% of total billed charges,68.48,80,,54.784,percent of total billed charges,80% of total billed charges,32.85,38.38,,26.28,percent of total billed charges,38.38% of total billed charges,68.48,80,,54.784,percent of total billed charges,80% of total billed charges,52.85,61.74,,42.28,percent of total billed charges,61.74% of total billed charges,87.31,102,,69.848,percent of total billed charges,102% of total billed charges,32.53,38,,26.024,percent of total billed charges,38% of total billed charges,29.96,87.31,
BORDETELLA PERTUSSIS AB,5000089,CDM,302,RC,86615,HCPCS,Outpatient,,,86,64.5,,67.08,78,,53.664,percent of total billed charges,78% of total billed charges,16.59,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.19,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.19,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,17.42,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,57.86,67.275,,46.288,percent of total billed charges,67.275% of total billed charges,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,13.32,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,53.1,61.74,,42.48,percent of total billed charges,61.74% of total billed charges,16.92,102,,,Fee Schedule,102% of GA Medicaid Rate,13.19,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.19,77.4,
PNEUMOCYSTIS CARINNI DETECTION DFA,5000770,CDM,306,RC,87281,HCPCS,Outpatient,,,86,64.5,,67.08,78,,53.664,percent of total billed charges,78% of total billed charges,15.08,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,11.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,15.83,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,57.86,67.275,,46.288,percent of total billed charges,67.275% of total billed charges,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,12.1,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,53.1,61.74,,42.48,percent of total billed charges,61.74% of total billed charges,15.38,102,,,Fee Schedule,102% of GA Medicaid Rate,11.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.98,77.4,
STREP PNEUMO ANTIGEN,5000914,CDM,302,RC,86403,HCPCS,Outpatient,,,86,64.5,,67.08,78,,53.664,percent of total billed charges,78% of total billed charges,10,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,11.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,10.5,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,57.86,67.275,,46.288,percent of total billed charges,67.275% of total billed charges,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,11.66,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,53.1,61.74,,42.48,percent of total billed charges,61.74% of total billed charges,10.2,102,,,Fee Schedule,102% of GA Medicaid Rate,11.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10,77.4,
MYCOPLASMA IGG AB,5001717,CDM,302,RC,86738,HCPCS,Outpatient,,,86,64.5,,67.08,78,,53.664,percent of total billed charges,78% of total billed charges,16.66,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.24,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.24,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,17.49,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,57.86,67.275,,46.288,percent of total billed charges,67.275% of total billed charges,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,13.37,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,53.1,61.74,,42.48,percent of total billed charges,61.74% of total billed charges,16.99,102,,,Fee Schedule,102% of GA Medicaid Rate,13.24,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.24,77.4,
MYCOPLASMA IGM AB,5001730,CDM,300,RC,86738,HCPCS,Outpatient,,,86,64.5,,67.08,78,,53.664,percent of total billed charges,78% of total billed charges,16.66,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.24,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.24,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,17.49,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,57.86,67.275,,46.288,percent of total billed charges,67.275% of total billed charges,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,13.37,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,53.1,61.74,,42.48,percent of total billed charges,61.74% of total billed charges,16.99,102,,,Fee Schedule,102% of GA Medicaid Rate,13.24,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.24,77.4,
STREPTOZYME,5001924,CDM,300,RC,86403,HCPCS,Outpatient,,,86,64.5,,67.08,78,,53.664,percent of total billed charges,78% of total billed charges,10,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,11.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,10.5,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,57.86,67.275,,46.288,percent of total billed charges,67.275% of total billed charges,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,11.66,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,53.1,61.74,,42.48,percent of total billed charges,61.74% of total billed charges,10.2,102,,,Fee Schedule,102% of GA Medicaid Rate,11.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10,77.4,
BACTERIAL ANTIGENS,5001950,CDM,300,RC,86403,HCPCS,Outpatient,,,86,64.5,,67.08,78,,53.664,percent of total billed charges,78% of total billed charges,10,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,11.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,10.5,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,57.86,67.275,,46.288,percent of total billed charges,67.275% of total billed charges,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,11.66,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,53.1,61.74,,42.48,percent of total billed charges,61.74% of total billed charges,10.2,102,,,Fee Schedule,102% of GA Medicaid Rate,11.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10,77.4,
"CRYPTOCOCCAL Ag, W REFLEX TITER",5002103,CDM,302,RC,86403,HCPCS,Outpatient,,,86,64.5,,67.08,78,,53.664,percent of total billed charges,78% of total billed charges,10,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,11.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,10.5,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,57.86,67.275,,46.288,percent of total billed charges,67.275% of total billed charges,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,11.66,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,53.1,61.74,,42.48,percent of total billed charges,61.74% of total billed charges,10.2,102,,,Fee Schedule,102% of GA Medicaid Rate,11.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10,77.4,
Dnase B Ab,5003741,CDM,302,RC,86215,HCPCS,Outpatient,,,86,64.5,,67.08,78,,53.664,percent of total billed charges,78% of total billed charges,16.66,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,17.49,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,57.86,67.275,,46.288,percent of total billed charges,67.275% of total billed charges,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,13.38,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,53.1,61.74,,42.48,percent of total billed charges,61.74% of total billed charges,16.99,102,,,Fee Schedule,102% of GA Medicaid Rate,13.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.25,77.4,
HERPES SIMPLEX 1 IGG AB,5008406,CDM,302,RC,86695,HCPCS,Outpatient,,,86,64.5,,67.08,78,,53.664,percent of total billed charges,78% of total billed charges,16.59,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.19,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.19,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,17.42,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,57.86,67.275,,46.288,percent of total billed charges,67.275% of total billed charges,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,13.32,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,53.1,61.74,,42.48,percent of total billed charges,61.74% of total billed charges,16.92,102,,,Fee Schedule,102% of GA Medicaid Rate,13.19,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.19,77.4,
XEMG MOTOR NERVE LAT/AMP; EA NERVE W/O F,9600017,CDM,922,RC,95900,HCPCS,Outpatient,,,86,64.5,,67.08,78,,53.664,percent of total billed charges,78% of total billed charges,54.18,63,,43.344,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,32.68,38,,26.144,percent of total billed charges,38% of total billed charges,32.68,38,,26.144,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,30.1,35,,24.08,percent of total billed charges,35% of total billed charges,57.86,67.275,,46.288,percent of total billed charges,67.275% of total billed charges,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,33.01,38.38,,26.408,percent of total billed charges,38.38% of total billed charges,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,53.1,61.74,,42.48,percent of total billed charges,61.74% of total billed charges,87.72,102,,70.176,percent of total billed charges,102% of total billed charges,32.68,38,,26.144,percent of total billed charges,38% of total billed charges,30.1,87.72,
DRESSING & REACHING KIT,3000710,CDM,270,RC,,,Outpatient,,,86.52,64.89,,67.49,78,,53.992,percent of total billed charges,78% of total billed charges,54.51,63,,43.608,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,32.88,38,,26.304,percent of total billed charges,38% of total billed charges,32.88,38,,26.304,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,77.87,90,,62.296,percent of total billed charges,90% of total billed charges,30.28,35,,24.224,percent of total billed charges,35% of total billed charges,58.21,67.275,,46.568,percent of total billed charges,67.275% of total billed charges,69.22,80,,55.376,percent of total billed charges,80% of total billed charges,33.21,38.38,,26.568,percent of total billed charges,38.38% of total billed charges,69.22,80,,55.376,percent of total billed charges,80% of total billed charges,53.42,61.74,,42.736,percent of total billed charges,61.74% of total billed charges,88.25,102,,70.6,percent of total billed charges,102% of total billed charges,32.88,38,,26.304,percent of total billed charges,38% of total billed charges,30.28,88.25,
DARCO ORTHOWEDGE SHOE - LG,3005102,CDM,270,RC,,,Outpatient,,,86.6,64.95,,67.55,78,,54.04,percent of total billed charges,78% of total billed charges,54.56,63,,43.648,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,32.91,38,,26.328,percent of total billed charges,38% of total billed charges,32.91,38,,26.328,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,77.94,90,,62.352,percent of total billed charges,90% of total billed charges,30.31,35,,24.248,percent of total billed charges,35% of total billed charges,58.26,67.275,,46.608,percent of total billed charges,67.275% of total billed charges,69.28,80,,55.424,percent of total billed charges,80% of total billed charges,33.24,38.38,,26.592,percent of total billed charges,38.38% of total billed charges,69.28,80,,55.424,percent of total billed charges,80% of total billed charges,53.47,61.74,,42.776,percent of total billed charges,61.74% of total billed charges,88.33,102,,70.664,percent of total billed charges,102% of total billed charges,32.91,38,,26.328,percent of total billed charges,38% of total billed charges,30.31,88.33,
TRIGLYCERIDE,5000723,CDM,301,RC,84478,HCPCS,Outpatient,,,87,65.25,,67.86,78,,54.288,percent of total billed charges,78% of total billed charges,6.35,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,6.67,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,58.53,67.275,,46.824,percent of total billed charges,67.275% of total billed charges,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,5.8,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,53.71,61.74,,42.968,percent of total billed charges,61.74% of total billed charges,6.48,102,,,Fee Schedule,102% of GA Medicaid Rate,5.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.74,78.3,
C-2 COMPLEMENT,5001954,CDM,302,RC,86160,HCPCS,Outpatient,,,87,65.25,,67.86,78,,54.288,percent of total billed charges,78% of total billed charges,15.1,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,15.86,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,58.53,67.275,,46.824,percent of total billed charges,67.275% of total billed charges,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,12.12,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,53.71,61.74,,42.968,percent of total billed charges,61.74% of total billed charges,15.4,102,,,Fee Schedule,102% of GA Medicaid Rate,12,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12,78.3,
PAMELOR (NORTRIPTYLINE),5001969,CDM,300,RC,84478,HCPCS,Outpatient,,,87,65.25,,67.86,78,,54.288,percent of total billed charges,78% of total billed charges,6.35,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,6.67,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,58.53,67.275,,46.824,percent of total billed charges,67.275% of total billed charges,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,5.8,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,53.71,61.74,,42.968,percent of total billed charges,61.74% of total billed charges,6.48,102,,,Fee Schedule,102% of GA Medicaid Rate,5.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.74,78.3,
C-3 COMPLEMENT,5001975,CDM,302,RC,86160,HCPCS,Outpatient,,,87,65.25,,67.86,78,,54.288,percent of total billed charges,78% of total billed charges,15.1,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,15.86,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,58.53,67.275,,46.824,percent of total billed charges,67.275% of total billed charges,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,12.12,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,53.71,61.74,,42.968,percent of total billed charges,61.74% of total billed charges,15.4,102,,,Fee Schedule,102% of GA Medicaid Rate,12,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12,78.3,
C-4 COMPLEMENT,5001976,CDM,302,RC,86160,HCPCS,Outpatient,,,87,65.25,,67.86,78,,54.288,percent of total billed charges,78% of total billed charges,15.1,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,15.86,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,58.53,67.275,,46.824,percent of total billed charges,67.275% of total billed charges,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,12.12,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,53.71,61.74,,42.968,percent of total billed charges,61.74% of total billed charges,15.4,102,,,Fee Schedule,102% of GA Medicaid Rate,12,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12,78.3,
"TRIG, FLUID",5008407,CDM,301,RC,84478,HCPCS,Outpatient,,,87,65.25,,67.86,78,,54.288,percent of total billed charges,78% of total billed charges,6.35,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,6.67,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,58.53,67.275,,46.824,percent of total billed charges,67.275% of total billed charges,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,5.8,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,53.71,61.74,,42.968,percent of total billed charges,61.74% of total billed charges,6.48,102,,,Fee Schedule,102% of GA Medicaid Rate,5.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.74,78.3,
C-5 COMPLEMENT,5008408,CDM,302,RC,86160,HCPCS,Outpatient,,,87,65.25,,67.86,78,,54.288,percent of total billed charges,78% of total billed charges,15.1,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,15.86,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,58.53,67.275,,46.824,percent of total billed charges,67.275% of total billed charges,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,12.12,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,53.71,61.74,,42.968,percent of total billed charges,61.74% of total billed charges,15.4,102,,,Fee Schedule,102% of GA Medicaid Rate,12,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12,78.3,
BIOPSY NDL TRU-CUT 2N2704X,3000130,CDM,270,RC,,,Outpatient,,,87.34,65.51,,68.13,78,,54.504,percent of total billed charges,78% of total billed charges,55.02,63,,44.016,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,33.19,38,,26.552,percent of total billed charges,38% of total billed charges,33.19,38,,26.552,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,78.61,90,,62.888,percent of total billed charges,90% of total billed charges,30.57,35,,24.456,percent of total billed charges,35% of total billed charges,58.76,67.275,,47.008,percent of total billed charges,67.275% of total billed charges,69.87,80,,55.896,percent of total billed charges,80% of total billed charges,33.52,38.38,,26.816,percent of total billed charges,38.38% of total billed charges,69.87,80,,55.896,percent of total billed charges,80% of total billed charges,53.92,61.74,,43.136,percent of total billed charges,61.74% of total billed charges,89.09,102,,71.272,percent of total billed charges,102% of total billed charges,33.19,38,,26.552,percent of total billed charges,38% of total billed charges,30.57,89.09,
"HEEL RAISER PRO II, BOOT",3000720,CDM,270,RC,,,Outpatient,,,87.5,65.63,,68.25,78,,54.6,percent of total billed charges,78% of total billed charges,55.13,63,,44.104,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,33.25,38,,26.6,percent of total billed charges,38% of total billed charges,33.25,38,,26.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,78.75,90,,63,percent of total billed charges,90% of total billed charges,30.63,35,,24.504,percent of total billed charges,35% of total billed charges,58.87,67.275,,47.096,percent of total billed charges,67.275% of total billed charges,70,80,,56,percent of total billed charges,80% of total billed charges,33.58,38.38,,26.864,percent of total billed charges,38.38% of total billed charges,70,80,,56,percent of total billed charges,80% of total billed charges,54.02,61.74,,43.216,percent of total billed charges,61.74% of total billed charges,89.25,102,,71.4,percent of total billed charges,102% of total billed charges,33.25,38,,26.6,percent of total billed charges,38% of total billed charges,30.63,89.25,
SPLINT UPPER EXTREMITY,1001086,CDM,450,RC,,,Outpatient,,,88,66,,68.64,78,,54.912,percent of total billed charges,78% of total billed charges,55.44,63,,44.352,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,33.44,38,,26.752,percent of total billed charges,38% of total billed charges,33.44,38,,26.752,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,30.8,35,,24.64,percent of total billed charges,35% of total billed charges,59.2,67.275,,47.36,percent of total billed charges,67.275% of total billed charges,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,33.77,38.38,,27.016,percent of total billed charges,38.38% of total billed charges,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,54.33,61.74,,43.464,percent of total billed charges,61.74% of total billed charges,89.76,102,,71.808,percent of total billed charges,102% of total billed charges,33.44,38,,26.752,percent of total billed charges,38% of total billed charges,30.8,89.76,
ALPHA-1 ANTITRYPSIN,5000240,CDM,301,RC,82103,HCPCS,Outpatient,,,88,66,,68.64,78,,54.912,percent of total billed charges,78% of total billed charges,16.89,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.44,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.44,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,17.73,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,59.2,67.275,,47.36,percent of total billed charges,67.275% of total billed charges,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,13.57,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,54.33,61.74,,43.464,percent of total billed charges,61.74% of total billed charges,17.23,102,,,Fee Schedule,102% of GA Medicaid Rate,13.44,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.44,79.2,
PHOSPHORUS,5000716,CDM,301,RC,84100,HCPCS,Outpatient,,,88,66,,68.64,78,,54.912,percent of total billed charges,78% of total billed charges,5.97,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,6.27,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,59.2,67.275,,47.36,percent of total billed charges,67.275% of total billed charges,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,4.79,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,54.33,61.74,,43.464,percent of total billed charges,61.74% of total billed charges,6.09,102,,,Fee Schedule,102% of GA Medicaid Rate,4.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.74,79.2,
CHOLESTEROL,5000722,CDM,301,RC,82465,HCPCS,Outpatient,,,88,66,,68.64,78,,54.912,percent of total billed charges,78% of total billed charges,5.47,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.35,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.35,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,5.74,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,59.2,67.275,,47.36,percent of total billed charges,67.275% of total billed charges,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,4.39,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,54.33,61.74,,43.464,percent of total billed charges,61.74% of total billed charges,5.58,102,,,Fee Schedule,102% of GA Medicaid Rate,4.35,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.35,79.2,
CPK ISOENZYMES,5000829,CDM,301,RC,82552,HCPCS,Outpatient,,,88,66,,68.64,78,,54.912,percent of total billed charges,78% of total billed charges,16.84,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,17.68,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,59.2,67.275,,47.36,percent of total billed charges,67.275% of total billed charges,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,13.52,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,54.33,61.74,,43.464,percent of total billed charges,61.74% of total billed charges,17.18,102,,,Fee Schedule,102% of GA Medicaid Rate,13.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.39,79.2,
THEOPHYLLINE MULTIPLE,5009136,CDM,301,RC,80198,HCPCS,Outpatient,,,88,66,,68.64,78,,54.912,percent of total billed charges,78% of total billed charges,17.79,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.14,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.14,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,18.68,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,59.2,67.275,,47.36,percent of total billed charges,67.275% of total billed charges,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,14.28,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,54.33,61.74,,43.464,percent of total billed charges,61.74% of total billed charges,18.15,102,,,Fee Schedule,102% of GA Medicaid Rate,14.14,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.14,79.2,
BOVIE LONG,3003077,CDM,270,RC,,,Outpatient,,,88.15,66.11,,68.76,78,,55.008,percent of total billed charges,78% of total billed charges,55.53,63,,44.424,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,33.5,38,,26.8,percent of total billed charges,38% of total billed charges,33.5,38,,26.8,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,79.34,90,,63.472,percent of total billed charges,90% of total billed charges,30.85,35,,24.68,percent of total billed charges,35% of total billed charges,59.3,67.275,,47.44,percent of total billed charges,67.275% of total billed charges,70.52,80,,56.416,percent of total billed charges,80% of total billed charges,33.83,38.38,,27.064,percent of total billed charges,38.38% of total billed charges,70.52,80,,56.416,percent of total billed charges,80% of total billed charges,54.42,61.74,,43.536,percent of total billed charges,61.74% of total billed charges,89.91,102,,71.928,percent of total billed charges,102% of total billed charges,33.5,38,,26.8,percent of total billed charges,38% of total billed charges,30.85,89.91,
DISPOSABLE INJECTOR LOWER,3001008,CDM,270,RC,,,Outpatient,,,88.88,66.66,,69.33,78,,55.464,percent of total billed charges,78% of total billed charges,55.99,63,,44.792,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,33.77,38,,27.016,percent of total billed charges,38% of total billed charges,33.77,38,,27.016,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,79.99,90,,63.992,percent of total billed charges,90% of total billed charges,31.11,35,,24.888,percent of total billed charges,35% of total billed charges,59.79,67.275,,47.832,percent of total billed charges,67.275% of total billed charges,71.1,80,,56.88,percent of total billed charges,80% of total billed charges,34.11,38.38,,27.288,percent of total billed charges,38.38% of total billed charges,71.1,80,,56.88,percent of total billed charges,80% of total billed charges,54.87,61.74,,43.896,percent of total billed charges,61.74% of total billed charges,90.66,102,,72.528,percent of total billed charges,102% of total billed charges,33.77,38,,27.016,percent of total billed charges,38% of total billed charges,31.11,90.66,
THORACENTESIS,1200194,CDM,981,RC,32421,HCPCS,Outpatient,,,89,66.75,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,53.85,61.74,,43.08,percent of total billed charges,61.74% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,53.85,53.85,
KETAMINE,5000184,CDM,301,RC,80357,HCPCS,Outpatient,,,89,66.75,,69.42,78,,55.536,percent of total billed charges,78% of total billed charges,56.07,63,,44.856,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,33.82,38,,27.056,percent of total billed charges,38% of total billed charges,33.82,38,,27.056,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,31.15,35,,24.92,percent of total billed charges,35% of total billed charges,59.87,67.275,,47.896,percent of total billed charges,67.275% of total billed charges,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,34.16,38.38,,27.328,percent of total billed charges,38.38% of total billed charges,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,54.95,61.74,,43.96,percent of total billed charges,61.74% of total billed charges,90.78,102,,72.624,percent of total billed charges,102% of total billed charges,33.82,38,,27.056,percent of total billed charges,38% of total billed charges,31.15,90.78,
NON PARASITE ID,5001523,CDM,306,RC,87999,HCPCS,Outpatient,,,89,66.75,,69.42,78,,55.536,percent of total billed charges,78% of total billed charges,56.07,63,,44.856,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,33.82,38,,27.056,percent of total billed charges,38% of total billed charges,33.82,38,,27.056,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,31.15,35,,24.92,percent of total billed charges,35% of total billed charges,59.87,67.275,,47.896,percent of total billed charges,67.275% of total billed charges,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,34.16,38.38,,27.328,percent of total billed charges,38.38% of total billed charges,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,54.95,61.74,,43.96,percent of total billed charges,61.74% of total billed charges,90.78,102,,72.624,percent of total billed charges,102% of total billed charges,33.82,38,,27.056,percent of total billed charges,38% of total billed charges,31.15,90.78,
CYSTATIN C,5002047,CDM,301,RC,82610,HCPCS,Outpatient,,,89,66.75,,69.42,78,,55.536,percent of total billed charges,78% of total billed charges,17.1,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.52,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.52,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,17.96,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,59.87,67.275,,47.896,percent of total billed charges,67.275% of total billed charges,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,18.71,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,54.95,61.74,,43.96,percent of total billed charges,61.74% of total billed charges,17.44,102,,,Fee Schedule,102% of GA Medicaid Rate,18.52,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.1,80.1,
Blood test to if peptic ulcers are caused by a certain bacterium,5086677,CDM,302,RC,86677,HCPCS,Outpatient,,,89,66.75,,69.42,78,,55.536,percent of total billed charges,78% of total billed charges,18.25,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.85,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.85,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,19.16,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,59.87,67.275,,47.896,percent of total billed charges,67.275% of total billed charges,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,17.02,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,54.95,61.74,,43.96,percent of total billed charges,61.74% of total billed charges,18.62,102,,,Fee Schedule,102% of GA Medicaid Rate,16.85,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.85,80.1,
CERV COLLAR PHILADELPHIA PEDS,3001320,CDM,270,RC,,,Outpatient,,,89.9,67.43,,70.12,78,,56.096,percent of total billed charges,78% of total billed charges,56.64,63,,45.312,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,34.16,38,,27.328,percent of total billed charges,38% of total billed charges,34.16,38,,27.328,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,80.91,90,,64.728,percent of total billed charges,90% of total billed charges,31.47,35,,25.176,percent of total billed charges,35% of total billed charges,60.48,67.275,,48.384,percent of total billed charges,67.275% of total billed charges,71.92,80,,57.536,percent of total billed charges,80% of total billed charges,34.5,38.38,,27.6,percent of total billed charges,38.38% of total billed charges,71.92,80,,57.536,percent of total billed charges,80% of total billed charges,55.5,61.74,,44.4,percent of total billed charges,61.74% of total billed charges,91.7,102,,73.36,percent of total billed charges,102% of total billed charges,34.16,38,,27.328,percent of total billed charges,38% of total billed charges,31.47,91.7,
GLIDESCOPE 4,3004651,CDM,270,RC,,,Outpatient,,,90,67.5,,70.2,78,,56.16,percent of total billed charges,78% of total billed charges,56.7,63,,45.36,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,34.2,38,,27.36,percent of total billed charges,38% of total billed charges,34.2,38,,27.36,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,81,90,,64.8,percent of total billed charges,90% of total billed charges,31.5,35,,25.2,percent of total billed charges,35% of total billed charges,60.55,67.275,,48.44,percent of total billed charges,67.275% of total billed charges,72,80,,57.6,percent of total billed charges,80% of total billed charges,34.54,38.38,,27.632,percent of total billed charges,38.38% of total billed charges,72,80,,57.6,percent of total billed charges,80% of total billed charges,55.57,61.74,,44.456,percent of total billed charges,61.74% of total billed charges,91.8,102,,73.44,percent of total billed charges,102% of total billed charges,34.2,38,,27.36,percent of total billed charges,38% of total billed charges,31.5,91.8,
BILIRUBIN TOTAL,5000709,CDM,301,RC,82247,HCPCS,Outpatient,,,90,67.5,,70.2,78,,56.16,percent of total billed charges,78% of total billed charges,6.32,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,81,90,,64.8,percent of total billed charges,90% of total billed charges,6.64,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,60.55,67.275,,48.44,percent of total billed charges,67.275% of total billed charges,72,80,,57.6,percent of total billed charges,80% of total billed charges,5.07,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,72,80,,57.6,percent of total billed charges,80% of total billed charges,55.57,61.74,,44.456,percent of total billed charges,61.74% of total billed charges,6.45,102,,,Fee Schedule,102% of GA Medicaid Rate,5.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.02,81,
.BILIRUBIN TOTAL PEDIATRIC,5000710,CDM,301,RC,82247,HCPCS,Outpatient,,,90,67.5,,70.2,78,,56.16,percent of total billed charges,78% of total billed charges,6.32,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,81,90,,64.8,percent of total billed charges,90% of total billed charges,6.64,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,60.55,67.275,,48.44,percent of total billed charges,67.275% of total billed charges,72,80,,57.6,percent of total billed charges,80% of total billed charges,5.07,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,72,80,,57.6,percent of total billed charges,80% of total billed charges,55.57,61.74,,44.456,percent of total billed charges,61.74% of total billed charges,6.45,102,,,Fee Schedule,102% of GA Medicaid Rate,5.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.02,81,
ALCOHOL-MULTIPLE,5009135,CDM,301,RC,80320,HCPCS,Outpatient,,,90,67.5,,70.2,78,,56.16,percent of total billed charges,78% of total billed charges,13.59,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,34.2,38,,27.36,percent of total billed charges,38% of total billed charges,34.2,38,,27.36,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,81,90,,64.8,percent of total billed charges,90% of total billed charges,14.27,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,60.55,67.275,,48.44,percent of total billed charges,67.275% of total billed charges,72,80,,57.6,percent of total billed charges,80% of total billed charges,34.54,38.38,,27.632,percent of total billed charges,38.38% of total billed charges,72,80,,57.6,percent of total billed charges,80% of total billed charges,55.57,61.74,,44.456,percent of total billed charges,61.74% of total billed charges,13.86,102,,,Fee Schedule,102% of GA Medicaid Rate,34.2,38,,27.36,percent of total billed charges,38% of total billed charges,13.59,81,
OXYCODONE DRUG SCREENING,5080365,CDM,301,RC,80365,HCPCS,Outpatient,,,90,67.5,,70.2,78,,56.16,percent of total billed charges,78% of total billed charges,56.7,63,,45.36,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,34.2,38,,27.36,percent of total billed charges,38% of total billed charges,34.2,38,,27.36,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,81,90,,64.8,percent of total billed charges,90% of total billed charges,31.5,35,,25.2,percent of total billed charges,35% of total billed charges,60.55,67.275,,48.44,percent of total billed charges,67.275% of total billed charges,72,80,,57.6,percent of total billed charges,80% of total billed charges,34.54,38.38,,27.632,percent of total billed charges,38.38% of total billed charges,72,80,,57.6,percent of total billed charges,80% of total billed charges,55.57,61.74,,44.456,percent of total billed charges,61.74% of total billed charges,91.8,102,,73.44,percent of total billed charges,102% of total billed charges,34.2,38,,27.36,percent of total billed charges,38% of total billed charges,31.5,91.8,
PT FUNCTIONAL EVALUATION,9000010,CDM,420,RC,97750,HCPCS,Outpatient,,,90,67.5,,70.2,78,,56.16,percent of total billed charges,78% of total billed charges,56.7,63,,45.36,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,34.2,38,,27.36,percent of total billed charges,38% of total billed charges,34.2,38,,27.36,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,81,90,,64.8,percent of total billed charges,90% of total billed charges,31.5,35,,25.2,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,72,80,,57.6,percent of total billed charges,80% of total billed charges,34.54,38.38,,27.632,percent of total billed charges,38.38% of total billed charges,72,80,,57.6,percent of total billed charges,80% of total billed charges,55.57,61.74,,44.456,percent of total billed charges,61.74% of total billed charges,91.8,102,,73.44,percent of total billed charges,102% of total billed charges,34.2,38,,27.36,percent of total billed charges,38% of total billed charges,31.5,145.93,
MEDTOX URINE DRUG SCREEN,5000101,CDM,300,RC,,,Outpatient,,,91,68.25,,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,57.33,63,,45.864,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,34.58,38,,27.664,percent of total billed charges,38% of total billed charges,34.58,38,,27.664,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,31.85,35,,25.48,percent of total billed charges,35% of total billed charges,61.22,67.275,,48.976,percent of total billed charges,67.275% of total billed charges,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,34.93,38.38,,27.944,percent of total billed charges,38.38% of total billed charges,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,56.18,61.74,,44.944,percent of total billed charges,61.74% of total billed charges,92.82,102,,74.256,percent of total billed charges,102% of total billed charges,34.58,38,,27.664,percent of total billed charges,38% of total billed charges,31.85,92.82,
URINE DRUG SCREEN (IN-HOUSE),5001745,CDM,301,RC,80305,HCPCS,Outpatient,,,91,68.25,,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,11.47,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,12.04,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,61.22,67.275,,48.976,percent of total billed charges,67.275% of total billed charges,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,12.73,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,56.18,61.74,,44.944,percent of total billed charges,61.74% of total billed charges,11.7,102,,,Fee Schedule,102% of GA Medicaid Rate,12.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.47,81.9,
CALCIUM 24 HR URINE,5001849,CDM,301,RC,82340,HCPCS,Outpatient,,,91,68.25,,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,7.59,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.03,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.03,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,7.97,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,61.22,67.275,,48.976,percent of total billed charges,67.275% of total billed charges,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,6.09,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,56.18,61.74,,44.944,percent of total billed charges,61.74% of total billed charges,7.74,102,,,Fee Schedule,102% of GA Medicaid Rate,6.03,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.03,81.9,
DRUG SCREEN STUDENT; SPECIAL PRICING,5002095,CDM,301,RC,80305,HCPCS,Outpatient,,,91,68.25,,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,11.47,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,12.04,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,61.22,67.275,,48.976,percent of total billed charges,67.275% of total billed charges,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,12.73,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,56.18,61.74,,44.944,percent of total billed charges,61.74% of total billed charges,11.7,102,,,Fee Schedule,102% of GA Medicaid Rate,12.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.47,81.9,
CHEST DECUBITUS LEFT,7000206,CDM,320,RC,71010,HCPCS,Outpatient,,,91,68.25,,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,57.33,63,,45.864,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,34.58,38,,27.664,percent of total billed charges,38% of total billed charges,34.58,38,,27.664,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,31.85,35,,25.48,percent of total billed charges,35% of total billed charges,61.22,67.275,,48.976,percent of total billed charges,67.275% of total billed charges,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,34.93,38.38,,27.944,percent of total billed charges,38.38% of total billed charges,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,56.18,61.74,,44.944,percent of total billed charges,61.74% of total billed charges,92.82,102,,74.256,percent of total billed charges,102% of total billed charges,34.58,38,,27.664,percent of total billed charges,38% of total billed charges,31.85,92.82,
CHEST DECUBITUS RIGHT,7000207,CDM,320,RC,71010,HCPCS,Outpatient,,,91,68.25,,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,57.33,63,,45.864,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,34.58,38,,27.664,percent of total billed charges,38% of total billed charges,34.58,38,,27.664,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,31.85,35,,25.48,percent of total billed charges,35% of total billed charges,61.22,67.275,,48.976,percent of total billed charges,67.275% of total billed charges,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,34.93,38.38,,27.944,percent of total billed charges,38.38% of total billed charges,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,56.18,61.74,,44.944,percent of total billed charges,61.74% of total billed charges,92.82,102,,74.256,percent of total billed charges,102% of total billed charges,34.58,38,,27.664,percent of total billed charges,38% of total billed charges,31.85,92.82,
K-WIRE THREADED DOUBLE 9 X.062,3005122,CDM,270,RC,,,Outpatient,,,91.25,68.44,,71.18,78,,56.944,percent of total billed charges,78% of total billed charges,57.49,63,,45.992,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,34.68,38,,27.744,percent of total billed charges,38% of total billed charges,34.68,38,,27.744,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,82.13,90,,65.704,percent of total billed charges,90% of total billed charges,31.94,35,,25.552,percent of total billed charges,35% of total billed charges,61.39,67.275,,49.112,percent of total billed charges,67.275% of total billed charges,73,80,,58.4,percent of total billed charges,80% of total billed charges,35.02,38.38,,28.016,percent of total billed charges,38.38% of total billed charges,73,80,,58.4,percent of total billed charges,80% of total billed charges,56.34,61.74,,45.072,percent of total billed charges,61.74% of total billed charges,93.08,102,,74.464,percent of total billed charges,102% of total billed charges,34.68,38,,27.744,percent of total billed charges,38% of total billed charges,31.94,93.08,
NASAL PACKING - MEDIUM,3001538,CDM,270,RC,,,Outpatient,,,91.27,68.45,,71.19,78,,56.952,percent of total billed charges,78% of total billed charges,57.5,63,,46,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,34.68,38,,27.744,percent of total billed charges,38% of total billed charges,34.68,38,,27.744,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,82.14,90,,65.712,percent of total billed charges,90% of total billed charges,31.94,35,,25.552,percent of total billed charges,35% of total billed charges,61.4,67.275,,49.12,percent of total billed charges,67.275% of total billed charges,73.02,80,,58.416,percent of total billed charges,80% of total billed charges,35.03,38.38,,28.024,percent of total billed charges,38.38% of total billed charges,73.02,80,,58.416,percent of total billed charges,80% of total billed charges,56.35,61.74,,45.08,percent of total billed charges,61.74% of total billed charges,93.1,102,,74.48,percent of total billed charges,102% of total billed charges,34.68,38,,27.744,percent of total billed charges,38% of total billed charges,31.94,93.1,
MASK AF531 with 4pt Headgear - MD,3004233,CDM,270,RC,,,Outpatient,,,91.8,68.85,,71.6,78,,57.28,percent of total billed charges,78% of total billed charges,57.83,63,,46.264,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,34.88,38,,27.904,percent of total billed charges,38% of total billed charges,34.88,38,,27.904,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,82.62,90,,66.096,percent of total billed charges,90% of total billed charges,32.13,35,,25.704,percent of total billed charges,35% of total billed charges,61.76,67.275,,49.408,percent of total billed charges,67.275% of total billed charges,73.44,80,,58.752,percent of total billed charges,80% of total billed charges,35.23,38.38,,28.184,percent of total billed charges,38.38% of total billed charges,73.44,80,,58.752,percent of total billed charges,80% of total billed charges,56.68,61.74,,45.344,percent of total billed charges,61.74% of total billed charges,93.64,102,,74.912,percent of total billed charges,102% of total billed charges,34.88,38,,27.904,percent of total billed charges,38% of total billed charges,32.13,93.64,
CHEMILUMINESCENT ASSAY,5001955,CDM,301,RC,82397,HCPCS,Outpatient,,,92,69,,71.76,78,,57.408,percent of total billed charges,78% of total billed charges,17.77,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.12,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.12,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,18.66,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,61.89,67.275,,49.512,percent of total billed charges,67.275% of total billed charges,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,14.26,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,56.8,61.74,,45.44,percent of total billed charges,61.74% of total billed charges,18.13,102,,,Fee Schedule,102% of GA Medicaid Rate,14.12,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.12,82.8,
PYRUVATE,5003728,CDM,301,RC,84210,HCPCS,Outpatient,,,92,69,,71.76,78,,57.408,percent of total billed charges,78% of total billed charges,13.65,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.48,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.48,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,14.33,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,61.89,67.275,,49.512,percent of total billed charges,67.275% of total billed charges,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,14.62,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,56.8,61.74,,45.44,percent of total billed charges,61.74% of total billed charges,13.92,102,,,Fee Schedule,102% of GA Medicaid Rate,14.48,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.65,82.8,
.ACETAMINOPHEN-MULTIPLE,5009168,CDM,301,RC,82003,HCPCS,Outpatient,,,92,69,,71.76,78,,57.408,percent of total billed charges,78% of total billed charges,57.96,63,,46.368,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,34.96,38,,27.968,percent of total billed charges,38% of total billed charges,34.96,38,,27.968,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,32.2,35,,25.76,percent of total billed charges,35% of total billed charges,61.89,67.275,,49.512,percent of total billed charges,67.275% of total billed charges,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,35.31,38.38,,28.248,percent of total billed charges,38.38% of total billed charges,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,56.8,61.74,,45.44,percent of total billed charges,61.74% of total billed charges,93.84,102,,75.072,percent of total billed charges,102% of total billed charges,34.96,38,,27.968,percent of total billed charges,38% of total billed charges,32.2,93.84,
STETHOSCOPE DISPOSABLE,3000702,CDM,270,RC,,,Outpatient,,,92.7,69.53,,72.31,78,,57.848,percent of total billed charges,78% of total billed charges,58.4,63,,46.72,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,35.23,38,,28.184,percent of total billed charges,38% of total billed charges,35.23,38,,28.184,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,83.43,90,,66.744,percent of total billed charges,90% of total billed charges,32.45,35,,25.96,percent of total billed charges,35% of total billed charges,62.36,67.275,,49.888,percent of total billed charges,67.275% of total billed charges,74.16,80,,59.328,percent of total billed charges,80% of total billed charges,35.58,38.38,,28.464,percent of total billed charges,38.38% of total billed charges,74.16,80,,59.328,percent of total billed charges,80% of total billed charges,57.23,61.74,,45.784,percent of total billed charges,61.74% of total billed charges,94.55,102,,75.64,percent of total billed charges,102% of total billed charges,35.23,38,,28.184,percent of total billed charges,38% of total billed charges,32.45,94.55,
CORTICAL SCREW 3.5 MM x 12mm,3000029,CDM,270,RC,,,Outpatient,,,93,69.75,,72.54,78,,58.032,percent of total billed charges,78% of total billed charges,58.59,63,,46.872,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,35.34,38,,28.272,percent of total billed charges,38% of total billed charges,35.34,38,,28.272,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,32.55,35,,26.04,percent of total billed charges,35% of total billed charges,62.57,67.275,,50.056,percent of total billed charges,67.275% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,35.69,38.38,,28.552,percent of total billed charges,38.38% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,57.42,61.74,,45.936,percent of total billed charges,61.74% of total billed charges,94.86,102,,75.888,percent of total billed charges,102% of total billed charges,35.34,38,,28.272,percent of total billed charges,38% of total billed charges,32.55,94.86,
Blood test to determine infection with Hepatitis C,5001739,CDM,300,RC,86803,HCPCS,Outpatient,,,93,69.75,,72.54,78,,58.032,percent of total billed charges,78% of total billed charges,10,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,10.5,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,62.57,67.275,,50.056,percent of total billed charges,67.275% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,14.41,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,57.42,61.74,,45.936,percent of total billed charges,61.74% of total billed charges,10.2,102,,,Fee Schedule,102% of GA Medicaid Rate,14.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10,83.7,
.HEPATITIS C GEL ELECTRO,5001748,CDM,301,RC,83894,HCPCS,Outpatient,,,93,69.75,,72.54,78,,58.032,percent of total billed charges,78% of total billed charges,58.59,63,,46.872,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,35.34,38,,28.272,percent of total billed charges,38% of total billed charges,35.34,38,,28.272,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,32.55,35,,26.04,percent of total billed charges,35% of total billed charges,62.57,67.275,,50.056,percent of total billed charges,67.275% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,35.69,38.38,,28.552,percent of total billed charges,38.38% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,57.42,61.74,,45.936,percent of total billed charges,61.74% of total billed charges,94.86,102,,75.888,percent of total billed charges,102% of total billed charges,35.34,38,,28.272,percent of total billed charges,38% of total billed charges,32.55,94.86,
.HEP C REVERSE TRNSCRIPT,5001749,CDM,301,RC,83902,HCPCS,Outpatient,,,93,69.75,,72.54,78,,58.032,percent of total billed charges,78% of total billed charges,58.59,63,,46.872,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,35.34,38,,28.272,percent of total billed charges,38% of total billed charges,35.34,38,,28.272,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,32.55,35,,26.04,percent of total billed charges,35% of total billed charges,62.57,67.275,,50.056,percent of total billed charges,67.275% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,35.69,38.38,,28.552,percent of total billed charges,38.38% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,57.42,61.74,,45.936,percent of total billed charges,61.74% of total billed charges,94.86,102,,75.888,percent of total billed charges,102% of total billed charges,35.34,38,,28.272,percent of total billed charges,38% of total billed charges,32.55,94.86,
.PCR EACH PAIR,5001751,CDM,301,RC,83898,HCPCS,Outpatient,,,93,69.75,,72.54,78,,58.032,percent of total billed charges,78% of total billed charges,58.59,63,,46.872,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,35.34,38,,28.272,percent of total billed charges,38% of total billed charges,35.34,38,,28.272,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,32.55,35,,26.04,percent of total billed charges,35% of total billed charges,62.57,67.275,,50.056,percent of total billed charges,67.275% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,35.69,38.38,,28.552,percent of total billed charges,38.38% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,57.42,61.74,,45.936,percent of total billed charges,61.74% of total billed charges,94.86,102,,75.888,percent of total billed charges,102% of total billed charges,35.34,38,,28.272,percent of total billed charges,38% of total billed charges,32.55,94.86,
.HEPC ENZYMATIC DIGESTION,5001752,CDM,301,RC,83892,HCPCS,Outpatient,,,93,69.75,,72.54,78,,58.032,percent of total billed charges,78% of total billed charges,58.59,63,,46.872,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,35.34,38,,28.272,percent of total billed charges,38% of total billed charges,35.34,38,,28.272,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,32.55,35,,26.04,percent of total billed charges,35% of total billed charges,62.57,67.275,,50.056,percent of total billed charges,67.275% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,35.69,38.38,,28.552,percent of total billed charges,38.38% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,57.42,61.74,,45.936,percent of total billed charges,61.74% of total billed charges,94.86,102,,75.888,percent of total billed charges,102% of total billed charges,35.34,38,,28.272,percent of total billed charges,38% of total billed charges,32.55,94.86,
.HPC INTERP & REPORT,5001753,CDM,301,RC,83912,HCPCS,Outpatient,,,93,69.75,,72.54,78,,58.032,percent of total billed charges,78% of total billed charges,58.59,63,,46.872,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,35.34,38,,28.272,percent of total billed charges,38% of total billed charges,35.34,38,,28.272,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,32.55,35,,26.04,percent of total billed charges,35% of total billed charges,62.57,67.275,,50.056,percent of total billed charges,67.275% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,35.69,38.38,,28.552,percent of total billed charges,38.38% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,57.42,61.74,,45.936,percent of total billed charges,61.74% of total billed charges,94.86,102,,75.888,percent of total billed charges,102% of total billed charges,35.34,38,,28.272,percent of total billed charges,38% of total billed charges,32.55,94.86,
.MOLECULAR DIAG-INTERPRET,5001814,CDM,301,RC,83912,HCPCS,Outpatient,,,93,69.75,,72.54,78,,58.032,percent of total billed charges,78% of total billed charges,58.59,63,,46.872,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,35.34,38,,28.272,percent of total billed charges,38% of total billed charges,35.34,38,,28.272,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,32.55,35,,26.04,percent of total billed charges,35% of total billed charges,62.57,67.275,,50.056,percent of total billed charges,67.275% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,35.69,38.38,,28.552,percent of total billed charges,38.38% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,57.42,61.74,,45.936,percent of total billed charges,61.74% of total billed charges,94.86,102,,75.888,percent of total billed charges,102% of total billed charges,35.34,38,,28.272,percent of total billed charges,38% of total billed charges,32.55,94.86,
HUMAN GROWTH HORMONE,5001826,CDM,301,RC,83003,HCPCS,Outpatient,,,93,69.75,,72.54,78,,58.032,percent of total billed charges,78% of total billed charges,17.9,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.67,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.67,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,18.8,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,62.57,67.275,,50.056,percent of total billed charges,67.275% of total billed charges,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,16.84,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,57.42,61.74,,45.936,percent of total billed charges,61.74% of total billed charges,18.26,102,,,Fee Schedule,102% of GA Medicaid Rate,16.67,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.67,83.7,
MASK BIPAP C-PAP MEDIUM,3000260,CDM,270,RC,,,Outpatient,,,94,70.5,,73.32,78,,58.656,percent of total billed charges,78% of total billed charges,59.22,63,,47.376,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,35.72,38,,28.576,percent of total billed charges,38% of total billed charges,35.72,38,,28.576,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,32.9,35,,26.32,percent of total billed charges,35% of total billed charges,63.24,67.275,,50.592,percent of total billed charges,67.275% of total billed charges,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,36.08,38.38,,28.864,percent of total billed charges,38.38% of total billed charges,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,58.04,61.74,,46.432,percent of total billed charges,61.74% of total billed charges,95.88,102,,76.704,percent of total billed charges,102% of total billed charges,35.72,38,,28.576,percent of total billed charges,38% of total billed charges,32.9,95.88,
PLEUR EVAC LATEX FREE,3001834,CDM,270,RC,,,Outpatient,,,94,70.5,,73.32,78,,58.656,percent of total billed charges,78% of total billed charges,59.22,63,,47.376,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,35.72,38,,28.576,percent of total billed charges,38% of total billed charges,35.72,38,,28.576,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,32.9,35,,26.32,percent of total billed charges,35% of total billed charges,63.24,67.275,,50.592,percent of total billed charges,67.275% of total billed charges,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,36.08,38.38,,28.864,percent of total billed charges,38.38% of total billed charges,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,58.04,61.74,,46.432,percent of total billed charges,61.74% of total billed charges,95.88,102,,76.704,percent of total billed charges,102% of total billed charges,35.72,38,,28.576,percent of total billed charges,38% of total billed charges,32.9,95.88,
MASK AF531 LARGE,3004231,CDM,270,RC,,,Outpatient,,,94,70.5,,73.32,78,,58.656,percent of total billed charges,78% of total billed charges,59.22,63,,47.376,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,35.72,38,,28.576,percent of total billed charges,38% of total billed charges,35.72,38,,28.576,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,32.9,35,,26.32,percent of total billed charges,35% of total billed charges,63.24,67.275,,50.592,percent of total billed charges,67.275% of total billed charges,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,36.08,38.38,,28.864,percent of total billed charges,38.38% of total billed charges,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,58.04,61.74,,46.432,percent of total billed charges,61.74% of total billed charges,95.88,102,,76.704,percent of total billed charges,102% of total billed charges,35.72,38,,28.576,percent of total billed charges,38% of total billed charges,32.9,95.88,
Blood test to screen for antibodies that could harm red blood cells,5200405,CDM,300,RC,86850,HCPCS,Outpatient,,,94,70.5,,73.32,78,,58.656,percent of total billed charges,78% of total billed charges,15.23,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,9.77,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,9.77,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,15.99,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,63.24,67.275,,50.592,percent of total billed charges,67.275% of total billed charges,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,9.87,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,58.04,61.74,,46.432,percent of total billed charges,61.74% of total billed charges,15.53,102,,,Fee Schedule,102% of GA Medicaid Rate,9.77,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,9.77,84.6,
COUDE FOLEY SILICONE 14FR,3000267,CDM,270,RC,,,Outpatient,,,94.25,70.69,,73.52,78,,58.816,percent of total billed charges,78% of total billed charges,59.38,63,,47.504,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,35.82,38,,28.656,percent of total billed charges,38% of total billed charges,35.82,38,,28.656,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,84.83,90,,67.864,percent of total billed charges,90% of total billed charges,32.99,35,,26.392,percent of total billed charges,35% of total billed charges,63.41,67.275,,50.728,percent of total billed charges,67.275% of total billed charges,75.4,80,,60.32,percent of total billed charges,80% of total billed charges,36.17,38.38,,28.936,percent of total billed charges,38.38% of total billed charges,75.4,80,,60.32,percent of total billed charges,80% of total billed charges,58.19,61.74,,46.552,percent of total billed charges,61.74% of total billed charges,96.14,102,,76.912,percent of total billed charges,102% of total billed charges,35.82,38,,28.656,percent of total billed charges,38% of total billed charges,32.99,96.14,
COUDE FOLEY SILICONE 16FR,3000270,CDM,270,RC,,,Outpatient,,,94.25,70.69,,73.52,78,,58.816,percent of total billed charges,78% of total billed charges,59.38,63,,47.504,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,35.82,38,,28.656,percent of total billed charges,38% of total billed charges,35.82,38,,28.656,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,84.83,90,,67.864,percent of total billed charges,90% of total billed charges,32.99,35,,26.392,percent of total billed charges,35% of total billed charges,63.41,67.275,,50.728,percent of total billed charges,67.275% of total billed charges,75.4,80,,60.32,percent of total billed charges,80% of total billed charges,36.17,38.38,,28.936,percent of total billed charges,38.38% of total billed charges,75.4,80,,60.32,percent of total billed charges,80% of total billed charges,58.19,61.74,,46.552,percent of total billed charges,61.74% of total billed charges,96.14,102,,76.912,percent of total billed charges,102% of total billed charges,35.82,38,,28.656,percent of total billed charges,38% of total billed charges,32.99,96.14,
COUDE FOLEY SILICONE 18FR,3000271,CDM,270,RC,,,Outpatient,,,94.25,70.69,,73.52,78,,58.816,percent of total billed charges,78% of total billed charges,59.38,63,,47.504,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,35.82,38,,28.656,percent of total billed charges,38% of total billed charges,35.82,38,,28.656,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,84.83,90,,67.864,percent of total billed charges,90% of total billed charges,32.99,35,,26.392,percent of total billed charges,35% of total billed charges,63.41,67.275,,50.728,percent of total billed charges,67.275% of total billed charges,75.4,80,,60.32,percent of total billed charges,80% of total billed charges,36.17,38.38,,28.936,percent of total billed charges,38.38% of total billed charges,75.4,80,,60.32,percent of total billed charges,80% of total billed charges,58.19,61.74,,46.552,percent of total billed charges,61.74% of total billed charges,96.14,102,,76.912,percent of total billed charges,102% of total billed charges,35.82,38,,28.656,percent of total billed charges,38% of total billed charges,32.99,96.14,
Blood test to assist with diagnosis,5000508,CDM,300,RC,88312,HCPCS,Outpatient,,,95,71.25,,74.1,78,,59.28,percent of total billed charges,78% of total billed charges,43.39,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,45.56,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,63.91,67.275,,51.128,percent of total billed charges,67.275% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,36.46,38.38,,29.168,percent of total billed charges,38.38% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,58.65,61.74,,46.92,percent of total billed charges,61.74% of total billed charges,44.26,102,,,Fee Schedule,102% of GA Medicaid Rate,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,36.1,85.5,
Blood test to if peptic ulcers are caused by a certain bacterium,5001732,CDM,302,RC,86677,HCPCS,Outpatient,,,95,71.25,,74.1,78,,59.28,percent of total billed charges,78% of total billed charges,18.25,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.85,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.85,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,19.16,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,63.91,67.275,,51.128,percent of total billed charges,67.275% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,17.02,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,76,80,,60.8,percent of total billed charges,80% of total billed charges,58.65,61.74,,46.92,percent of total billed charges,61.74% of total billed charges,18.62,102,,,Fee Schedule,102% of GA Medicaid Rate,16.85,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.85,85.5,
Blood test to if peptic ulcers are caused by a certain bacterium,5001766,CDM,302,RC,86677,HCPCS,Outpatient,,,95,71.25,,74.1,78,,59.28,percent of total billed charges,78% of total billed charges,18.25,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.85,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.85,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,19.16,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,63.91,67.275,,51.128,percent of total billed charges,67.275% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,17.02,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,76,80,,60.8,percent of total billed charges,80% of total billed charges,58.65,61.74,,46.92,percent of total billed charges,61.74% of total billed charges,18.62,102,,,Fee Schedule,102% of GA Medicaid Rate,16.85,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.85,85.5,
Blood test to if peptic ulcers are caused by a certain bacterium,5001776,CDM,302,RC,86677,HCPCS,Outpatient,,,95,71.25,,74.1,78,,59.28,percent of total billed charges,78% of total billed charges,18.25,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.85,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.85,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,19.16,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,63.91,67.275,,51.128,percent of total billed charges,67.275% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,17.02,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,76,80,,60.8,percent of total billed charges,80% of total billed charges,58.65,61.74,,46.92,percent of total billed charges,61.74% of total billed charges,18.62,102,,,Fee Schedule,102% of GA Medicaid Rate,16.85,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.85,85.5,
Blood test to if peptic ulcers are caused by a certain bacterium,5001777,CDM,302,RC,86677,HCPCS,Outpatient,,,95,71.25,,74.1,78,,59.28,percent of total billed charges,78% of total billed charges,18.25,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.85,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.85,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,19.16,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,63.91,67.275,,51.128,percent of total billed charges,67.275% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,17.02,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,76,80,,60.8,percent of total billed charges,80% of total billed charges,58.65,61.74,,46.92,percent of total billed charges,61.74% of total billed charges,18.62,102,,,Fee Schedule,102% of GA Medicaid Rate,16.85,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.85,85.5,
HGE AB,5001877,CDM,302,RC,86609,HCPCS,Outpatient,,,95,71.25,,74.1,78,,59.28,percent of total billed charges,78% of total billed charges,16.2,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,17.01,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,63.91,67.275,,51.128,percent of total billed charges,67.275% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,13.01,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,76,80,,60.8,percent of total billed charges,80% of total billed charges,58.65,61.74,,46.92,percent of total billed charges,61.74% of total billed charges,16.52,102,,,Fee Schedule,102% of GA Medicaid Rate,12.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.88,85.5,
PATH LEVEL I,5002010,CDM,312,RC,88300,HCPCS,Outpatient,,,95,71.25,,74.1,78,,59.28,percent of total billed charges,78% of total billed charges,14.3,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,15.02,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,63.91,67.275,,51.128,percent of total billed charges,67.275% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,36.46,38.38,,29.168,percent of total billed charges,38.38% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,58.65,61.74,,46.92,percent of total billed charges,61.74% of total billed charges,14.59,102,,,Fee Schedule,102% of GA Medicaid Rate,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,14.3,85.5,
PATH LEVEL II,5002011,CDM,312,RC,88302,HCPCS,Outpatient,,,95,71.25,,74.1,78,,59.28,percent of total billed charges,78% of total billed charges,35.06,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,36.81,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,63.91,67.275,,51.128,percent of total billed charges,67.275% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,36.46,38.38,,29.168,percent of total billed charges,38.38% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,58.65,61.74,,46.92,percent of total billed charges,61.74% of total billed charges,35.76,102,,,Fee Schedule,102% of GA Medicaid Rate,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,35.06,85.5,
PATH GROSS,5003007,CDM,312,RC,88300,HCPCS,Outpatient,,,95,71.25,,74.1,78,,59.28,percent of total billed charges,78% of total billed charges,14.3,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,15.02,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,63.91,67.275,,51.128,percent of total billed charges,67.275% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,36.46,38.38,,29.168,percent of total billed charges,38.38% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,58.65,61.74,,46.92,percent of total billed charges,61.74% of total billed charges,14.59,102,,,Fee Schedule,102% of GA Medicaid Rate,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,14.3,85.5,
PATH BLOCK H & E,5003029,CDM,312,RC,88302,HCPCS,Outpatient,,,95,71.25,,74.1,78,,59.28,percent of total billed charges,78% of total billed charges,35.06,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,36.81,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,63.91,67.275,,51.128,percent of total billed charges,67.275% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,36.46,38.38,,29.168,percent of total billed charges,38.38% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,58.65,61.74,,46.92,percent of total billed charges,61.74% of total billed charges,35.76,102,,,Fee Schedule,102% of GA Medicaid Rate,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,35.06,85.5,
PATH ADD SLIDE H & E,5003030,CDM,312,RC,88302,HCPCS,Outpatient,,,95,71.25,,74.1,78,,59.28,percent of total billed charges,78% of total billed charges,35.06,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,36.81,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,63.91,67.275,,51.128,percent of total billed charges,67.275% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,36.46,38.38,,29.168,percent of total billed charges,38.38% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,58.65,61.74,,46.92,percent of total billed charges,61.74% of total billed charges,35.76,102,,,Fee Schedule,102% of GA Medicaid Rate,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,35.06,85.5,
Blood test to assist with diagnosis,5003074,CDM,312,RC,88313,HCPCS,Outpatient,,,95,71.25,,74.1,78,,59.28,percent of total billed charges,78% of total billed charges,44.91,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,47.16,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,63.91,67.275,,51.128,percent of total billed charges,67.275% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,36.46,38.38,,29.168,percent of total billed charges,38.38% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,58.65,61.74,,46.92,percent of total billed charges,61.74% of total billed charges,45.81,102,,,Fee Schedule,102% of GA Medicaid Rate,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,36.1,85.5,
Blood test to assist with diagnosis,5003121,CDM,312,RC,88312,HCPCS,Outpatient,,,95,71.25,,74.1,78,,59.28,percent of total billed charges,78% of total billed charges,43.39,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,45.56,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,63.91,67.275,,51.128,percent of total billed charges,67.275% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,36.46,38.38,,29.168,percent of total billed charges,38.38% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,58.65,61.74,,46.92,percent of total billed charges,61.74% of total billed charges,44.26,102,,,Fee Schedule,102% of GA Medicaid Rate,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,36.1,85.5,
Blood test to assist with diagnosis,5003132,CDM,312,RC,88313,HCPCS,Outpatient,,,95,71.25,,74.1,78,,59.28,percent of total billed charges,78% of total billed charges,44.91,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,47.16,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,63.91,67.275,,51.128,percent of total billed charges,67.275% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,36.46,38.38,,29.168,percent of total billed charges,38.38% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,58.65,61.74,,46.92,percent of total billed charges,61.74% of total billed charges,45.81,102,,,Fee Schedule,102% of GA Medicaid Rate,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,36.1,85.5,
Blood test to assist with diagnosis,5003133,CDM,312,RC,88313,HCPCS,Outpatient,,,95,71.25,,74.1,78,,59.28,percent of total billed charges,78% of total billed charges,44.91,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,47.16,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,63.91,67.275,,51.128,percent of total billed charges,67.275% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,36.46,38.38,,29.168,percent of total billed charges,38.38% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,58.65,61.74,,46.92,percent of total billed charges,61.74% of total billed charges,45.81,102,,,Fee Schedule,102% of GA Medicaid Rate,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,36.1,85.5,
Blood test to assist with diagnosis,5003143,CDM,312,RC,88313,HCPCS,Outpatient,,,95,71.25,,74.1,78,,59.28,percent of total billed charges,78% of total billed charges,44.91,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,47.16,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,63.91,67.275,,51.128,percent of total billed charges,67.275% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,36.46,38.38,,29.168,percent of total billed charges,38.38% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,58.65,61.74,,46.92,percent of total billed charges,61.74% of total billed charges,45.81,102,,,Fee Schedule,102% of GA Medicaid Rate,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,36.1,85.5,
Blood test to assist with diagnosis,5003154,CDM,312,RC,88313,HCPCS,Outpatient,,,95,71.25,,74.1,78,,59.28,percent of total billed charges,78% of total billed charges,44.91,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,47.16,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,63.91,67.275,,51.128,percent of total billed charges,67.275% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,36.46,38.38,,29.168,percent of total billed charges,38.38% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,58.65,61.74,,46.92,percent of total billed charges,61.74% of total billed charges,45.81,102,,,Fee Schedule,102% of GA Medicaid Rate,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,36.1,85.5,
LESION TISSUE PROCESSING,5003205,CDM,312,RC,88302,HCPCS,Outpatient,,,95,71.25,,74.1,78,,59.28,percent of total billed charges,78% of total billed charges,35.06,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,36.81,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,63.91,67.275,,51.128,percent of total billed charges,67.275% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,36.46,38.38,,29.168,percent of total billed charges,38.38% of total billed charges,76,80,,60.8,percent of total billed charges,80% of total billed charges,58.65,61.74,,46.92,percent of total billed charges,61.74% of total billed charges,35.76,102,,,Fee Schedule,102% of GA Medicaid Rate,36.1,38,,28.88,percent of total billed charges,38% of total billed charges,35.06,85.5,
HOT BIOPSY FORCEP,3004048,CDM,270,RC,,,Outpatient,,,95.3,71.48,,74.33,78,,59.464,percent of total billed charges,78% of total billed charges,60.04,63,,48.032,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,36.21,38,,28.968,percent of total billed charges,38% of total billed charges,36.21,38,,28.968,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,85.77,90,,68.616,percent of total billed charges,90% of total billed charges,33.36,35,,26.688,percent of total billed charges,35% of total billed charges,64.11,67.275,,51.288,percent of total billed charges,67.275% of total billed charges,76.24,80,,60.992,percent of total billed charges,80% of total billed charges,36.58,38.38,,29.264,percent of total billed charges,38.38% of total billed charges,76.24,80,,60.992,percent of total billed charges,80% of total billed charges,58.84,61.74,,47.072,percent of total billed charges,61.74% of total billed charges,97.21,102,,77.768,percent of total billed charges,102% of total billed charges,36.21,38,,28.968,percent of total billed charges,38% of total billed charges,33.36,97.21,
K-WIRE THREADED DOUBLE 9  .045  1.1MM,3005121,CDM,270,RC,,,Outpatient,,,95.32,71.49,,74.35,78,,59.48,percent of total billed charges,78% of total billed charges,60.05,63,,48.04,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,36.22,38,,28.976,percent of total billed charges,38% of total billed charges,36.22,38,,28.976,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,85.79,90,,68.632,percent of total billed charges,90% of total billed charges,33.36,35,,26.688,percent of total billed charges,35% of total billed charges,64.13,67.275,,51.304,percent of total billed charges,67.275% of total billed charges,76.26,80,,61.008,percent of total billed charges,80% of total billed charges,36.58,38.38,,29.264,percent of total billed charges,38.38% of total billed charges,76.26,80,,61.008,percent of total billed charges,80% of total billed charges,58.85,61.74,,47.08,percent of total billed charges,61.74% of total billed charges,97.23,102,,77.784,percent of total billed charges,102% of total billed charges,36.22,38,,28.976,percent of total billed charges,38% of total billed charges,33.36,97.23,
RADIAL ARTERY CATH KIT,3004265,CDM,270,RC,,,Outpatient,,,96,72,,74.88,78,,59.904,percent of total billed charges,78% of total billed charges,60.48,63,,48.384,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,36.48,38,,29.184,percent of total billed charges,38% of total billed charges,36.48,38,,29.184,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,33.6,35,,26.88,percent of total billed charges,35% of total billed charges,64.58,67.275,,51.664,percent of total billed charges,67.275% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,36.84,38.38,,29.472,percent of total billed charges,38.38% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,59.27,61.74,,47.416,percent of total billed charges,61.74% of total billed charges,97.92,102,,78.336,percent of total billed charges,102% of total billed charges,36.48,38,,29.184,percent of total billed charges,38% of total billed charges,33.6,97.92,
BROSELOW PED ER TAPE,3004646,CDM,270,RC,,,Outpatient,,,96,72,,74.88,78,,59.904,percent of total billed charges,78% of total billed charges,60.48,63,,48.384,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,36.48,38,,29.184,percent of total billed charges,38% of total billed charges,36.48,38,,29.184,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,33.6,35,,26.88,percent of total billed charges,35% of total billed charges,64.58,67.275,,51.664,percent of total billed charges,67.275% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,36.84,38.38,,29.472,percent of total billed charges,38.38% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,59.27,61.74,,47.416,percent of total billed charges,61.74% of total billed charges,97.92,102,,78.336,percent of total billed charges,102% of total billed charges,36.48,38,,29.184,percent of total billed charges,38% of total billed charges,33.6,97.92,
CHOLANGIOGRAM SHEATHS,3005401,CDM,270,RC,,,Outpatient,,,96,72,,74.88,78,,59.904,percent of total billed charges,78% of total billed charges,60.48,63,,48.384,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,36.48,38,,29.184,percent of total billed charges,38% of total billed charges,36.48,38,,29.184,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,33.6,35,,26.88,percent of total billed charges,35% of total billed charges,64.58,67.275,,51.664,percent of total billed charges,67.275% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,36.84,38.38,,29.472,percent of total billed charges,38.38% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,59.27,61.74,,47.416,percent of total billed charges,61.74% of total billed charges,97.92,102,,78.336,percent of total billed charges,102% of total billed charges,36.48,38,,29.184,percent of total billed charges,38% of total billed charges,33.6,97.92,
THREADED ROD 100MM,3006004,CDM,270,RC,,,Outpatient,,,96,72,,74.88,78,,59.904,percent of total billed charges,78% of total billed charges,60.48,63,,48.384,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,36.48,38,,29.184,percent of total billed charges,38% of total billed charges,36.48,38,,29.184,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,33.6,35,,26.88,percent of total billed charges,35% of total billed charges,64.58,67.275,,51.664,percent of total billed charges,67.275% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,36.84,38.38,,29.472,percent of total billed charges,38.38% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,59.27,61.74,,47.416,percent of total billed charges,61.74% of total billed charges,97.92,102,,78.336,percent of total billed charges,102% of total billed charges,36.48,38,,29.184,percent of total billed charges,38% of total billed charges,33.6,97.92,
PURKINJE CELL (YO),5001236,CDM,302,RC,86256,HCPCS,Outpatient,,,96,72,,74.88,78,,59.904,percent of total billed charges,78% of total billed charges,15.16,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,15.92,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,64.58,67.275,,51.664,percent of total billed charges,67.275% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,12.17,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,59.27,61.74,,47.416,percent of total billed charges,61.74% of total billed charges,15.46,102,,,Fee Schedule,102% of GA Medicaid Rate,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.05,86.4,
NEURONAL NUCLEAR Ab (HU),5001237,CDM,302,RC,86256,HCPCS,Outpatient,,,96,72,,74.88,78,,59.904,percent of total billed charges,78% of total billed charges,15.16,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,15.92,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,64.58,67.275,,51.664,percent of total billed charges,67.275% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,12.17,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,59.27,61.74,,47.416,percent of total billed charges,61.74% of total billed charges,15.46,102,,,Fee Schedule,102% of GA Medicaid Rate,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.05,86.4,
ANTI-YO TITER,5001238,CDM,302,RC,86256,HCPCS,Outpatient,,,96,72,,74.88,78,,59.904,percent of total billed charges,78% of total billed charges,15.16,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,15.92,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,64.58,67.275,,51.664,percent of total billed charges,67.275% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,12.17,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,59.27,61.74,,47.416,percent of total billed charges,61.74% of total billed charges,15.46,102,,,Fee Schedule,102% of GA Medicaid Rate,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.05,86.4,
ANTI-HU TITER,5001239,CDM,302,RC,86256,HCPCS,Outpatient,,,96,72,,74.88,78,,59.904,percent of total billed charges,78% of total billed charges,15.16,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,15.92,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,64.58,67.275,,51.664,percent of total billed charges,67.275% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,12.17,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,59.27,61.74,,47.416,percent of total billed charges,61.74% of total billed charges,15.46,102,,,Fee Schedule,102% of GA Medicaid Rate,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.05,86.4,
ANTINUCULEAR CYTOPLASM AB,5001406,CDM,302,RC,86256,HCPCS,Outpatient,,,96,72,,74.88,78,,59.904,percent of total billed charges,78% of total billed charges,15.16,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,15.92,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,64.58,67.275,,51.664,percent of total billed charges,67.275% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,12.17,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,59.27,61.74,,47.416,percent of total billed charges,61.74% of total billed charges,15.46,102,,,Fee Schedule,102% of GA Medicaid Rate,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.05,86.4,
MITOCHONDRIAL AB TITER,5001744,CDM,302,RC,86256,HCPCS,Outpatient,,,96,72,,74.88,78,,59.904,percent of total billed charges,78% of total billed charges,15.16,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,15.92,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,64.58,67.275,,51.664,percent of total billed charges,67.275% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,12.17,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,59.27,61.74,,47.416,percent of total billed charges,61.74% of total billed charges,15.46,102,,,Fee Schedule,102% of GA Medicaid Rate,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.05,86.4,
LEGIONELLA PNEUMOPHILA AB,5001795,CDM,302,RC,86256,HCPCS,Outpatient,,,96,72,,74.88,78,,59.904,percent of total billed charges,78% of total billed charges,15.16,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,15.92,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,64.58,67.275,,51.664,percent of total billed charges,67.275% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,12.17,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,59.27,61.74,,47.416,percent of total billed charges,61.74% of total billed charges,15.46,102,,,Fee Schedule,102% of GA Medicaid Rate,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.05,86.4,
PORPHYRINS QUANT URINE,5001856,CDM,301,RC,84120,HCPCS,Outpatient,,,96,72,,74.88,78,,59.904,percent of total billed charges,78% of total billed charges,18.5,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.71,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.71,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,19.43,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,64.58,67.275,,51.664,percent of total billed charges,67.275% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,14.86,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,59.27,61.74,,47.416,percent of total billed charges,61.74% of total billed charges,18.87,102,,,Fee Schedule,102% of GA Medicaid Rate,14.71,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.71,86.4,
OT RE-EVALUATION,9590201,CDM,430,RC,,,Outpatient,,,96,72,,74.88,78,,59.904,percent of total billed charges,78% of total billed charges,60.48,63,,48.384,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,36.48,38,,29.184,percent of total billed charges,38% of total billed charges,36.48,38,,29.184,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,33.6,35,,26.88,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,36.84,38.38,,29.472,percent of total billed charges,38.38% of total billed charges,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,59.27,61.74,,47.416,percent of total billed charges,61.74% of total billed charges,97.92,102,,78.336,percent of total billed charges,102% of total billed charges,36.48,38,,29.184,percent of total billed charges,38% of total billed charges,33.6,145.93,
LC ASPIRATION NEEDLE,3004047,CDM,270,RC,,,Outpatient,,,96.32,72.24,,75.13,78,,60.104,percent of total billed charges,78% of total billed charges,60.68,63,,48.544,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,36.6,38,,29.28,percent of total billed charges,38% of total billed charges,36.6,38,,29.28,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,86.69,90,,69.352,percent of total billed charges,90% of total billed charges,33.71,35,,26.968,percent of total billed charges,35% of total billed charges,64.8,67.275,,51.84,percent of total billed charges,67.275% of total billed charges,77.06,80,,61.648,percent of total billed charges,80% of total billed charges,36.97,38.38,,29.576,percent of total billed charges,38.38% of total billed charges,77.06,80,,61.648,percent of total billed charges,80% of total billed charges,59.47,61.74,,47.576,percent of total billed charges,61.74% of total billed charges,98.25,102,,78.6,percent of total billed charges,102% of total billed charges,36.6,38,,29.28,percent of total billed charges,38% of total billed charges,33.71,98.25,
DEFIB MONITOR PADS,3000310,CDM,270,RC,,,Outpatient,,,96.42,72.32,,75.21,78,,60.168,percent of total billed charges,78% of total billed charges,60.74,63,,48.592,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,36.64,38,,29.312,percent of total billed charges,38% of total billed charges,36.64,38,,29.312,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,86.78,90,,69.424,percent of total billed charges,90% of total billed charges,33.75,35,,27,percent of total billed charges,35% of total billed charges,64.87,67.275,,51.896,percent of total billed charges,67.275% of total billed charges,77.14,80,,61.712,percent of total billed charges,80% of total billed charges,37.01,38.38,,29.608,percent of total billed charges,38.38% of total billed charges,77.14,80,,61.712,percent of total billed charges,80% of total billed charges,59.53,61.74,,47.624,percent of total billed charges,61.74% of total billed charges,98.35,102,,78.68,percent of total billed charges,102% of total billed charges,36.64,38,,29.312,percent of total billed charges,38% of total billed charges,33.75,98.35,
"MUMPS TITER, IGM",5000832,CDM,302,RC,86735,HCPCS,Outpatient,,,97,72.75,,75.66,78,,60.528,percent of total billed charges,78% of total billed charges,16.41,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,17.23,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,65.26,67.275,,52.208,percent of total billed charges,67.275% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,13.18,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,59.89,61.74,,47.912,percent of total billed charges,61.74% of total billed charges,16.74,102,,,Fee Schedule,102% of GA Medicaid Rate,13.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.05,87.3,
MUMPS TITER IGG,5000833,CDM,302,RC,86735,HCPCS,Outpatient,,,97,72.75,,75.66,78,,60.528,percent of total billed charges,78% of total billed charges,16.41,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,17.23,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,65.26,67.275,,52.208,percent of total billed charges,67.275% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,13.18,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,59.89,61.74,,47.912,percent of total billed charges,61.74% of total billed charges,16.74,102,,,Fee Schedule,102% of GA Medicaid Rate,13.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.05,87.3,
TETANUS ANTITOXOID AB,5001501,CDM,302,RC,86774,HCPCS,Outpatient,,,97,72.75,,75.66,78,,60.528,percent of total billed charges,78% of total billed charges,18.61,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,19.54,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,65.26,67.275,,52.208,percent of total billed charges,67.275% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,14.95,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,59.89,61.74,,47.912,percent of total billed charges,61.74% of total billed charges,18.98,102,,,Fee Schedule,102% of GA Medicaid Rate,14.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.8,87.3,
ETHYLENE GLYCOL,5001921,CDM,301,RC,82693,HCPCS,Outpatient,,,97,72.75,,75.66,78,,60.528,percent of total billed charges,78% of total billed charges,18.74,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.9,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.9,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,19.68,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,65.26,67.275,,52.208,percent of total billed charges,67.275% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,15.05,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,59.89,61.74,,47.912,percent of total billed charges,61.74% of total billed charges,19.11,102,,,Fee Schedule,102% of GA Medicaid Rate,14.9,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.9,87.3,
"Incorporates the use of multiple parameters, such as balance, strength, and range of motion, for a functional activity",9000022,CDM,420,RC,97530,HCPCS,Outpatient,,,97,72.75,,75.66,78,,60.528,percent of total billed charges,78% of total billed charges,61.11,63,,48.888,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,36.86,38,,29.488,percent of total billed charges,38% of total billed charges,36.86,38,,29.488,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,33.95,35,,27.16,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,37.23,38.38,,29.784,percent of total billed charges,38.38% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,59.89,61.74,,47.912,percent of total billed charges,61.74% of total billed charges,98.94,102,,79.152,percent of total billed charges,102% of total billed charges,36.86,38,,29.488,percent of total billed charges,38% of total billed charges,33.95,145.93,
PT PROSTH TRAINING,9000030,CDM,420,RC,97761,HCPCS,Outpatient,,,97,72.75,,75.66,78,,60.528,percent of total billed charges,78% of total billed charges,61.11,63,,48.888,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,36.86,38,,29.488,percent of total billed charges,38% of total billed charges,36.86,38,,29.488,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,33.95,35,,27.16,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,37.23,38.38,,29.784,percent of total billed charges,38.38% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,59.89,61.74,,47.912,percent of total billed charges,61.74% of total billed charges,98.94,102,,79.152,percent of total billed charges,102% of total billed charges,36.86,38,,29.488,percent of total billed charges,38% of total billed charges,33.95,145.93,
"Incorporates the use of multiple parameters, such as balance, strength, and range of motion, for a functional activity",9000220,CDM,430,RC,97530,HCPCS,Outpatient,,,97,72.75,,75.66,78,,60.528,percent of total billed charges,78% of total billed charges,61.11,63,,48.888,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,36.86,38,,29.488,percent of total billed charges,38% of total billed charges,36.86,38,,29.488,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,33.95,35,,27.16,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,37.23,38.38,,29.784,percent of total billed charges,38.38% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,59.89,61.74,,47.912,percent of total billed charges,61.74% of total billed charges,98.94,102,,79.152,percent of total billed charges,102% of total billed charges,36.86,38,,29.488,percent of total billed charges,38% of total billed charges,33.95,145.93,
"OT PROSTHETIC TRAINING, EA 15 MIN",9000232,CDM,430,RC,97761,HCPCS,Outpatient,,,97,72.75,,75.66,78,,60.528,percent of total billed charges,78% of total billed charges,61.11,63,,48.888,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,36.86,38,,29.488,percent of total billed charges,38% of total billed charges,36.86,38,,29.488,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,33.95,35,,27.16,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,37.23,38.38,,29.784,percent of total billed charges,38.38% of total billed charges,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,59.89,61.74,,47.912,percent of total billed charges,61.74% of total billed charges,98.94,102,,79.152,percent of total billed charges,102% of total billed charges,36.86,38,,29.488,percent of total billed charges,38% of total billed charges,33.95,145.93,
VENAFLOW CALF CUFF 19,3004220,CDM,270,RC,,,Outpatient,,,97.12,72.84,,75.75,78,,60.6,percent of total billed charges,78% of total billed charges,61.19,63,,48.952,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,36.91,38,,29.528,percent of total billed charges,38% of total billed charges,36.91,38,,29.528,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,87.41,90,,69.928,percent of total billed charges,90% of total billed charges,33.99,35,,27.192,percent of total billed charges,35% of total billed charges,65.34,67.275,,52.272,percent of total billed charges,67.275% of total billed charges,77.7,80,,62.16,percent of total billed charges,80% of total billed charges,37.27,38.38,,29.816,percent of total billed charges,38.38% of total billed charges,77.7,80,,62.16,percent of total billed charges,80% of total billed charges,59.96,61.74,,47.968,percent of total billed charges,61.74% of total billed charges,99.06,102,,79.248,percent of total billed charges,102% of total billed charges,36.91,38,,29.528,percent of total billed charges,38% of total billed charges,33.99,99.06,
INTRINSIC FACTOR BLOCKING Ab,5000342,CDM,302,RC,86340,HCPCS,Outpatient,,,98,73.5,,76.44,78,,61.152,percent of total billed charges,78% of total billed charges,18.95,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,15.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,19.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,65.93,67.275,,52.744,percent of total billed charges,67.275% of total billed charges,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,15.23,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,60.51,61.74,,48.408,percent of total billed charges,61.74% of total billed charges,19.33,102,,,Fee Schedule,102% of GA Medicaid Rate,15.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.08,88.2,
ANTITHROMBIN III,5000450,CDM,305,RC,85300,HCPCS,Outpatient,,,98,73.5,,76.44,78,,61.152,percent of total billed charges,78% of total billed charges,14.9,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,11.85,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.85,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,15.65,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,65.93,67.275,,52.744,percent of total billed charges,67.275% of total billed charges,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,11.97,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,60.51,61.74,,48.408,percent of total billed charges,61.74% of total billed charges,15.2,102,,,Fee Schedule,102% of GA Medicaid Rate,11.85,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.85,88.2,
PARVOVIRUS B19 IGG ANTIBODY,5000834,CDM,302,RC,86747,HCPCS,Outpatient,,,98,73.5,,76.44,78,,61.152,percent of total billed charges,78% of total billed charges,18.9,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,15.03,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.03,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,19.85,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,65.93,67.275,,52.744,percent of total billed charges,67.275% of total billed charges,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,15.18,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,60.51,61.74,,48.408,percent of total billed charges,61.74% of total billed charges,19.28,102,,,Fee Schedule,102% of GA Medicaid Rate,15.03,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.03,88.2,
PARVOVIRUS B19 IGM ANTIBODY,5000836,CDM,302,RC,86747,HCPCS,Outpatient,,,98,73.5,,76.44,78,,61.152,percent of total billed charges,78% of total billed charges,18.9,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,15.03,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.03,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,19.85,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,65.93,67.275,,52.744,percent of total billed charges,67.275% of total billed charges,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,15.18,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,60.51,61.74,,48.408,percent of total billed charges,61.74% of total billed charges,19.28,102,,,Fee Schedule,102% of GA Medicaid Rate,15.03,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.03,88.2,
T3 UPTAKE,5001402,CDM,301,RC,84479,HCPCS,Outpatient,,,98,73.5,,76.44,78,,61.152,percent of total billed charges,78% of total billed charges,8.14,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,8.55,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,65.93,67.275,,52.744,percent of total billed charges,67.275% of total billed charges,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,6.53,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,60.51,61.74,,48.408,percent of total billed charges,61.74% of total billed charges,8.3,102,,,Fee Schedule,102% of GA Medicaid Rate,6.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.47,88.2,
Blood test to measure B-12,5001419,CDM,301,RC,82607,HCPCS,Outpatient,,,98,73.5,,76.44,78,,61.152,percent of total billed charges,78% of total billed charges,18.95,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,15.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,19.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,65.93,67.275,,52.744,percent of total billed charges,67.275% of total billed charges,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,15.23,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,60.51,61.74,,48.408,percent of total billed charges,61.74% of total billed charges,19.33,102,,,Fee Schedule,102% of GA Medicaid Rate,15.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.08,88.2,
FRUCTOSAMINE,5001653,CDM,301,RC,82985,HCPCS,Outpatient,,,98,73.5,,76.44,78,,61.152,percent of total billed charges,78% of total billed charges,18.95,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.76,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.76,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,19.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,65.93,67.275,,52.744,percent of total billed charges,67.275% of total billed charges,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,16.93,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,60.51,61.74,,48.408,percent of total billed charges,61.74% of total billed charges,19.33,102,,,Fee Schedule,102% of GA Medicaid Rate,16.76,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.76,88.2,
Test to measure arterial blood gases,5009125,CDM,301,RC,82803,HCPCS,Outpatient,,,98,73.5,,76.44,78,,61.152,percent of total billed charges,78% of total billed charges,24.34,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,26.07,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,26.07,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,25.56,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,65.93,67.275,,52.744,percent of total billed charges,67.275% of total billed charges,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,26.33,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,60.51,61.74,,48.408,percent of total billed charges,61.74% of total billed charges,24.83,102,,,Fee Schedule,102% of GA Medicaid Rate,26.07,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,24.34,88.2,
THORA/PARACENTESIS TRAY PRIMARY,3002996,CDM,270,RC,,,Outpatient,,,98.28,73.71,,76.66,78,,61.328,percent of total billed charges,78% of total billed charges,61.92,63,,49.536,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,37.35,38,,29.88,percent of total billed charges,38% of total billed charges,37.35,38,,29.88,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,88.45,90,,70.76,percent of total billed charges,90% of total billed charges,34.4,35,,27.52,percent of total billed charges,35% of total billed charges,66.12,67.275,,52.896,percent of total billed charges,67.275% of total billed charges,78.62,80,,62.896,percent of total billed charges,80% of total billed charges,37.72,38.38,,30.176,percent of total billed charges,38.38% of total billed charges,78.62,80,,62.896,percent of total billed charges,80% of total billed charges,60.68,61.74,,48.544,percent of total billed charges,61.74% of total billed charges,100.25,102,,80.2,percent of total billed charges,102% of total billed charges,37.35,38,,29.88,percent of total billed charges,38% of total billed charges,34.4,100.25,
ER VISIT SIGNIFICANT PROC,1001018,CDM,450,RC,,,Outpatient,,,99,74.25,,77.22,78,,61.776,percent of total billed charges,78% of total billed charges,62.37,63,,49.896,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,37.62,38,,30.096,percent of total billed charges,38% of total billed charges,37.62,38,,30.096,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,34.65,35,,27.72,percent of total billed charges,35% of total billed charges,66.6,67.275,,53.28,percent of total billed charges,67.275% of total billed charges,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,38,38.38,,30.4,percent of total billed charges,38.38% of total billed charges,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,61.12,61.74,,48.896,percent of total billed charges,61.74% of total billed charges,100.98,102,,80.784,percent of total billed charges,102% of total billed charges,37.62,38,,30.096,percent of total billed charges,38% of total billed charges,34.65,100.98,
CANCELLOUS SCREW PART THR,3000027,CDM,270,RC,,,Outpatient,,,99,74.25,,77.22,78,,61.776,percent of total billed charges,78% of total billed charges,62.37,63,,49.896,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,37.62,38,,30.096,percent of total billed charges,38% of total billed charges,37.62,38,,30.096,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,34.65,35,,27.72,percent of total billed charges,35% of total billed charges,66.6,67.275,,53.28,percent of total billed charges,67.275% of total billed charges,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,38,38.38,,30.4,percent of total billed charges,38.38% of total billed charges,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,61.12,61.74,,48.896,percent of total billed charges,61.74% of total billed charges,100.98,102,,80.784,percent of total billed charges,102% of total billed charges,37.62,38,,30.096,percent of total billed charges,38% of total billed charges,34.65,100.98,
NASAL PACKING - LARGE,3001539,CDM,270,RC,,,Outpatient,,,99,74.25,,77.22,78,,61.776,percent of total billed charges,78% of total billed charges,62.37,63,,49.896,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,37.62,38,,30.096,percent of total billed charges,38% of total billed charges,37.62,38,,30.096,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,34.65,35,,27.72,percent of total billed charges,35% of total billed charges,66.6,67.275,,53.28,percent of total billed charges,67.275% of total billed charges,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,38,38.38,,30.4,percent of total billed charges,38.38% of total billed charges,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,61.12,61.74,,48.896,percent of total billed charges,61.74% of total billed charges,100.98,102,,80.784,percent of total billed charges,102% of total billed charges,37.62,38,,30.096,percent of total billed charges,38% of total billed charges,34.65,100.98,
VALPROIC ACID TOTAL AND FREE,5001691,CDM,301,RC,80164,HCPCS,Outpatient,,,99,74.25,,77.22,78,,61.776,percent of total billed charges,78% of total billed charges,14.27,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,14.98,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,66.6,67.275,,53.28,percent of total billed charges,67.275% of total billed charges,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,13.68,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,61.12,61.74,,48.896,percent of total billed charges,61.74% of total billed charges,14.56,102,,,Fee Schedule,102% of GA Medicaid Rate,13.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.54,89.1,
"Blood test, lipids (cholesterol and triglycerides)",5001780,CDM,301,RC,80061,HCPCS,Outpatient,,,99,74.25,,77.22,78,,61.776,percent of total billed charges,78% of total billed charges,16.85,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,17.69,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,66.6,67.275,,53.28,percent of total billed charges,67.275% of total billed charges,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,13.52,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,61.12,61.74,,48.896,percent of total billed charges,61.74% of total billed charges,17.19,102,,,Fee Schedule,102% of GA Medicaid Rate,13.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.39,89.1,
SALT AIRWAY SYSTEM,3003093,CDM,270,RC,,,Outpatient,,,99.8,74.85,,77.84,78,,62.272,percent of total billed charges,78% of total billed charges,62.87,63,,50.296,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,37.92,38,,30.336,percent of total billed charges,38% of total billed charges,37.92,38,,30.336,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,89.82,90,,71.856,percent of total billed charges,90% of total billed charges,34.93,35,,27.944,percent of total billed charges,35% of total billed charges,67.14,67.275,,53.712,percent of total billed charges,67.275% of total billed charges,79.84,80,,63.872,percent of total billed charges,80% of total billed charges,38.3,38.38,,30.64,percent of total billed charges,38.38% of total billed charges,79.84,80,,63.872,percent of total billed charges,80% of total billed charges,61.62,61.74,,49.296,percent of total billed charges,61.74% of total billed charges,101.8,102,,81.44,percent of total billed charges,102% of total billed charges,37.92,38,,30.336,percent of total billed charges,38% of total billed charges,34.93,101.8,
K-WIRE THREADED 1.6,3000301,CDM,270,RC,,,Outpatient,,,100,75,,78,78,,62.4,percent of total billed charges,78% of total billed charges,63,63,,50.4,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,38,38,,30.4,percent of total billed charges,38% of total billed charges,38,38,,30.4,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,90,90,,72,percent of total billed charges,90% of total billed charges,35,35,,28,percent of total billed charges,35% of total billed charges,67.28,67.275,,53.824,percent of total billed charges,67.275% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,38.38,38.38,,30.704,percent of total billed charges,38.38% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,61.74,61.74,,49.392,percent of total billed charges,61.74% of total billed charges,102,102,,81.6,percent of total billed charges,102% of total billed charges,38,38,,30.4,percent of total billed charges,38% of total billed charges,35,102,
THREADED ROD 120MM,3006005,CDM,270,RC,,,Outpatient,,,100,75,,78,78,,62.4,percent of total billed charges,78% of total billed charges,63,63,,50.4,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,38,38,,30.4,percent of total billed charges,38% of total billed charges,38,38,,30.4,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,90,90,,72,percent of total billed charges,90% of total billed charges,35,35,,28,percent of total billed charges,35% of total billed charges,67.28,67.275,,53.824,percent of total billed charges,67.275% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,38.38,38.38,,30.704,percent of total billed charges,38.38% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,61.74,61.74,,49.392,percent of total billed charges,61.74% of total billed charges,102,102,,81.6,percent of total billed charges,102% of total billed charges,38,38,,30.4,percent of total billed charges,38% of total billed charges,35,102,
THREADED ROD 150MM,3006006,CDM,270,RC,,,Outpatient,,,100,75,,78,78,,62.4,percent of total billed charges,78% of total billed charges,63,63,,50.4,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,38,38,,30.4,percent of total billed charges,38% of total billed charges,38,38,,30.4,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,90,90,,72,percent of total billed charges,90% of total billed charges,35,35,,28,percent of total billed charges,35% of total billed charges,67.28,67.275,,53.824,percent of total billed charges,67.275% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,38.38,38.38,,30.704,percent of total billed charges,38.38% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,61.74,61.74,,49.392,percent of total billed charges,61.74% of total billed charges,102,102,,81.6,percent of total billed charges,102% of total billed charges,38,38,,30.4,percent of total billed charges,38% of total billed charges,35,102,
SENSITIVITY EACH ADDITION,5000020,CDM,306,RC,87187,HCPCS,Outpatient,,,100,75,,78,78,,62.4,percent of total billed charges,78% of total billed charges,13.03,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,40.17,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,40.17,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,90,90,,72,percent of total billed charges,90% of total billed charges,13.68,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,67.28,67.275,,53.824,percent of total billed charges,67.275% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,40.57,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,80,80,,64,percent of total billed charges,80% of total billed charges,61.74,61.74,,49.392,percent of total billed charges,61.74% of total billed charges,13.29,102,,,Fee Schedule,102% of GA Medicaid Rate,40.17,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.03,90,
DIPTHERIA ANTITOXOID AB,5001502,CDM,302,RC,86648,HCPCS,Outpatient,,,100,75,,78,78,,62.4,percent of total billed charges,78% of total billed charges,19.13,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,15.21,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.21,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,90,90,,72,percent of total billed charges,90% of total billed charges,20.09,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,67.28,67.275,,53.824,percent of total billed charges,67.275% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,15.36,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,80,80,,64,percent of total billed charges,80% of total billed charges,61.74,61.74,,49.392,percent of total billed charges,61.74% of total billed charges,19.51,102,,,Fee Schedule,102% of GA Medicaid Rate,15.21,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.21,90,
.ARTHRITIS PROFILE,5001740,CDM,301,RC,80072,HCPCS,Outpatient,,,100,75,,78,78,,62.4,percent of total billed charges,78% of total billed charges,63,63,,50.4,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,38,38,,30.4,percent of total billed charges,38% of total billed charges,38,38,,30.4,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,90,90,,72,percent of total billed charges,90% of total billed charges,35,35,,28,percent of total billed charges,35% of total billed charges,67.28,67.275,,53.824,percent of total billed charges,67.275% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,38.38,38.38,,30.704,percent of total billed charges,38.38% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,61.74,61.74,,49.392,percent of total billed charges,61.74% of total billed charges,102,102,,81.6,percent of total billed charges,102% of total billed charges,38,38,,30.4,percent of total billed charges,38% of total billed charges,35,102,
Blood test to measure a certain protein in the blood to determine heart muscle damage,5001951,CDM,300,RC,84484,HCPCS,Outpatient,,,100,75,,78,78,,62.4,percent of total billed charges,78% of total billed charges,12.38,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,90,90,,72,percent of total billed charges,90% of total billed charges,13,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,67.28,67.275,,53.824,percent of total billed charges,67.275% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,12.59,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,80,80,,64,percent of total billed charges,80% of total billed charges,61.74,61.74,,49.392,percent of total billed charges,61.74% of total billed charges,12.63,102,,,Fee Schedule,102% of GA Medicaid Rate,12.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.38,90,
Blood test to measure a certain protein in the blood to determine heart muscle damage,5001952,CDM,301,RC,84484,HCPCS,Outpatient,,,100,75,,78,78,,62.4,percent of total billed charges,78% of total billed charges,12.38,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,90,90,,72,percent of total billed charges,90% of total billed charges,13,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,67.28,67.275,,53.824,percent of total billed charges,67.275% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,12.59,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,80,80,,64,percent of total billed charges,80% of total billed charges,61.74,61.74,,49.392,percent of total billed charges,61.74% of total billed charges,12.63,102,,,Fee Schedule,102% of GA Medicaid Rate,12.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.38,90,
.IDENTIFICATION EA ADD PLATE,5002000,CDM,306,RC,87187,HCPCS,Outpatient,,,100,75,,78,78,,62.4,percent of total billed charges,78% of total billed charges,13.03,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,40.17,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,40.17,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,90,90,,72,percent of total billed charges,90% of total billed charges,13.68,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,67.28,67.275,,53.824,percent of total billed charges,67.275% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,40.57,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,80,80,,64,percent of total billed charges,80% of total billed charges,61.74,61.74,,49.392,percent of total billed charges,61.74% of total billed charges,13.29,102,,,Fee Schedule,102% of GA Medicaid Rate,40.17,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.03,90,
"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)",5009134,CDM,301,RC,80051,HCPCS,Outpatient,,,100,75,,78,78,,62.4,percent of total billed charges,78% of total billed charges,8.82,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,7.01,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.01,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,90,90,,72,percent of total billed charges,90% of total billed charges,9.26,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,67.28,67.275,,53.824,percent of total billed charges,67.275% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,7.08,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,80,80,,64,percent of total billed charges,80% of total billed charges,61.74,61.74,,49.392,percent of total billed charges,61.74% of total billed charges,9,102,,,Fee Schedule,102% of GA Medicaid Rate,7.01,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.01,90,
Liver function blood test panel,5009158,CDM,301,RC,80076,HCPCS,Outpatient,,,100,75,,78,78,,62.4,percent of total billed charges,78% of total billed charges,10.28,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.17,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.17,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,90,90,,72,percent of total billed charges,90% of total billed charges,10.79,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,67.28,67.275,,53.824,percent of total billed charges,67.275% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,8.25,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,80,80,,64,percent of total billed charges,80% of total billed charges,61.74,61.74,,49.392,percent of total billed charges,61.74% of total billed charges,10.49,102,,,Fee Schedule,102% of GA Medicaid Rate,8.17,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.17,90,
CANNABINOIDS NATURAL,5080349,CDM,301,RC,80349,HCPCS,Outpatient,,,100,75,,78,78,,62.4,percent of total billed charges,78% of total billed charges,63,63,,50.4,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,38,38,,30.4,percent of total billed charges,38% of total billed charges,38,38,,30.4,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,90,90,,72,percent of total billed charges,90% of total billed charges,35,35,,28,percent of total billed charges,35% of total billed charges,67.28,67.275,,53.824,percent of total billed charges,67.275% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,38.38,38.38,,30.704,percent of total billed charges,38.38% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,61.74,61.74,,49.392,percent of total billed charges,61.74% of total billed charges,102,102,,81.6,percent of total billed charges,102% of total billed charges,38,38,,30.4,percent of total billed charges,38% of total billed charges,35,102,
CHLAM PNEUMONIA,5087486,CDM,306,RC,87486,HCPCS,Outpatient,,,100,75,,78,78,,62.4,percent of total billed charges,78% of total billed charges,24.67,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,90,90,,72,percent of total billed charges,90% of total billed charges,25.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,67.28,67.275,,53.824,percent of total billed charges,67.275% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,35.44,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,80,80,,64,percent of total billed charges,80% of total billed charges,61.74,61.74,,49.392,percent of total billed charges,61.74% of total billed charges,25.16,102,,,Fee Schedule,102% of GA Medicaid Rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,24.67,90,
MYCOPLASMA PNEUMONIA,5087581,CDM,306,RC,87581,HCPCS,Outpatient,,,100,75,,78,78,,62.4,percent of total billed charges,78% of total billed charges,24.67,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,90,90,,72,percent of total billed charges,90% of total billed charges,25.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,67.28,67.275,,53.824,percent of total billed charges,67.275% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,35.44,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,80,80,,64,percent of total billed charges,80% of total billed charges,61.74,61.74,,49.392,percent of total billed charges,61.74% of total billed charges,25.16,102,,,Fee Schedule,102% of GA Medicaid Rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,24.67,90,
Blood test for an STD,5087661,CDM,306,RC,87661,HCPCS,Outpatient,,,100,75,,78,78,,62.4,percent of total billed charges,78% of total billed charges,21.42,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,90,90,,72,percent of total billed charges,90% of total billed charges,22.49,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,67.28,67.275,,53.824,percent of total billed charges,67.275% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,35.44,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,80,80,,64,percent of total billed charges,80% of total billed charges,61.74,61.74,,49.392,percent of total billed charges,61.74% of total billed charges,21.85,102,,,Fee Schedule,102% of GA Medicaid Rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,21.42,90,
"MM SCREEN, FILM",7600900,CDM,403,RC,77057,HCPCS,Outpatient,,,100,75,,78,78,,62.4,percent of total billed charges,78% of total billed charges,63,63,,50.4,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,38,38,,30.4,percent of total billed charges,38% of total billed charges,38,38,,30.4,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,90,90,,72,percent of total billed charges,90% of total billed charges,35,35,,28,percent of total billed charges,35% of total billed charges,67.28,67.275,,53.824,percent of total billed charges,67.275% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,38.38,38.38,,30.704,percent of total billed charges,38.38% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,61.74,61.74,,49.392,percent of total billed charges,61.74% of total billed charges,102,102,,81.6,percent of total billed charges,102% of total billed charges,38,38,,30.4,percent of total billed charges,38% of total billed charges,35,102,
"MM SPECIAL SCREEN, FILM",7600945,CDM,403,RC,77057,HCPCS,Outpatient,,,100,75,,78,78,,62.4,percent of total billed charges,78% of total billed charges,63,63,,50.4,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,38,38,,30.4,percent of total billed charges,38% of total billed charges,38,38,,30.4,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,90,90,,72,percent of total billed charges,90% of total billed charges,35,35,,28,percent of total billed charges,35% of total billed charges,67.28,67.275,,53.824,percent of total billed charges,67.275% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,38.38,38.38,,30.704,percent of total billed charges,38.38% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,61.74,61.74,,49.392,percent of total billed charges,61.74% of total billed charges,102,102,,81.6,percent of total billed charges,102% of total billed charges,38,38,,30.4,percent of total billed charges,38% of total billed charges,35,102,
XEMG MOTOR NERVE WITH F WAVE,9600018,CDM,922,RC,95903,HCPCS,Outpatient,,,100,75,,78,78,,62.4,percent of total billed charges,78% of total billed charges,63,63,,50.4,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,38,38,,30.4,percent of total billed charges,38% of total billed charges,38,38,,30.4,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,90,90,,72,percent of total billed charges,90% of total billed charges,35,35,,28,percent of total billed charges,35% of total billed charges,67.28,67.275,,53.824,percent of total billed charges,67.275% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,38.38,38.38,,30.704,percent of total billed charges,38.38% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,61.74,61.74,,49.392,percent of total billed charges,61.74% of total billed charges,102,102,,81.6,percent of total billed charges,102% of total billed charges,38,38,,30.4,percent of total billed charges,38% of total billed charges,35,102,
XEMG MOTOR NERVE WITH F WAVE,9600024,CDM,922,RC,95903,HCPCS,Outpatient,,,100,75,,78,78,,62.4,percent of total billed charges,78% of total billed charges,63,63,,50.4,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,38,38,,30.4,percent of total billed charges,38% of total billed charges,38,38,,30.4,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,90,90,,72,percent of total billed charges,90% of total billed charges,35,35,,28,percent of total billed charges,35% of total billed charges,67.28,67.275,,53.824,percent of total billed charges,67.275% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,38.38,38.38,,30.704,percent of total billed charges,38.38% of total billed charges,80,80,,64,percent of total billed charges,80% of total billed charges,61.74,61.74,,49.392,percent of total billed charges,61.74% of total billed charges,102,102,,81.6,percent of total billed charges,102% of total billed charges,38,38,,30.4,percent of total billed charges,38% of total billed charges,35,102,
ORAL CARE SUCTION KIT - VENT ONLY,3000712,CDM,270,RC,,,Outpatient,,,100.05,75.04,,78.04,78,,62.432,percent of total billed charges,78% of total billed charges,63.03,63,,50.424,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,38.02,38,,30.416,percent of total billed charges,38% of total billed charges,38.02,38,,30.416,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,90.05,90,,72.04,percent of total billed charges,90% of total billed charges,35.02,35,,28.016,percent of total billed charges,35% of total billed charges,67.31,67.275,,53.848,percent of total billed charges,67.275% of total billed charges,80.04,80,,64.032,percent of total billed charges,80% of total billed charges,38.4,38.38,,30.72,percent of total billed charges,38.38% of total billed charges,80.04,80,,64.032,percent of total billed charges,80% of total billed charges,61.77,61.74,,49.416,percent of total billed charges,61.74% of total billed charges,102.05,102,,81.64,percent of total billed charges,102% of total billed charges,38.02,38,,30.416,percent of total billed charges,38% of total billed charges,35.02,102.05,
MASK AF531 with strap cap,3004232,CDM,270,RC,,,Outpatient,,,100.56,75.42,,78.44,78,,62.752,percent of total billed charges,78% of total billed charges,63.35,63,,50.68,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,38.21,38,,30.568,percent of total billed charges,38% of total billed charges,38.21,38,,30.568,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,90.5,90,,72.4,percent of total billed charges,90% of total billed charges,35.2,35,,28.16,percent of total billed charges,35% of total billed charges,67.65,67.275,,54.12,percent of total billed charges,67.275% of total billed charges,80.45,80,,64.36,percent of total billed charges,80% of total billed charges,38.59,38.38,,30.872,percent of total billed charges,38.38% of total billed charges,80.45,80,,64.36,percent of total billed charges,80% of total billed charges,62.09,61.74,,49.672,percent of total billed charges,61.74% of total billed charges,102.57,102,,82.056,percent of total billed charges,102% of total billed charges,38.21,38,,30.568,percent of total billed charges,38% of total billed charges,35.2,102.57,
FEMORAL ARTERY CATH KIT,3004261,CDM,270,RC,,,Outpatient,,,100.8,75.6,,78.62,78,,62.896,percent of total billed charges,78% of total billed charges,63.5,63,,50.8,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,38.3,38,,30.64,percent of total billed charges,38% of total billed charges,38.3,38,,30.64,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,90.72,90,,72.576,percent of total billed charges,90% of total billed charges,35.28,35,,28.224,percent of total billed charges,35% of total billed charges,67.81,67.275,,54.248,percent of total billed charges,67.275% of total billed charges,80.64,80,,64.512,percent of total billed charges,80% of total billed charges,38.69,38.38,,30.952,percent of total billed charges,38.38% of total billed charges,80.64,80,,64.512,percent of total billed charges,80% of total billed charges,62.23,61.74,,49.784,percent of total billed charges,61.74% of total billed charges,102.82,102,,82.256,percent of total billed charges,102% of total billed charges,38.3,38,,30.64,percent of total billed charges,38% of total billed charges,35.28,102.82,
ACTIVATED PROTEIN C RESISTANCE,5000446,CDM,305,RC,85307,HCPCS,Outpatient,,,101,75.75,,78.78,78,,63.024,percent of total billed charges,78% of total billed charges,19.27,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,15.32,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.32,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,20.23,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,67.95,67.275,,54.36,percent of total billed charges,67.275% of total billed charges,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,15.47,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,62.36,61.74,,49.888,percent of total billed charges,61.74% of total billed charges,19.66,102,,,Fee Schedule,102% of GA Medicaid Rate,15.32,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.32,90.9,
.LYME DISEASE IGG WESTERN,5001408,CDM,301,RC,86617,HCPCS,Outpatient,,,101,75.75,,78.78,78,,63.024,percent of total billed charges,78% of total billed charges,19.48,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,15.49,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.49,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,20.45,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,67.95,67.275,,54.36,percent of total billed charges,67.275% of total billed charges,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,15.64,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,62.36,61.74,,49.888,percent of total billed charges,61.74% of total billed charges,19.87,102,,,Fee Schedule,102% of GA Medicaid Rate,15.49,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.49,90.9,
.LYME DISEASE IGM WESTERN,5001409,CDM,301,RC,86617,HCPCS,Outpatient,,,101,75.75,,78.78,78,,63.024,percent of total billed charges,78% of total billed charges,19.48,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,15.49,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.49,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,20.45,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,67.95,67.275,,54.36,percent of total billed charges,67.275% of total billed charges,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,15.64,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,62.36,61.74,,49.888,percent of total billed charges,61.74% of total billed charges,19.87,102,,,Fee Schedule,102% of GA Medicaid Rate,15.49,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.49,90.9,
HEP C IMMUNOBLOT,5001743,CDM,302,RC,86804,HCPCS,Outpatient,,,101,75.75,,78.78,78,,63.024,percent of total billed charges,78% of total billed charges,19.48,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,15.49,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.49,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,20.45,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,67.95,67.275,,54.36,percent of total billed charges,67.275% of total billed charges,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,15.64,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,62.36,61.74,,49.888,percent of total billed charges,61.74% of total billed charges,19.87,102,,,Fee Schedule,102% of GA Medicaid Rate,15.49,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.49,90.9,
OSMOLALITY SERUM,5001900,CDM,301,RC,83930,HCPCS,Outpatient,,,101,75.75,,78.78,78,,63.024,percent of total billed charges,78% of total billed charges,8.32,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.61,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.61,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,8.74,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,67.95,67.275,,54.36,percent of total billed charges,67.275% of total billed charges,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,6.68,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,62.36,61.74,,49.888,percent of total billed charges,61.74% of total billed charges,8.49,102,,,Fee Schedule,102% of GA Medicaid Rate,6.61,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.61,90.9,
"VANILLYLMANDELIC ACID, UR",5001906,CDM,301,RC,84585,HCPCS,Outpatient,,,101,75.75,,78.78,78,,63.024,percent of total billed charges,78% of total billed charges,19.49,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,15.5,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.5,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,20.46,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,67.95,67.275,,54.36,percent of total billed charges,67.275% of total billed charges,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,15.66,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,62.36,61.74,,49.888,percent of total billed charges,61.74% of total billed charges,19.88,102,,,Fee Schedule,102% of GA Medicaid Rate,15.5,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.5,90.9,
APOLIPOPROTEIN B,5002035,CDM,301,RC,82172,HCPCS,Outpatient,,,101,75.75,,78.78,78,,63.024,percent of total billed charges,78% of total billed charges,19.49,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,21.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,21.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,20.46,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,67.95,67.275,,54.36,percent of total billed charges,67.275% of total billed charges,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,21.3,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,62.36,61.74,,49.888,percent of total billed charges,61.74% of total billed charges,19.88,102,,,Fee Schedule,102% of GA Medicaid Rate,21.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,19.49,90.9,
SMEAR TO PATHOLOGIST,5008404,CDM,305,RC,85060,HCPCS,Outpatient,,,101,75.75,,78.78,78,,63.024,percent of total billed charges,78% of total billed charges,25.97,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,38.38,38,,30.704,percent of total billed charges,38% of total billed charges,38.38,38,,30.704,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,27.27,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,67.95,67.275,,54.36,percent of total billed charges,67.275% of total billed charges,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,38.76,38.38,,31.008,percent of total billed charges,38.38% of total billed charges,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,62.36,61.74,,49.888,percent of total billed charges,61.74% of total billed charges,26.49,102,,,Fee Schedule,102% of GA Medicaid Rate,38.38,38,,30.704,percent of total billed charges,38% of total billed charges,25.97,90.9,
XEMG H REFLEX; OTHER THAN GASTROC BIL,9600026,CDM,922,RC,95936,HCPCS,Outpatient,,,101,75.75,,78.78,78,,63.024,percent of total billed charges,78% of total billed charges,63.63,63,,50.904,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,38.38,38,,30.704,percent of total billed charges,38% of total billed charges,38.38,38,,30.704,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,35.35,35,,28.28,percent of total billed charges,35% of total billed charges,67.95,67.275,,54.36,percent of total billed charges,67.275% of total billed charges,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,38.76,38.38,,31.008,percent of total billed charges,38.38% of total billed charges,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,62.36,61.74,,49.888,percent of total billed charges,61.74% of total billed charges,103.02,102,,82.416,percent of total billed charges,102% of total billed charges,38.38,38,,30.704,percent of total billed charges,38% of total billed charges,35.35,103.02,
INFUSION HYDRATION EA ADD'L 31 M TO 1 HR,1001272,CDM,450,RC,96361,HCPCS,Outpatient,,,102,76.5,,79.56,78,,63.648,percent of total billed charges,78% of total billed charges,64.26,63,,51.408,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,38.76,38,,31.008,percent of total billed charges,38% of total billed charges,38.76,38,,31.008,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,35.7,35,,28.56,percent of total billed charges,35% of total billed charges,68.62,67.275,,54.896,percent of total billed charges,67.275% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,39.15,38.38,,31.32,percent of total billed charges,38.38% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,62.97,61.74,,50.376,percent of total billed charges,61.74% of total billed charges,104.04,102,,83.232,percent of total billed charges,102% of total billed charges,38.76,38,,31.008,percent of total billed charges,38% of total billed charges,35.7,104.04,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-additional infusions",1001276,CDM,450,RC,96366,HCPCS,Outpatient,,,102,76.5,,79.56,78,,63.648,percent of total billed charges,78% of total billed charges,64.26,63,,51.408,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,38.76,38,,31.008,percent of total billed charges,38% of total billed charges,38.76,38,,31.008,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,35.7,35,,28.56,percent of total billed charges,35% of total billed charges,68.62,67.275,,54.896,percent of total billed charges,67.275% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,39.15,38.38,,31.32,percent of total billed charges,38.38% of total billed charges,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,62.97,61.74,,50.376,percent of total billed charges,61.74% of total billed charges,104.04,102,,83.232,percent of total billed charges,102% of total billed charges,38.76,38,,31.008,percent of total billed charges,38% of total billed charges,35.7,104.04,
DARCO ORTHOWEDGE SHOE - XS,3005096,CDM,270,RC,,,Outpatient,,,102.64,76.98,,80.06,78,,64.048,percent of total billed charges,78% of total billed charges,64.66,63,,51.728,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,39,38,,31.2,percent of total billed charges,38% of total billed charges,39,38,,31.2,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,92.38,90,,73.904,percent of total billed charges,90% of total billed charges,35.92,35,,28.736,percent of total billed charges,35% of total billed charges,69.05,67.275,,55.24,percent of total billed charges,67.275% of total billed charges,82.11,80,,65.688,percent of total billed charges,80% of total billed charges,39.39,38.38,,31.512,percent of total billed charges,38.38% of total billed charges,82.11,80,,65.688,percent of total billed charges,80% of total billed charges,63.37,61.74,,50.696,percent of total billed charges,61.74% of total billed charges,104.69,102,,83.752,percent of total billed charges,102% of total billed charges,39,38,,31.2,percent of total billed charges,38% of total billed charges,35.92,104.69,
DARCO ORTHOWEDGE SHOE - XL,3005098,CDM,270,RC,,,Outpatient,,,102.64,76.98,,80.06,78,,64.048,percent of total billed charges,78% of total billed charges,64.66,63,,51.728,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,39,38,,31.2,percent of total billed charges,38% of total billed charges,39,38,,31.2,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,92.38,90,,73.904,percent of total billed charges,90% of total billed charges,35.92,35,,28.736,percent of total billed charges,35% of total billed charges,69.05,67.275,,55.24,percent of total billed charges,67.275% of total billed charges,82.11,80,,65.688,percent of total billed charges,80% of total billed charges,39.39,38.38,,31.512,percent of total billed charges,38.38% of total billed charges,82.11,80,,65.688,percent of total billed charges,80% of total billed charges,63.37,61.74,,50.696,percent of total billed charges,61.74% of total billed charges,104.69,102,,83.752,percent of total billed charges,102% of total billed charges,39,38,,31.2,percent of total billed charges,38% of total billed charges,35.92,104.69,
DEBRIDE SKIN PARTIAL/FULL,1001178,CDM,450,RC,,,Outpatient,,,103,77.25,,80.34,78,,64.272,percent of total billed charges,78% of total billed charges,64.89,63,,51.912,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,39.14,38,,31.312,percent of total billed charges,38% of total billed charges,39.14,38,,31.312,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,36.05,35,,28.84,percent of total billed charges,35% of total billed charges,69.29,67.275,,55.432,percent of total billed charges,67.275% of total billed charges,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,39.53,38.38,,31.624,percent of total billed charges,38.38% of total billed charges,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,63.59,61.74,,50.872,percent of total billed charges,61.74% of total billed charges,105.06,102,,84.048,percent of total billed charges,102% of total billed charges,39.14,38,,31.312,percent of total billed charges,38% of total billed charges,36.05,105.06,
MASK AF531 MEDIUM,3000015,CDM,270,RC,,,Outpatient,,,103,77.25,,80.34,78,,64.272,percent of total billed charges,78% of total billed charges,64.89,63,,51.912,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,39.14,38,,31.312,percent of total billed charges,38% of total billed charges,39.14,38,,31.312,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,36.05,35,,28.84,percent of total billed charges,35% of total billed charges,69.29,67.275,,55.432,percent of total billed charges,67.275% of total billed charges,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,39.53,38.38,,31.624,percent of total billed charges,38.38% of total billed charges,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,63.59,61.74,,50.872,percent of total billed charges,61.74% of total billed charges,105.06,102,,84.048,percent of total billed charges,102% of total billed charges,39.14,38,,31.312,percent of total billed charges,38% of total billed charges,36.05,105.06,
MASK AF531 SMALL,3000032,CDM,270,RC,,,Outpatient,,,103,77.25,,80.34,78,,64.272,percent of total billed charges,78% of total billed charges,64.89,63,,51.912,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,39.14,38,,31.312,percent of total billed charges,38% of total billed charges,39.14,38,,31.312,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,36.05,35,,28.84,percent of total billed charges,35% of total billed charges,69.29,67.275,,55.432,percent of total billed charges,67.275% of total billed charges,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,39.53,38.38,,31.624,percent of total billed charges,38.38% of total billed charges,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,63.59,61.74,,50.872,percent of total billed charges,61.74% of total billed charges,105.06,102,,84.048,percent of total billed charges,102% of total billed charges,39.14,38,,31.312,percent of total billed charges,38% of total billed charges,36.05,105.06,
"PROTEIN S ACTIVITY,REFLEX",5001831,CDM,305,RC,85306,HCPCS,Outpatient,,,103,77.25,,80.34,78,,64.272,percent of total billed charges,78% of total billed charges,19.27,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,15.32,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.32,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,20.23,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,69.29,67.275,,55.432,percent of total billed charges,67.275% of total billed charges,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,15.47,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,63.59,61.74,,50.872,percent of total billed charges,61.74% of total billed charges,19.66,102,,,Fee Schedule,102% of GA Medicaid Rate,15.32,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.32,92.7,
REVERSE T3,5001862,CDM,301,RC,84482,HCPCS,Outpatient,,,103,77.25,,80.34,78,,64.272,percent of total billed charges,78% of total billed charges,19.82,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,15.76,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.76,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,20.81,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,69.29,67.275,,55.432,percent of total billed charges,67.275% of total billed charges,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,15.92,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,63.59,61.74,,50.872,percent of total billed charges,61.74% of total billed charges,20.22,102,,,Fee Schedule,102% of GA Medicaid Rate,15.76,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.76,92.7,
MASK AF531 with 4pt Headgear - LG,3004234,CDM,270,RC,,,Outpatient,,,104,78,,81.12,78,,64.896,percent of total billed charges,78% of total billed charges,65.52,63,,52.416,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,39.52,38,,31.616,percent of total billed charges,38% of total billed charges,39.52,38,,31.616,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,36.4,35,,29.12,percent of total billed charges,35% of total billed charges,69.97,67.275,,55.976,percent of total billed charges,67.275% of total billed charges,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,39.92,38.38,,31.936,percent of total billed charges,38.38% of total billed charges,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,64.21,61.74,,51.368,percent of total billed charges,61.74% of total billed charges,106.08,102,,84.864,percent of total billed charges,102% of total billed charges,39.52,38,,31.616,percent of total billed charges,38% of total billed charges,36.4,106.08,
C-PEPTIDE,5000236,CDM,301,RC,84681,HCPCS,Outpatient,,,104,78,,81.12,78,,64.896,percent of total billed charges,78% of total billed charges,19.98,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,20.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,20.98,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,69.97,67.275,,55.976,percent of total billed charges,67.275% of total billed charges,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,21.02,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,64.21,61.74,,51.368,percent of total billed charges,61.74% of total billed charges,20.38,102,,,Fee Schedule,102% of GA Medicaid Rate,20.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,19.98,93.6,
COAGULASE EA ADDITIONAL,5000907,CDM,306,RC,87450,HCPCS,Outpatient,,,104,78,,81.12,78,,64.896,percent of total billed charges,78% of total billed charges,12.05,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,39.52,38,,31.616,percent of total billed charges,38% of total billed charges,39.52,38,,31.616,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,12.65,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,69.97,67.275,,55.976,percent of total billed charges,67.275% of total billed charges,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,39.92,38.38,,31.936,percent of total billed charges,38.38% of total billed charges,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,64.21,61.74,,51.368,percent of total billed charges,61.74% of total billed charges,12.29,102,,,Fee Schedule,102% of GA Medicaid Rate,39.52,38,,31.616,percent of total billed charges,38% of total billed charges,12.05,93.6,
Blood test to measure a type of thyroid hormone,5001403,CDM,301,RC,84436,HCPCS,Outpatient,,,104,78,,81.12,78,,64.896,percent of total billed charges,78% of total billed charges,8.65,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,9.08,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,69.97,67.275,,55.976,percent of total billed charges,67.275% of total billed charges,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,6.94,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,64.21,61.74,,51.368,percent of total billed charges,61.74% of total billed charges,8.82,102,,,Fee Schedule,102% of GA Medicaid Rate,6.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.87,93.6,
ANTI THYROGLOBULIN AB,5001836,CDM,302,RC,86800,HCPCS,Outpatient,,,104,78,,81.12,78,,64.896,percent of total billed charges,78% of total billed charges,20,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,15.91,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.91,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,21,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,69.97,67.275,,55.976,percent of total billed charges,67.275% of total billed charges,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,16.07,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,64.21,61.74,,51.368,percent of total billed charges,61.74% of total billed charges,20.4,102,,,Fee Schedule,102% of GA Medicaid Rate,15.91,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.91,93.6,
ANTI-DNA (DS),5001974,CDM,302,RC,86225,HCPCS,Outpatient,,,104,78,,81.12,78,,64.896,percent of total billed charges,78% of total billed charges,17.28,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,18.14,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,69.97,67.275,,55.976,percent of total billed charges,67.275% of total billed charges,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,13.88,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,64.21,61.74,,51.368,percent of total billed charges,61.74% of total billed charges,17.63,102,,,Fee Schedule,102% of GA Medicaid Rate,13.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.74,93.6,
DNA(DS)ANTIBODY,5001985,CDM,302,RC,86225,HCPCS,Outpatient,,,104,78,,81.12,78,,64.896,percent of total billed charges,78% of total billed charges,17.28,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,18.14,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,69.97,67.275,,55.976,percent of total billed charges,67.275% of total billed charges,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,13.88,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,64.21,61.74,,51.368,percent of total billed charges,61.74% of total billed charges,17.63,102,,,Fee Schedule,102% of GA Medicaid Rate,13.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.74,93.6,
"C-PEPTIDE,24 HR URINE",5002036,CDM,301,RC,84681,HCPCS,Outpatient,,,104,78,,81.12,78,,64.896,percent of total billed charges,78% of total billed charges,19.98,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,20.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,20.98,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,69.97,67.275,,55.976,percent of total billed charges,67.275% of total billed charges,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,21.02,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,64.21,61.74,,51.368,percent of total billed charges,61.74% of total billed charges,20.38,102,,,Fee Schedule,102% of GA Medicaid Rate,20.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,19.98,93.6,
BARTONELLA SP AB (IGG.IGM),5000189,CDM,302,RC,86611,HCPCS,Outpatient,,,105,78.75,,81.9,78,,65.52,percent of total billed charges,78% of total billed charges,12.8,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,10.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,13.44,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,70.64,67.275,,56.512,percent of total billed charges,67.275% of total billed charges,84,80,,67.2,percent of total billed charges,80% of total billed charges,10.28,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,84,80,,67.2,percent of total billed charges,80% of total billed charges,64.83,61.74,,51.864,percent of total billed charges,61.74% of total billed charges,13.06,102,,,Fee Schedule,102% of GA Medicaid Rate,10.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.18,94.5,
VOLATILES,5000196,CDM,301,RC,84600,HCPCS,Outpatient,,,105,78.75,,81.9,78,,65.52,percent of total billed charges,78% of total billed charges,20.21,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,17.11,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.11,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,21.22,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,70.64,67.275,,56.512,percent of total billed charges,67.275% of total billed charges,84,80,,67.2,percent of total billed charges,80% of total billed charges,17.28,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,84,80,,67.2,percent of total billed charges,80% of total billed charges,64.83,61.74,,51.864,percent of total billed charges,61.74% of total billed charges,20.61,102,,,Fee Schedule,102% of GA Medicaid Rate,17.11,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.11,94.5,
"BARTONELLA HENSELAE AB IGG,IGM",5000289,CDM,302,RC,86611,HCPCS,Outpatient,,,105,78.75,,81.9,78,,65.52,percent of total billed charges,78% of total billed charges,12.8,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,10.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,13.44,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,70.64,67.275,,56.512,percent of total billed charges,67.275% of total billed charges,84,80,,67.2,percent of total billed charges,80% of total billed charges,10.28,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,84,80,,67.2,percent of total billed charges,80% of total billed charges,64.83,61.74,,51.864,percent of total billed charges,61.74% of total billed charges,13.06,102,,,Fee Schedule,102% of GA Medicaid Rate,10.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.18,94.5,
METHANOL,5000906,CDM,301,RC,84600,HCPCS,Outpatient,,,105,78.75,,81.9,78,,65.52,percent of total billed charges,78% of total billed charges,20.21,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,17.11,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.11,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,21.22,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,70.64,67.275,,56.512,percent of total billed charges,67.275% of total billed charges,84,80,,67.2,percent of total billed charges,80% of total billed charges,17.28,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,84,80,,67.2,percent of total billed charges,80% of total billed charges,64.83,61.74,,51.864,percent of total billed charges,61.74% of total billed charges,20.61,102,,,Fee Schedule,102% of GA Medicaid Rate,17.11,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.11,94.5,
LISTERIA Ab,5002041,CDM,302,RC,86609,HCPCS,Outpatient,,,105,78.75,,81.9,78,,65.52,percent of total billed charges,78% of total billed charges,16.2,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,17.01,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,70.64,67.275,,56.512,percent of total billed charges,67.275% of total billed charges,84,80,,67.2,percent of total billed charges,80% of total billed charges,13.01,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,84,80,,67.2,percent of total billed charges,80% of total billed charges,64.83,61.74,,51.864,percent of total billed charges,61.74% of total billed charges,16.52,102,,,Fee Schedule,102% of GA Medicaid Rate,12.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.88,94.5,
B HENSELAE IGG SCREEN,5003717,CDM,302,RC,86611,HCPCS,Outpatient,,,105,78.75,,81.9,78,,65.52,percent of total billed charges,78% of total billed charges,12.8,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,10.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,13.44,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,70.64,67.275,,56.512,percent of total billed charges,67.275% of total billed charges,84,80,,67.2,percent of total billed charges,80% of total billed charges,10.28,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,84,80,,67.2,percent of total billed charges,80% of total billed charges,64.83,61.74,,51.864,percent of total billed charges,61.74% of total billed charges,13.06,102,,,Fee Schedule,102% of GA Medicaid Rate,10.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.18,94.5,
B HENSELAE IGG TITER,5003718,CDM,302,RC,86611,HCPCS,Outpatient,,,105,78.75,,81.9,78,,65.52,percent of total billed charges,78% of total billed charges,12.8,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,10.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,13.44,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,70.64,67.275,,56.512,percent of total billed charges,67.275% of total billed charges,84,80,,67.2,percent of total billed charges,80% of total billed charges,10.28,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,84,80,,67.2,percent of total billed charges,80% of total billed charges,64.83,61.74,,51.864,percent of total billed charges,61.74% of total billed charges,13.06,102,,,Fee Schedule,102% of GA Medicaid Rate,10.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.18,94.5,
B QUINTANA IGG SCREEN,5003719,CDM,302,RC,86611,HCPCS,Outpatient,,,105,78.75,,81.9,78,,65.52,percent of total billed charges,78% of total billed charges,12.8,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,10.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,13.44,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,70.64,67.275,,56.512,percent of total billed charges,67.275% of total billed charges,84,80,,67.2,percent of total billed charges,80% of total billed charges,10.28,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,84,80,,67.2,percent of total billed charges,80% of total billed charges,64.83,61.74,,51.864,percent of total billed charges,61.74% of total billed charges,13.06,102,,,Fee Schedule,102% of GA Medicaid Rate,10.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.18,94.5,
B QUINTANA IGG TITER,5003720,CDM,302,RC,86611,HCPCS,Outpatient,,,105,78.75,,81.9,78,,65.52,percent of total billed charges,78% of total billed charges,12.8,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,10.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,13.44,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,70.64,67.275,,56.512,percent of total billed charges,67.275% of total billed charges,84,80,,67.2,percent of total billed charges,80% of total billed charges,10.28,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,84,80,,67.2,percent of total billed charges,80% of total billed charges,64.83,61.74,,51.864,percent of total billed charges,61.74% of total billed charges,13.06,102,,,Fee Schedule,102% of GA Medicaid Rate,10.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.18,94.5,
B QUINTANA IGM SCREEN,5003721,CDM,302,RC,86611,HCPCS,Outpatient,,,105,78.75,,81.9,78,,65.52,percent of total billed charges,78% of total billed charges,12.8,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,10.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,13.44,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,70.64,67.275,,56.512,percent of total billed charges,67.275% of total billed charges,84,80,,67.2,percent of total billed charges,80% of total billed charges,10.28,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,84,80,,67.2,percent of total billed charges,80% of total billed charges,64.83,61.74,,51.864,percent of total billed charges,61.74% of total billed charges,13.06,102,,,Fee Schedule,102% of GA Medicaid Rate,10.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.18,94.5,
B QUINTANA IGM TITER,5003722,CDM,302,RC,86611,HCPCS,Outpatient,,,105,78.75,,81.9,78,,65.52,percent of total billed charges,78% of total billed charges,12.8,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,10.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,13.44,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,70.64,67.275,,56.512,percent of total billed charges,67.275% of total billed charges,84,80,,67.2,percent of total billed charges,80% of total billed charges,10.28,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,84,80,,67.2,percent of total billed charges,80% of total billed charges,64.83,61.74,,51.864,percent of total billed charges,61.74% of total billed charges,13.06,102,,,Fee Schedule,102% of GA Medicaid Rate,10.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.18,94.5,
B HENSELAE IGM SCREEN,5003723,CDM,302,RC,86611,HCPCS,Outpatient,,,105,78.75,,81.9,78,,65.52,percent of total billed charges,78% of total billed charges,12.8,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,10.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,13.44,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,70.64,67.275,,56.512,percent of total billed charges,67.275% of total billed charges,84,80,,67.2,percent of total billed charges,80% of total billed charges,10.28,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,84,80,,67.2,percent of total billed charges,80% of total billed charges,64.83,61.74,,51.864,percent of total billed charges,61.74% of total billed charges,13.06,102,,,Fee Schedule,102% of GA Medicaid Rate,10.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.18,94.5,
B HENSELAE IGM TITER,5003724,CDM,302,RC,86611,HCPCS,Outpatient,,,105,78.75,,81.9,78,,65.52,percent of total billed charges,78% of total billed charges,12.8,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,10.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,13.44,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,70.64,67.275,,56.512,percent of total billed charges,67.275% of total billed charges,84,80,,67.2,percent of total billed charges,80% of total billed charges,10.28,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,84,80,,67.2,percent of total billed charges,80% of total billed charges,64.83,61.74,,51.864,percent of total billed charges,61.74% of total billed charges,13.06,102,,,Fee Schedule,102% of GA Medicaid Rate,10.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.18,94.5,
.SALICYLATE-MULTIPLE,5009133,CDM,301,RC,80196,HCPCS,Outpatient,,,105,78.75,,81.9,78,,65.52,percent of total billed charges,78% of total billed charges,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,39.9,38,,31.92,percent of total billed charges,38% of total billed charges,39.9,38,,31.92,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,36.75,35,,29.4,percent of total billed charges,35% of total billed charges,70.64,67.275,,56.512,percent of total billed charges,67.275% of total billed charges,84,80,,67.2,percent of total billed charges,80% of total billed charges,40.3,38.38,,32.24,percent of total billed charges,38.38% of total billed charges,84,80,,67.2,percent of total billed charges,80% of total billed charges,64.83,61.74,,51.864,percent of total billed charges,61.74% of total billed charges,107.1,102,,85.68,percent of total billed charges,102% of total billed charges,39.9,38,,31.92,percent of total billed charges,38% of total billed charges,36.75,107.1,
"MM DX UNILAT RT, FILM",7600899,CDM,401,RC,77055,HCPCS,Outpatient,,,105,78.75,,81.9,78,,65.52,percent of total billed charges,78% of total billed charges,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,39.9,38,,31.92,percent of total billed charges,38% of total billed charges,39.9,38,,31.92,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,36.75,35,,29.4,percent of total billed charges,35% of total billed charges,70.64,67.275,,56.512,percent of total billed charges,67.275% of total billed charges,84,80,,67.2,percent of total billed charges,80% of total billed charges,40.3,38.38,,32.24,percent of total billed charges,38.38% of total billed charges,84,80,,67.2,percent of total billed charges,80% of total billed charges,64.83,61.74,,51.864,percent of total billed charges,61.74% of total billed charges,107.1,102,,85.68,percent of total billed charges,102% of total billed charges,39.9,38,,31.92,percent of total billed charges,38% of total billed charges,36.75,107.1,
"MM DX UNILAT LT, FILM",7600902,CDM,401,RC,77055,HCPCS,Outpatient,,,105,78.75,,81.9,78,,65.52,percent of total billed charges,78% of total billed charges,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,39.9,38,,31.92,percent of total billed charges,38% of total billed charges,39.9,38,,31.92,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,36.75,35,,29.4,percent of total billed charges,35% of total billed charges,70.64,67.275,,56.512,percent of total billed charges,67.275% of total billed charges,84,80,,67.2,percent of total billed charges,80% of total billed charges,40.3,38.38,,32.24,percent of total billed charges,38.38% of total billed charges,84,80,,67.2,percent of total billed charges,80% of total billed charges,64.83,61.74,,51.864,percent of total billed charges,61.74% of total billed charges,107.1,102,,85.68,percent of total billed charges,102% of total billed charges,39.9,38,,31.92,percent of total billed charges,38% of total billed charges,36.75,107.1,
"MM SPECIAL DX UNI LT, FILM",7600903,CDM,401,RC,77055,HCPCS,Outpatient,,,105,78.75,,81.9,78,,65.52,percent of total billed charges,78% of total billed charges,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,39.9,38,,31.92,percent of total billed charges,38% of total billed charges,39.9,38,,31.92,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,36.75,35,,29.4,percent of total billed charges,35% of total billed charges,70.64,67.275,,56.512,percent of total billed charges,67.275% of total billed charges,84,80,,67.2,percent of total billed charges,80% of total billed charges,40.3,38.38,,32.24,percent of total billed charges,38.38% of total billed charges,84,80,,67.2,percent of total billed charges,80% of total billed charges,64.83,61.74,,51.864,percent of total billed charges,61.74% of total billed charges,107.1,102,,85.68,percent of total billed charges,102% of total billed charges,39.9,38,,31.92,percent of total billed charges,38% of total billed charges,36.75,107.1,
"MM SPECIAL DX UNI RT, FILM",7600947,CDM,401,RC,77055,HCPCS,Outpatient,,,105,78.75,,81.9,78,,65.52,percent of total billed charges,78% of total billed charges,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,39.9,38,,31.92,percent of total billed charges,38% of total billed charges,39.9,38,,31.92,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,36.75,35,,29.4,percent of total billed charges,35% of total billed charges,70.64,67.275,,56.512,percent of total billed charges,67.275% of total billed charges,84,80,,67.2,percent of total billed charges,80% of total billed charges,40.3,38.38,,32.24,percent of total billed charges,38.38% of total billed charges,84,80,,67.2,percent of total billed charges,80% of total billed charges,64.83,61.74,,51.864,percent of total billed charges,61.74% of total billed charges,107.1,102,,85.68,percent of total billed charges,102% of total billed charges,39.9,38,,31.92,percent of total billed charges,38% of total billed charges,36.75,107.1,
PERTUSSIS BY DIRECT SMEAR,5000197,CDM,306,RC,87265,HCPCS,Outpatient,,,106,79.5,,82.68,78,,66.144,percent of total billed charges,78% of total billed charges,15.08,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,11.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,15.83,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,71.31,67.275,,57.048,percent of total billed charges,67.275% of total billed charges,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,12.1,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,65.44,61.74,,52.352,percent of total billed charges,61.74% of total billed charges,15.38,102,,,Fee Schedule,102% of GA Medicaid Rate,11.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.98,95.4,
Blood test to assess for pregnancy,5000326,CDM,300,RC,84703,HCPCS,Outpatient,,,106,79.5,,82.68,78,,66.144,percent of total billed charges,78% of total billed charges,8.07,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,7.52,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.52,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,8.47,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,71.31,67.275,,57.048,percent of total billed charges,67.275% of total billed charges,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,7.6,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,65.44,61.74,,52.352,percent of total billed charges,61.74% of total billed charges,8.23,102,,,Fee Schedule,102% of GA Medicaid Rate,7.52,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.52,95.4,
Blood test to detect heart enzymes,5001430,CDM,301,RC,82553,HCPCS,Outpatient,,,106,79.5,,82.68,78,,66.144,percent of total billed charges,78% of total billed charges,14.52,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,11.55,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.55,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,15.25,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,71.31,67.275,,57.048,percent of total billed charges,67.275% of total billed charges,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,11.67,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,65.44,61.74,,52.352,percent of total billed charges,61.74% of total billed charges,14.81,102,,,Fee Schedule,102% of GA Medicaid Rate,11.55,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.55,95.4,
CULTURE RSV,5001441,CDM,306,RC,87253,HCPCS,Outpatient,,,106,79.5,,82.68,78,,66.144,percent of total billed charges,78% of total billed charges,20.48,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,20.2,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.2,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,21.5,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,71.31,67.275,,57.048,percent of total billed charges,67.275% of total billed charges,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,20.4,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,65.44,61.74,,52.352,percent of total billed charges,61.74% of total billed charges,20.89,102,,,Fee Schedule,102% of GA Medicaid Rate,20.2,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.2,95.4,
".CORTISOL, TOTAL",5001645,CDM,301,RC,82533,HCPCS,Outpatient,,,106,79.5,,82.68,78,,66.144,percent of total billed charges,78% of total billed charges,20.5,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.3,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.3,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,21.53,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,71.31,67.275,,57.048,percent of total billed charges,67.275% of total billed charges,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,16.46,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,65.44,61.74,,52.352,percent of total billed charges,61.74% of total billed charges,20.91,102,,,Fee Schedule,102% of GA Medicaid Rate,16.3,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.3,95.4,
MERCURY / BLOOD,5001773,CDM,301,RC,83825,HCPCS,Outpatient,,,106,79.5,,82.68,78,,66.144,percent of total billed charges,78% of total billed charges,20.45,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.26,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.26,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,21.47,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,71.31,67.275,,57.048,percent of total billed charges,67.275% of total billed charges,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,16.42,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,65.44,61.74,,52.352,percent of total billed charges,61.74% of total billed charges,20.86,102,,,Fee Schedule,102% of GA Medicaid Rate,16.26,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.26,95.4,
RMSF,5001800,CDM,302,RC,86609,HCPCS,Outpatient,,,106,79.5,,82.68,78,,66.144,percent of total billed charges,78% of total billed charges,16.2,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,17.01,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,71.31,67.275,,57.048,percent of total billed charges,67.275% of total billed charges,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,13.01,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,65.44,61.74,,52.352,percent of total billed charges,61.74% of total billed charges,16.52,102,,,Fee Schedule,102% of GA Medicaid Rate,12.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.88,95.4,
MERCURY 24 HR UNINE,5001859,CDM,301,RC,83825,HCPCS,Outpatient,,,106,79.5,,82.68,78,,66.144,percent of total billed charges,78% of total billed charges,20.45,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.26,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.26,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,21.47,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,71.31,67.275,,57.048,percent of total billed charges,67.275% of total billed charges,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,16.42,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,65.44,61.74,,52.352,percent of total billed charges,61.74% of total billed charges,20.86,102,,,Fee Schedule,102% of GA Medicaid Rate,16.26,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.26,95.4,
".CORTISOL TOTAL,/LC/MS/MS",5001879,CDM,301,RC,82533,HCPCS,Outpatient,,,106,79.5,,82.68,78,,66.144,percent of total billed charges,78% of total billed charges,20.5,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.3,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.3,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,21.53,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,71.31,67.275,,57.048,percent of total billed charges,67.275% of total billed charges,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,16.46,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,65.44,61.74,,52.352,percent of total billed charges,61.74% of total billed charges,20.91,102,,,Fee Schedule,102% of GA Medicaid Rate,16.3,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.3,95.4,
"CORTISOL, TOTAL",5001886,CDM,301,RC,82533,HCPCS,Outpatient,,,106,79.5,,82.68,78,,66.144,percent of total billed charges,78% of total billed charges,20.5,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.3,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.3,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,21.53,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,71.31,67.275,,57.048,percent of total billed charges,67.275% of total billed charges,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,16.46,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,65.44,61.74,,52.352,percent of total billed charges,61.74% of total billed charges,20.91,102,,,Fee Schedule,102% of GA Medicaid Rate,16.3,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.3,95.4,
"MERCURY, RANDOM URINE",5002025,CDM,301,RC,83825,HCPCS,Outpatient,,,106,79.5,,82.68,78,,66.144,percent of total billed charges,78% of total billed charges,20.45,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.26,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.26,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,21.47,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,71.31,67.275,,57.048,percent of total billed charges,67.275% of total billed charges,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,16.42,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,65.44,61.74,,52.352,percent of total billed charges,61.74% of total billed charges,20.86,102,,,Fee Schedule,102% of GA Medicaid Rate,16.26,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.26,95.4,
PREFAB ORTHOSIS - XLG LEFT,3005099,CDM,270,RC,,,Outpatient,,,106.24,79.68,,82.87,78,,66.296,percent of total billed charges,78% of total billed charges,66.93,63,,53.544,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,40.37,38,,32.296,percent of total billed charges,38% of total billed charges,40.37,38,,32.296,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,95.62,90,,76.496,percent of total billed charges,90% of total billed charges,37.18,35,,29.744,percent of total billed charges,35% of total billed charges,71.47,67.275,,57.176,percent of total billed charges,67.275% of total billed charges,84.99,80,,67.992,percent of total billed charges,80% of total billed charges,40.77,38.38,,32.616,percent of total billed charges,38.38% of total billed charges,84.99,80,,67.992,percent of total billed charges,80% of total billed charges,65.59,61.74,,52.472,percent of total billed charges,61.74% of total billed charges,108.36,102,,86.688,percent of total billed charges,102% of total billed charges,40.37,38,,32.296,percent of total billed charges,38% of total billed charges,37.18,108.36,
MORGAN MEDI-FLOW LENS AE-1695,3000020,CDM,270,RC,,,Outpatient,,,106.36,79.77,,82.96,78,,66.368,percent of total billed charges,78% of total billed charges,67.01,63,,53.608,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,40.42,38,,32.336,percent of total billed charges,38% of total billed charges,40.42,38,,32.336,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,95.72,90,,76.576,percent of total billed charges,90% of total billed charges,37.23,35,,29.784,percent of total billed charges,35% of total billed charges,71.55,67.275,,57.24,percent of total billed charges,67.275% of total billed charges,85.09,80,,68.072,percent of total billed charges,80% of total billed charges,40.82,38.38,,32.656,percent of total billed charges,38.38% of total billed charges,85.09,80,,68.072,percent of total billed charges,80% of total billed charges,65.67,61.74,,52.536,percent of total billed charges,61.74% of total billed charges,108.49,102,,86.792,percent of total billed charges,102% of total billed charges,40.42,38,,32.336,percent of total billed charges,38% of total billed charges,37.23,108.49,
AQUACEL 3.5X6,3000516,CDM,270,RC,,,Outpatient,,,106.73,80.05,,83.25,78,,66.6,percent of total billed charges,78% of total billed charges,67.24,63,,53.792,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,40.56,38,,32.448,percent of total billed charges,38% of total billed charges,40.56,38,,32.448,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,96.06,90,,76.848,percent of total billed charges,90% of total billed charges,37.36,35,,29.888,percent of total billed charges,35% of total billed charges,71.8,67.275,,57.44,percent of total billed charges,67.275% of total billed charges,85.38,80,,68.304,percent of total billed charges,80% of total billed charges,40.96,38.38,,32.768,percent of total billed charges,38.38% of total billed charges,85.38,80,,68.304,percent of total billed charges,80% of total billed charges,65.9,61.74,,52.72,percent of total billed charges,61.74% of total billed charges,108.86,102,,87.088,percent of total billed charges,102% of total billed charges,40.56,38,,32.448,percent of total billed charges,38% of total billed charges,37.36,108.86,
DELTA AMINOLEVULINIC ACID (ALA),5001230,CDM,301,RC,82135,HCPCS,Outpatient,,,107,80.25,,83.46,78,,66.768,percent of total billed charges,78% of total billed charges,20.7,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,21.74,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,71.98,67.275,,57.584,percent of total billed charges,67.275% of total billed charges,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,16.61,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,66.06,61.74,,52.848,percent of total billed charges,61.74% of total billed charges,21.11,102,,,Fee Schedule,102% of GA Medicaid Rate,16.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.45,96.3,
METHADONE SERUM,5001637,CDM,301,RC,80358,HCPCS,Outpatient,,,107,80.25,,83.46,78,,66.768,percent of total billed charges,78% of total billed charges,20.53,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,40.66,38,,32.528,percent of total billed charges,38% of total billed charges,40.66,38,,32.528,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,21.56,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,71.98,67.275,,57.584,percent of total billed charges,67.275% of total billed charges,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,41.07,38.38,,32.856,percent of total billed charges,38.38% of total billed charges,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,66.06,61.74,,52.848,percent of total billed charges,61.74% of total billed charges,20.94,102,,,Fee Schedule,102% of GA Medicaid Rate,40.66,38,,32.528,percent of total billed charges,38% of total billed charges,20.53,96.3,
"Blood test, comprehensive group of blood chemicals",5009165,CDM,301,RC,80053,HCPCS,Outpatient,,,107,80.25,,83.46,78,,66.768,percent of total billed charges,78% of total billed charges,13.29,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,10.56,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.56,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,13.95,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,71.98,67.275,,57.584,percent of total billed charges,67.275% of total billed charges,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,10.67,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,66.06,61.74,,52.848,percent of total billed charges,61.74% of total billed charges,13.56,102,,,Fee Schedule,102% of GA Medicaid Rate,10.56,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.56,96.3,
Radiologic examination of the finger(s),7000761,CDM,320,RC,73140,HCPCS,Outpatient,,,107,80.25,,83.46,78,,66.768,percent of total billed charges,78% of total billed charges,67.41,63,,53.928,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,40.66,38,,32.528,percent of total billed charges,38% of total billed charges,40.66,38,,32.528,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,37.45,35,,29.96,percent of total billed charges,35% of total billed charges,71.98,67.275,,57.584,percent of total billed charges,67.275% of total billed charges,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,41.07,38.38,,32.856,percent of total billed charges,38.38% of total billed charges,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,66.06,61.74,,52.848,percent of total billed charges,61.74% of total billed charges,109.14,102,,87.312,percent of total billed charges,102% of total billed charges,40.66,38,,32.528,percent of total billed charges,38% of total billed charges,37.45,109.14,
Radiologic examination of the finger(s),7000762,CDM,320,RC,73140,HCPCS,Outpatient,,,107,80.25,,83.46,78,,66.768,percent of total billed charges,78% of total billed charges,67.41,63,,53.928,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,40.66,38,,32.528,percent of total billed charges,38% of total billed charges,40.66,38,,32.528,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,37.45,35,,29.96,percent of total billed charges,35% of total billed charges,71.98,67.275,,57.584,percent of total billed charges,67.275% of total billed charges,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,41.07,38.38,,32.856,percent of total billed charges,38.38% of total billed charges,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,66.06,61.74,,52.848,percent of total billed charges,61.74% of total billed charges,109.14,102,,87.312,percent of total billed charges,102% of total billed charges,40.66,38,,32.528,percent of total billed charges,38% of total billed charges,37.45,109.14,
TROCAR 12MM,3004076,CDM,270,RC,,,Outpatient,,,108,81,,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,68.04,63,,54.432,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,41.04,38,,32.832,percent of total billed charges,38% of total billed charges,41.04,38,,32.832,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,37.8,35,,30.24,percent of total billed charges,35% of total billed charges,72.66,67.275,,58.128,percent of total billed charges,67.275% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,41.45,38.38,,33.16,percent of total billed charges,38.38% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,66.68,61.74,,53.344,percent of total billed charges,61.74% of total billed charges,110.16,102,,88.128,percent of total billed charges,102% of total billed charges,41.04,38,,32.832,percent of total billed charges,38% of total billed charges,37.8,110.16,
TROCAR 12MM BLUNT TIP,3004101,CDM,270,RC,,,Outpatient,,,108,81,,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,68.04,63,,54.432,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,41.04,38,,32.832,percent of total billed charges,38% of total billed charges,41.04,38,,32.832,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,37.8,35,,30.24,percent of total billed charges,35% of total billed charges,72.66,67.275,,58.128,percent of total billed charges,67.275% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,41.45,38.38,,33.16,percent of total billed charges,38.38% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,66.68,61.74,,53.344,percent of total billed charges,61.74% of total billed charges,110.16,102,,88.128,percent of total billed charges,102% of total billed charges,41.04,38,,32.832,percent of total billed charges,38% of total billed charges,37.8,110.16,
ARTHRITIS COMPRESSION GLOVE,3001501,CDM,270,RC,,,Outpatient,,,108.6,81.45,,84.71,78,,67.768,percent of total billed charges,78% of total billed charges,68.42,63,,54.736,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,41.27,38,,33.016,percent of total billed charges,38% of total billed charges,41.27,38,,33.016,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,97.74,90,,78.192,percent of total billed charges,90% of total billed charges,38.01,35,,30.408,percent of total billed charges,35% of total billed charges,73.06,67.275,,58.448,percent of total billed charges,67.275% of total billed charges,86.88,80,,69.504,percent of total billed charges,80% of total billed charges,41.68,38.38,,33.344,percent of total billed charges,38.38% of total billed charges,86.88,80,,69.504,percent of total billed charges,80% of total billed charges,67.05,61.74,,53.64,percent of total billed charges,61.74% of total billed charges,110.77,102,,88.616,percent of total billed charges,102% of total billed charges,41.27,38,,33.016,percent of total billed charges,38% of total billed charges,38.01,110.77,
ESTROGEN TOTAL SERUM,5001758,CDM,301,RC,82672,HCPCS,Outpatient,,,109,81.75,,85.02,78,,68.016,percent of total billed charges,78% of total billed charges,20.94,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,21.7,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,21.7,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,21.99,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,73.33,67.275,,58.664,percent of total billed charges,67.275% of total billed charges,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,21.92,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,67.3,61.74,,53.84,percent of total billed charges,61.74% of total billed charges,21.36,102,,,Fee Schedule,102% of GA Medicaid Rate,21.7,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.94,98.1,
CORTISOL FREE 24 HR URINE,5001852,CDM,301,RC,82530,HCPCS,Outpatient,,,109,81.75,,85.02,78,,68.016,percent of total billed charges,78% of total billed charges,21.02,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.71,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.71,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,22.07,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,73.33,67.275,,58.664,percent of total billed charges,67.275% of total billed charges,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,16.88,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,67.3,61.74,,53.84,percent of total billed charges,61.74% of total billed charges,21.44,102,,,Fee Schedule,102% of GA Medicaid Rate,16.71,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.71,98.1,
HEEL GUARD POSEY,3000716,CDM,270,RC,,,Outpatient,,,109.88,82.41,,85.71,78,,68.568,percent of total billed charges,78% of total billed charges,69.22,63,,55.376,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,41.75,38,,33.4,percent of total billed charges,38% of total billed charges,41.75,38,,33.4,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,98.89,90,,79.112,percent of total billed charges,90% of total billed charges,38.46,35,,30.768,percent of total billed charges,35% of total billed charges,73.92,67.275,,59.136,percent of total billed charges,67.275% of total billed charges,87.9,80,,70.32,percent of total billed charges,80% of total billed charges,42.17,38.38,,33.736,percent of total billed charges,38.38% of total billed charges,87.9,80,,70.32,percent of total billed charges,80% of total billed charges,67.84,61.74,,54.272,percent of total billed charges,61.74% of total billed charges,112.08,102,,89.664,percent of total billed charges,102% of total billed charges,41.75,38,,33.4,percent of total billed charges,38% of total billed charges,38.46,112.08,
STRYKER ASNIS 1.2MM K WIRE,3005060,CDM,270,RC,,,Outpatient,,,110,82.5,,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,41.8,38,,33.44,percent of total billed charges,38% of total billed charges,41.8,38,,33.44,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,99,90,,79.2,percent of total billed charges,90% of total billed charges,38.5,35,,30.8,percent of total billed charges,35% of total billed charges,74,67.275,,59.2,percent of total billed charges,67.275% of total billed charges,88,80,,70.4,percent of total billed charges,80% of total billed charges,42.22,38.38,,33.776,percent of total billed charges,38.38% of total billed charges,88,80,,70.4,percent of total billed charges,80% of total billed charges,67.91,61.74,,54.328,percent of total billed charges,61.74% of total billed charges,112.2,102,,89.76,percent of total billed charges,102% of total billed charges,41.8,38,,33.44,percent of total billed charges,38% of total billed charges,38.5,112.2,
WEST NILE IGM-SERUM,5000028,CDM,302,RC,86788,HCPCS,Outpatient,,,110,82.5,,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,21.19,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.85,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.85,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,99,90,,79.2,percent of total billed charges,90% of total billed charges,22.25,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,74,67.275,,59.2,percent of total billed charges,67.275% of total billed charges,88,80,,70.4,percent of total billed charges,80% of total billed charges,17.02,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,88,80,,70.4,percent of total billed charges,80% of total billed charges,67.91,61.74,,54.328,percent of total billed charges,61.74% of total billed charges,21.61,102,,,Fee Schedule,102% of GA Medicaid Rate,16.85,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.85,99,
"WEST NILE IGG,IGM,CSF",5000038,CDM,302,RC,86788,HCPCS,Outpatient,,,110,82.5,,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,21.19,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.85,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.85,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,99,90,,79.2,percent of total billed charges,90% of total billed charges,22.25,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,74,67.275,,59.2,percent of total billed charges,67.275% of total billed charges,88,80,,70.4,percent of total billed charges,80% of total billed charges,17.02,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,88,80,,70.4,percent of total billed charges,80% of total billed charges,67.91,61.74,,54.328,percent of total billed charges,61.74% of total billed charges,21.61,102,,,Fee Schedule,102% of GA Medicaid Rate,16.85,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.85,99,
SULFONYLUREA,5000249,CDM,301,RC,83789,HCPCS,Outpatient,,,110,82.5,,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,7.55,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,24.11,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,24.11,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,99,90,,79.2,percent of total billed charges,90% of total billed charges,7.93,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,74,67.275,,59.2,percent of total billed charges,67.275% of total billed charges,88,80,,70.4,percent of total billed charges,80% of total billed charges,24.35,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,88,80,,70.4,percent of total billed charges,80% of total billed charges,67.91,61.74,,54.328,percent of total billed charges,61.74% of total billed charges,7.7,102,,,Fee Schedule,102% of GA Medicaid Rate,24.11,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.55,99,
SULFONYLUREA URINE,5000252,CDM,301,RC,82542,HCPCS,Outpatient,,,110,82.5,,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,7.55,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,24.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,24.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,99,90,,79.2,percent of total billed charges,90% of total billed charges,7.93,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,74,67.275,,59.2,percent of total billed charges,67.275% of total billed charges,88,80,,70.4,percent of total billed charges,80% of total billed charges,24.33,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,88,80,,70.4,percent of total billed charges,80% of total billed charges,67.91,61.74,,54.328,percent of total billed charges,61.74% of total billed charges,7.7,102,,,Fee Schedule,102% of GA Medicaid Rate,24.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.55,99,
CARNITINE,5001451,CDM,301,RC,82379,HCPCS,Outpatient,,,110,82.5,,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,21.21,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,99,90,,79.2,percent of total billed charges,90% of total billed charges,22.27,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,74,67.275,,59.2,percent of total billed charges,67.275% of total billed charges,88,80,,70.4,percent of total billed charges,80% of total billed charges,17.04,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,88,80,,70.4,percent of total billed charges,80% of total billed charges,67.91,61.74,,54.328,percent of total billed charges,61.74% of total billed charges,21.63,102,,,Fee Schedule,102% of GA Medicaid Rate,16.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.87,99,
FECAL FAT QUANTITATIVE,5001663,CDM,301,RC,82710,HCPCS,Outpatient,,,110,82.5,,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,21.12,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,99,90,,79.2,percent of total billed charges,90% of total billed charges,22.18,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,74,67.275,,59.2,percent of total billed charges,67.275% of total billed charges,88,80,,70.4,percent of total billed charges,80% of total billed charges,16.97,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,88,80,,70.4,percent of total billed charges,80% of total billed charges,67.91,61.74,,54.328,percent of total billed charges,61.74% of total billed charges,21.54,102,,,Fee Schedule,102% of GA Medicaid Rate,16.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.8,99,
HOMOCYSTEINE NUTRITIONAL & CONGENITAL,5001665,CDM,301,RC,83090,HCPCS,Outpatient,,,110,82.5,,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,21.21,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,17.92,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.92,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,99,90,,79.2,percent of total billed charges,90% of total billed charges,22.27,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,74,67.275,,59.2,percent of total billed charges,67.275% of total billed charges,88,80,,70.4,percent of total billed charges,80% of total billed charges,18.1,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,88,80,,70.4,percent of total billed charges,80% of total billed charges,67.91,61.74,,54.328,percent of total billed charges,61.74% of total billed charges,21.63,102,,,Fee Schedule,102% of GA Medicaid Rate,17.92,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.92,99,
VARICELLA ZOSTER VIRUS,5001811,CDM,306,RC,87290,HCPCS,Outpatient,,,110,82.5,,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,15.08,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.42,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.42,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,99,90,,79.2,percent of total billed charges,90% of total billed charges,15.83,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,74,67.275,,59.2,percent of total billed charges,67.275% of total billed charges,88,80,,70.4,percent of total billed charges,80% of total billed charges,13.55,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,88,80,,70.4,percent of total billed charges,80% of total billed charges,67.91,61.74,,54.328,percent of total billed charges,61.74% of total billed charges,15.38,102,,,Fee Schedule,102% of GA Medicaid Rate,13.42,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.42,99,
"HOMOCYSTEINE,CARDIO",5001821,CDM,301,RC,83090,HCPCS,Outpatient,,,110,82.5,,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,21.21,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,17.92,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.92,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,99,90,,79.2,percent of total billed charges,90% of total billed charges,22.27,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,74,67.275,,59.2,percent of total billed charges,67.275% of total billed charges,88,80,,70.4,percent of total billed charges,80% of total billed charges,18.1,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,88,80,,70.4,percent of total billed charges,80% of total billed charges,67.91,61.74,,54.328,percent of total billed charges,61.74% of total billed charges,21.63,102,,,Fee Schedule,102% of GA Medicaid Rate,17.92,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.92,99,
"PORPHYRINS,FRACTIONATED,PLASMA",5001874,CDM,301,RC,82542,HCPCS,Outpatient,,,110,82.5,,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,7.55,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,24.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,24.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,99,90,,79.2,percent of total billed charges,90% of total billed charges,7.93,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,74,67.275,,59.2,percent of total billed charges,67.275% of total billed charges,88,80,,70.4,percent of total billed charges,80% of total billed charges,24.33,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,88,80,,70.4,percent of total billed charges,80% of total billed charges,67.91,61.74,,54.328,percent of total billed charges,61.74% of total billed charges,7.7,102,,,Fee Schedule,102% of GA Medicaid Rate,24.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.55,99,
.METANEPHRINES 24HR URINE,5001916,CDM,301,RC,83835,HCPCS,Outpatient,,,110,82.5,,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,21.3,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.94,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.94,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,99,90,,79.2,percent of total billed charges,90% of total billed charges,22.37,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,74,67.275,,59.2,percent of total billed charges,67.275% of total billed charges,88,80,,70.4,percent of total billed charges,80% of total billed charges,17.11,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,88,80,,70.4,percent of total billed charges,80% of total billed charges,67.91,61.74,,54.328,percent of total billed charges,61.74% of total billed charges,21.73,102,,,Fee Schedule,102% of GA Medicaid Rate,16.94,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.94,99,
"METANEPHRINE, FRACT,24HR",5001923,CDM,301,RC,83835,HCPCS,Outpatient,,,110,82.5,,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,21.3,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.94,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.94,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,99,90,,79.2,percent of total billed charges,90% of total billed charges,22.37,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,74,67.275,,59.2,percent of total billed charges,67.275% of total billed charges,88,80,,70.4,percent of total billed charges,80% of total billed charges,17.11,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,88,80,,70.4,percent of total billed charges,80% of total billed charges,67.91,61.74,,54.328,percent of total billed charges,61.74% of total billed charges,21.73,102,,,Fee Schedule,102% of GA Medicaid Rate,16.94,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.94,99,
"METANEPHRINES, FRACT 24 HR UR",5001964,CDM,301,RC,83835,HCPCS,Outpatient,,,110,82.5,,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,21.3,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.94,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.94,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,99,90,,79.2,percent of total billed charges,90% of total billed charges,22.37,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,74,67.275,,59.2,percent of total billed charges,67.275% of total billed charges,88,80,,70.4,percent of total billed charges,80% of total billed charges,17.11,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,88,80,,70.4,percent of total billed charges,80% of total billed charges,67.91,61.74,,54.328,percent of total billed charges,61.74% of total billed charges,21.73,102,,,Fee Schedule,102% of GA Medicaid Rate,16.94,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.94,99,
".METANEPHRINE, FRACTIONATED",5002028,CDM,301,RC,83835,HCPCS,Outpatient,,,110,82.5,,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,21.3,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.94,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.94,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,99,90,,79.2,percent of total billed charges,90% of total billed charges,22.37,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,74,67.275,,59.2,percent of total billed charges,67.275% of total billed charges,88,80,,70.4,percent of total billed charges,80% of total billed charges,17.11,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,88,80,,70.4,percent of total billed charges,80% of total billed charges,67.91,61.74,,54.328,percent of total billed charges,61.74% of total billed charges,21.73,102,,,Fee Schedule,102% of GA Medicaid Rate,16.94,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.94,99,
"METANEPHRINE, FRACT, PLASMA",5002038,CDM,301,RC,83835,HCPCS,Outpatient,,,110,82.5,,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,21.3,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.94,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.94,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,99,90,,79.2,percent of total billed charges,90% of total billed charges,22.37,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,74,67.275,,59.2,percent of total billed charges,67.275% of total billed charges,88,80,,70.4,percent of total billed charges,80% of total billed charges,17.11,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,88,80,,70.4,percent of total billed charges,80% of total billed charges,67.91,61.74,,54.328,percent of total billed charges,61.74% of total billed charges,21.73,102,,,Fee Schedule,102% of GA Medicaid Rate,16.94,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.94,99,
ARTERIAL CATH PERCU,1001132,CDM,450,RC,36620,HCPCS,Outpatient,,,111,83.25,,86.58,78,,69.264,percent of total billed charges,78% of total billed charges,69.93,63,,55.944,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,42.18,38,,33.744,percent of total billed charges,38% of total billed charges,42.18,38,,33.744,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,38.85,35,,31.08,percent of total billed charges,35% of total billed charges,74.68,67.275,,59.744,percent of total billed charges,67.275% of total billed charges,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,42.6,38.38,,34.08,percent of total billed charges,38.38% of total billed charges,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,68.53,61.74,,54.824,percent of total billed charges,61.74% of total billed charges,113.22,102,,90.576,percent of total billed charges,102% of total billed charges,42.18,38,,33.744,percent of total billed charges,38% of total billed charges,38.85,113.22,
RESTING SPLINT - MD LEFT,3003041,CDM,270,RC,,,Outpatient,,,111,83.25,,86.58,78,,69.264,percent of total billed charges,78% of total billed charges,69.93,63,,55.944,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,42.18,38,,33.744,percent of total billed charges,38% of total billed charges,42.18,38,,33.744,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,38.85,35,,31.08,percent of total billed charges,35% of total billed charges,74.68,67.275,,59.744,percent of total billed charges,67.275% of total billed charges,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,42.6,38.38,,34.08,percent of total billed charges,38.38% of total billed charges,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,68.53,61.74,,54.824,percent of total billed charges,61.74% of total billed charges,113.22,102,,90.576,percent of total billed charges,102% of total billed charges,42.18,38,,33.744,percent of total billed charges,38% of total billed charges,38.85,113.22,
CRYSTAL ID FLUID,5000212,CDM,309,RC,89060,HCPCS,Outpatient,,,111,83.25,,86.58,78,,69.264,percent of total billed charges,78% of total billed charges,8.99,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,7.33,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.33,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,9.44,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,74.68,67.275,,59.744,percent of total billed charges,67.275% of total billed charges,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,7.4,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,68.53,61.74,,54.824,percent of total billed charges,61.74% of total billed charges,9.17,102,,,Fee Schedule,102% of GA Medicaid Rate,7.33,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.33,99.9,
".LYME AB IGG,IGM W/REFL",5001412,CDM,302,RC,86618,HCPCS,Outpatient,,,111,83.25,,86.58,78,,69.264,percent of total billed charges,78% of total billed charges,21.42,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,17.03,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.03,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,22.49,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,74.68,67.275,,59.744,percent of total billed charges,67.275% of total billed charges,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,17.2,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,68.53,61.74,,54.824,percent of total billed charges,61.74% of total billed charges,21.85,102,,,Fee Schedule,102% of GA Medicaid Rate,17.03,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.03,99.9,
"LYME AB IGG,IGM WESTERN BLOT",5001413,CDM,302,RC,86618,HCPCS,Outpatient,,,111,83.25,,86.58,78,,69.264,percent of total billed charges,78% of total billed charges,21.42,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,17.03,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.03,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,22.49,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,74.68,67.275,,59.744,percent of total billed charges,67.275% of total billed charges,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,17.2,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,68.53,61.74,,54.824,percent of total billed charges,61.74% of total billed charges,21.85,102,,,Fee Schedule,102% of GA Medicaid Rate,17.03,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.03,99.9,
THYROTROPIN RECEPTOR Ab,5002064,CDM,301,RC,83519,HCPCS,Outpatient,,,111,83.25,,86.58,78,,69.264,percent of total billed charges,78% of total billed charges,16.99,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,17.84,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,74.68,67.275,,59.744,percent of total billed charges,67.275% of total billed charges,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,18.58,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,68.53,61.74,,54.824,percent of total billed charges,61.74% of total billed charges,17.33,102,,,Fee Schedule,102% of GA Medicaid Rate,18.4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.99,99.9,
ALPHA-1-ANTITRYPSIN PHENOTYPE,5002065,CDM,301,RC,82104,HCPCS,Outpatient,,,111,83.25,,86.58,78,,69.264,percent of total billed charges,78% of total billed charges,18.18,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.46,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.46,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,19.09,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,74.68,67.275,,59.744,percent of total billed charges,67.275% of total billed charges,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,14.6,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,68.53,61.74,,54.824,percent of total billed charges,61.74% of total billed charges,18.54,102,,,Fee Schedule,102% of GA Medicaid Rate,14.46,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.46,99.9,
MASK BIPAP C-PAP SMALL,3000259,CDM,270,RC,,,Outpatient,,,111.12,83.34,,86.67,78,,69.336,percent of total billed charges,78% of total billed charges,70.01,63,,56.008,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,42.23,38,,33.784,percent of total billed charges,38% of total billed charges,42.23,38,,33.784,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,100.01,90,,80.008,percent of total billed charges,90% of total billed charges,38.89,35,,31.112,percent of total billed charges,35% of total billed charges,74.76,67.275,,59.808,percent of total billed charges,67.275% of total billed charges,88.9,80,,71.12,percent of total billed charges,80% of total billed charges,42.65,38.38,,34.12,percent of total billed charges,38.38% of total billed charges,88.9,80,,71.12,percent of total billed charges,80% of total billed charges,68.61,61.74,,54.888,percent of total billed charges,61.74% of total billed charges,113.34,102,,90.672,percent of total billed charges,102% of total billed charges,42.23,38,,33.784,percent of total billed charges,38% of total billed charges,38.89,113.34,
MASK BIPAP C-PAP LARGE,3000261,CDM,270,RC,,,Outpatient,,,111.12,83.34,,86.67,78,,69.336,percent of total billed charges,78% of total billed charges,70.01,63,,56.008,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,42.23,38,,33.784,percent of total billed charges,38% of total billed charges,42.23,38,,33.784,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,100.01,90,,80.008,percent of total billed charges,90% of total billed charges,38.89,35,,31.112,percent of total billed charges,35% of total billed charges,74.76,67.275,,59.808,percent of total billed charges,67.275% of total billed charges,88.9,80,,71.12,percent of total billed charges,80% of total billed charges,42.65,38.38,,34.12,percent of total billed charges,38.38% of total billed charges,88.9,80,,71.12,percent of total billed charges,80% of total billed charges,68.61,61.74,,54.888,percent of total billed charges,61.74% of total billed charges,113.34,102,,90.672,percent of total billed charges,102% of total billed charges,42.23,38,,33.784,percent of total billed charges,38% of total billed charges,38.89,113.34,
CRUTCH CHILD,3004206,CDM,270,RC,,,Outpatient,,,111.56,83.67,,87.02,78,,69.616,percent of total billed charges,78% of total billed charges,70.28,63,,56.224,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,42.39,38,,33.912,percent of total billed charges,38% of total billed charges,42.39,38,,33.912,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,100.4,90,,80.32,percent of total billed charges,90% of total billed charges,39.05,35,,31.24,percent of total billed charges,35% of total billed charges,75.05,67.275,,60.04,percent of total billed charges,67.275% of total billed charges,89.25,80,,71.4,percent of total billed charges,80% of total billed charges,42.82,38.38,,34.256,percent of total billed charges,38.38% of total billed charges,89.25,80,,71.4,percent of total billed charges,80% of total billed charges,68.88,61.74,,55.104,percent of total billed charges,61.74% of total billed charges,113.79,102,,91.032,percent of total billed charges,102% of total billed charges,42.39,38,,33.912,percent of total billed charges,38% of total billed charges,39.05,113.79,
CAMPYLOBACTERJEJUNI AB,5000144,CDM,302,RC,86625,HCPCS,Outpatient,,,112,84,,87.36,78,,69.888,percent of total billed charges,78% of total billed charges,16.5,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.12,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.12,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,100.8,90,,80.64,percent of total billed charges,90% of total billed charges,17.33,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,75.35,67.275,,60.28,percent of total billed charges,67.275% of total billed charges,89.6,80,,71.68,percent of total billed charges,80% of total billed charges,13.25,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,89.6,80,,71.68,percent of total billed charges,80% of total billed charges,69.15,61.74,,55.32,percent of total billed charges,61.74% of total billed charges,16.83,102,,,Fee Schedule,102% of GA Medicaid Rate,13.12,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.12,100.8,
PSA (prostate specific antigen),5001718,CDM,301,RC,84153,HCPCS,Outpatient,,,112,84,,87.36,78,,69.888,percent of total billed charges,78% of total billed charges,23.13,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,100.8,90,,80.64,percent of total billed charges,90% of total billed charges,24.29,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,75.35,67.275,,60.28,percent of total billed charges,67.275% of total billed charges,89.6,80,,71.68,percent of total billed charges,80% of total billed charges,18.57,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,89.6,80,,71.68,percent of total billed charges,80% of total billed charges,69.15,61.74,,55.32,percent of total billed charges,61.74% of total billed charges,23.59,102,,,Fee Schedule,102% of GA Medicaid Rate,18.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.39,100.8,
HEPATITIS B SURF AG,5001736,CDM,306,RC,87340,HCPCS,Outpatient,,,112,84,,87.36,78,,69.888,percent of total billed charges,78% of total billed charges,12.99,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,10.33,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.33,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,100.8,90,,80.64,percent of total billed charges,90% of total billed charges,13.64,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,75.35,67.275,,60.28,percent of total billed charges,67.275% of total billed charges,89.6,80,,71.68,percent of total billed charges,80% of total billed charges,10.43,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,89.6,80,,71.68,percent of total billed charges,80% of total billed charges,69.15,61.74,,55.32,percent of total billed charges,61.74% of total billed charges,13.25,102,,,Fee Schedule,102% of GA Medicaid Rate,10.33,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.33,100.8,
PT ORTHOTIC MGMT & TRAINING,9000029,CDM,420,RC,97760,HCPCS,Outpatient,,,112,84,,87.36,78,,69.888,percent of total billed charges,78% of total billed charges,70.56,63,,56.448,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,42.56,38,,34.048,percent of total billed charges,38% of total billed charges,42.56,38,,34.048,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,100.8,90,,80.64,percent of total billed charges,90% of total billed charges,39.2,35,,31.36,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,89.6,80,,71.68,percent of total billed charges,80% of total billed charges,42.99,38.38,,34.392,percent of total billed charges,38.38% of total billed charges,89.6,80,,71.68,percent of total billed charges,80% of total billed charges,69.15,61.74,,55.32,percent of total billed charges,61.74% of total billed charges,114.24,102,,91.392,percent of total billed charges,102% of total billed charges,42.56,38,,34.048,percent of total billed charges,38% of total billed charges,39.2,145.93,
"OT ORTHOTIC MGMT & TRAINING, EA 15 MIN",9000230,CDM,430,RC,97760,HCPCS,Outpatient,,,112,84,,87.36,78,,69.888,percent of total billed charges,78% of total billed charges,70.56,63,,56.448,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,42.56,38,,34.048,percent of total billed charges,38% of total billed charges,42.56,38,,34.048,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,100.8,90,,80.64,percent of total billed charges,90% of total billed charges,39.2,35,,31.36,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,89.6,80,,71.68,percent of total billed charges,80% of total billed charges,42.99,38.38,,34.392,percent of total billed charges,38.38% of total billed charges,89.6,80,,71.68,percent of total billed charges,80% of total billed charges,69.15,61.74,,55.32,percent of total billed charges,61.74% of total billed charges,114.24,102,,91.392,percent of total billed charges,102% of total billed charges,42.56,38,,34.048,percent of total billed charges,38% of total billed charges,39.2,145.93,
URIC ACID,5000766,CDM,301,RC,84550,HCPCS,Outpatient,,,113,84.75,,88.14,78,,70.512,percent of total billed charges,78% of total billed charges,5.68,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.52,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.52,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,5.96,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,76.02,67.275,,60.816,percent of total billed charges,67.275% of total billed charges,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,4.57,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,69.77,61.74,,55.816,percent of total billed charges,61.74% of total billed charges,5.79,102,,,Fee Schedule,102% of GA Medicaid Rate,4.52,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.52,101.7,
.RBC FOLATE,5001417,CDM,301,RC,82747,HCPCS,Outpatient,,,113,84.75,,88.14,78,,70.512,percent of total billed charges,78% of total billed charges,21.78,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,17.65,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.65,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,22.87,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,76.02,67.275,,60.816,percent of total billed charges,67.275% of total billed charges,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,17.83,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,69.77,61.74,,55.816,percent of total billed charges,61.74% of total billed charges,22.22,102,,,Fee Schedule,102% of GA Medicaid Rate,17.65,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.65,101.7,
FOLATE RBC,5001422,CDM,301,RC,82747,HCPCS,Outpatient,,,113,84.75,,88.14,78,,70.512,percent of total billed charges,78% of total billed charges,21.78,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,17.65,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.65,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,22.87,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,76.02,67.275,,60.816,percent of total billed charges,67.275% of total billed charges,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,17.83,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,69.77,61.74,,55.816,percent of total billed charges,61.74% of total billed charges,22.22,102,,,Fee Schedule,102% of GA Medicaid Rate,17.65,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.65,101.7,
ROLYAN  HINGED KNEE WRAP BRACE - MD,3006011,CDM,270,RC,,,Outpatient,,,113.36,85.02,,88.42,78,,70.736,percent of total billed charges,78% of total billed charges,71.42,63,,57.136,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,43.08,38,,34.464,percent of total billed charges,38% of total billed charges,43.08,38,,34.464,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,102.02,90,,81.616,percent of total billed charges,90% of total billed charges,39.68,35,,31.744,percent of total billed charges,35% of total billed charges,76.26,67.275,,61.008,percent of total billed charges,67.275% of total billed charges,90.69,80,,72.552,percent of total billed charges,80% of total billed charges,43.51,38.38,,34.808,percent of total billed charges,38.38% of total billed charges,90.69,80,,72.552,percent of total billed charges,80% of total billed charges,69.99,61.74,,55.992,percent of total billed charges,61.74% of total billed charges,115.63,102,,92.504,percent of total billed charges,102% of total billed charges,43.08,38,,34.464,percent of total billed charges,38% of total billed charges,39.68,115.63,
L&B KIT,3001912,CDM,270,RC,,,Outpatient,,,113.68,85.26,,88.67,78,,70.936,percent of total billed charges,78% of total billed charges,71.62,63,,57.296,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,43.2,38,,34.56,percent of total billed charges,38% of total billed charges,43.2,38,,34.56,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,102.31,90,,81.848,percent of total billed charges,90% of total billed charges,39.79,35,,31.832,percent of total billed charges,35% of total billed charges,76.48,67.275,,61.184,percent of total billed charges,67.275% of total billed charges,90.94,80,,72.752,percent of total billed charges,80% of total billed charges,43.63,38.38,,34.904,percent of total billed charges,38.38% of total billed charges,90.94,80,,72.752,percent of total billed charges,80% of total billed charges,70.19,61.74,,56.152,percent of total billed charges,61.74% of total billed charges,115.95,102,,92.76,percent of total billed charges,102% of total billed charges,43.2,38,,34.56,percent of total billed charges,38% of total billed charges,39.79,115.95,
CLOSED FRACT FING/TOE/TR,1001070,CDM,450,RC,,,Outpatient,,,114,85.5,,88.92,78,,71.136,percent of total billed charges,78% of total billed charges,71.82,63,,57.456,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,43.32,38,,34.656,percent of total billed charges,38% of total billed charges,43.32,38,,34.656,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,39.9,35,,31.92,percent of total billed charges,35% of total billed charges,76.69,67.275,,61.352,percent of total billed charges,67.275% of total billed charges,91.2,80,,72.96,percent of total billed charges,80% of total billed charges,43.75,38.38,,35,percent of total billed charges,38.38% of total billed charges,91.2,80,,72.96,percent of total billed charges,80% of total billed charges,70.38,61.74,,56.304,percent of total billed charges,61.74% of total billed charges,116.28,102,,93.024,percent of total billed charges,102% of total billed charges,43.32,38,,34.656,percent of total billed charges,38% of total billed charges,39.9,116.28,
CLOSED FRACT W/O MANIP,1001074,CDM,450,RC,,,Outpatient,,,114,85.5,,88.92,78,,71.136,percent of total billed charges,78% of total billed charges,71.82,63,,57.456,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,43.32,38,,34.656,percent of total billed charges,38% of total billed charges,43.32,38,,34.656,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,39.9,35,,31.92,percent of total billed charges,35% of total billed charges,76.69,67.275,,61.352,percent of total billed charges,67.275% of total billed charges,91.2,80,,72.96,percent of total billed charges,80% of total billed charges,43.75,38.38,,35,percent of total billed charges,38.38% of total billed charges,91.2,80,,72.96,percent of total billed charges,80% of total billed charges,70.38,61.74,,56.304,percent of total billed charges,61.74% of total billed charges,116.28,102,,93.024,percent of total billed charges,102% of total billed charges,43.32,38,,34.656,percent of total billed charges,38% of total billed charges,39.9,116.28,
CLOSED DISLOC W/O MANIP,1001078,CDM,450,RC,,,Outpatient,,,114,85.5,,88.92,78,,71.136,percent of total billed charges,78% of total billed charges,71.82,63,,57.456,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,43.32,38,,34.656,percent of total billed charges,38% of total billed charges,43.32,38,,34.656,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,39.9,35,,31.92,percent of total billed charges,35% of total billed charges,76.69,67.275,,61.352,percent of total billed charges,67.275% of total billed charges,91.2,80,,72.96,percent of total billed charges,80% of total billed charges,43.75,38.38,,35,percent of total billed charges,38.38% of total billed charges,91.2,80,,72.96,percent of total billed charges,80% of total billed charges,70.38,61.74,,56.304,percent of total billed charges,61.74% of total billed charges,116.28,102,,93.024,percent of total billed charges,102% of total billed charges,43.32,38,,34.656,percent of total billed charges,38% of total billed charges,39.9,116.28,
10 HYDROXYCARBAZEPINE,5003905,CDM,301,RC,80183,HCPCS,Outpatient,,,114,85.5,,88.92,78,,71.136,percent of total billed charges,78% of total billed charges,14.47,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,15.19,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,76.69,67.275,,61.352,percent of total billed charges,67.275% of total billed charges,91.2,80,,72.96,percent of total billed charges,80% of total billed charges,13.38,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,91.2,80,,72.96,percent of total billed charges,80% of total billed charges,70.38,61.74,,56.304,percent of total billed charges,61.74% of total billed charges,14.76,102,,,Fee Schedule,102% of GA Medicaid Rate,13.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.25,102.6,
Radiologic examination of the knee with 1 or 2 views,7000702,CDM,320,RC,73560,HCPCS,Outpatient,,,114,85.5,,88.92,78,,71.136,percent of total billed charges,78% of total billed charges,71.82,63,,57.456,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,43.32,38,,34.656,percent of total billed charges,38% of total billed charges,43.32,38,,34.656,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,39.9,35,,31.92,percent of total billed charges,35% of total billed charges,76.69,67.275,,61.352,percent of total billed charges,67.275% of total billed charges,91.2,80,,72.96,percent of total billed charges,80% of total billed charges,43.75,38.38,,35,percent of total billed charges,38.38% of total billed charges,91.2,80,,72.96,percent of total billed charges,80% of total billed charges,70.38,61.74,,56.304,percent of total billed charges,61.74% of total billed charges,116.28,102,,93.024,percent of total billed charges,102% of total billed charges,43.32,38,,34.656,percent of total billed charges,38% of total billed charges,39.9,116.28,
Radiologic examination of the knee with 1 or 2 views,7000712,CDM,320,RC,73560,HCPCS,Outpatient,,,114,85.5,,88.92,78,,71.136,percent of total billed charges,78% of total billed charges,71.82,63,,57.456,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,43.32,38,,34.656,percent of total billed charges,38% of total billed charges,43.32,38,,34.656,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,39.9,35,,31.92,percent of total billed charges,35% of total billed charges,76.69,67.275,,61.352,percent of total billed charges,67.275% of total billed charges,91.2,80,,72.96,percent of total billed charges,80% of total billed charges,43.75,38.38,,35,percent of total billed charges,38.38% of total billed charges,91.2,80,,72.96,percent of total billed charges,80% of total billed charges,70.38,61.74,,56.304,percent of total billed charges,61.74% of total billed charges,116.28,102,,93.024,percent of total billed charges,102% of total billed charges,43.32,38,,34.656,percent of total billed charges,38% of total billed charges,39.9,116.28,
"Blood test, comprehensive group of blood chemicals",5000017,CDM,301,RC,80053,HCPCS,Outpatient,,,115,86.25,,89.7,78,,71.76,percent of total billed charges,78% of total billed charges,13.29,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,10.56,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.56,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,13.95,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,77.37,67.275,,61.896,percent of total billed charges,67.275% of total billed charges,92,80,,73.6,percent of total billed charges,80% of total billed charges,10.67,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,92,80,,73.6,percent of total billed charges,80% of total billed charges,71,61.74,,56.8,percent of total billed charges,61.74% of total billed charges,13.56,102,,,Fee Schedule,102% of GA Medicaid Rate,10.56,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.56,103.5,
"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)",5000733,CDM,301,RC,80051,HCPCS,Outpatient,,,115,86.25,,89.7,78,,71.76,percent of total billed charges,78% of total billed charges,8.82,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,7.01,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.01,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,9.26,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,77.37,67.275,,61.896,percent of total billed charges,67.275% of total billed charges,92,80,,73.6,percent of total billed charges,80% of total billed charges,7.08,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,92,80,,73.6,percent of total billed charges,80% of total billed charges,71,61.74,,56.8,percent of total billed charges,61.74% of total billed charges,9,102,,,Fee Schedule,102% of GA Medicaid Rate,7.01,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.01,103.5,
Liver function blood test panel,5000758,CDM,301,RC,80076,HCPCS,Outpatient,,,115,86.25,,89.7,78,,71.76,percent of total billed charges,78% of total billed charges,10.28,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.17,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.17,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,10.79,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,77.37,67.275,,61.896,percent of total billed charges,67.275% of total billed charges,92,80,,73.6,percent of total billed charges,80% of total billed charges,8.25,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,92,80,,73.6,percent of total billed charges,80% of total billed charges,71,61.74,,56.8,percent of total billed charges,61.74% of total billed charges,10.49,102,,,Fee Schedule,102% of GA Medicaid Rate,8.17,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.17,103.5,
PAP 1 SLIDE,5001278,CDM,300,RC,88164,HCPCS,Outpatient,,,115,86.25,,89.7,78,,71.76,percent of total billed charges,78% of total billed charges,13.28,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,17.31,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.31,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,13.94,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,77.37,67.275,,61.896,percent of total billed charges,67.275% of total billed charges,92,80,,73.6,percent of total billed charges,80% of total billed charges,17.48,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,92,80,,73.6,percent of total billed charges,80% of total billed charges,71,61.74,,56.8,percent of total billed charges,61.74% of total billed charges,13.55,102,,,Fee Schedule,102% of GA Medicaid Rate,17.31,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.28,103.5,
GASTRIN,5001896,CDM,301,RC,82941,HCPCS,Outpatient,,,115,86.25,,89.7,78,,71.76,percent of total billed charges,78% of total billed charges,22.18,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,17.63,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.63,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,23.29,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,77.37,67.275,,61.896,percent of total billed charges,67.275% of total billed charges,92,80,,73.6,percent of total billed charges,80% of total billed charges,17.81,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,92,80,,73.6,percent of total billed charges,80% of total billed charges,71,61.74,,56.8,percent of total billed charges,61.74% of total billed charges,22.62,102,,,Fee Schedule,102% of GA Medicaid Rate,17.63,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.63,103.5,
SHOULDER POST RED RIGHT,7000306,CDM,320,RC,73020,HCPCS,Outpatient,,,115,86.25,,89.7,78,,71.76,percent of total billed charges,78% of total billed charges,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,43.7,38,,34.96,percent of total billed charges,38% of total billed charges,43.7,38,,34.96,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,40.25,35,,32.2,percent of total billed charges,35% of total billed charges,77.37,67.275,,61.896,percent of total billed charges,67.275% of total billed charges,92,80,,73.6,percent of total billed charges,80% of total billed charges,44.14,38.38,,35.312,percent of total billed charges,38.38% of total billed charges,92,80,,73.6,percent of total billed charges,80% of total billed charges,71,61.74,,56.8,percent of total billed charges,61.74% of total billed charges,117.3,102,,93.84,percent of total billed charges,102% of total billed charges,43.7,38,,34.96,percent of total billed charges,38% of total billed charges,40.25,117.3,
SHOULDER POST RED LEFT,7300307,CDM,320,RC,73020,HCPCS,Outpatient,,,115,86.25,,89.7,78,,71.76,percent of total billed charges,78% of total billed charges,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,43.7,38,,34.96,percent of total billed charges,38% of total billed charges,43.7,38,,34.96,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,40.25,35,,32.2,percent of total billed charges,35% of total billed charges,77.37,67.275,,61.896,percent of total billed charges,67.275% of total billed charges,92,80,,73.6,percent of total billed charges,80% of total billed charges,44.14,38.38,,35.312,percent of total billed charges,38.38% of total billed charges,92,80,,73.6,percent of total billed charges,80% of total billed charges,71,61.74,,56.8,percent of total billed charges,61.74% of total billed charges,117.3,102,,93.84,percent of total billed charges,102% of total billed charges,43.7,38,,34.96,percent of total billed charges,38% of total billed charges,40.25,117.3,
OASIS DRY SUCTION DRAIN,3001803,CDM,270,RC,,,Outpatient,,,116,87,,90.48,78,,72.384,percent of total billed charges,78% of total billed charges,73.08,63,,58.464,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,44.08,38,,35.264,percent of total billed charges,38% of total billed charges,44.08,38,,35.264,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,40.6,35,,32.48,percent of total billed charges,35% of total billed charges,78.04,67.275,,62.432,percent of total billed charges,67.275% of total billed charges,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,44.52,38.38,,35.616,percent of total billed charges,38.38% of total billed charges,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,71.62,61.74,,57.296,percent of total billed charges,61.74% of total billed charges,118.32,102,,94.656,percent of total billed charges,102% of total billed charges,44.08,38,,35.264,percent of total billed charges,38% of total billed charges,40.6,118.32,
PROINSULIN,5000245,CDM,301,RC,84206,HCPCS,Outpatient,,,116,87,,90.48,78,,72.384,percent of total billed charges,78% of total billed charges,22.4,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,26.69,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,26.69,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,23.52,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,78.04,67.275,,62.432,percent of total billed charges,67.275% of total billed charges,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,26.96,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,71.62,61.74,,57.296,percent of total billed charges,61.74% of total billed charges,22.85,102,,,Fee Schedule,102% of GA Medicaid Rate,26.69,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,22.4,104.4,
PROTEIN ELECT (URINE 24 HR),5000246,CDM,301,RC,84166,HCPCS,Outpatient,,,116,87,,90.48,78,,72.384,percent of total billed charges,78% of total billed charges,22.43,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,17.83,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.83,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,23.55,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,78.04,67.275,,62.432,percent of total billed charges,67.275% of total billed charges,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,18.01,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,71.62,61.74,,57.296,percent of total billed charges,61.74% of total billed charges,22.88,102,,,Fee Schedule,102% of GA Medicaid Rate,17.83,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.83,104.4,
"PROTEIN ELECTROPHORESIS, RANDOM URINE",5002020,CDM,301,RC,84166,HCPCS,Outpatient,,,116,87,,90.48,78,,72.384,percent of total billed charges,78% of total billed charges,22.43,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,17.83,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.83,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,23.55,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,78.04,67.275,,62.432,percent of total billed charges,67.275% of total billed charges,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,18.01,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,71.62,61.74,,57.296,percent of total billed charges,61.74% of total billed charges,22.88,102,,,Fee Schedule,102% of GA Medicaid Rate,17.83,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.83,104.4,
MATERNAL SCREEN 4,5000516,CDM,301,RC,82105,HCPCS,Outpatient,,,117,87.75,,91.26,78,,73.008,percent of total billed charges,78% of total billed charges,21.1,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.77,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.77,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,22.16,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,78.71,67.275,,62.968,percent of total billed charges,67.275% of total billed charges,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,16.94,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,72.24,61.74,,57.792,percent of total billed charges,61.74% of total billed charges,21.52,102,,,Fee Schedule,102% of GA Medicaid Rate,16.77,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.77,105.3,
AMITRIPTYLENE,5001641,CDM,301,RC,80335,HCPCS,Outpatient,,,117,87.75,,91.26,78,,73.008,percent of total billed charges,78% of total billed charges,22.51,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,44.46,38,,35.568,percent of total billed charges,38% of total billed charges,44.46,38,,35.568,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,23.64,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,78.71,67.275,,62.968,percent of total billed charges,67.275% of total billed charges,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,44.9,38.38,,35.92,percent of total billed charges,38.38% of total billed charges,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,72.24,61.74,,57.792,percent of total billed charges,61.74% of total billed charges,22.96,102,,,Fee Schedule,102% of GA Medicaid Rate,44.46,38,,35.568,percent of total billed charges,38% of total billed charges,22.51,105.3,
NORTRIPTYLINE,5001642,CDM,301,RC,80335,HCPCS,Outpatient,,,117,87.75,,91.26,78,,73.008,percent of total billed charges,78% of total billed charges,22.51,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,44.46,38,,35.568,percent of total billed charges,38% of total billed charges,44.46,38,,35.568,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,23.64,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,78.71,67.275,,62.968,percent of total billed charges,67.275% of total billed charges,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,44.9,38.38,,35.92,percent of total billed charges,38.38% of total billed charges,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,72.24,61.74,,57.792,percent of total billed charges,61.74% of total billed charges,22.96,102,,,Fee Schedule,102% of GA Medicaid Rate,44.46,38,,35.568,percent of total billed charges,38% of total billed charges,22.51,105.3,
AFP TRIPLE SCREEN,5001898,CDM,301,RC,82105,HCPCS,Outpatient,,,117,87.75,,91.26,78,,73.008,percent of total billed charges,78% of total billed charges,21.1,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.77,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.77,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,22.16,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,78.71,67.275,,62.968,percent of total billed charges,67.275% of total billed charges,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,16.94,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,72.24,61.74,,57.792,percent of total billed charges,61.74% of total billed charges,21.52,102,,,Fee Schedule,102% of GA Medicaid Rate,16.77,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.77,105.3,
ALPHA FETOPROTEIN T MARKE,5001899,CDM,301,RC,82105,HCPCS,Outpatient,,,117,87.75,,91.26,78,,73.008,percent of total billed charges,78% of total billed charges,21.1,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.77,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.77,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,22.16,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,78.71,67.275,,62.968,percent of total billed charges,67.275% of total billed charges,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,16.94,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,72.24,61.74,,57.792,percent of total billed charges,61.74% of total billed charges,21.52,102,,,Fee Schedule,102% of GA Medicaid Rate,16.77,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.77,105.3,
FACTOR VIII ACTIVITY,5001947,CDM,305,RC,85240,HCPCS,Outpatient,,,117,87.75,,91.26,78,,73.008,percent of total billed charges,78% of total billed charges,22.52,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,17.9,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.9,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,23.65,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,78.71,67.275,,62.968,percent of total billed charges,67.275% of total billed charges,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,18.08,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,72.24,61.74,,57.792,percent of total billed charges,61.74% of total billed charges,22.97,102,,,Fee Schedule,102% of GA Medicaid Rate,17.9,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.9,105.3,
SJOGREN'S AB SSA,5001977,CDM,302,RC,86235,HCPCS,Outpatient,,,117,87.75,,91.26,78,,73.008,percent of total billed charges,78% of total billed charges,22.55,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,17.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,23.68,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,78.71,67.275,,62.968,percent of total billed charges,67.275% of total billed charges,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,18.11,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,72.24,61.74,,57.792,percent of total billed charges,61.74% of total billed charges,23,102,,,Fee Schedule,102% of GA Medicaid Rate,17.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.93,105.3,
ANTI ENA ANTIBODY,5001978,CDM,302,RC,86235,HCPCS,Outpatient,,,117,87.75,,91.26,78,,73.008,percent of total billed charges,78% of total billed charges,22.55,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,17.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,23.68,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,78.71,67.275,,62.968,percent of total billed charges,67.275% of total billed charges,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,18.11,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,72.24,61.74,,57.792,percent of total billed charges,61.74% of total billed charges,23,102,,,Fee Schedule,102% of GA Medicaid Rate,17.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.93,105.3,
SM AND SM/RNP ANTIBODIES,5001983,CDM,302,RC,86235,HCPCS,Outpatient,,,117,87.75,,91.26,78,,73.008,percent of total billed charges,78% of total billed charges,22.55,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,17.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,23.68,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,78.71,67.275,,62.968,percent of total billed charges,67.275% of total billed charges,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,18.11,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,72.24,61.74,,57.792,percent of total billed charges,61.74% of total billed charges,23,102,,,Fee Schedule,102% of GA Medicaid Rate,17.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.93,105.3,
RNP ANTIBODY,5001984,CDM,302,RC,86235,HCPCS,Outpatient,,,117,87.75,,91.26,78,,73.008,percent of total billed charges,78% of total billed charges,22.55,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,17.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,23.68,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,78.71,67.275,,62.968,percent of total billed charges,67.275% of total billed charges,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,18.11,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,72.24,61.74,,57.792,percent of total billed charges,61.74% of total billed charges,23,102,,,Fee Schedule,102% of GA Medicaid Rate,17.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.93,105.3,
SJOGREN'S AB SSA/SSB,5001987,CDM,302,RC,86235,HCPCS,Outpatient,,,117,87.75,,91.26,78,,73.008,percent of total billed charges,78% of total billed charges,22.55,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,17.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,23.68,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,78.71,67.275,,62.968,percent of total billed charges,67.275% of total billed charges,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,18.11,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,72.24,61.74,,57.792,percent of total billed charges,61.74% of total billed charges,23,102,,,Fee Schedule,102% of GA Medicaid Rate,17.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.93,105.3,
SCLERADERMA AB,5001996,CDM,302,RC,86235,HCPCS,Outpatient,,,117,87.75,,91.26,78,,73.008,percent of total billed charges,78% of total billed charges,22.55,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,17.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,23.68,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,78.71,67.275,,62.968,percent of total billed charges,67.275% of total billed charges,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,18.11,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,72.24,61.74,,57.792,percent of total billed charges,61.74% of total billed charges,23,102,,,Fee Schedule,102% of GA Medicaid Rate,17.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.93,105.3,
JO-1 Ab,5002046,CDM,302,RC,86235,HCPCS,Outpatient,,,117,87.75,,91.26,78,,73.008,percent of total billed charges,78% of total billed charges,22.55,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,17.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,23.68,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,78.71,67.275,,62.968,percent of total billed charges,67.275% of total billed charges,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,18.11,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,72.24,61.74,,57.792,percent of total billed charges,61.74% of total billed charges,23,102,,,Fee Schedule,102% of GA Medicaid Rate,17.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.93,105.3,
CHROMATIN,5002078,CDM,302,RC,86235,HCPCS,Outpatient,,,117,87.75,,91.26,78,,73.008,percent of total billed charges,78% of total billed charges,22.55,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,17.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,23.68,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,78.71,67.275,,62.968,percent of total billed charges,67.275% of total billed charges,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,18.11,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,72.24,61.74,,57.792,percent of total billed charges,61.74% of total billed charges,23,102,,,Fee Schedule,102% of GA Medicaid Rate,17.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.93,105.3,
ANKLE/FOOT ORTHOSIS - LG LEFT,3005090,CDM,270,RC,,,Outpatient,,,117.04,87.78,,91.29,78,,73.032,percent of total billed charges,78% of total billed charges,73.74,63,,58.992,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,44.48,38,,35.584,percent of total billed charges,38% of total billed charges,44.48,38,,35.584,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,105.34,90,,84.272,percent of total billed charges,90% of total billed charges,40.96,35,,32.768,percent of total billed charges,35% of total billed charges,78.74,67.275,,62.992,percent of total billed charges,67.275% of total billed charges,93.63,80,,74.904,percent of total billed charges,80% of total billed charges,44.92,38.38,,35.936,percent of total billed charges,38.38% of total billed charges,93.63,80,,74.904,percent of total billed charges,80% of total billed charges,72.26,61.74,,57.808,percent of total billed charges,61.74% of total billed charges,119.38,102,,95.504,percent of total billed charges,102% of total billed charges,44.48,38,,35.584,percent of total billed charges,38% of total billed charges,40.96,119.38,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",1001122,CDM,450,RC,96374,HCPCS,Outpatient,,,118,88.5,,92.04,78,,73.632,percent of total billed charges,78% of total billed charges,74.34,63,,59.472,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,44.84,38,,35.872,percent of total billed charges,38% of total billed charges,44.84,38,,35.872,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,41.3,35,,33.04,percent of total billed charges,35% of total billed charges,79.38,67.275,,63.504,percent of total billed charges,67.275% of total billed charges,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,45.29,38.38,,36.232,percent of total billed charges,38.38% of total billed charges,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,72.85,61.74,,58.28,percent of total billed charges,61.74% of total billed charges,120.36,102,,96.288,percent of total billed charges,102% of total billed charges,44.84,38,,35.872,percent of total billed charges,38% of total billed charges,41.3,120.36,
FINGER SPLINT,1200187,CDM,981,RC,29130,HCPCS,Outpatient,,,118,88.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,33.05,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,33.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,33.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,33.05,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,33.05,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,34.07,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,34.29,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,71.4,61.74,,57.12,percent of total billed charges,61.74% of total billed charges,32.45,102,,,Fee Schedule,102% of GA Medicaid Rate,33.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,32.45,71.4,
Test to predict likelihood of gestational diabetes,5000739,CDM,301,RC,82951,HCPCS,Outpatient,,,118,88.5,,92.04,78,,73.632,percent of total billed charges,78% of total billed charges,16.19,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,17,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,79.38,67.275,,63.504,percent of total billed charges,67.275% of total billed charges,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,13,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,72.85,61.74,,58.28,percent of total billed charges,61.74% of total billed charges,16.51,102,,,Fee Schedule,102% of GA Medicaid Rate,12.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.87,106.2,
Test to predict likelihood of gestational diabetes,5000741,CDM,301,RC,82951,HCPCS,Outpatient,,,118,88.5,,92.04,78,,73.632,percent of total billed charges,78% of total billed charges,16.19,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,17,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,79.38,67.275,,63.504,percent of total billed charges,67.275% of total billed charges,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,13,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,72.85,61.74,,58.28,percent of total billed charges,61.74% of total billed charges,16.51,102,,,Fee Schedule,102% of GA Medicaid Rate,12.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.87,106.2,
Test to predict likelihood of gestational diabetes,5000742,CDM,301,RC,82951,HCPCS,Outpatient,,,118,88.5,,92.04,78,,73.632,percent of total billed charges,78% of total billed charges,16.19,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,17,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,79.38,67.275,,63.504,percent of total billed charges,67.275% of total billed charges,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,13,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,72.85,61.74,,58.28,percent of total billed charges,61.74% of total billed charges,16.51,102,,,Fee Schedule,102% of GA Medicaid Rate,12.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.87,106.2,
Test to predict likelihood of gestational diabetes,5000743,CDM,301,RC,82951,HCPCS,Outpatient,,,118,88.5,,92.04,78,,73.632,percent of total billed charges,78% of total billed charges,16.19,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,17,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,79.38,67.275,,63.504,percent of total billed charges,67.275% of total billed charges,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,13,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,72.85,61.74,,58.28,percent of total billed charges,61.74% of total billed charges,16.51,102,,,Fee Schedule,102% of GA Medicaid Rate,12.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.87,106.2,
.ANCA -PROTEINASE,5001442,CDM,302,RC,86021,HCPCS,Outpatient,,,118,88.5,,92.04,78,,73.632,percent of total billed charges,78% of total billed charges,18.93,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,15.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,19.88,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,79.38,67.275,,63.504,percent of total billed charges,67.275% of total billed charges,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,15.2,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,72.85,61.74,,58.28,percent of total billed charges,61.74% of total billed charges,19.31,102,,,Fee Schedule,102% of GA Medicaid Rate,15.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.05,106.2,
ANCA SCREEN W/ REFLEX,5001443,CDM,302,RC,86021,HCPCS,Outpatient,,,118,88.5,,92.04,78,,73.632,percent of total billed charges,78% of total billed charges,18.93,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,15.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,19.88,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,79.38,67.275,,63.504,percent of total billed charges,67.275% of total billed charges,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,15.2,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,72.85,61.74,,58.28,percent of total billed charges,61.74% of total billed charges,19.31,102,,,Fee Schedule,102% of GA Medicaid Rate,15.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.05,106.2,
ANTI-MUSK AB,5001453,CDM,301,RC,83519,HCPCS,Outpatient,,,118,88.5,,92.04,78,,73.632,percent of total billed charges,78% of total billed charges,16.99,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,17.84,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,79.38,67.275,,63.504,percent of total billed charges,67.275% of total billed charges,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,18.58,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,72.85,61.74,,58.28,percent of total billed charges,61.74% of total billed charges,17.33,102,,,Fee Schedule,102% of GA Medicaid Rate,18.4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.99,106.2,
GLUTAMIC ACID DECARBOXYLASE,5001804,CDM,301,RC,83519,HCPCS,Outpatient,,,118,88.5,,92.04,78,,73.632,percent of total billed charges,78% of total billed charges,16.99,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,17.84,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,79.38,67.275,,63.504,percent of total billed charges,67.275% of total billed charges,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,18.58,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,72.85,61.74,,58.28,percent of total billed charges,61.74% of total billed charges,17.33,102,,,Fee Schedule,102% of GA Medicaid Rate,18.4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.99,106.2,
PLATELET NEUTRALIZATION,5001928,CDM,300,RC,85597,HCPCS,Outpatient,,,118,88.5,,92.04,78,,73.632,percent of total billed charges,78% of total billed charges,22.61,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,17.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,23.74,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,79.38,67.275,,63.504,percent of total billed charges,67.275% of total billed charges,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,18.16,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,72.85,61.74,,58.28,percent of total billed charges,61.74% of total billed charges,23.06,102,,,Fee Schedule,102% of GA Medicaid Rate,17.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,17.98,106.2,
IMMUNOREACTIVE TRYPSINOGE,5001989,CDM,301,RC,83519,HCPCS,Outpatient,,,118,88.5,,92.04,78,,73.632,percent of total billed charges,78% of total billed charges,16.99,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,17.84,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,79.38,67.275,,63.504,percent of total billed charges,67.275% of total billed charges,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,18.58,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,72.85,61.74,,58.28,percent of total billed charges,61.74% of total billed charges,17.33,102,,,Fee Schedule,102% of GA Medicaid Rate,18.4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.99,106.2,
PTH-RELATED PROTEIN,5002066,CDM,301,RC,83519,HCPCS,Outpatient,,,118,88.5,,92.04,78,,73.632,percent of total billed charges,78% of total billed charges,16.99,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,17.84,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,79.38,67.275,,63.504,percent of total billed charges,67.275% of total billed charges,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,18.58,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,72.85,61.74,,58.28,percent of total billed charges,61.74% of total billed charges,17.33,102,,,Fee Schedule,102% of GA Medicaid Rate,18.4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.99,106.2,
TRYPSIN,5002071,CDM,301,RC,83519,HCPCS,Outpatient,,,118,88.5,,92.04,78,,73.632,percent of total billed charges,78% of total billed charges,16.99,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,17.84,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,79.38,67.275,,63.504,percent of total billed charges,67.275% of total billed charges,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,18.58,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,72.85,61.74,,58.28,percent of total billed charges,61.74% of total billed charges,17.33,102,,,Fee Schedule,102% of GA Medicaid Rate,18.4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.99,106.2,
ACETYCHOLINE RECEPTOR MOD Ab,5008409,CDM,301,RC,83519,HCPCS,Outpatient,,,118,88.5,,92.04,78,,73.632,percent of total billed charges,78% of total billed charges,16.99,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,17.84,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,79.38,67.275,,63.504,percent of total billed charges,67.275% of total billed charges,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,18.58,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,72.85,61.74,,58.28,percent of total billed charges,61.74% of total billed charges,17.33,102,,,Fee Schedule,102% of GA Medicaid Rate,18.4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.99,106.2,
ACETYCHOLINE RECEPTOR BLOCKING Ab,5008410,CDM,301,RC,83519,HCPCS,Outpatient,,,118,88.5,,92.04,78,,73.632,percent of total billed charges,78% of total billed charges,16.99,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,17.84,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,79.38,67.275,,63.504,percent of total billed charges,67.275% of total billed charges,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,18.58,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,72.85,61.74,,58.28,percent of total billed charges,61.74% of total billed charges,17.33,102,,,Fee Schedule,102% of GA Medicaid Rate,18.4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.99,106.2,
EKG,6000028,CDM,730,RC,93005,HCPCS,Outpatient,,,118,88.5,,92.04,78,,73.632,percent of total billed charges,78% of total billed charges,74.34,63,,59.472,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,44.84,38,,35.872,percent of total billed charges,38% of total billed charges,44.84,38,,35.872,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,41.3,35,,33.04,percent of total billed charges,35% of total billed charges,79.38,67.275,,63.504,percent of total billed charges,67.275% of total billed charges,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,45.29,38.38,,36.232,percent of total billed charges,38.38% of total billed charges,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,72.85,61.74,,58.28,percent of total billed charges,61.74% of total billed charges,120.36,102,,96.288,percent of total billed charges,102% of total billed charges,44.84,38,,35.872,percent of total billed charges,38% of total billed charges,41.3,120.36,
PT DEBRIDEMENT EA ADD'L 20 SQ CM PER SES,9000013,CDM,420,RC,97598,HCPCS,Outpatient,,,118,88.5,,92.04,78,,73.632,percent of total billed charges,78% of total billed charges,74.34,63,,59.472,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,44.84,38,,35.872,percent of total billed charges,38% of total billed charges,44.84,38,,35.872,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,41.3,35,,33.04,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,45.29,38.38,,36.232,percent of total billed charges,38.38% of total billed charges,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,72.85,61.74,,58.28,percent of total billed charges,61.74% of total billed charges,120.36,102,,96.288,percent of total billed charges,102% of total billed charges,44.84,38,,35.872,percent of total billed charges,38% of total billed charges,41.3,145.93,
EMG LIMITED STUDY,9600016,CDM,922,RC,95870,HCPCS,Outpatient,,,118,88.5,,92.04,78,,73.632,percent of total billed charges,78% of total billed charges,74.34,63,,59.472,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,44.84,38,,35.872,percent of total billed charges,38% of total billed charges,44.84,38,,35.872,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,41.3,35,,33.04,percent of total billed charges,35% of total billed charges,79.38,67.275,,63.504,percent of total billed charges,67.275% of total billed charges,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,45.29,38.38,,36.232,percent of total billed charges,38.38% of total billed charges,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,72.85,61.74,,58.28,percent of total billed charges,61.74% of total billed charges,120.36,102,,96.288,percent of total billed charges,102% of total billed charges,44.84,38,,35.872,percent of total billed charges,38% of total billed charges,41.3,120.36,
LAP ELECTRODE L-HOOK 5X32,3000419,CDM,270,RC,,,Outpatient,,,118.88,89.16,,92.73,78,,74.184,percent of total billed charges,78% of total billed charges,74.89,63,,59.912,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,45.17,38,,36.136,percent of total billed charges,38% of total billed charges,45.17,38,,36.136,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,106.99,90,,85.592,percent of total billed charges,90% of total billed charges,41.61,35,,33.288,percent of total billed charges,35% of total billed charges,79.98,67.275,,63.984,percent of total billed charges,67.275% of total billed charges,95.1,80,,76.08,percent of total billed charges,80% of total billed charges,45.63,38.38,,36.504,percent of total billed charges,38.38% of total billed charges,95.1,80,,76.08,percent of total billed charges,80% of total billed charges,73.4,61.74,,58.72,percent of total billed charges,61.74% of total billed charges,121.26,102,,97.008,percent of total billed charges,102% of total billed charges,45.17,38,,36.136,percent of total billed charges,38% of total billed charges,41.61,121.26,
OUTPATIENT VISIT LEVEL 1,1001021,CDM,510,RC,99201,HCPCS,Outpatient,,,119,89.25,,92.82,78,,74.256,percent of total billed charges,78% of total billed charges,74.97,63,,59.976,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,45.22,38,,36.176,percent of total billed charges,38% of total billed charges,45.22,38,,36.176,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,107.1,90,,85.68,percent of total billed charges,90% of total billed charges,41.65,35,,33.32,percent of total billed charges,35% of total billed charges,133.52,67.275,,106.816,percent of total billed charges,67.275% of total billed charges,95.2,80,,76.16,percent of total billed charges,80% of total billed charges,45.67,38.38,,36.536,percent of total billed charges,38.38% of total billed charges,95.2,80,,76.16,percent of total billed charges,80% of total billed charges,73.47,61.74,,58.776,percent of total billed charges,61.74% of total billed charges,121.38,102,,97.104,percent of total billed charges,102% of total billed charges,45.22,38,,36.176,percent of total billed charges,38% of total billed charges,41.65,133.52,
OUTPATIENT SIMPLE PROCEDURE,1001027,CDM,510,RC,99201,HCPCS,Outpatient,,,119,89.25,,92.82,78,,74.256,percent of total billed charges,78% of total billed charges,74.97,63,,59.976,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,45.22,38,,36.176,percent of total billed charges,38% of total billed charges,45.22,38,,36.176,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,107.1,90,,85.68,percent of total billed charges,90% of total billed charges,41.65,35,,33.32,percent of total billed charges,35% of total billed charges,133.52,67.275,,106.816,percent of total billed charges,67.275% of total billed charges,95.2,80,,76.16,percent of total billed charges,80% of total billed charges,45.67,38.38,,36.536,percent of total billed charges,38.38% of total billed charges,95.2,80,,76.16,percent of total billed charges,80% of total billed charges,73.47,61.74,,58.776,percent of total billed charges,61.74% of total billed charges,121.38,102,,97.104,percent of total billed charges,102% of total billed charges,45.22,38,,36.176,percent of total billed charges,38% of total billed charges,41.65,133.52,
C02 FLOW SENSOR,3003090,CDM,270,RC,,,Outpatient,,,119.04,89.28,,92.85,78,,74.28,percent of total billed charges,78% of total billed charges,75,63,,60,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,45.24,38,,36.192,percent of total billed charges,38% of total billed charges,45.24,38,,36.192,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,107.14,90,,85.712,percent of total billed charges,90% of total billed charges,41.66,35,,33.328,percent of total billed charges,35% of total billed charges,80.08,67.275,,64.064,percent of total billed charges,67.275% of total billed charges,95.23,80,,76.184,percent of total billed charges,80% of total billed charges,45.69,38.38,,36.552,percent of total billed charges,38.38% of total billed charges,95.23,80,,76.184,percent of total billed charges,80% of total billed charges,73.5,61.74,,58.8,percent of total billed charges,61.74% of total billed charges,121.42,102,,97.136,percent of total billed charges,102% of total billed charges,45.24,38,,36.192,percent of total billed charges,38% of total billed charges,41.66,121.42,
EVENup leveler shoe - small,3005103,CDM,270,RC,,,Outpatient,,,119.96,89.97,,93.57,78,,74.856,percent of total billed charges,78% of total billed charges,75.57,63,,60.456,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,45.58,38,,36.464,percent of total billed charges,38% of total billed charges,45.58,38,,36.464,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,107.96,90,,86.368,percent of total billed charges,90% of total billed charges,41.99,35,,33.592,percent of total billed charges,35% of total billed charges,80.7,67.275,,64.56,percent of total billed charges,67.275% of total billed charges,95.97,80,,76.776,percent of total billed charges,80% of total billed charges,46.04,38.38,,36.832,percent of total billed charges,38.38% of total billed charges,95.97,80,,76.776,percent of total billed charges,80% of total billed charges,74.06,61.74,,59.248,percent of total billed charges,61.74% of total billed charges,122.36,102,,97.888,percent of total billed charges,102% of total billed charges,45.58,38,,36.464,percent of total billed charges,38% of total billed charges,41.99,122.36,
CURVED SCISSORS 5MM,3004054,CDM,270,RC,,,Outpatient,,,120,90,,93.6,78,,74.88,percent of total billed charges,78% of total billed charges,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,45.6,38,,36.48,percent of total billed charges,38% of total billed charges,45.6,38,,36.48,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,108,90,,86.4,percent of total billed charges,90% of total billed charges,42,35,,33.6,percent of total billed charges,35% of total billed charges,80.73,67.275,,64.584,percent of total billed charges,67.275% of total billed charges,96,80,,76.8,percent of total billed charges,80% of total billed charges,46.06,38.38,,36.848,percent of total billed charges,38.38% of total billed charges,96,80,,76.8,percent of total billed charges,80% of total billed charges,74.09,61.74,,59.272,percent of total billed charges,61.74% of total billed charges,122.4,102,,97.92,percent of total billed charges,102% of total billed charges,45.6,38,,36.48,percent of total billed charges,38% of total billed charges,42,122.4,
PLATELET COUNT,5000115,CDM,305,RC,85049,HCPCS,Outpatient,,,120,90,,93.6,78,,74.88,percent of total billed charges,78% of total billed charges,5.63,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,4.48,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.48,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,108,90,,86.4,percent of total billed charges,90% of total billed charges,5.91,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,80.73,67.275,,64.584,percent of total billed charges,67.275% of total billed charges,96,80,,76.8,percent of total billed charges,80% of total billed charges,4.52,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,96,80,,76.8,percent of total billed charges,80% of total billed charges,74.09,61.74,,59.272,percent of total billed charges,61.74% of total billed charges,5.74,102,,,Fee Schedule,102% of GA Medicaid Rate,4.48,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.48,108,
I&D SKIN ABSCESS 1,1001160,CDM,450,RC,,,Outpatient,,,121,90.75,,94.38,78,,75.504,percent of total billed charges,78% of total billed charges,76.23,63,,60.984,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,45.98,38,,36.784,percent of total billed charges,38% of total billed charges,45.98,38,,36.784,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,42.35,35,,33.88,percent of total billed charges,35% of total billed charges,81.4,67.275,,65.12,percent of total billed charges,67.275% of total billed charges,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,46.44,38.38,,37.152,percent of total billed charges,38.38% of total billed charges,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,74.71,61.74,,59.768,percent of total billed charges,61.74% of total billed charges,123.42,102,,98.736,percent of total billed charges,102% of total billed charges,45.98,38,,36.784,percent of total billed charges,38% of total billed charges,42.35,123.42,
I&D SKIN ABSCESS > 1,1001162,CDM,450,RC,,,Outpatient,,,121,90.75,,94.38,78,,75.504,percent of total billed charges,78% of total billed charges,76.23,63,,60.984,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,45.98,38,,36.784,percent of total billed charges,38% of total billed charges,45.98,38,,36.784,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,42.35,35,,33.88,percent of total billed charges,35% of total billed charges,81.4,67.275,,65.12,percent of total billed charges,67.275% of total billed charges,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,46.44,38.38,,37.152,percent of total billed charges,38.38% of total billed charges,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,74.71,61.74,,59.768,percent of total billed charges,61.74% of total billed charges,123.42,102,,98.736,percent of total billed charges,102% of total billed charges,45.98,38,,36.784,percent of total billed charges,38% of total billed charges,42.35,123.42,
GUIDEWIRE 1.1 MM,3006031,CDM,270,RC,,,Outpatient,,,121,90.75,,94.38,78,,75.504,percent of total billed charges,78% of total billed charges,76.23,63,,60.984,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,45.98,38,,36.784,percent of total billed charges,38% of total billed charges,45.98,38,,36.784,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,42.35,35,,33.88,percent of total billed charges,35% of total billed charges,81.4,67.275,,65.12,percent of total billed charges,67.275% of total billed charges,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,46.44,38.38,,37.152,percent of total billed charges,38.38% of total billed charges,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,74.71,61.74,,59.768,percent of total billed charges,61.74% of total billed charges,123.42,102,,98.736,percent of total billed charges,102% of total billed charges,45.98,38,,36.784,percent of total billed charges,38% of total billed charges,42.35,123.42,
Test of hormone in the blood,5001725,CDM,301,RC,83001,HCPCS,Outpatient,,,121,90.75,,94.38,78,,75.504,percent of total billed charges,78% of total billed charges,23.37,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.58,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.58,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,24.54,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,81.4,67.275,,65.12,percent of total billed charges,67.275% of total billed charges,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,18.77,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,74.71,61.74,,59.768,percent of total billed charges,61.74% of total billed charges,23.84,102,,,Fee Schedule,102% of GA Medicaid Rate,18.58,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.58,108.9,
ALPRAZOLAM,5001784,CDM,301,RC,80346,HCPCS,Outpatient,,,121,90.75,,94.38,78,,75.504,percent of total billed charges,78% of total billed charges,23.26,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,45.98,38,,36.784,percent of total billed charges,38% of total billed charges,45.98,38,,36.784,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,24.42,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,81.4,67.275,,65.12,percent of total billed charges,67.275% of total billed charges,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,46.44,38.38,,37.152,percent of total billed charges,38.38% of total billed charges,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,74.71,61.74,,59.768,percent of total billed charges,61.74% of total billed charges,23.73,102,,,Fee Schedule,102% of GA Medicaid Rate,45.98,38,,36.784,percent of total billed charges,38% of total billed charges,23.26,108.9,
Test of hormone in the blood,5001820,CDM,301,RC,83002,HCPCS,Outpatient,,,121,90.75,,94.38,78,,75.504,percent of total billed charges,78% of total billed charges,23.29,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.52,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.52,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,24.45,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,81.4,67.275,,65.12,percent of total billed charges,67.275% of total billed charges,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,18.71,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,74.71,61.74,,59.768,percent of total billed charges,61.74% of total billed charges,23.76,102,,,Fee Schedule,102% of GA Medicaid Rate,18.52,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.52,108.9,
XEMG H REFLEX; RECORD FROM GASTROC BILAT,9600025,CDM,922,RC,95934,HCPCS,Outpatient,,,121,90.75,,94.38,78,,75.504,percent of total billed charges,78% of total billed charges,76.23,63,,60.984,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,45.98,38,,36.784,percent of total billed charges,38% of total billed charges,45.98,38,,36.784,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,42.35,35,,33.88,percent of total billed charges,35% of total billed charges,81.4,67.275,,65.12,percent of total billed charges,67.275% of total billed charges,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,46.44,38.38,,37.152,percent of total billed charges,38.38% of total billed charges,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,74.71,61.74,,59.768,percent of total billed charges,61.74% of total billed charges,123.42,102,,98.736,percent of total billed charges,102% of total billed charges,45.98,38,,36.784,percent of total billed charges,38% of total billed charges,42.35,123.42,
STRAPPING LOWER EXTREMITY,1001092,CDM,450,RC,,,Outpatient,,,122,91.5,,95.16,78,,76.128,percent of total billed charges,78% of total billed charges,76.86,63,,61.488,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,46.36,38,,37.088,percent of total billed charges,38% of total billed charges,46.36,38,,37.088,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,42.7,35,,34.16,percent of total billed charges,35% of total billed charges,82.08,67.275,,65.664,percent of total billed charges,67.275% of total billed charges,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,46.82,38.38,,37.456,percent of total billed charges,38.38% of total billed charges,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,75.32,61.74,,60.256,percent of total billed charges,61.74% of total billed charges,124.44,102,,99.552,percent of total billed charges,102% of total billed charges,46.36,38,,37.088,percent of total billed charges,38% of total billed charges,42.7,124.44,
INJECTION SC/IM,1001120,CDM,450,RC,96372,HCPCS,Outpatient,,,122,91.5,,95.16,78,,76.128,percent of total billed charges,78% of total billed charges,76.86,63,,61.488,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,46.36,38,,37.088,percent of total billed charges,38% of total billed charges,46.36,38,,37.088,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,42.7,35,,34.16,percent of total billed charges,35% of total billed charges,82.08,67.275,,65.664,percent of total billed charges,67.275% of total billed charges,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,46.82,38.38,,37.456,percent of total billed charges,38.38% of total billed charges,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,75.32,61.74,,60.256,percent of total billed charges,61.74% of total billed charges,124.44,102,,99.552,percent of total billed charges,102% of total billed charges,46.36,38,,37.088,percent of total billed charges,38% of total billed charges,42.7,124.44,
INJ OF ANTIBIOTIC IM,1001124,CDM,450,RC,96372,HCPCS,Outpatient,,,122,91.5,,95.16,78,,76.128,percent of total billed charges,78% of total billed charges,76.86,63,,61.488,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,46.36,38,,37.088,percent of total billed charges,38% of total billed charges,46.36,38,,37.088,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,42.7,35,,34.16,percent of total billed charges,35% of total billed charges,82.08,67.275,,65.664,percent of total billed charges,67.275% of total billed charges,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,46.82,38.38,,37.456,percent of total billed charges,38.38% of total billed charges,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,75.32,61.74,,60.256,percent of total billed charges,61.74% of total billed charges,124.44,102,,99.552,percent of total billed charges,102% of total billed charges,46.36,38,,37.088,percent of total billed charges,38% of total billed charges,42.7,124.44,
Immunization administration by a medical assistant or nurse,1001146,CDM,450,RC,90471,HCPCS,Outpatient,,,122,91.5,,95.16,78,,76.128,percent of total billed charges,78% of total billed charges,76.86,63,,61.488,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,46.36,38,,37.088,percent of total billed charges,38% of total billed charges,46.36,38,,37.088,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,42.7,35,,34.16,percent of total billed charges,35% of total billed charges,82.08,67.275,,65.664,percent of total billed charges,67.275% of total billed charges,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,46.82,38.38,,37.456,percent of total billed charges,38.38% of total billed charges,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,75.32,61.74,,60.256,percent of total billed charges,61.74% of total billed charges,124.44,102,,99.552,percent of total billed charges,102% of total billed charges,46.36,38,,37.088,percent of total billed charges,38% of total billed charges,42.7,124.44,
NOSEBLEED CAUTERIZATION,1001218,CDM,450,RC,,,Outpatient,,,122,91.5,,95.16,78,,76.128,percent of total billed charges,78% of total billed charges,76.86,63,,61.488,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,46.36,38,,37.088,percent of total billed charges,38% of total billed charges,46.36,38,,37.088,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,42.7,35,,34.16,percent of total billed charges,35% of total billed charges,82.08,67.275,,65.664,percent of total billed charges,67.275% of total billed charges,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,46.82,38.38,,37.456,percent of total billed charges,38.38% of total billed charges,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,75.32,61.74,,60.256,percent of total billed charges,61.74% of total billed charges,124.44,102,,99.552,percent of total billed charges,102% of total billed charges,46.36,38,,37.088,percent of total billed charges,38% of total billed charges,42.7,124.44,
INFUSION DX SEQUENTIAL TO 1 HR,1001277,CDM,450,RC,96367,HCPCS,Outpatient,,,122,91.5,,95.16,78,,76.128,percent of total billed charges,78% of total billed charges,76.86,63,,61.488,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,46.36,38,,37.088,percent of total billed charges,38% of total billed charges,46.36,38,,37.088,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,42.7,35,,34.16,percent of total billed charges,35% of total billed charges,82.08,67.275,,65.664,percent of total billed charges,67.275% of total billed charges,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,46.82,38.38,,37.456,percent of total billed charges,38.38% of total billed charges,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,75.32,61.74,,60.256,percent of total billed charges,61.74% of total billed charges,124.44,102,,99.552,percent of total billed charges,102% of total billed charges,46.36,38,,37.088,percent of total billed charges,38% of total billed charges,42.7,124.44,
Immunization administration by a medical assistant or nurse,1001282,CDM,771,RC,90471,HCPCS,Outpatient,,,122,91.5,,95.16,78,,76.128,percent of total billed charges,78% of total billed charges,76.86,63,,61.488,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,46.36,38,,37.088,percent of total billed charges,38% of total billed charges,46.36,38,,37.088,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,42.7,35,,34.16,percent of total billed charges,35% of total billed charges,82.08,67.275,,65.664,percent of total billed charges,67.275% of total billed charges,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,46.82,38.38,,37.456,percent of total billed charges,38.38% of total billed charges,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,75.32,61.74,,60.256,percent of total billed charges,61.74% of total billed charges,124.44,102,,99.552,percent of total billed charges,102% of total billed charges,46.36,38,,37.088,percent of total billed charges,38% of total billed charges,42.7,124.44,
C-TELOPEPTIDE (CTX),5000744,CDM,301,RC,82523,HCPCS,Outpatient,,,122,91.5,,95.16,78,,76.128,percent of total billed charges,78% of total billed charges,23.5,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.68,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.68,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,24.68,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,82.08,67.275,,65.664,percent of total billed charges,67.275% of total billed charges,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,18.87,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,75.32,61.74,,60.256,percent of total billed charges,61.74% of total billed charges,23.97,102,,,Fee Schedule,102% of GA Medicaid Rate,18.68,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.68,109.8,
Kidney function panel test,5001747,CDM,301,RC,80069,HCPCS,Outpatient,,,122,91.5,,95.16,78,,76.128,percent of total billed charges,78% of total billed charges,10.92,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.68,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.68,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,11.47,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,82.08,67.275,,65.664,percent of total billed charges,67.275% of total billed charges,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,8.77,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,75.32,61.74,,60.256,percent of total billed charges,61.74% of total billed charges,11.14,102,,,Fee Schedule,102% of GA Medicaid Rate,8.68,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.68,109.8,
CARBOXYHEMOGLOBIN,5001778,CDM,301,RC,82375,HCPCS,Outpatient,,,122,91.5,,95.16,78,,76.128,percent of total billed charges,78% of total billed charges,3.62,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.32,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.32,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,3.8,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,82.08,67.275,,65.664,percent of total billed charges,67.275% of total billed charges,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,12.44,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,75.32,61.74,,60.256,percent of total billed charges,61.74% of total billed charges,3.69,102,,,Fee Schedule,102% of GA Medicaid Rate,12.32,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.62,109.8,
N-TELOPEPTIDE (NTX),5001893,CDM,301,RC,82523,HCPCS,Outpatient,,,122,91.5,,95.16,78,,76.128,percent of total billed charges,78% of total billed charges,23.5,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.68,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.68,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,24.68,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,82.08,67.275,,65.664,percent of total billed charges,67.275% of total billed charges,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,18.87,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,75.32,61.74,,60.256,percent of total billed charges,61.74% of total billed charges,23.97,102,,,Fee Schedule,102% of GA Medicaid Rate,18.68,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.68,109.8,
CULTURE ANAEROBIC BACTERIA,5000202,CDM,306,RC,87076,HCPCS,Outpatient,,,123,92.25,,95.94,78,,76.752,percent of total billed charges,78% of total billed charges,10.16,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,10.67,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,82.75,67.275,,66.2,percent of total billed charges,67.275% of total billed charges,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,8.16,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,75.94,61.74,,60.752,percent of total billed charges,61.74% of total billed charges,10.36,102,,,Fee Schedule,102% of GA Medicaid Rate,8.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.08,110.7,
Culture of the urine to determine bacterial infection,5000205,CDM,306,RC,87088,HCPCS,Outpatient,,,123,92.25,,95.94,78,,76.752,percent of total billed charges,78% of total billed charges,10.18,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,10.69,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,82.75,67.275,,66.2,percent of total billed charges,67.275% of total billed charges,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,8.17,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,75.94,61.74,,60.752,percent of total billed charges,61.74% of total billed charges,10.38,102,,,Fee Schedule,102% of GA Medicaid Rate,8.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.09,110.7,
REF URINE ID & SENS,5000206,CDM,300,RC,87076,HCPCS,Outpatient,,,123,92.25,,95.94,78,,76.752,percent of total billed charges,78% of total billed charges,10.16,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,10.67,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,82.75,67.275,,66.2,percent of total billed charges,67.275% of total billed charges,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,8.16,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,75.94,61.74,,60.752,percent of total billed charges,61.74% of total billed charges,10.36,102,,,Fee Schedule,102% of GA Medicaid Rate,8.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.08,110.7,
ANAEROBE ID,5000211,CDM,306,RC,87076,HCPCS,Outpatient,,,123,92.25,,95.94,78,,76.752,percent of total billed charges,78% of total billed charges,10.16,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,10.67,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,82.75,67.275,,66.2,percent of total billed charges,67.275% of total billed charges,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,8.16,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,75.94,61.74,,60.752,percent of total billed charges,61.74% of total billed charges,10.36,102,,,Fee Schedule,102% of GA Medicaid Rate,8.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.08,110.7,
"Blood test, comprehensive group of blood chemicals",5000765,CDM,301,RC,80053,HCPCS,Outpatient,,,123,92.25,,95.94,78,,76.752,percent of total billed charges,78% of total billed charges,13.29,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,10.56,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.56,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,13.95,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,82.75,67.275,,66.2,percent of total billed charges,67.275% of total billed charges,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,10.67,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,75.94,61.74,,60.752,percent of total billed charges,61.74% of total billed charges,13.56,102,,,Fee Schedule,102% of GA Medicaid Rate,10.56,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.56,110.7,
VALPROIC ACID,5001635,CDM,301,RC,80164,HCPCS,Outpatient,,,123,92.25,,95.94,78,,76.752,percent of total billed charges,78% of total billed charges,14.27,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,14.98,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,82.75,67.275,,66.2,percent of total billed charges,67.275% of total billed charges,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,13.68,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,75.94,61.74,,60.752,percent of total billed charges,61.74% of total billed charges,14.56,102,,,Fee Schedule,102% of GA Medicaid Rate,13.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.54,110.7,
ERYTHROPOIETIN,5001823,CDM,301,RC,82668,HCPCS,Outpatient,,,123,92.25,,95.94,78,,76.752,percent of total billed charges,78% of total billed charges,23.63,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.79,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.79,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,24.81,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,82.75,67.275,,66.2,percent of total billed charges,67.275% of total billed charges,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,18.98,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,75.94,61.74,,60.752,percent of total billed charges,61.74% of total billed charges,24.1,102,,,Fee Schedule,102% of GA Medicaid Rate,18.79,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.79,110.7,
BRA SURGICAL MEDIUM,3004107,CDM,270,RC,,,Outpatient,,,123.92,92.94,,96.66,78,,77.328,percent of total billed charges,78% of total billed charges,78.07,63,,62.456,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,47.09,38,,37.672,percent of total billed charges,38% of total billed charges,47.09,38,,37.672,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,111.53,90,,89.224,percent of total billed charges,90% of total billed charges,43.37,35,,34.696,percent of total billed charges,35% of total billed charges,83.37,67.275,,66.696,percent of total billed charges,67.275% of total billed charges,99.14,80,,79.312,percent of total billed charges,80% of total billed charges,47.56,38.38,,38.048,percent of total billed charges,38.38% of total billed charges,99.14,80,,79.312,percent of total billed charges,80% of total billed charges,76.51,61.74,,61.208,percent of total billed charges,61.74% of total billed charges,126.4,102,,101.12,percent of total billed charges,102% of total billed charges,47.09,38,,37.672,percent of total billed charges,38% of total billed charges,43.37,126.4,
BRA SURGICAL LARGE,3005010,CDM,270,RC,,,Outpatient,,,123.92,92.94,,96.66,78,,77.328,percent of total billed charges,78% of total billed charges,78.07,63,,62.456,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,47.09,38,,37.672,percent of total billed charges,38% of total billed charges,47.09,38,,37.672,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,111.53,90,,89.224,percent of total billed charges,90% of total billed charges,43.37,35,,34.696,percent of total billed charges,35% of total billed charges,83.37,67.275,,66.696,percent of total billed charges,67.275% of total billed charges,99.14,80,,79.312,percent of total billed charges,80% of total billed charges,47.56,38.38,,38.048,percent of total billed charges,38.38% of total billed charges,99.14,80,,79.312,percent of total billed charges,80% of total billed charges,76.51,61.74,,61.208,percent of total billed charges,61.74% of total billed charges,126.4,102,,101.12,percent of total billed charges,102% of total billed charges,47.09,38,,37.672,percent of total billed charges,38% of total billed charges,43.37,126.4,
Basic metabolic panel,5000016,CDM,301,RC,80048,HCPCS,Outpatient,,,124,93,,96.72,78,,77.376,percent of total billed charges,78% of total billed charges,10.65,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.46,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.46,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,111.6,90,,89.28,percent of total billed charges,90% of total billed charges,11.18,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,83.42,67.275,,66.736,percent of total billed charges,67.275% of total billed charges,99.2,80,,79.36,percent of total billed charges,80% of total billed charges,8.54,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,99.2,80,,79.36,percent of total billed charges,80% of total billed charges,76.56,61.74,,61.248,percent of total billed charges,61.74% of total billed charges,10.86,102,,,Fee Schedule,102% of GA Medicaid Rate,8.46,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.46,111.6,
ARSENIC-BLOOD,5000239,CDM,301,RC,82175,HCPCS,Outpatient,,,124,93,,96.72,78,,77.376,percent of total billed charges,78% of total billed charges,23.86,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.97,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.97,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,111.6,90,,89.28,percent of total billed charges,90% of total billed charges,25.05,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,83.42,67.275,,66.736,percent of total billed charges,67.275% of total billed charges,99.2,80,,79.36,percent of total billed charges,80% of total billed charges,19.16,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,99.2,80,,79.36,percent of total billed charges,80% of total billed charges,76.56,61.74,,61.248,percent of total billed charges,61.74% of total billed charges,24.34,102,,,Fee Schedule,102% of GA Medicaid Rate,18.97,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.97,111.6,
PHENOBARBITAL LEVEL,5001416,CDM,301,RC,80184,HCPCS,Outpatient,,,124,93,,96.72,78,,77.376,percent of total billed charges,78% of total billed charges,14.41,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,15.3,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.3,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,111.6,90,,89.28,percent of total billed charges,90% of total billed charges,15.13,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,83.42,67.275,,66.736,percent of total billed charges,67.275% of total billed charges,99.2,80,,79.36,percent of total billed charges,80% of total billed charges,15.45,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,99.2,80,,79.36,percent of total billed charges,80% of total billed charges,76.56,61.74,,61.248,percent of total billed charges,61.74% of total billed charges,14.7,102,,,Fee Schedule,102% of GA Medicaid Rate,15.3,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.41,111.6,
ARSENIC 24 HR URINE,5001858,CDM,301,RC,82175,HCPCS,Outpatient,,,124,93,,96.72,78,,77.376,percent of total billed charges,78% of total billed charges,23.86,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.97,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.97,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,111.6,90,,89.28,percent of total billed charges,90% of total billed charges,25.05,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,83.42,67.275,,66.736,percent of total billed charges,67.275% of total billed charges,99.2,80,,79.36,percent of total billed charges,80% of total billed charges,19.16,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,99.2,80,,79.36,percent of total billed charges,80% of total billed charges,76.56,61.74,,61.248,percent of total billed charges,61.74% of total billed charges,24.34,102,,,Fee Schedule,102% of GA Medicaid Rate,18.97,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.97,111.6,
"ARSENIC, RANDOM URINE",5002024,CDM,301,RC,82175,HCPCS,Outpatient,,,124,93,,96.72,78,,77.376,percent of total billed charges,78% of total billed charges,23.86,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.97,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.97,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,111.6,90,,89.28,percent of total billed charges,90% of total billed charges,25.05,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,83.42,67.275,,66.736,percent of total billed charges,67.275% of total billed charges,99.2,80,,79.36,percent of total billed charges,80% of total billed charges,19.16,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,99.2,80,,79.36,percent of total billed charges,80% of total billed charges,76.56,61.74,,61.248,percent of total billed charges,61.74% of total billed charges,24.34,102,,,Fee Schedule,102% of GA Medicaid Rate,18.97,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.97,111.6,
PATH PAP BRUSH ADD 2,5002209,CDM,311,RC,88160,HCPCS,Outpatient,,,124,93,,96.72,78,,77.376,percent of total billed charges,78% of total billed charges,46.13,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,47.12,38,,37.696,percent of total billed charges,38% of total billed charges,47.12,38,,37.696,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,111.6,90,,89.28,percent of total billed charges,90% of total billed charges,48.44,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,83.42,67.275,,66.736,percent of total billed charges,67.275% of total billed charges,99.2,80,,79.36,percent of total billed charges,80% of total billed charges,47.59,38.38,,38.072,percent of total billed charges,38.38% of total billed charges,99.2,80,,79.36,percent of total billed charges,80% of total billed charges,76.56,61.74,,61.248,percent of total billed charges,61.74% of total billed charges,47.05,102,,,Fee Schedule,102% of GA Medicaid Rate,47.12,38,,37.696,percent of total billed charges,38% of total billed charges,46.13,111.6,
PATH CONSULTATION/REFERD SLIDE,5003713,CDM,312,RC,88321,HCPCS,Outpatient,,,124,93,,96.72,78,,77.376,percent of total billed charges,78% of total billed charges,59.02,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,47.12,38,,37.696,percent of total billed charges,38% of total billed charges,47.12,38,,37.696,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,111.6,90,,89.28,percent of total billed charges,90% of total billed charges,61.97,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,83.42,67.275,,66.736,percent of total billed charges,67.275% of total billed charges,99.2,80,,79.36,percent of total billed charges,80% of total billed charges,47.59,38.38,,38.072,percent of total billed charges,38.38% of total billed charges,99.2,80,,79.36,percent of total billed charges,80% of total billed charges,76.56,61.74,,61.248,percent of total billed charges,61.74% of total billed charges,60.2,102,,,Fee Schedule,102% of GA Medicaid Rate,47.12,38,,37.696,percent of total billed charges,38% of total billed charges,47.12,111.6,
Basic metabolic panel,5009156,CDM,301,RC,80048,HCPCS,Outpatient,,,124,93,,96.72,78,,77.376,percent of total billed charges,78% of total billed charges,10.65,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.46,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.46,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,111.6,90,,89.28,percent of total billed charges,90% of total billed charges,11.18,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,83.42,67.275,,66.736,percent of total billed charges,67.275% of total billed charges,99.2,80,,79.36,percent of total billed charges,80% of total billed charges,8.54,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,99.2,80,,79.36,percent of total billed charges,80% of total billed charges,76.56,61.74,,61.248,percent of total billed charges,61.74% of total billed charges,10.86,102,,,Fee Schedule,102% of GA Medicaid Rate,8.46,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.46,111.6,
INDIAN INK,3007000,CDM,270,RC,,,Outpatient,,,124.44,93.33,,97.06,78,,77.648,percent of total billed charges,78% of total billed charges,78.4,63,,62.72,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,47.29,38,,37.832,percent of total billed charges,38% of total billed charges,47.29,38,,37.832,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,112,90,,89.6,percent of total billed charges,90% of total billed charges,43.55,35,,34.84,percent of total billed charges,35% of total billed charges,83.72,67.275,,66.976,percent of total billed charges,67.275% of total billed charges,99.55,80,,79.64,percent of total billed charges,80% of total billed charges,47.76,38.38,,38.208,percent of total billed charges,38.38% of total billed charges,99.55,80,,79.64,percent of total billed charges,80% of total billed charges,76.83,61.74,,61.464,percent of total billed charges,61.74% of total billed charges,126.93,102,,101.544,percent of total billed charges,102% of total billed charges,47.29,38,,37.832,percent of total billed charges,38% of total billed charges,43.55,126.93,
COXSACKIE B AB,5000504,CDM,302,RC,,,Outpatient,,,125,93.75,,97.5,78,,78,percent of total billed charges,78% of total billed charges,78.75,63,,63,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,47.5,38,,38,percent of total billed charges,38% of total billed charges,47.5,38,,38,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,112.5,90,,90,percent of total billed charges,90% of total billed charges,43.75,35,,35,percent of total billed charges,35% of total billed charges,84.09,67.275,,67.272,percent of total billed charges,67.275% of total billed charges,100,80,,80,percent of total billed charges,80% of total billed charges,47.98,38.38,,38.384,percent of total billed charges,38.38% of total billed charges,100,80,,80,percent of total billed charges,80% of total billed charges,77.18,61.74,,61.744,percent of total billed charges,61.74% of total billed charges,127.5,102,,102,percent of total billed charges,102% of total billed charges,47.5,38,,38,percent of total billed charges,38% of total billed charges,43.75,127.5,
HEPATITIS BE ANTIGEN,5001764,CDM,302,RC,87350,HCPCS,Outpatient,,,125,93.75,,97.5,78,,78,percent of total billed charges,78% of total billed charges,14.49,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,11.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,112.5,90,,90,percent of total billed charges,90% of total billed charges,15.21,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,84.09,67.275,,67.272,percent of total billed charges,67.275% of total billed charges,100,80,,80,percent of total billed charges,80% of total billed charges,11.65,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,100,80,,80,percent of total billed charges,80% of total billed charges,77.18,61.74,,61.744,percent of total billed charges,61.74% of total billed charges,14.78,102,,,Fee Schedule,102% of GA Medicaid Rate,11.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.53,112.5,
HAPTOGLOBIN,5001830,CDM,301,RC,83010,HCPCS,Outpatient,,,125,93.75,,97.5,78,,78,percent of total billed charges,78% of total billed charges,4.69,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.58,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.58,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,112.5,90,,90,percent of total billed charges,90% of total billed charges,4.92,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,84.09,67.275,,67.272,percent of total billed charges,67.275% of total billed charges,100,80,,80,percent of total billed charges,80% of total billed charges,12.71,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,100,80,,80,percent of total billed charges,80% of total billed charges,77.18,61.74,,61.744,percent of total billed charges,61.74% of total billed charges,4.78,102,,,Fee Schedule,102% of GA Medicaid Rate,12.58,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.69,112.5,
BETA HYDROXYBUTYRATE,5002089,CDM,301,RC,82010,HCPCS,Outpatient,,,125,93.75,,97.5,78,,78,percent of total billed charges,78% of total billed charges,10.28,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.17,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.17,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,112.5,90,,90,percent of total billed charges,90% of total billed charges,10.79,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,84.09,67.275,,67.272,percent of total billed charges,67.275% of total billed charges,100,80,,80,percent of total billed charges,80% of total billed charges,8.25,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,100,80,,80,percent of total billed charges,80% of total billed charges,77.18,61.74,,61.744,percent of total billed charges,61.74% of total billed charges,10.49,102,,,Fee Schedule,102% of GA Medicaid Rate,8.17,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.17,112.5,
Detection test for human papillomavirus (hpv),5087624,CDM,300,RC,87624,HCPCS,Outpatient,,,125,93.75,,97.5,78,,78,percent of total billed charges,78% of total billed charges,18.25,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,112.5,90,,90,percent of total billed charges,90% of total billed charges,19.16,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,84.09,67.275,,67.272,percent of total billed charges,67.275% of total billed charges,100,80,,80,percent of total billed charges,80% of total billed charges,35.44,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,100,80,,80,percent of total billed charges,80% of total billed charges,77.18,61.74,,61.744,percent of total billed charges,61.74% of total billed charges,18.62,102,,,Fee Schedule,102% of GA Medicaid Rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.25,112.5,
TRACHEOSTOMY DISP 8DCFS,3004105,CDM,270,RC,,,Outpatient,,,125.2,93.9,,97.66,78,,78.128,percent of total billed charges,78% of total billed charges,78.88,63,,63.104,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,47.58,38,,38.064,percent of total billed charges,38% of total billed charges,47.58,38,,38.064,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,112.68,90,,90.144,percent of total billed charges,90% of total billed charges,43.82,35,,35.056,percent of total billed charges,35% of total billed charges,84.23,67.275,,67.384,percent of total billed charges,67.275% of total billed charges,100.16,80,,80.128,percent of total billed charges,80% of total billed charges,48.05,38.38,,38.44,percent of total billed charges,38.38% of total billed charges,100.16,80,,80.128,percent of total billed charges,80% of total billed charges,77.3,61.74,,61.84,percent of total billed charges,61.74% of total billed charges,127.7,102,,102.16,percent of total billed charges,102% of total billed charges,47.58,38,,38.064,percent of total billed charges,38% of total billed charges,43.82,127.7,
CHLAMYD DNA (EYE SWAB),5000253,CDM,306,RC,87490,HCPCS,Outpatient,,,126,94.5,,98.28,78,,78.624,percent of total billed charges,78% of total billed charges,24.8,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,22.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,22.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,26.04,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,84.77,67.275,,67.816,percent of total billed charges,67.275% of total billed charges,100.8,80,,80.64,percent of total billed charges,80% of total billed charges,22.98,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,100.8,80,,80.64,percent of total billed charges,80% of total billed charges,77.79,61.74,,62.232,percent of total billed charges,61.74% of total billed charges,25.3,102,,,Fee Schedule,102% of GA Medicaid Rate,22.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,22.75,113.4,
HIP ABDUCTION WEDGE - SMALL,3005020,CDM,270,RC,,,Outpatient,,,126.36,94.77,,98.56,78,,78.848,percent of total billed charges,78% of total billed charges,79.61,63,,63.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,48.02,38,,38.416,percent of total billed charges,38% of total billed charges,48.02,38,,38.416,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,113.72,90,,90.976,percent of total billed charges,90% of total billed charges,44.23,35,,35.384,percent of total billed charges,35% of total billed charges,85.01,67.275,,68.008,percent of total billed charges,67.275% of total billed charges,101.09,80,,80.872,percent of total billed charges,80% of total billed charges,48.5,38.38,,38.8,percent of total billed charges,38.38% of total billed charges,101.09,80,,80.872,percent of total billed charges,80% of total billed charges,78.01,61.74,,62.408,percent of total billed charges,61.74% of total billed charges,128.89,102,,103.112,percent of total billed charges,102% of total billed charges,48.02,38,,38.416,percent of total billed charges,38% of total billed charges,44.23,128.89,
HIV-2 CONFIRMATION WB,5000022,CDM,302,RC,86689,HCPCS,Outpatient,,,127,95.25,,99.06,78,,79.248,percent of total billed charges,78% of total billed charges,21.12,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,19.35,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,19.35,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,22.18,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,85.44,67.275,,68.352,percent of total billed charges,67.275% of total billed charges,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,19.54,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,78.41,61.74,,62.728,percent of total billed charges,61.74% of total billed charges,21.54,102,,,Fee Schedule,102% of GA Medicaid Rate,19.35,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,19.35,114.3,
Test to measure arterial blood gases,5000125,CDM,301,RC,82803,HCPCS,Outpatient,,,127,95.25,,99.06,78,,79.248,percent of total billed charges,78% of total billed charges,24.34,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,26.07,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,26.07,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,25.56,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,85.44,67.275,,68.352,percent of total billed charges,67.275% of total billed charges,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,26.33,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,78.41,61.74,,62.728,percent of total billed charges,61.74% of total billed charges,24.83,102,,,Fee Schedule,102% of GA Medicaid Rate,26.07,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,24.34,114.3,
Test to measure arterial blood gases,5000126,CDM,301,RC,82803,HCPCS,Outpatient,,,127,95.25,,99.06,78,,79.248,percent of total billed charges,78% of total billed charges,24.34,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,26.07,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,26.07,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,25.56,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,85.44,67.275,,68.352,percent of total billed charges,67.275% of total billed charges,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,26.33,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,78.41,61.74,,62.728,percent of total billed charges,61.74% of total billed charges,24.83,102,,,Fee Schedule,102% of GA Medicaid Rate,26.07,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,24.34,114.3,
HEPARIN ANTI Xa,5000300,CDM,300,RC,85520,HCPCS,Outpatient,,,127,95.25,,99.06,78,,79.248,percent of total billed charges,78% of total billed charges,16.46,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,17.28,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,85.44,67.275,,68.352,percent of total billed charges,67.275% of total billed charges,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,13.22,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,78.41,61.74,,62.728,percent of total billed charges,61.74% of total billed charges,16.79,102,,,Fee Schedule,102% of GA Medicaid Rate,13.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.09,114.3,
HERPES VIRUS I/2 IGM,5000774,CDM,302,RC,86696,HCPCS,Outpatient,,,127,95.25,,99.06,78,,79.248,percent of total billed charges,78% of total billed charges,24.35,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,19.35,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,19.35,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,25.57,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,85.44,67.275,,68.352,percent of total billed charges,67.275% of total billed charges,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,19.54,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,78.41,61.74,,62.728,percent of total billed charges,61.74% of total billed charges,24.84,102,,,Fee Schedule,102% of GA Medicaid Rate,19.35,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,19.35,114.3,
"PAIN MGNT WITH OPIATES, W/ CONFIRMATION",5001674,CDM,301,RC,80361,HCPCS,Outpatient,,,127,95.25,,99.06,78,,79.248,percent of total billed charges,78% of total billed charges,25.97,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,48.26,38,,38.608,percent of total billed charges,38% of total billed charges,48.26,38,,38.608,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,27.27,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,85.44,67.275,,68.352,percent of total billed charges,67.275% of total billed charges,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,48.74,38.38,,38.992,percent of total billed charges,38.38% of total billed charges,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,78.41,61.74,,62.728,percent of total billed charges,61.74% of total billed charges,26.49,102,,,Fee Schedule,102% of GA Medicaid Rate,48.26,38,,38.608,percent of total billed charges,38% of total billed charges,25.97,114.3,
"OPIATES, GC/MS CONFIRMATION",5001675,CDM,301,RC,80361,HCPCS,Outpatient,,,127,95.25,,99.06,78,,79.248,percent of total billed charges,78% of total billed charges,25.97,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,48.26,38,,38.608,percent of total billed charges,38% of total billed charges,48.26,38,,38.608,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,27.27,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,85.44,67.275,,68.352,percent of total billed charges,67.275% of total billed charges,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,48.74,38.38,,38.992,percent of total billed charges,38.38% of total billed charges,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,78.41,61.74,,62.728,percent of total billed charges,61.74% of total billed charges,26.49,102,,,Fee Schedule,102% of GA Medicaid Rate,48.26,38,,38.608,percent of total billed charges,38% of total billed charges,25.97,114.3,
PROLACTIN,5001722,CDM,301,RC,84146,HCPCS,Outpatient,,,127,95.25,,99.06,78,,79.248,percent of total billed charges,78% of total billed charges,24.37,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,19.38,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,19.38,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,25.59,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,85.44,67.275,,68.352,percent of total billed charges,67.275% of total billed charges,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,19.57,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,78.41,61.74,,62.728,percent of total billed charges,61.74% of total billed charges,24.86,102,,,Fee Schedule,102% of GA Medicaid Rate,19.38,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,19.38,114.3,
HIV-1 CONFIRMATION WB,5001822,CDM,302,RC,86689,HCPCS,Outpatient,,,127,95.25,,99.06,78,,79.248,percent of total billed charges,78% of total billed charges,21.12,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,19.35,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,19.35,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,22.18,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,85.44,67.275,,68.352,percent of total billed charges,67.275% of total billed charges,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,19.54,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,78.41,61.74,,62.728,percent of total billed charges,61.74% of total billed charges,21.54,102,,,Fee Schedule,102% of GA Medicaid Rate,19.35,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,19.35,114.3,
RICKETTSIAL AB-RMSF,5001990,CDM,302,RC,86757,HCPCS,Outpatient,,,127,95.25,,99.06,78,,79.248,percent of total billed charges,78% of total billed charges,24.35,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,19.35,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,19.35,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,25.57,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,85.44,67.275,,68.352,percent of total billed charges,67.275% of total billed charges,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,19.54,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,78.41,61.74,,62.728,percent of total billed charges,61.74% of total billed charges,24.84,102,,,Fee Schedule,102% of GA Medicaid Rate,19.35,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,19.35,114.3,
RICKETTSIAL AB TYPHUS,5001991,CDM,302,RC,86757,HCPCS,Outpatient,,,127,95.25,,99.06,78,,79.248,percent of total billed charges,78% of total billed charges,24.35,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,19.35,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,19.35,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,25.57,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,85.44,67.275,,68.352,percent of total billed charges,67.275% of total billed charges,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,19.54,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,78.41,61.74,,62.728,percent of total billed charges,61.74% of total billed charges,24.84,102,,,Fee Schedule,102% of GA Medicaid Rate,19.35,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,19.35,114.3,
HERPES SIMPLEX II IGG AB,5003708,CDM,302,RC,86696,HCPCS,Outpatient,,,127,95.25,,99.06,78,,79.248,percent of total billed charges,78% of total billed charges,24.35,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,19.35,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,19.35,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,25.57,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,85.44,67.275,,68.352,percent of total billed charges,67.275% of total billed charges,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,19.54,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,78.41,61.74,,62.728,percent of total billed charges,61.74% of total billed charges,24.84,102,,,Fee Schedule,102% of GA Medicaid Rate,19.35,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,19.35,114.3,
REPAIR OF NAIL PLATE,1001176,CDM,450,RC,,,Outpatient,,,128,96,,99.84,78,,79.872,percent of total billed charges,78% of total billed charges,80.64,63,,64.512,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,48.64,38,,38.912,percent of total billed charges,38% of total billed charges,48.64,38,,38.912,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,115.2,90,,92.16,percent of total billed charges,90% of total billed charges,44.8,35,,35.84,percent of total billed charges,35% of total billed charges,86.11,67.275,,68.888,percent of total billed charges,67.275% of total billed charges,102.4,80,,81.92,percent of total billed charges,80% of total billed charges,49.13,38.38,,39.304,percent of total billed charges,38.38% of total billed charges,102.4,80,,81.92,percent of total billed charges,80% of total billed charges,79.03,61.74,,63.224,percent of total billed charges,61.74% of total billed charges,130.56,102,,104.448,percent of total billed charges,102% of total billed charges,48.64,38,,38.912,percent of total billed charges,38% of total billed charges,44.8,130.56,
KNEE IMMOBILIZER BARIATRIC,3005353,CDM,270,RC,,,Outpatient,,,128.36,96.27,,100.12,78,,80.096,percent of total billed charges,78% of total billed charges,80.87,63,,64.696,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,48.78,38,,39.024,percent of total billed charges,38% of total billed charges,48.78,38,,39.024,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,115.52,90,,92.416,percent of total billed charges,90% of total billed charges,44.93,35,,35.944,percent of total billed charges,35% of total billed charges,86.35,67.275,,69.08,percent of total billed charges,67.275% of total billed charges,102.69,80,,82.152,percent of total billed charges,80% of total billed charges,49.26,38.38,,39.408,percent of total billed charges,38.38% of total billed charges,102.69,80,,82.152,percent of total billed charges,80% of total billed charges,79.25,61.74,,63.4,percent of total billed charges,61.74% of total billed charges,130.93,102,,104.744,percent of total billed charges,102% of total billed charges,48.78,38,,39.024,percent of total billed charges,38% of total billed charges,44.93,130.93,
CULTURE C-DIFF TOXIN B TISSUE,5000506,CDM,306,RC,87230,HCPCS,Outpatient,,,129,96.75,,100.62,78,,80.496,percent of total billed charges,78% of total billed charges,24.83,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,19.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,19.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,26.07,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,86.78,67.275,,69.424,percent of total billed charges,67.275% of total billed charges,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,19.94,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,79.64,61.74,,63.712,percent of total billed charges,61.74% of total billed charges,25.33,102,,,Fee Schedule,102% of GA Medicaid Rate,19.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,19.74,116.1,
.C DIFF COM ANTI A&B,5000512,CDM,306,RC,87230,HCPCS,Outpatient,,,129,96.75,,100.62,78,,80.496,percent of total billed charges,78% of total billed charges,24.83,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,19.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,19.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,26.07,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,86.78,67.275,,69.424,percent of total billed charges,67.275% of total billed charges,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,19.94,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,79.64,61.74,,63.712,percent of total billed charges,61.74% of total billed charges,25.33,102,,,Fee Schedule,102% of GA Medicaid Rate,19.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,19.74,116.1,
PLASMA PROTEIN A (PAPP-A),5001667,CDM,301,RC,84163,HCPCS,Outpatient,,,129,96.75,,100.62,78,,80.496,percent of total billed charges,78% of total billed charges,8.07,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,15.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,8.47,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,86.78,67.275,,69.424,percent of total billed charges,67.275% of total billed charges,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,15.2,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,79.64,61.74,,63.712,percent of total billed charges,61.74% of total billed charges,8.23,102,,,Fee Schedule,102% of GA Medicaid Rate,15.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.07,116.1,
MYCOBACTERIUM ID,5002088,CDM,306,RC,87149,HCPCS,Outpatient,,,129,96.75,,100.62,78,,80.496,percent of total billed charges,78% of total billed charges,24.8,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,20.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,26.04,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,86.78,67.275,,69.424,percent of total billed charges,67.275% of total billed charges,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,20.25,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,79.64,61.74,,63.712,percent of total billed charges,61.74% of total billed charges,25.3,102,,,Fee Schedule,102% of GA Medicaid Rate,20.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.05,116.1,
GASTROSTOMY TUBE 18FR,3001618,CDM,270,RC,,,Outpatient,,,129.28,96.96,,100.84,78,,80.672,percent of total billed charges,78% of total billed charges,81.45,63,,65.16,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,49.13,38,,39.304,percent of total billed charges,38% of total billed charges,49.13,38,,39.304,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,116.35,90,,93.08,percent of total billed charges,90% of total billed charges,45.25,35,,36.2,percent of total billed charges,35% of total billed charges,86.97,67.275,,69.576,percent of total billed charges,67.275% of total billed charges,103.42,80,,82.736,percent of total billed charges,80% of total billed charges,49.62,38.38,,39.696,percent of total billed charges,38.38% of total billed charges,103.42,80,,82.736,percent of total billed charges,80% of total billed charges,79.82,61.74,,63.856,percent of total billed charges,61.74% of total billed charges,131.87,102,,105.496,percent of total billed charges,102% of total billed charges,49.13,38,,39.304,percent of total billed charges,38% of total billed charges,45.25,131.87,
GASTROSTOMY TUBE 22FR,3001619,CDM,270,RC,,,Outpatient,,,129.28,96.96,,100.84,78,,80.672,percent of total billed charges,78% of total billed charges,81.45,63,,65.16,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,49.13,38,,39.304,percent of total billed charges,38% of total billed charges,49.13,38,,39.304,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,116.35,90,,93.08,percent of total billed charges,90% of total billed charges,45.25,35,,36.2,percent of total billed charges,35% of total billed charges,86.97,67.275,,69.576,percent of total billed charges,67.275% of total billed charges,103.42,80,,82.736,percent of total billed charges,80% of total billed charges,49.62,38.38,,39.696,percent of total billed charges,38.38% of total billed charges,103.42,80,,82.736,percent of total billed charges,80% of total billed charges,79.82,61.74,,63.856,percent of total billed charges,61.74% of total billed charges,131.87,102,,105.496,percent of total billed charges,102% of total billed charges,49.13,38,,39.304,percent of total billed charges,38% of total billed charges,45.25,131.87,
GASTROSTOMY TUBE 24FR,3001620,CDM,270,RC,,,Outpatient,,,129.28,96.96,,100.84,78,,80.672,percent of total billed charges,78% of total billed charges,81.45,63,,65.16,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,49.13,38,,39.304,percent of total billed charges,38% of total billed charges,49.13,38,,39.304,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,116.35,90,,93.08,percent of total billed charges,90% of total billed charges,45.25,35,,36.2,percent of total billed charges,35% of total billed charges,86.97,67.275,,69.576,percent of total billed charges,67.275% of total billed charges,103.42,80,,82.736,percent of total billed charges,80% of total billed charges,49.62,38.38,,39.696,percent of total billed charges,38.38% of total billed charges,103.42,80,,82.736,percent of total billed charges,80% of total billed charges,79.82,61.74,,63.856,percent of total billed charges,61.74% of total billed charges,131.87,102,,105.496,percent of total billed charges,102% of total billed charges,49.13,38,,39.304,percent of total billed charges,38% of total billed charges,45.25,131.87,
GASTROSTOMY TUBE 20FR,3001622,CDM,270,RC,,,Outpatient,,,129.28,96.96,,100.84,78,,80.672,percent of total billed charges,78% of total billed charges,81.45,63,,65.16,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,49.13,38,,39.304,percent of total billed charges,38% of total billed charges,49.13,38,,39.304,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,116.35,90,,93.08,percent of total billed charges,90% of total billed charges,45.25,35,,36.2,percent of total billed charges,35% of total billed charges,86.97,67.275,,69.576,percent of total billed charges,67.275% of total billed charges,103.42,80,,82.736,percent of total billed charges,80% of total billed charges,49.62,38.38,,39.696,percent of total billed charges,38.38% of total billed charges,103.42,80,,82.736,percent of total billed charges,80% of total billed charges,79.82,61.74,,63.856,percent of total billed charges,61.74% of total billed charges,131.87,102,,105.496,percent of total billed charges,102% of total billed charges,49.13,38,,39.304,percent of total billed charges,38% of total billed charges,45.25,131.87,
TRACHEOSTOMY DISP 6DCFN,3004111,CDM,270,RC,,,Outpatient,,,130,97.5,,101.4,78,,81.12,percent of total billed charges,78% of total billed charges,81.9,63,,65.52,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,49.4,38,,39.52,percent of total billed charges,38% of total billed charges,49.4,38,,39.52,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,117,90,,93.6,percent of total billed charges,90% of total billed charges,45.5,35,,36.4,percent of total billed charges,35% of total billed charges,87.46,67.275,,69.968,percent of total billed charges,67.275% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,49.89,38.38,,39.912,percent of total billed charges,38.38% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,80.26,61.74,,64.208,percent of total billed charges,61.74% of total billed charges,132.6,102,,106.08,percent of total billed charges,102% of total billed charges,49.4,38,,39.52,percent of total billed charges,38% of total billed charges,45.5,132.6,
Test for RSV,5000460,CDM,306,RC,87807,HCPCS,Outpatient,,,130,97.5,,101.4,78,,81.12,percent of total billed charges,78% of total billed charges,15.08,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.1,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.1,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,117,90,,93.6,percent of total billed charges,90% of total billed charges,15.83,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,87.46,67.275,,69.968,percent of total billed charges,67.275% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,13.23,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,104,80,,83.2,percent of total billed charges,80% of total billed charges,80.26,61.74,,64.208,percent of total billed charges,61.74% of total billed charges,15.38,102,,,Fee Schedule,102% of GA Medicaid Rate,13.1,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.1,117,
E COLI SHIGA TOXIN,5001506,CDM,306,RC,87427,HCPCS,Outpatient,,,130,97.5,,101.4,78,,81.12,percent of total billed charges,78% of total billed charges,15.08,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,11.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,117,90,,93.6,percent of total billed charges,90% of total billed charges,15.83,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,87.46,67.275,,69.968,percent of total billed charges,67.275% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,12.1,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,104,80,,83.2,percent of total billed charges,80% of total billed charges,80.26,61.74,,64.208,percent of total billed charges,61.74% of total billed charges,15.38,102,,,Fee Schedule,102% of GA Medicaid Rate,11.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.98,117,
TOPIRAMATE,5001619,CDM,301,RC,80201,HCPCS,Outpatient,,,130,97.5,,101.4,78,,81.12,percent of total billed charges,78% of total billed charges,14.99,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,11.92,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.92,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,117,90,,93.6,percent of total billed charges,90% of total billed charges,15.74,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,87.46,67.275,,69.968,percent of total billed charges,67.275% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,12.04,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,104,80,,83.2,percent of total billed charges,80% of total billed charges,80.26,61.74,,64.208,percent of total billed charges,61.74% of total billed charges,15.29,102,,,Fee Schedule,102% of GA Medicaid Rate,11.92,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.92,117,
ROTAVIRUS ANTIGEN,5001790,CDM,302,RC,87425,HCPCS,Outpatient,,,130,97.5,,101.4,78,,81.12,percent of total billed charges,78% of total billed charges,15.08,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,11.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,117,90,,93.6,percent of total billed charges,90% of total billed charges,15.83,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,87.46,67.275,,69.968,percent of total billed charges,67.275% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,12.1,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,104,80,,83.2,percent of total billed charges,80% of total billed charges,80.26,61.74,,64.208,percent of total billed charges,61.74% of total billed charges,15.38,102,,,Fee Schedule,102% of GA Medicaid Rate,11.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.98,117,
LEGIONELLA PNEUMO ANTIGEN UR,5001796,CDM,306,RC,87449,HCPCS,Outpatient,,,130,97.5,,101.4,78,,81.12,percent of total billed charges,78% of total billed charges,15.08,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,11.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,117,90,,93.6,percent of total billed charges,90% of total billed charges,15.83,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,87.46,67.275,,69.968,percent of total billed charges,67.275% of total billed charges,104,80,,83.2,percent of total billed charges,80% of total billed charges,12.1,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,104,80,,83.2,percent of total billed charges,80% of total billed charges,80.26,61.74,,64.208,percent of total billed charges,61.74% of total billed charges,15.38,102,,,Fee Schedule,102% of GA Medicaid Rate,11.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.98,117,
BRA SURG 2X,3005011,CDM,270,RC,,,Outpatient,,,130.4,97.8,,101.71,78,,81.368,percent of total billed charges,78% of total billed charges,82.15,63,,65.72,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,49.55,38,,39.64,percent of total billed charges,38% of total billed charges,49.55,38,,39.64,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,117.36,90,,93.888,percent of total billed charges,90% of total billed charges,45.64,35,,36.512,percent of total billed charges,35% of total billed charges,87.73,67.275,,70.184,percent of total billed charges,67.275% of total billed charges,104.32,80,,83.456,percent of total billed charges,80% of total billed charges,50.05,38.38,,40.04,percent of total billed charges,38.38% of total billed charges,104.32,80,,83.456,percent of total billed charges,80% of total billed charges,80.51,61.74,,64.408,percent of total billed charges,61.74% of total billed charges,133.01,102,,106.408,percent of total billed charges,102% of total billed charges,49.55,38,,39.64,percent of total billed charges,38% of total billed charges,45.64,133.01,
ROLYAN  HINGED KNEE WALKING BRACE - SM,3006000,CDM,270,RC,,,Outpatient,,,130.48,97.86,,101.77,78,,81.416,percent of total billed charges,78% of total billed charges,82.2,63,,65.76,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,49.58,38,,39.664,percent of total billed charges,38% of total billed charges,49.58,38,,39.664,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,117.43,90,,93.944,percent of total billed charges,90% of total billed charges,45.67,35,,36.536,percent of total billed charges,35% of total billed charges,87.78,67.275,,70.224,percent of total billed charges,67.275% of total billed charges,104.38,80,,83.504,percent of total billed charges,80% of total billed charges,50.08,38.38,,40.064,percent of total billed charges,38.38% of total billed charges,104.38,80,,83.504,percent of total billed charges,80% of total billed charges,80.56,61.74,,64.448,percent of total billed charges,61.74% of total billed charges,133.09,102,,106.472,percent of total billed charges,102% of total billed charges,49.58,38,,39.664,percent of total billed charges,38% of total billed charges,45.67,133.09,
RECOVERY EA ADDL 15 MIN,600002,CDM,710,RC,,,Outpatient,,,131,98.25,,102.18,78,,81.744,percent of total billed charges,78% of total billed charges,82.53,63,,66.024,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,49.78,38,,39.824,percent of total billed charges,38% of total billed charges,49.78,38,,39.824,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,45.85,35,,36.68,percent of total billed charges,35% of total billed charges,88.13,67.275,,70.504,percent of total billed charges,67.275% of total billed charges,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,50.28,38.38,,40.224,percent of total billed charges,38.38% of total billed charges,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,80.88,61.74,,64.704,percent of total billed charges,61.74% of total billed charges,133.62,102,,106.896,percent of total billed charges,102% of total billed charges,49.78,38,,39.824,percent of total billed charges,38% of total billed charges,45.85,133.62,
COGENTIN,5000235,CDM,301,RC,80299,HCPCS,Outpatient,,,131,98.25,,102.18,78,,81.744,percent of total billed charges,78% of total billed charges,15.14,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,15.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,88.13,67.275,,70.504,percent of total billed charges,67.275% of total billed charges,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,18.83,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,80.88,61.74,,64.704,percent of total billed charges,61.74% of total billed charges,15.44,102,,,Fee Schedule,102% of GA Medicaid Rate,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.14,117.9,
PROTEIN C ANTIGEN,5000447,CDM,305,RC,85302,HCPCS,Outpatient,,,131,98.25,,102.18,78,,81.744,percent of total billed charges,78% of total billed charges,15.12,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.01,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.01,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,15.88,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,88.13,67.275,,70.504,percent of total billed charges,67.275% of total billed charges,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,12.13,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,80.88,61.74,,64.704,percent of total billed charges,61.74% of total billed charges,15.42,102,,,Fee Schedule,102% of GA Medicaid Rate,12.01,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.01,117.9,
PROTEIN C ACTIVITY,5000451,CDM,301,RC,85302,HCPCS,Outpatient,,,131,98.25,,102.18,78,,81.744,percent of total billed charges,78% of total billed charges,15.12,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.01,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.01,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,15.88,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,88.13,67.275,,70.504,percent of total billed charges,67.275% of total billed charges,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,12.13,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,80.88,61.74,,64.704,percent of total billed charges,61.74% of total billed charges,15.42,102,,,Fee Schedule,102% of GA Medicaid Rate,12.01,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.01,117.9,
.LAMICATAL,5000453,CDM,301,RC,80299,HCPCS,Outpatient,,,131,98.25,,102.18,78,,81.744,percent of total billed charges,78% of total billed charges,15.14,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,15.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,88.13,67.275,,70.504,percent of total billed charges,67.275% of total billed charges,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,18.83,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,80.88,61.74,,64.704,percent of total billed charges,61.74% of total billed charges,15.44,102,,,Fee Schedule,102% of GA Medicaid Rate,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.14,117.9,
VANCOMYCIN TROUGH,5001651,CDM,301,RC,80202,HCPCS,Outpatient,,,131,98.25,,102.18,78,,81.744,percent of total billed charges,78% of total billed charges,14.27,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,14.98,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,88.13,67.275,,70.504,percent of total billed charges,67.275% of total billed charges,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,13.68,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,80.88,61.74,,64.704,percent of total billed charges,61.74% of total billed charges,14.56,102,,,Fee Schedule,102% of GA Medicaid Rate,13.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.54,117.9,
Test to assess for nerve damage,9600033,CDM,922,RC,95886,HCPCS,Outpatient,,,131,98.25,,102.18,78,,81.744,percent of total billed charges,78% of total billed charges,82.53,63,,66.024,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,49.78,38,,39.824,percent of total billed charges,38% of total billed charges,49.78,38,,39.824,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,45.85,35,,36.68,percent of total billed charges,35% of total billed charges,88.13,67.275,,70.504,percent of total billed charges,67.275% of total billed charges,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,50.28,38.38,,40.224,percent of total billed charges,38.38% of total billed charges,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,80.88,61.74,,64.704,percent of total billed charges,61.74% of total billed charges,133.62,102,,106.896,percent of total billed charges,102% of total billed charges,49.78,38,,39.824,percent of total billed charges,38% of total billed charges,45.85,133.62,
DRILL BIT 2.7MM,3000890,CDM,270,RC,,,Outpatient,,,132,99,,102.96,78,,82.368,percent of total billed charges,78% of total billed charges,83.16,63,,66.528,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,50.16,38,,40.128,percent of total billed charges,38% of total billed charges,50.16,38,,40.128,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,46.2,35,,36.96,percent of total billed charges,35% of total billed charges,88.8,67.275,,71.04,percent of total billed charges,67.275% of total billed charges,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,50.66,38.38,,40.528,percent of total billed charges,38.38% of total billed charges,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,81.5,61.74,,65.2,percent of total billed charges,61.74% of total billed charges,134.64,102,,107.712,percent of total billed charges,102% of total billed charges,50.16,38,,40.128,percent of total billed charges,38% of total billed charges,46.2,134.64,
THREADED ROD 200MM,3006007,CDM,270,RC,,,Outpatient,,,132,99,,102.96,78,,82.368,percent of total billed charges,78% of total billed charges,83.16,63,,66.528,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,50.16,38,,40.128,percent of total billed charges,38% of total billed charges,50.16,38,,40.128,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,46.2,35,,36.96,percent of total billed charges,35% of total billed charges,88.8,67.275,,71.04,percent of total billed charges,67.275% of total billed charges,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,50.66,38.38,,40.528,percent of total billed charges,38.38% of total billed charges,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,81.5,61.74,,65.2,percent of total billed charges,61.74% of total billed charges,134.64,102,,107.712,percent of total billed charges,102% of total billed charges,50.16,38,,40.128,percent of total billed charges,38% of total billed charges,46.2,134.64,
ACETAMINOPHEN,5001768,CDM,301,RC,80329,HCPCS,Outpatient,,,132,99,,102.96,78,,82.368,percent of total billed charges,78% of total billed charges,25.45,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,50.16,38,,40.128,percent of total billed charges,38% of total billed charges,50.16,38,,40.128,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,26.72,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,88.8,67.275,,71.04,percent of total billed charges,67.275% of total billed charges,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,50.66,38.38,,40.528,percent of total billed charges,38.38% of total billed charges,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,81.5,61.74,,65.2,percent of total billed charges,61.74% of total billed charges,25.96,102,,,Fee Schedule,102% of GA Medicaid Rate,50.16,38,,40.128,percent of total billed charges,38% of total billed charges,25.45,118.8,
SALICYLATE,5001933,CDM,301,RC,80329,HCPCS,Outpatient,,,132,99,,102.96,78,,82.368,percent of total billed charges,78% of total billed charges,25.45,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,50.16,38,,40.128,percent of total billed charges,38% of total billed charges,50.16,38,,40.128,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,26.72,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,88.8,67.275,,71.04,percent of total billed charges,67.275% of total billed charges,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,50.66,38.38,,40.528,percent of total billed charges,38.38% of total billed charges,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,81.5,61.74,,65.2,percent of total billed charges,61.74% of total billed charges,25.96,102,,,Fee Schedule,102% of GA Medicaid Rate,50.16,38,,40.128,percent of total billed charges,38% of total billed charges,25.45,118.8,
MALARIA IFA SCREEN,5002077,CDM,302,RC,86750,HCPCS,Outpatient,,,132,99,,102.96,78,,82.368,percent of total billed charges,78% of total billed charges,16.59,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.19,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.19,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,17.42,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,88.8,67.275,,71.04,percent of total billed charges,67.275% of total billed charges,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,13.32,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,81.5,61.74,,65.2,percent of total billed charges,61.74% of total billed charges,16.92,102,,,Fee Schedule,102% of GA Medicaid Rate,13.19,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.19,118.8,
"MM DX BILAT, FILM",7600901,CDM,401,RC,77056,HCPCS,Outpatient,,,132,99,,102.96,78,,82.368,percent of total billed charges,78% of total billed charges,83.16,63,,66.528,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,50.16,38,,40.128,percent of total billed charges,38% of total billed charges,50.16,38,,40.128,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,46.2,35,,36.96,percent of total billed charges,35% of total billed charges,88.8,67.275,,71.04,percent of total billed charges,67.275% of total billed charges,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,50.66,38.38,,40.528,percent of total billed charges,38.38% of total billed charges,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,81.5,61.74,,65.2,percent of total billed charges,61.74% of total billed charges,134.64,102,,107.712,percent of total billed charges,102% of total billed charges,50.16,38,,40.128,percent of total billed charges,38% of total billed charges,46.2,134.64,
"MM SPECIAL DX BILAT, FILM",7600946,CDM,401,RC,77056,HCPCS,Outpatient,,,132,99,,102.96,78,,82.368,percent of total billed charges,78% of total billed charges,83.16,63,,66.528,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,50.16,38,,40.128,percent of total billed charges,38% of total billed charges,50.16,38,,40.128,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,46.2,35,,36.96,percent of total billed charges,35% of total billed charges,88.8,67.275,,71.04,percent of total billed charges,67.275% of total billed charges,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,50.66,38.38,,40.528,percent of total billed charges,38.38% of total billed charges,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,81.5,61.74,,65.2,percent of total billed charges,61.74% of total billed charges,134.64,102,,107.712,percent of total billed charges,102% of total billed charges,50.16,38,,40.128,percent of total billed charges,38% of total billed charges,46.2,134.64,
ANKLE/FOOT ORTHOSIS - LG RIGHT,3005091,CDM,270,RC,,,Outpatient,,,132.44,99.33,,103.3,78,,82.64,percent of total billed charges,78% of total billed charges,83.44,63,,66.752,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,50.33,38,,40.264,percent of total billed charges,38% of total billed charges,50.33,38,,40.264,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,119.2,90,,95.36,percent of total billed charges,90% of total billed charges,46.35,35,,37.08,percent of total billed charges,35% of total billed charges,89.1,67.275,,71.28,percent of total billed charges,67.275% of total billed charges,105.95,80,,84.76,percent of total billed charges,80% of total billed charges,50.83,38.38,,40.664,percent of total billed charges,38.38% of total billed charges,105.95,80,,84.76,percent of total billed charges,80% of total billed charges,81.77,61.74,,65.416,percent of total billed charges,61.74% of total billed charges,135.09,102,,108.072,percent of total billed charges,102% of total billed charges,50.33,38,,40.264,percent of total billed charges,38% of total billed charges,46.35,135.09,
DARCO HEELWEDGE SHOE - MD,3005092,CDM,270,RC,,,Outpatient,,,132.44,99.33,,103.3,78,,82.64,percent of total billed charges,78% of total billed charges,83.44,63,,66.752,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,50.33,38,,40.264,percent of total billed charges,38% of total billed charges,50.33,38,,40.264,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,119.2,90,,95.36,percent of total billed charges,90% of total billed charges,46.35,35,,37.08,percent of total billed charges,35% of total billed charges,89.1,67.275,,71.28,percent of total billed charges,67.275% of total billed charges,105.95,80,,84.76,percent of total billed charges,80% of total billed charges,50.83,38.38,,40.664,percent of total billed charges,38.38% of total billed charges,105.95,80,,84.76,percent of total billed charges,80% of total billed charges,81.77,61.74,,65.416,percent of total billed charges,61.74% of total billed charges,135.09,102,,108.072,percent of total billed charges,102% of total billed charges,50.33,38,,40.264,percent of total billed charges,38% of total billed charges,46.35,135.09,
ANKLE/FOOT ORTHOSIS - MD LEFT,3005093,CDM,270,RC,,,Outpatient,,,132.44,99.33,,103.3,78,,82.64,percent of total billed charges,78% of total billed charges,83.44,63,,66.752,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,50.33,38,,40.264,percent of total billed charges,38% of total billed charges,50.33,38,,40.264,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,119.2,90,,95.36,percent of total billed charges,90% of total billed charges,46.35,35,,37.08,percent of total billed charges,35% of total billed charges,89.1,67.275,,71.28,percent of total billed charges,67.275% of total billed charges,105.95,80,,84.76,percent of total billed charges,80% of total billed charges,50.83,38.38,,40.664,percent of total billed charges,38.38% of total billed charges,105.95,80,,84.76,percent of total billed charges,80% of total billed charges,81.77,61.74,,65.416,percent of total billed charges,61.74% of total billed charges,135.09,102,,108.072,percent of total billed charges,102% of total billed charges,50.33,38,,40.264,percent of total billed charges,38% of total billed charges,46.35,135.09,
ANKLE/FOOT ORTHOSIS - MD RIGHT,3005094,CDM,270,RC,,,Outpatient,,,132.44,99.33,,103.3,78,,82.64,percent of total billed charges,78% of total billed charges,83.44,63,,66.752,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,50.33,38,,40.264,percent of total billed charges,38% of total billed charges,50.33,38,,40.264,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,119.2,90,,95.36,percent of total billed charges,90% of total billed charges,46.35,35,,37.08,percent of total billed charges,35% of total billed charges,89.1,67.275,,71.28,percent of total billed charges,67.275% of total billed charges,105.95,80,,84.76,percent of total billed charges,80% of total billed charges,50.83,38.38,,40.664,percent of total billed charges,38.38% of total billed charges,105.95,80,,84.76,percent of total billed charges,80% of total billed charges,81.77,61.74,,65.416,percent of total billed charges,61.74% of total billed charges,135.09,102,,108.072,percent of total billed charges,102% of total billed charges,50.33,38,,40.264,percent of total billed charges,38% of total billed charges,46.35,135.09,
CONTINUOUS BRONCHDIL ADDL HOUR,8094645,CDM,410,RC,94645,HCPCS,Outpatient,,,133,99.75,,103.74,78,,82.992,percent of total billed charges,78% of total billed charges,83.79,63,,67.032,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,50.54,38,,40.432,percent of total billed charges,38% of total billed charges,50.54,38,,40.432,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,46.55,35,,37.24,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,51.05,38.38,,40.84,percent of total billed charges,38.38% of total billed charges,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,82.11,61.74,,65.688,percent of total billed charges,61.74% of total billed charges,135.66,102,,108.528,percent of total billed charges,102% of total billed charges,50.54,38,,40.432,percent of total billed charges,38% of total billed charges,46.55,145.93,
INTUBATION MODULE YELLOW  7700YIO,3000018,CDM,270,RC,,,Outpatient,,,133.92,100.44,,104.46,78,,83.568,percent of total billed charges,78% of total billed charges,84.37,63,,67.496,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,50.89,38,,40.712,percent of total billed charges,38% of total billed charges,50.89,38,,40.712,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,120.53,90,,96.424,percent of total billed charges,90% of total billed charges,46.87,35,,37.496,percent of total billed charges,35% of total billed charges,90.09,67.275,,72.072,percent of total billed charges,67.275% of total billed charges,107.14,80,,85.712,percent of total billed charges,80% of total billed charges,51.4,38.38,,41.12,percent of total billed charges,38.38% of total billed charges,107.14,80,,85.712,percent of total billed charges,80% of total billed charges,82.68,61.74,,66.144,percent of total billed charges,61.74% of total billed charges,136.6,102,,109.28,percent of total billed charges,102% of total billed charges,50.89,38,,40.712,percent of total billed charges,38% of total billed charges,46.87,136.6,
MODULE INTUB WHITE   7700WIN,3000019,CDM,270,RC,,,Outpatient,,,133.92,100.44,,104.46,78,,83.568,percent of total billed charges,78% of total billed charges,84.37,63,,67.496,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,50.89,38,,40.712,percent of total billed charges,38% of total billed charges,50.89,38,,40.712,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,120.53,90,,96.424,percent of total billed charges,90% of total billed charges,46.87,35,,37.496,percent of total billed charges,35% of total billed charges,90.09,67.275,,72.072,percent of total billed charges,67.275% of total billed charges,107.14,80,,85.712,percent of total billed charges,80% of total billed charges,51.4,38.38,,41.12,percent of total billed charges,38.38% of total billed charges,107.14,80,,85.712,percent of total billed charges,80% of total billed charges,82.68,61.74,,66.144,percent of total billed charges,61.74% of total billed charges,136.6,102,,109.28,percent of total billed charges,102% of total billed charges,50.89,38,,40.712,percent of total billed charges,38% of total billed charges,46.87,136.6,
INTUBATION MODULE BLUE 7700BIN,3000030,CDM,270,RC,,,Outpatient,,,133.92,100.44,,104.46,78,,83.568,percent of total billed charges,78% of total billed charges,84.37,63,,67.496,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,50.89,38,,40.712,percent of total billed charges,38% of total billed charges,50.89,38,,40.712,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,120.53,90,,96.424,percent of total billed charges,90% of total billed charges,46.87,35,,37.496,percent of total billed charges,35% of total billed charges,90.09,67.275,,72.072,percent of total billed charges,67.275% of total billed charges,107.14,80,,85.712,percent of total billed charges,80% of total billed charges,51.4,38.38,,41.12,percent of total billed charges,38.38% of total billed charges,107.14,80,,85.712,percent of total billed charges,80% of total billed charges,82.68,61.74,,66.144,percent of total billed charges,61.74% of total billed charges,136.6,102,,109.28,percent of total billed charges,102% of total billed charges,50.89,38,,40.712,percent of total billed charges,38% of total billed charges,46.87,136.6,
MODULE INTUB PINK/RED,3000031,CDM,270,RC,,,Outpatient,,,133.92,100.44,,104.46,78,,83.568,percent of total billed charges,78% of total billed charges,84.37,63,,67.496,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,50.89,38,,40.712,percent of total billed charges,38% of total billed charges,50.89,38,,40.712,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,120.53,90,,96.424,percent of total billed charges,90% of total billed charges,46.87,35,,37.496,percent of total billed charges,35% of total billed charges,90.09,67.275,,72.072,percent of total billed charges,67.275% of total billed charges,107.14,80,,85.712,percent of total billed charges,80% of total billed charges,51.4,38.38,,41.12,percent of total billed charges,38.38% of total billed charges,107.14,80,,85.712,percent of total billed charges,80% of total billed charges,82.68,61.74,,66.144,percent of total billed charges,61.74% of total billed charges,136.6,102,,109.28,percent of total billed charges,102% of total billed charges,50.89,38,,40.712,percent of total billed charges,38% of total billed charges,46.87,136.6,
MODULE INTUB PURPLE,3000069,CDM,270,RC,,,Outpatient,,,133.92,100.44,,104.46,78,,83.568,percent of total billed charges,78% of total billed charges,84.37,63,,67.496,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,50.89,38,,40.712,percent of total billed charges,38% of total billed charges,50.89,38,,40.712,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,120.53,90,,96.424,percent of total billed charges,90% of total billed charges,46.87,35,,37.496,percent of total billed charges,35% of total billed charges,90.09,67.275,,72.072,percent of total billed charges,67.275% of total billed charges,107.14,80,,85.712,percent of total billed charges,80% of total billed charges,51.4,38.38,,41.12,percent of total billed charges,38.38% of total billed charges,107.14,80,,85.712,percent of total billed charges,80% of total billed charges,82.68,61.74,,66.144,percent of total billed charges,61.74% of total billed charges,136.6,102,,109.28,percent of total billed charges,102% of total billed charges,50.89,38,,40.712,percent of total billed charges,38% of total billed charges,46.87,136.6,
MODULE INTUB ORANGE,3000070,CDM,270,RC,,,Outpatient,,,133.92,100.44,,104.46,78,,83.568,percent of total billed charges,78% of total billed charges,84.37,63,,67.496,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,50.89,38,,40.712,percent of total billed charges,38% of total billed charges,50.89,38,,40.712,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,120.53,90,,96.424,percent of total billed charges,90% of total billed charges,46.87,35,,37.496,percent of total billed charges,35% of total billed charges,90.09,67.275,,72.072,percent of total billed charges,67.275% of total billed charges,107.14,80,,85.712,percent of total billed charges,80% of total billed charges,51.4,38.38,,41.12,percent of total billed charges,38.38% of total billed charges,107.14,80,,85.712,percent of total billed charges,80% of total billed charges,82.68,61.74,,66.144,percent of total billed charges,61.74% of total billed charges,136.6,102,,109.28,percent of total billed charges,102% of total billed charges,50.89,38,,40.712,percent of total billed charges,38% of total billed charges,46.87,136.6,
MODULE INTUB GREEN,3000071,CDM,270,RC,,,Outpatient,,,133.92,100.44,,104.46,78,,83.568,percent of total billed charges,78% of total billed charges,84.37,63,,67.496,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,50.89,38,,40.712,percent of total billed charges,38% of total billed charges,50.89,38,,40.712,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,120.53,90,,96.424,percent of total billed charges,90% of total billed charges,46.87,35,,37.496,percent of total billed charges,35% of total billed charges,90.09,67.275,,72.072,percent of total billed charges,67.275% of total billed charges,107.14,80,,85.712,percent of total billed charges,80% of total billed charges,51.4,38.38,,41.12,percent of total billed charges,38.38% of total billed charges,107.14,80,,85.712,percent of total billed charges,80% of total billed charges,82.68,61.74,,66.144,percent of total billed charges,61.74% of total billed charges,136.6,102,,109.28,percent of total billed charges,102% of total billed charges,50.89,38,,40.712,percent of total billed charges,38% of total billed charges,46.87,136.6,
SPLINT LOWER EXTREMITY,1001088,CDM,450,RC,,,Outpatient,,,134,100.5,,104.52,78,,83.616,percent of total billed charges,78% of total billed charges,84.42,63,,67.536,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,50.92,38,,40.736,percent of total billed charges,38% of total billed charges,50.92,38,,40.736,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,120.6,90,,96.48,percent of total billed charges,90% of total billed charges,46.9,35,,37.52,percent of total billed charges,35% of total billed charges,90.15,67.275,,72.12,percent of total billed charges,67.275% of total billed charges,107.2,80,,85.76,percent of total billed charges,80% of total billed charges,51.43,38.38,,41.144,percent of total billed charges,38.38% of total billed charges,107.2,80,,85.76,percent of total billed charges,80% of total billed charges,82.73,61.74,,66.184,percent of total billed charges,61.74% of total billed charges,136.68,102,,109.344,percent of total billed charges,102% of total billed charges,50.92,38,,40.736,percent of total billed charges,38% of total billed charges,46.9,136.68,
LAYER CLOSURE WOUND,1001190,CDM,450,RC,,,Outpatient,,,134,100.5,,104.52,78,,83.616,percent of total billed charges,78% of total billed charges,84.42,63,,67.536,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,50.92,38,,40.736,percent of total billed charges,38% of total billed charges,50.92,38,,40.736,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,120.6,90,,96.48,percent of total billed charges,90% of total billed charges,46.9,35,,37.52,percent of total billed charges,35% of total billed charges,90.15,67.275,,72.12,percent of total billed charges,67.275% of total billed charges,107.2,80,,85.76,percent of total billed charges,80% of total billed charges,51.43,38.38,,41.144,percent of total billed charges,38.38% of total billed charges,107.2,80,,85.76,percent of total billed charges,80% of total billed charges,82.73,61.74,,66.184,percent of total billed charges,61.74% of total billed charges,136.68,102,,109.344,percent of total billed charges,102% of total billed charges,50.92,38,,40.736,percent of total billed charges,38% of total billed charges,46.9,136.68,
PANCREATIC ELASTASE,5002070,CDM,301,RC,82656,HCPCS,Outpatient,,,134,100.5,,104.52,78,,83.616,percent of total billed charges,78% of total billed charges,84.42,63,,67.536,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,11.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,120.6,90,,96.48,percent of total billed charges,90% of total billed charges,46.9,35,,37.52,percent of total billed charges,35% of total billed charges,90.15,67.275,,72.12,percent of total billed charges,67.275% of total billed charges,107.2,80,,85.76,percent of total billed charges,80% of total billed charges,11.65,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,107.2,80,,85.76,percent of total billed charges,80% of total billed charges,82.73,61.74,,66.184,percent of total billed charges,61.74% of total billed charges,136.68,102,,109.344,percent of total billed charges,102% of total billed charges,11.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.53,136.68,
PREGNENOLONE,5002068,CDM,301,RC,84140,HCPCS,Outpatient,,,135,101.25,,105.3,78,,84.24,percent of total billed charges,78% of total billed charges,26,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,20.67,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.67,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,121.5,90,,97.2,percent of total billed charges,90% of total billed charges,27.3,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,90.82,67.275,,72.656,percent of total billed charges,67.275% of total billed charges,108,80,,86.4,percent of total billed charges,80% of total billed charges,20.88,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,108,80,,86.4,percent of total billed charges,80% of total billed charges,83.35,61.74,,66.68,percent of total billed charges,61.74% of total billed charges,26.52,102,,,Fee Schedule,102% of GA Medicaid Rate,20.67,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.67,121.5,
CA 27-29,5000242,CDM,301,RC,86316,HCPCS,Outpatient,,,136,102,,106.08,78,,84.864,percent of total billed charges,78% of total billed charges,26.16,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,20.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,27.47,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,91.49,67.275,,73.192,percent of total billed charges,67.275% of total billed charges,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,21.02,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,83.97,61.74,,67.176,percent of total billed charges,61.74% of total billed charges,26.68,102,,,Fee Schedule,102% of GA Medicaid Rate,20.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.81,122.4,
Blood test to monitor breast cancer,5000261,CDM,301,RC,86300,HCPCS,Outpatient,,,136,102,,106.08,78,,84.864,percent of total billed charges,78% of total billed charges,26.16,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,20.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,27.47,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,91.49,67.275,,73.192,percent of total billed charges,67.275% of total billed charges,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,21.02,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,83.97,61.74,,67.176,percent of total billed charges,61.74% of total billed charges,26.68,102,,,Fee Schedule,102% of GA Medicaid Rate,20.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.81,122.4,
Basic metabolic panel,5000756,CDM,301,RC,80048,HCPCS,Outpatient,,,136,102,,106.08,78,,84.864,percent of total billed charges,78% of total billed charges,10.65,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.46,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.46,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,11.18,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,91.49,67.275,,73.192,percent of total billed charges,67.275% of total billed charges,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,8.54,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,83.97,61.74,,67.176,percent of total billed charges,61.74% of total billed charges,10.86,102,,,Fee Schedule,102% of GA Medicaid Rate,8.46,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.46,122.4,
URINE BLADDER TUMOR ANTIG,5001500,CDM,300,RC,86316,HCPCS,Outpatient,,,136,102,,106.08,78,,84.864,percent of total billed charges,78% of total billed charges,26.16,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,20.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,27.47,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,91.49,67.275,,73.192,percent of total billed charges,67.275% of total billed charges,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,21.02,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,83.97,61.74,,67.176,percent of total billed charges,61.74% of total billed charges,26.68,102,,,Fee Schedule,102% of GA Medicaid Rate,20.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.81,122.4,
OVA & PARASITE,5001520,CDM,306,RC,87177,HCPCS,Outpatient,,,136,102,,106.08,78,,84.864,percent of total billed charges,78% of total billed charges,11.19,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,8.9,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.9,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,11.75,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,91.49,67.275,,73.192,percent of total billed charges,67.275% of total billed charges,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,8.99,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,83.97,61.74,,67.176,percent of total billed charges,61.74% of total billed charges,11.41,102,,,Fee Schedule,102% of GA Medicaid Rate,8.9,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.9,122.4,
ANTI PLATELET Ab IgG,5001652,CDM,302,RC,86022,HCPCS,Outpatient,,,136,102,,106.08,78,,84.864,percent of total billed charges,78% of total billed charges,23.09,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.37,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.37,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,24.24,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,91.49,67.275,,73.192,percent of total billed charges,67.275% of total billed charges,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,18.55,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,83.97,61.74,,67.176,percent of total billed charges,61.74% of total billed charges,23.55,102,,,Fee Schedule,102% of GA Medicaid Rate,18.37,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.37,122.4,
CA 19-9,5001914,CDM,300,RC,86316,HCPCS,Outpatient,,,136,102,,106.08,78,,84.864,percent of total billed charges,78% of total billed charges,26.16,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,20.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,27.47,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,91.49,67.275,,73.192,percent of total billed charges,67.275% of total billed charges,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,21.02,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,83.97,61.74,,67.176,percent of total billed charges,61.74% of total billed charges,26.68,102,,,Fee Schedule,102% of GA Medicaid Rate,20.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.81,122.4,
CHROMOGRANIN A,5002029,CDM,300,RC,86316,HCPCS,Outpatient,,,136,102,,106.08,78,,84.864,percent of total billed charges,78% of total billed charges,26.16,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,20.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,27.47,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,91.49,67.275,,73.192,percent of total billed charges,67.275% of total billed charges,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,21.02,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,83.97,61.74,,67.176,percent of total billed charges,61.74% of total billed charges,26.68,102,,,Fee Schedule,102% of GA Medicaid Rate,20.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.81,122.4,
PT RE-EVALUATION AND PLAN OF CARE,9000510,CDM,420,RC,97164,HCPCS,Outpatient,,,136,102,,106.08,78,,84.864,percent of total billed charges,78% of total billed charges,85.68,63,,68.544,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,51.68,38,,41.344,percent of total billed charges,38% of total billed charges,51.68,38,,41.344,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,47.6,35,,38.08,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,52.2,38.38,,41.76,percent of total billed charges,38.38% of total billed charges,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,83.97,61.74,,67.176,percent of total billed charges,61.74% of total billed charges,138.72,102,,110.976,percent of total billed charges,102% of total billed charges,51.68,38,,41.344,percent of total billed charges,38% of total billed charges,47.6,145.93,
BRA SURG 3X,3005012,CDM,270,RC,,,Outpatient,,,136.68,102.51,,106.61,78,,85.288,percent of total billed charges,78% of total billed charges,86.11,63,,68.888,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,51.94,38,,41.552,percent of total billed charges,38% of total billed charges,51.94,38,,41.552,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,123.01,90,,98.408,percent of total billed charges,90% of total billed charges,47.84,35,,38.272,percent of total billed charges,35% of total billed charges,91.95,67.275,,73.56,percent of total billed charges,67.275% of total billed charges,109.34,80,,87.472,percent of total billed charges,80% of total billed charges,52.46,38.38,,41.968,percent of total billed charges,38.38% of total billed charges,109.34,80,,87.472,percent of total billed charges,80% of total billed charges,84.39,61.74,,67.512,percent of total billed charges,61.74% of total billed charges,139.41,102,,111.528,percent of total billed charges,102% of total billed charges,51.94,38,,41.552,percent of total billed charges,38% of total billed charges,47.84,139.41,
Blood test to evaluate thyroid function,5001397,CDM,301,RC,84439,HCPCS,Outpatient,,,137,102.75,,106.86,78,,85.488,percent of total billed charges,78% of total billed charges,11.34,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,9.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,9.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,123.3,90,,98.64,percent of total billed charges,90% of total billed charges,11.91,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,92.17,67.275,,73.736,percent of total billed charges,67.275% of total billed charges,109.6,80,,87.68,percent of total billed charges,80% of total billed charges,9.11,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,109.6,80,,87.68,percent of total billed charges,80% of total billed charges,84.58,61.74,,67.664,percent of total billed charges,61.74% of total billed charges,11.57,102,,,Fee Schedule,102% of GA Medicaid Rate,9.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,9.02,123.3,
VANCOMYCIN PEAK,5001650,CDM,301,RC,80202,HCPCS,Outpatient,,,137,102.75,,106.86,78,,85.488,percent of total billed charges,78% of total billed charges,14.27,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,123.3,90,,98.64,percent of total billed charges,90% of total billed charges,14.98,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,92.17,67.275,,73.736,percent of total billed charges,67.275% of total billed charges,109.6,80,,87.68,percent of total billed charges,80% of total billed charges,13.68,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,109.6,80,,87.68,percent of total billed charges,80% of total billed charges,84.58,61.74,,67.664,percent of total billed charges,61.74% of total billed charges,14.56,102,,,Fee Schedule,102% of GA Medicaid Rate,13.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.54,123.3,
VANCOMYCIN RANDOM,5014003,CDM,301,RC,80202,HCPCS,Outpatient,,,137,102.75,,106.86,78,,85.488,percent of total billed charges,78% of total billed charges,14.27,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,123.3,90,,98.64,percent of total billed charges,90% of total billed charges,14.98,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,92.17,67.275,,73.736,percent of total billed charges,67.275% of total billed charges,109.6,80,,87.68,percent of total billed charges,80% of total billed charges,13.68,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,109.6,80,,87.68,percent of total billed charges,80% of total billed charges,84.58,61.74,,67.664,percent of total billed charges,61.74% of total billed charges,14.56,102,,,Fee Schedule,102% of GA Medicaid Rate,13.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.54,123.3,
"REC THERAPY EVAL, EA 15 MIN",9000040,CDM,420,RC,97001,HCPCS,Outpatient,,,137,102.75,,106.86,78,,85.488,percent of total billed charges,78% of total billed charges,86.31,63,,69.048,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,52.06,38,,41.648,percent of total billed charges,38% of total billed charges,52.06,38,,41.648,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,123.3,90,,98.64,percent of total billed charges,90% of total billed charges,47.95,35,,38.36,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,109.6,80,,87.68,percent of total billed charges,80% of total billed charges,52.58,38.38,,42.064,percent of total billed charges,38.38% of total billed charges,109.6,80,,87.68,percent of total billed charges,80% of total billed charges,84.58,61.74,,67.664,percent of total billed charges,61.74% of total billed charges,139.74,102,,111.792,percent of total billed charges,102% of total billed charges,52.06,38,,41.648,percent of total billed charges,38% of total billed charges,47.95,145.93,
PT EVALUATION,9590008,CDM,420,RC,,,Outpatient,,,137,102.75,,106.86,78,,85.488,percent of total billed charges,78% of total billed charges,86.31,63,,69.048,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,52.06,38,,41.648,percent of total billed charges,38% of total billed charges,52.06,38,,41.648,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,123.3,90,,98.64,percent of total billed charges,90% of total billed charges,47.95,35,,38.36,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,109.6,80,,87.68,percent of total billed charges,80% of total billed charges,52.58,38.38,,42.064,percent of total billed charges,38.38% of total billed charges,109.6,80,,87.68,percent of total billed charges,80% of total billed charges,84.58,61.74,,67.664,percent of total billed charges,61.74% of total billed charges,139.74,102,,111.792,percent of total billed charges,102% of total billed charges,52.06,38,,41.648,percent of total billed charges,38% of total billed charges,47.95,145.93,
ACYLCARNITINE,5002085,CDM,301,RC,82017,HCPCS,Outpatient,,,139,104.25,,108.42,78,,86.736,percent of total billed charges,78% of total billed charges,21.21,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,125.1,90,,100.08,percent of total billed charges,90% of total billed charges,22.27,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,93.51,67.275,,74.808,percent of total billed charges,67.275% of total billed charges,111.2,80,,88.96,percent of total billed charges,80% of total billed charges,17.04,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,111.2,80,,88.96,percent of total billed charges,80% of total billed charges,85.82,61.74,,68.656,percent of total billed charges,61.74% of total billed charges,21.63,102,,,Fee Schedule,102% of GA Medicaid Rate,16.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.87,125.1,
"US GUIDANCE, CENTRAL VENOUS ACCESSS",7300999,CDM,402,RC,76937,HCPCS,Outpatient,,,139,104.25,,108.42,78,,86.736,percent of total billed charges,78% of total billed charges,87.57,63,,70.056,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,52.82,38,,42.256,percent of total billed charges,38% of total billed charges,52.82,38,,42.256,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,125.1,90,,100.08,percent of total billed charges,90% of total billed charges,48.65,35,,38.92,percent of total billed charges,35% of total billed charges,93.51,67.275,,74.808,percent of total billed charges,67.275% of total billed charges,111.2,80,,88.96,percent of total billed charges,80% of total billed charges,53.35,38.38,,42.68,percent of total billed charges,38.38% of total billed charges,111.2,80,,88.96,percent of total billed charges,80% of total billed charges,85.82,61.74,,68.656,percent of total billed charges,61.74% of total billed charges,141.78,102,,113.424,percent of total billed charges,102% of total billed charges,52.82,38,,42.256,percent of total billed charges,38% of total billed charges,48.65,141.78,
"EMG NEEDLE, PER EXTREMITY; LIMITED",9600030,CDM,922,RC,95885,HCPCS,Outpatient,,,139,104.25,,108.42,78,,86.736,percent of total billed charges,78% of total billed charges,87.57,63,,70.056,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,52.82,38,,42.256,percent of total billed charges,38% of total billed charges,52.82,38,,42.256,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,125.1,90,,100.08,percent of total billed charges,90% of total billed charges,48.65,35,,38.92,percent of total billed charges,35% of total billed charges,93.51,67.275,,74.808,percent of total billed charges,67.275% of total billed charges,111.2,80,,88.96,percent of total billed charges,80% of total billed charges,53.35,38.38,,42.68,percent of total billed charges,38.38% of total billed charges,111.2,80,,88.96,percent of total billed charges,80% of total billed charges,85.82,61.74,,68.656,percent of total billed charges,61.74% of total billed charges,141.78,102,,113.424,percent of total billed charges,102% of total billed charges,52.82,38,,42.256,percent of total billed charges,38% of total billed charges,48.65,141.78,
CHOLANGIOGRAM CATHETER,3005225,CDM,270,RC,,,Outpatient,,,139.68,104.76,,108.95,78,,87.16,percent of total billed charges,78% of total billed charges,88,63,,70.4,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,53.08,38,,42.464,percent of total billed charges,38% of total billed charges,53.08,38,,42.464,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,125.71,90,,100.568,percent of total billed charges,90% of total billed charges,48.89,35,,39.112,percent of total billed charges,35% of total billed charges,93.97,67.275,,75.176,percent of total billed charges,67.275% of total billed charges,111.74,80,,89.392,percent of total billed charges,80% of total billed charges,53.61,38.38,,42.888,percent of total billed charges,38.38% of total billed charges,111.74,80,,89.392,percent of total billed charges,80% of total billed charges,86.24,61.74,,68.992,percent of total billed charges,61.74% of total billed charges,142.47,102,,113.976,percent of total billed charges,102% of total billed charges,53.08,38,,42.464,percent of total billed charges,38% of total billed charges,48.89,142.47,
"OSMOLALITY, FECES",5000736,CDM,309,RC,84999,HCPCS,Outpatient,,,140,105,,109.2,78,,87.36,percent of total billed charges,78% of total billed charges,88.2,63,,70.56,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,53.2,38,,42.56,percent of total billed charges,38% of total billed charges,53.2,38,,42.56,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,126,90,,100.8,percent of total billed charges,90% of total billed charges,49,35,,39.2,percent of total billed charges,35% of total billed charges,94.19,67.275,,75.352,percent of total billed charges,67.275% of total billed charges,112,80,,89.6,percent of total billed charges,80% of total billed charges,53.73,38.38,,42.984,percent of total billed charges,38.38% of total billed charges,112,80,,89.6,percent of total billed charges,80% of total billed charges,86.44,61.74,,69.152,percent of total billed charges,61.74% of total billed charges,142.8,102,,114.24,percent of total billed charges,102% of total billed charges,53.2,38,,42.56,percent of total billed charges,38% of total billed charges,49,142.8,
IA-2 AB,5001799,CDM,302,RC,86341,HCPCS,Outpatient,,,140,105,,109.2,78,,87.36,percent of total billed charges,78% of total billed charges,24.89,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,23.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,23.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,126,90,,100.8,percent of total billed charges,90% of total billed charges,26.13,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,94.19,67.275,,75.352,percent of total billed charges,67.275% of total billed charges,112,80,,89.6,percent of total billed charges,80% of total billed charges,23.81,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,112,80,,89.6,percent of total billed charges,80% of total billed charges,86.44,61.74,,69.152,percent of total billed charges,61.74% of total billed charges,25.39,102,,,Fee Schedule,102% of GA Medicaid Rate,23.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,23.57,126,
"CATHARTIC LAXATIVES PROF,STOOL",5002002,CDM,301,RC,84999,HCPCS,Outpatient,,,140,105,,109.2,78,,87.36,percent of total billed charges,78% of total billed charges,88.2,63,,70.56,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,53.2,38,,42.56,percent of total billed charges,38% of total billed charges,53.2,38,,42.56,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,126,90,,100.8,percent of total billed charges,90% of total billed charges,49,35,,39.2,percent of total billed charges,35% of total billed charges,94.19,67.275,,75.352,percent of total billed charges,67.275% of total billed charges,112,80,,89.6,percent of total billed charges,80% of total billed charges,53.73,38.38,,42.984,percent of total billed charges,38.38% of total billed charges,112,80,,89.6,percent of total billed charges,80% of total billed charges,86.44,61.74,,69.152,percent of total billed charges,61.74% of total billed charges,142.8,102,,114.24,percent of total billed charges,102% of total billed charges,53.2,38,,42.56,percent of total billed charges,38% of total billed charges,49,142.8,
ISLET CELL ANTIBODY WITH REFLEX,5003904,CDM,302,RC,86341,HCPCS,Outpatient,,,140,105,,109.2,78,,87.36,percent of total billed charges,78% of total billed charges,24.89,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,23.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,23.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,126,90,,100.8,percent of total billed charges,90% of total billed charges,26.13,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,94.19,67.275,,75.352,percent of total billed charges,67.275% of total billed charges,112,80,,89.6,percent of total billed charges,80% of total billed charges,23.81,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,112,80,,89.6,percent of total billed charges,80% of total billed charges,86.44,61.74,,69.152,percent of total billed charges,61.74% of total billed charges,25.39,102,,,Fee Schedule,102% of GA Medicaid Rate,23.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,23.57,126,
SCREW CORTICAL 2.0MM X 10MM,3000631,CDM,270,RC,,,Outpatient,,,140.12,105.09,,109.29,78,,87.432,percent of total billed charges,78% of total billed charges,88.28,63,,70.624,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,126.11,90,,100.888,percent of total billed charges,90% of total billed charges,49.04,35,,39.232,percent of total billed charges,35% of total billed charges,94.27,67.275,,75.416,percent of total billed charges,67.275% of total billed charges,112.1,80,,89.68,percent of total billed charges,80% of total billed charges,53.78,38.38,,43.024,percent of total billed charges,38.38% of total billed charges,112.1,80,,89.68,percent of total billed charges,80% of total billed charges,86.51,61.74,,69.208,percent of total billed charges,61.74% of total billed charges,142.92,102,,114.336,percent of total billed charges,102% of total billed charges,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,49.04,142.92,
SCREW CORTICAL  2.0MM X 18MM,3001510,CDM,270,RC,,,Outpatient,,,140.12,105.09,,109.29,78,,87.432,percent of total billed charges,78% of total billed charges,88.28,63,,70.624,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,126.11,90,,100.888,percent of total billed charges,90% of total billed charges,49.04,35,,39.232,percent of total billed charges,35% of total billed charges,94.27,67.275,,75.416,percent of total billed charges,67.275% of total billed charges,112.1,80,,89.68,percent of total billed charges,80% of total billed charges,53.78,38.38,,43.024,percent of total billed charges,38.38% of total billed charges,112.1,80,,89.68,percent of total billed charges,80% of total billed charges,86.51,61.74,,69.208,percent of total billed charges,61.74% of total billed charges,142.92,102,,114.336,percent of total billed charges,102% of total billed charges,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,49.04,142.92,
SCREW CORTICAL  2.0MM X 8MM,3006100,CDM,270,RC,,,Outpatient,,,140.12,105.09,,109.29,78,,87.432,percent of total billed charges,78% of total billed charges,88.28,63,,70.624,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,126.11,90,,100.888,percent of total billed charges,90% of total billed charges,49.04,35,,39.232,percent of total billed charges,35% of total billed charges,94.27,67.275,,75.416,percent of total billed charges,67.275% of total billed charges,112.1,80,,89.68,percent of total billed charges,80% of total billed charges,53.78,38.38,,43.024,percent of total billed charges,38.38% of total billed charges,112.1,80,,89.68,percent of total billed charges,80% of total billed charges,86.51,61.74,,69.208,percent of total billed charges,61.74% of total billed charges,142.92,102,,114.336,percent of total billed charges,102% of total billed charges,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,49.04,142.92,
SCREW CORTICAL  2.0MM X 12MM,3006101,CDM,270,RC,,,Outpatient,,,140.12,105.09,,109.29,78,,87.432,percent of total billed charges,78% of total billed charges,88.28,63,,70.624,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,126.11,90,,100.888,percent of total billed charges,90% of total billed charges,49.04,35,,39.232,percent of total billed charges,35% of total billed charges,94.27,67.275,,75.416,percent of total billed charges,67.275% of total billed charges,112.1,80,,89.68,percent of total billed charges,80% of total billed charges,53.78,38.38,,43.024,percent of total billed charges,38.38% of total billed charges,112.1,80,,89.68,percent of total billed charges,80% of total billed charges,86.51,61.74,,69.208,percent of total billed charges,61.74% of total billed charges,142.92,102,,114.336,percent of total billed charges,102% of total billed charges,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,49.04,142.92,
SCREW CORTICAL  2.0MM X 14MM,3006102,CDM,270,RC,,,Outpatient,,,140.12,105.09,,109.29,78,,87.432,percent of total billed charges,78% of total billed charges,88.28,63,,70.624,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,126.11,90,,100.888,percent of total billed charges,90% of total billed charges,49.04,35,,39.232,percent of total billed charges,35% of total billed charges,94.27,67.275,,75.416,percent of total billed charges,67.275% of total billed charges,112.1,80,,89.68,percent of total billed charges,80% of total billed charges,53.78,38.38,,43.024,percent of total billed charges,38.38% of total billed charges,112.1,80,,89.68,percent of total billed charges,80% of total billed charges,86.51,61.74,,69.208,percent of total billed charges,61.74% of total billed charges,142.92,102,,114.336,percent of total billed charges,102% of total billed charges,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,49.04,142.92,
SCREW CORTICAL  2.0MM X 16MM,3006103,CDM,270,RC,,,Outpatient,,,140.12,105.09,,109.29,78,,87.432,percent of total billed charges,78% of total billed charges,88.28,63,,70.624,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,126.11,90,,100.888,percent of total billed charges,90% of total billed charges,49.04,35,,39.232,percent of total billed charges,35% of total billed charges,94.27,67.275,,75.416,percent of total billed charges,67.275% of total billed charges,112.1,80,,89.68,percent of total billed charges,80% of total billed charges,53.78,38.38,,43.024,percent of total billed charges,38.38% of total billed charges,112.1,80,,89.68,percent of total billed charges,80% of total billed charges,86.51,61.74,,69.208,percent of total billed charges,61.74% of total billed charges,142.92,102,,114.336,percent of total billed charges,102% of total billed charges,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,49.04,142.92,
SCREW CORTICAL  2.0MM X 20MM,3006104,CDM,270,RC,,,Outpatient,,,140.12,105.09,,109.29,78,,87.432,percent of total billed charges,78% of total billed charges,88.28,63,,70.624,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,126.11,90,,100.888,percent of total billed charges,90% of total billed charges,49.04,35,,39.232,percent of total billed charges,35% of total billed charges,94.27,67.275,,75.416,percent of total billed charges,67.275% of total billed charges,112.1,80,,89.68,percent of total billed charges,80% of total billed charges,53.78,38.38,,43.024,percent of total billed charges,38.38% of total billed charges,112.1,80,,89.68,percent of total billed charges,80% of total billed charges,86.51,61.74,,69.208,percent of total billed charges,61.74% of total billed charges,142.92,102,,114.336,percent of total billed charges,102% of total billed charges,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,49.04,142.92,
SCREW CORTICAL  2.0MM X 22MM,3006105,CDM,270,RC,,,Outpatient,,,140.12,105.09,,109.29,78,,87.432,percent of total billed charges,78% of total billed charges,88.28,63,,70.624,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,126.11,90,,100.888,percent of total billed charges,90% of total billed charges,49.04,35,,39.232,percent of total billed charges,35% of total billed charges,94.27,67.275,,75.416,percent of total billed charges,67.275% of total billed charges,112.1,80,,89.68,percent of total billed charges,80% of total billed charges,53.78,38.38,,43.024,percent of total billed charges,38.38% of total billed charges,112.1,80,,89.68,percent of total billed charges,80% of total billed charges,86.51,61.74,,69.208,percent of total billed charges,61.74% of total billed charges,142.92,102,,114.336,percent of total billed charges,102% of total billed charges,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,49.04,142.92,
SCREW CORTICAL  2.0MM X 24MM,3006106,CDM,270,RC,,,Outpatient,,,140.12,105.09,,109.29,78,,87.432,percent of total billed charges,78% of total billed charges,88.28,63,,70.624,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,126.11,90,,100.888,percent of total billed charges,90% of total billed charges,49.04,35,,39.232,percent of total billed charges,35% of total billed charges,94.27,67.275,,75.416,percent of total billed charges,67.275% of total billed charges,112.1,80,,89.68,percent of total billed charges,80% of total billed charges,53.78,38.38,,43.024,percent of total billed charges,38.38% of total billed charges,112.1,80,,89.68,percent of total billed charges,80% of total billed charges,86.51,61.74,,69.208,percent of total billed charges,61.74% of total billed charges,142.92,102,,114.336,percent of total billed charges,102% of total billed charges,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,49.04,142.92,
SCREW CORTICAL  2.0MM X 26MM,3006107,CDM,270,RC,,,Outpatient,,,140.12,105.09,,109.29,78,,87.432,percent of total billed charges,78% of total billed charges,88.28,63,,70.624,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,126.11,90,,100.888,percent of total billed charges,90% of total billed charges,49.04,35,,39.232,percent of total billed charges,35% of total billed charges,94.27,67.275,,75.416,percent of total billed charges,67.275% of total billed charges,112.1,80,,89.68,percent of total billed charges,80% of total billed charges,53.78,38.38,,43.024,percent of total billed charges,38.38% of total billed charges,112.1,80,,89.68,percent of total billed charges,80% of total billed charges,86.51,61.74,,69.208,percent of total billed charges,61.74% of total billed charges,142.92,102,,114.336,percent of total billed charges,102% of total billed charges,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,49.04,142.92,
SCREW CORTICAL  2.0MM X 28MM,3006108,CDM,270,RC,,,Outpatient,,,140.12,105.09,,109.29,78,,87.432,percent of total billed charges,78% of total billed charges,88.28,63,,70.624,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,126.11,90,,100.888,percent of total billed charges,90% of total billed charges,49.04,35,,39.232,percent of total billed charges,35% of total billed charges,94.27,67.275,,75.416,percent of total billed charges,67.275% of total billed charges,112.1,80,,89.68,percent of total billed charges,80% of total billed charges,53.78,38.38,,43.024,percent of total billed charges,38.38% of total billed charges,112.1,80,,89.68,percent of total billed charges,80% of total billed charges,86.51,61.74,,69.208,percent of total billed charges,61.74% of total billed charges,142.92,102,,114.336,percent of total billed charges,102% of total billed charges,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,49.04,142.92,
SCREW CORTICAL  2.0MM X 30MM,3006109,CDM,270,RC,,,Outpatient,,,140.12,105.09,,109.29,78,,87.432,percent of total billed charges,78% of total billed charges,88.28,63,,70.624,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,126.11,90,,100.888,percent of total billed charges,90% of total billed charges,49.04,35,,39.232,percent of total billed charges,35% of total billed charges,94.27,67.275,,75.416,percent of total billed charges,67.275% of total billed charges,112.1,80,,89.68,percent of total billed charges,80% of total billed charges,53.78,38.38,,43.024,percent of total billed charges,38.38% of total billed charges,112.1,80,,89.68,percent of total billed charges,80% of total billed charges,86.51,61.74,,69.208,percent of total billed charges,61.74% of total billed charges,142.92,102,,114.336,percent of total billed charges,102% of total billed charges,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,49.04,142.92,
SCREW CORTICAL  2.0MM X 32MM,3006110,CDM,270,RC,,,Outpatient,,,140.12,105.09,,109.29,78,,87.432,percent of total billed charges,78% of total billed charges,88.28,63,,70.624,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,126.11,90,,100.888,percent of total billed charges,90% of total billed charges,49.04,35,,39.232,percent of total billed charges,35% of total billed charges,94.27,67.275,,75.416,percent of total billed charges,67.275% of total billed charges,112.1,80,,89.68,percent of total billed charges,80% of total billed charges,53.78,38.38,,43.024,percent of total billed charges,38.38% of total billed charges,112.1,80,,89.68,percent of total billed charges,80% of total billed charges,86.51,61.74,,69.208,percent of total billed charges,61.74% of total billed charges,142.92,102,,114.336,percent of total billed charges,102% of total billed charges,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,49.04,142.92,
SCREW CORTICAL  2.0MM X 34MM,3006111,CDM,270,RC,,,Outpatient,,,140.12,105.09,,109.29,78,,87.432,percent of total billed charges,78% of total billed charges,88.28,63,,70.624,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,126.11,90,,100.888,percent of total billed charges,90% of total billed charges,49.04,35,,39.232,percent of total billed charges,35% of total billed charges,94.27,67.275,,75.416,percent of total billed charges,67.275% of total billed charges,112.1,80,,89.68,percent of total billed charges,80% of total billed charges,53.78,38.38,,43.024,percent of total billed charges,38.38% of total billed charges,112.1,80,,89.68,percent of total billed charges,80% of total billed charges,86.51,61.74,,69.208,percent of total billed charges,61.74% of total billed charges,142.92,102,,114.336,percent of total billed charges,102% of total billed charges,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,49.04,142.92,
SCREW CORTICAL  2.0MM X 36MM,3006112,CDM,270,RC,,,Outpatient,,,140.12,105.09,,109.29,78,,87.432,percent of total billed charges,78% of total billed charges,88.28,63,,70.624,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,126.11,90,,100.888,percent of total billed charges,90% of total billed charges,49.04,35,,39.232,percent of total billed charges,35% of total billed charges,94.27,67.275,,75.416,percent of total billed charges,67.275% of total billed charges,112.1,80,,89.68,percent of total billed charges,80% of total billed charges,53.78,38.38,,43.024,percent of total billed charges,38.38% of total billed charges,112.1,80,,89.68,percent of total billed charges,80% of total billed charges,86.51,61.74,,69.208,percent of total billed charges,61.74% of total billed charges,142.92,102,,114.336,percent of total billed charges,102% of total billed charges,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,49.04,142.92,
SCREW CORTICAL  2.0MM X 38MM,3006113,CDM,270,RC,,,Outpatient,,,140.12,105.09,,109.29,78,,87.432,percent of total billed charges,78% of total billed charges,88.28,63,,70.624,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,126.11,90,,100.888,percent of total billed charges,90% of total billed charges,49.04,35,,39.232,percent of total billed charges,35% of total billed charges,94.27,67.275,,75.416,percent of total billed charges,67.275% of total billed charges,112.1,80,,89.68,percent of total billed charges,80% of total billed charges,53.78,38.38,,43.024,percent of total billed charges,38.38% of total billed charges,112.1,80,,89.68,percent of total billed charges,80% of total billed charges,86.51,61.74,,69.208,percent of total billed charges,61.74% of total billed charges,142.92,102,,114.336,percent of total billed charges,102% of total billed charges,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,49.04,142.92,
SCREW CORTICAL  2.0MM X 40MM,3006114,CDM,270,RC,,,Outpatient,,,140.12,105.09,,109.29,78,,87.432,percent of total billed charges,78% of total billed charges,88.28,63,,70.624,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,126.11,90,,100.888,percent of total billed charges,90% of total billed charges,49.04,35,,39.232,percent of total billed charges,35% of total billed charges,94.27,67.275,,75.416,percent of total billed charges,67.275% of total billed charges,112.1,80,,89.68,percent of total billed charges,80% of total billed charges,53.78,38.38,,43.024,percent of total billed charges,38.38% of total billed charges,112.1,80,,89.68,percent of total billed charges,80% of total billed charges,86.51,61.74,,69.208,percent of total billed charges,61.74% of total billed charges,142.92,102,,114.336,percent of total billed charges,102% of total billed charges,53.25,38,,42.6,percent of total billed charges,38% of total billed charges,49.04,142.92,
HEMI ARM SLING - LEFT - LG,3000026,CDM,270,RC,,,Outpatient,,,140.6,105.45,,109.67,78,,87.736,percent of total billed charges,78% of total billed charges,88.58,63,,70.864,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,53.43,38,,42.744,percent of total billed charges,38% of total billed charges,53.43,38,,42.744,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,126.54,90,,101.232,percent of total billed charges,90% of total billed charges,49.21,35,,39.368,percent of total billed charges,35% of total billed charges,94.59,67.275,,75.672,percent of total billed charges,67.275% of total billed charges,112.48,80,,89.984,percent of total billed charges,80% of total billed charges,53.96,38.38,,43.168,percent of total billed charges,38.38% of total billed charges,112.48,80,,89.984,percent of total billed charges,80% of total billed charges,86.81,61.74,,69.448,percent of total billed charges,61.74% of total billed charges,143.41,102,,114.728,percent of total billed charges,102% of total billed charges,53.43,38,,42.744,percent of total billed charges,38% of total billed charges,49.21,143.41,
Test to determine levels of immunoglobulins in the blood,5001844,CDM,301,RC,82784,HCPCS,Outpatient,,,141,105.75,,109.98,78,,87.984,percent of total billed charges,78% of total billed charges,11.69,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,9.3,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,9.3,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,126.9,90,,101.52,percent of total billed charges,90% of total billed charges,12.27,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,94.86,67.275,,75.888,percent of total billed charges,67.275% of total billed charges,112.8,80,,90.24,percent of total billed charges,80% of total billed charges,9.39,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,112.8,80,,90.24,percent of total billed charges,80% of total billed charges,87.05,61.74,,69.64,percent of total billed charges,61.74% of total billed charges,11.92,102,,,Fee Schedule,102% of GA Medicaid Rate,9.3,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,9.3,126.9,
Test to determine levels of immunoglobulins in the blood,5001846,CDM,302,RC,82784,HCPCS,Outpatient,,,141,105.75,,109.98,78,,87.984,percent of total billed charges,78% of total billed charges,11.69,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,9.3,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,9.3,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,126.9,90,,101.52,percent of total billed charges,90% of total billed charges,12.27,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,94.86,67.275,,75.888,percent of total billed charges,67.275% of total billed charges,112.8,80,,90.24,percent of total billed charges,80% of total billed charges,9.39,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,112.8,80,,90.24,percent of total billed charges,80% of total billed charges,87.05,61.74,,69.64,percent of total billed charges,61.74% of total billed charges,11.92,102,,,Fee Schedule,102% of GA Medicaid Rate,9.3,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,9.3,126.9,
Test to determine levels of immunoglobulins in the blood,5001848,CDM,301,RC,82784,HCPCS,Outpatient,,,141,105.75,,109.98,78,,87.984,percent of total billed charges,78% of total billed charges,11.69,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,9.3,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,9.3,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,126.9,90,,101.52,percent of total billed charges,90% of total billed charges,12.27,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,94.86,67.275,,75.888,percent of total billed charges,67.275% of total billed charges,112.8,80,,90.24,percent of total billed charges,80% of total billed charges,9.39,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,112.8,80,,90.24,percent of total billed charges,80% of total billed charges,87.05,61.74,,69.64,percent of total billed charges,61.74% of total billed charges,11.92,102,,,Fee Schedule,102% of GA Medicaid Rate,9.3,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,9.3,126.9,
SCREW CORTICAL 12MM X 2.7MM,3001020,CDM,270,RC,,,Outpatient,,,141.72,106.29,,110.54,78,,88.432,percent of total billed charges,78% of total billed charges,89.28,63,,71.424,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,53.85,38,,43.08,percent of total billed charges,38% of total billed charges,53.85,38,,43.08,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,127.55,90,,102.04,percent of total billed charges,90% of total billed charges,49.6,35,,39.68,percent of total billed charges,35% of total billed charges,95.34,67.275,,76.272,percent of total billed charges,67.275% of total billed charges,113.38,80,,90.704,percent of total billed charges,80% of total billed charges,54.39,38.38,,43.512,percent of total billed charges,38.38% of total billed charges,113.38,80,,90.704,percent of total billed charges,80% of total billed charges,87.5,61.74,,70,percent of total billed charges,61.74% of total billed charges,144.55,102,,115.64,percent of total billed charges,102% of total billed charges,53.85,38,,43.08,percent of total billed charges,38% of total billed charges,49.6,144.55,
SCREW CORTICAL 22MM X 2.7MM,3001110,CDM,270,RC,,,Outpatient,,,141.72,106.29,,110.54,78,,88.432,percent of total billed charges,78% of total billed charges,89.28,63,,71.424,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,53.85,38,,43.08,percent of total billed charges,38% of total billed charges,53.85,38,,43.08,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,127.55,90,,102.04,percent of total billed charges,90% of total billed charges,49.6,35,,39.68,percent of total billed charges,35% of total billed charges,95.34,67.275,,76.272,percent of total billed charges,67.275% of total billed charges,113.38,80,,90.704,percent of total billed charges,80% of total billed charges,54.39,38.38,,43.512,percent of total billed charges,38.38% of total billed charges,113.38,80,,90.704,percent of total billed charges,80% of total billed charges,87.5,61.74,,70,percent of total billed charges,61.74% of total billed charges,144.55,102,,115.64,percent of total billed charges,102% of total billed charges,53.85,38,,43.08,percent of total billed charges,38% of total billed charges,49.6,144.55,
SCREW CORTICAL 26MM X 2.7MM,3001540,CDM,270,RC,,,Outpatient,,,141.72,106.29,,110.54,78,,88.432,percent of total billed charges,78% of total billed charges,89.28,63,,71.424,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,53.85,38,,43.08,percent of total billed charges,38% of total billed charges,53.85,38,,43.08,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,127.55,90,,102.04,percent of total billed charges,90% of total billed charges,49.6,35,,39.68,percent of total billed charges,35% of total billed charges,95.34,67.275,,76.272,percent of total billed charges,67.275% of total billed charges,113.38,80,,90.704,percent of total billed charges,80% of total billed charges,54.39,38.38,,43.512,percent of total billed charges,38.38% of total billed charges,113.38,80,,90.704,percent of total billed charges,80% of total billed charges,87.5,61.74,,70,percent of total billed charges,61.74% of total billed charges,144.55,102,,115.64,percent of total billed charges,102% of total billed charges,53.85,38,,43.08,percent of total billed charges,38% of total billed charges,49.6,144.55,
SCREW CORTICAL 16MM X 2.7MM,3003029,CDM,270,RC,,,Outpatient,,,141.72,106.29,,110.54,78,,88.432,percent of total billed charges,78% of total billed charges,89.28,63,,71.424,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,53.85,38,,43.08,percent of total billed charges,38% of total billed charges,53.85,38,,43.08,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,127.55,90,,102.04,percent of total billed charges,90% of total billed charges,49.6,35,,39.68,percent of total billed charges,35% of total billed charges,95.34,67.275,,76.272,percent of total billed charges,67.275% of total billed charges,113.38,80,,90.704,percent of total billed charges,80% of total billed charges,54.39,38.38,,43.512,percent of total billed charges,38.38% of total billed charges,113.38,80,,90.704,percent of total billed charges,80% of total billed charges,87.5,61.74,,70,percent of total billed charges,61.74% of total billed charges,144.55,102,,115.64,percent of total billed charges,102% of total billed charges,53.85,38,,43.08,percent of total billed charges,38% of total billed charges,49.6,144.55,
SCREW CORTICAL 20MM X 2.7MM,3005076,CDM,270,RC,,,Outpatient,,,141.72,106.29,,110.54,78,,88.432,percent of total billed charges,78% of total billed charges,89.28,63,,71.424,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,53.85,38,,43.08,percent of total billed charges,38% of total billed charges,53.85,38,,43.08,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,127.55,90,,102.04,percent of total billed charges,90% of total billed charges,49.6,35,,39.68,percent of total billed charges,35% of total billed charges,95.34,67.275,,76.272,percent of total billed charges,67.275% of total billed charges,113.38,80,,90.704,percent of total billed charges,80% of total billed charges,54.39,38.38,,43.512,percent of total billed charges,38.38% of total billed charges,113.38,80,,90.704,percent of total billed charges,80% of total billed charges,87.5,61.74,,70,percent of total billed charges,61.74% of total billed charges,144.55,102,,115.64,percent of total billed charges,102% of total billed charges,53.85,38,,43.08,percent of total billed charges,38% of total billed charges,49.6,144.55,
SCREW CORTICAL 14MM X 2.7MM,3006030,CDM,270,RC,,,Outpatient,,,141.72,106.29,,110.54,78,,88.432,percent of total billed charges,78% of total billed charges,89.28,63,,71.424,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,53.85,38,,43.08,percent of total billed charges,38% of total billed charges,53.85,38,,43.08,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,127.55,90,,102.04,percent of total billed charges,90% of total billed charges,49.6,35,,39.68,percent of total billed charges,35% of total billed charges,95.34,67.275,,76.272,percent of total billed charges,67.275% of total billed charges,113.38,80,,90.704,percent of total billed charges,80% of total billed charges,54.39,38.38,,43.512,percent of total billed charges,38.38% of total billed charges,113.38,80,,90.704,percent of total billed charges,80% of total billed charges,87.5,61.74,,70,percent of total billed charges,61.74% of total billed charges,144.55,102,,115.64,percent of total billed charges,102% of total billed charges,53.85,38,,43.08,percent of total billed charges,38% of total billed charges,49.6,144.55,
SCREW CORTICAL 10MM X 2.7MM,3006039,CDM,270,RC,,,Outpatient,,,141.72,106.29,,110.54,78,,88.432,percent of total billed charges,78% of total billed charges,89.28,63,,71.424,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,53.85,38,,43.08,percent of total billed charges,38% of total billed charges,53.85,38,,43.08,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,127.55,90,,102.04,percent of total billed charges,90% of total billed charges,49.6,35,,39.68,percent of total billed charges,35% of total billed charges,95.34,67.275,,76.272,percent of total billed charges,67.275% of total billed charges,113.38,80,,90.704,percent of total billed charges,80% of total billed charges,54.39,38.38,,43.512,percent of total billed charges,38.38% of total billed charges,113.38,80,,90.704,percent of total billed charges,80% of total billed charges,87.5,61.74,,70,percent of total billed charges,61.74% of total billed charges,144.55,102,,115.64,percent of total billed charges,102% of total billed charges,53.85,38,,43.08,percent of total billed charges,38% of total billed charges,49.6,144.55,
SCREW CORTICAL 28MM X 2.7MM,3006115,CDM,270,RC,,,Outpatient,,,141.72,106.29,,110.54,78,,88.432,percent of total billed charges,78% of total billed charges,89.28,63,,71.424,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,53.85,38,,43.08,percent of total billed charges,38% of total billed charges,53.85,38,,43.08,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,127.55,90,,102.04,percent of total billed charges,90% of total billed charges,49.6,35,,39.68,percent of total billed charges,35% of total billed charges,95.34,67.275,,76.272,percent of total billed charges,67.275% of total billed charges,113.38,80,,90.704,percent of total billed charges,80% of total billed charges,54.39,38.38,,43.512,percent of total billed charges,38.38% of total billed charges,113.38,80,,90.704,percent of total billed charges,80% of total billed charges,87.5,61.74,,70,percent of total billed charges,61.74% of total billed charges,144.55,102,,115.64,percent of total billed charges,102% of total billed charges,53.85,38,,43.08,percent of total billed charges,38% of total billed charges,49.6,144.55,
SCREW CORTICAL 45MM X 2.7MM,3006116,CDM,270,RC,,,Outpatient,,,141.72,106.29,,110.54,78,,88.432,percent of total billed charges,78% of total billed charges,89.28,63,,71.424,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,53.85,38,,43.08,percent of total billed charges,38% of total billed charges,53.85,38,,43.08,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,127.55,90,,102.04,percent of total billed charges,90% of total billed charges,49.6,35,,39.68,percent of total billed charges,35% of total billed charges,95.34,67.275,,76.272,percent of total billed charges,67.275% of total billed charges,113.38,80,,90.704,percent of total billed charges,80% of total billed charges,54.39,38.38,,43.512,percent of total billed charges,38.38% of total billed charges,113.38,80,,90.704,percent of total billed charges,80% of total billed charges,87.5,61.74,,70,percent of total billed charges,61.74% of total billed charges,144.55,102,,115.64,percent of total billed charges,102% of total billed charges,53.85,38,,43.08,percent of total billed charges,38% of total billed charges,49.6,144.55,
SCREW CORTICAL 50MM X 2.7MM,3006117,CDM,270,RC,,,Outpatient,,,141.72,106.29,,110.54,78,,88.432,percent of total billed charges,78% of total billed charges,89.28,63,,71.424,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,53.85,38,,43.08,percent of total billed charges,38% of total billed charges,53.85,38,,43.08,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,127.55,90,,102.04,percent of total billed charges,90% of total billed charges,49.6,35,,39.68,percent of total billed charges,35% of total billed charges,95.34,67.275,,76.272,percent of total billed charges,67.275% of total billed charges,113.38,80,,90.704,percent of total billed charges,80% of total billed charges,54.39,38.38,,43.512,percent of total billed charges,38.38% of total billed charges,113.38,80,,90.704,percent of total billed charges,80% of total billed charges,87.5,61.74,,70,percent of total billed charges,61.74% of total billed charges,144.55,102,,115.64,percent of total billed charges,102% of total billed charges,53.85,38,,43.08,percent of total billed charges,38% of total billed charges,49.6,144.55,
SEX HORMONE BINDING GLOBU,5001946,CDM,301,RC,84270,HCPCS,Outpatient,,,142,106.5,,110.76,78,,88.608,percent of total billed charges,78% of total billed charges,27.32,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,21.73,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,21.73,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,28.69,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,95.53,67.275,,76.424,percent of total billed charges,67.275% of total billed charges,113.6,80,,90.88,percent of total billed charges,80% of total billed charges,21.95,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,113.6,80,,90.88,percent of total billed charges,80% of total billed charges,87.67,61.74,,70.136,percent of total billed charges,61.74% of total billed charges,27.87,102,,,Fee Schedule,102% of GA Medicaid Rate,21.73,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,21.73,127.8,
URANIUM,5001672,CDM,301,RC,83018,HCPCS,Outpatient,,,143,107.25,,111.54,78,,89.232,percent of total billed charges,78% of total billed charges,27.61,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,21.96,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,21.96,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,128.7,90,,102.96,percent of total billed charges,90% of total billed charges,28.99,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,96.2,67.275,,76.96,percent of total billed charges,67.275% of total billed charges,114.4,80,,91.52,percent of total billed charges,80% of total billed charges,22.18,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,114.4,80,,91.52,percent of total billed charges,80% of total billed charges,88.29,61.74,,70.632,percent of total billed charges,61.74% of total billed charges,28.16,102,,,Fee Schedule,102% of GA Medicaid Rate,21.96,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,21.96,128.7,
COBALT WHOLE BLOOD,5001677,CDM,301,RC,83018,HCPCS,Outpatient,,,143,107.25,,111.54,78,,89.232,percent of total billed charges,78% of total billed charges,27.61,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,21.96,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,21.96,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,128.7,90,,102.96,percent of total billed charges,90% of total billed charges,28.99,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,96.2,67.275,,76.96,percent of total billed charges,67.275% of total billed charges,114.4,80,,91.52,percent of total billed charges,80% of total billed charges,22.18,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,114.4,80,,91.52,percent of total billed charges,80% of total billed charges,88.29,61.74,,70.632,percent of total billed charges,61.74% of total billed charges,28.16,102,,,Fee Schedule,102% of GA Medicaid Rate,21.96,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,21.96,128.7,
COBALT URINE,5002091,CDM,301,RC,83018,HCPCS,Outpatient,,,143,107.25,,111.54,78,,89.232,percent of total billed charges,78% of total billed charges,27.61,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,21.96,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,21.96,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,128.7,90,,102.96,percent of total billed charges,90% of total billed charges,28.99,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,96.2,67.275,,76.96,percent of total billed charges,67.275% of total billed charges,114.4,80,,91.52,percent of total billed charges,80% of total billed charges,22.18,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,114.4,80,,91.52,percent of total billed charges,80% of total billed charges,88.29,61.74,,70.632,percent of total billed charges,61.74% of total billed charges,28.16,102,,,Fee Schedule,102% of GA Medicaid Rate,21.96,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,21.96,128.7,
MODULE IV PURPLE,3000038,CDM,270,RC,,,Outpatient,,,144,108,,112.32,78,,89.856,percent of total billed charges,78% of total billed charges,90.72,63,,72.576,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,54.72,38,,43.776,percent of total billed charges,38% of total billed charges,54.72,38,,43.776,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,50.4,35,,40.32,percent of total billed charges,35% of total billed charges,96.88,67.275,,77.504,percent of total billed charges,67.275% of total billed charges,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,55.27,38.38,,44.216,percent of total billed charges,38.38% of total billed charges,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,88.91,61.74,,71.128,percent of total billed charges,61.74% of total billed charges,146.88,102,,117.504,percent of total billed charges,102% of total billed charges,54.72,38,,43.776,percent of total billed charges,38% of total billed charges,50.4,146.88,
CORTICAL SCREW 3.5 MM x 34mm,3000039,CDM,270,RC,,,Outpatient,,,144,108,,112.32,78,,89.856,percent of total billed charges,78% of total billed charges,90.72,63,,72.576,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,54.72,38,,43.776,percent of total billed charges,38% of total billed charges,54.72,38,,43.776,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,50.4,35,,40.32,percent of total billed charges,35% of total billed charges,96.88,67.275,,77.504,percent of total billed charges,67.275% of total billed charges,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,55.27,38.38,,44.216,percent of total billed charges,38.38% of total billed charges,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,88.91,61.74,,71.128,percent of total billed charges,61.74% of total billed charges,146.88,102,,117.504,percent of total billed charges,102% of total billed charges,54.72,38,,43.776,percent of total billed charges,38% of total billed charges,50.4,146.88,
CORTICAL SCREW 3.5 MM,3000054,CDM,270,RC,,,Outpatient,,,144,108,,112.32,78,,89.856,percent of total billed charges,78% of total billed charges,90.72,63,,72.576,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,54.72,38,,43.776,percent of total billed charges,38% of total billed charges,54.72,38,,43.776,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,50.4,35,,40.32,percent of total billed charges,35% of total billed charges,96.88,67.275,,77.504,percent of total billed charges,67.275% of total billed charges,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,55.27,38.38,,44.216,percent of total billed charges,38.38% of total billed charges,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,88.91,61.74,,71.128,percent of total billed charges,61.74% of total billed charges,146.88,102,,117.504,percent of total billed charges,102% of total billed charges,54.72,38,,43.776,percent of total billed charges,38% of total billed charges,50.4,146.88,
SCREW CORTICAL 3.5MM,3004009,CDM,270,RC,,,Outpatient,,,144,108,,112.32,78,,89.856,percent of total billed charges,78% of total billed charges,90.72,63,,72.576,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,54.72,38,,43.776,percent of total billed charges,38% of total billed charges,54.72,38,,43.776,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,50.4,35,,40.32,percent of total billed charges,35% of total billed charges,96.88,67.275,,77.504,percent of total billed charges,67.275% of total billed charges,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,55.27,38.38,,44.216,percent of total billed charges,38.38% of total billed charges,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,88.91,61.74,,71.128,percent of total billed charges,61.74% of total billed charges,146.88,102,,117.504,percent of total billed charges,102% of total billed charges,54.72,38,,43.776,percent of total billed charges,38% of total billed charges,50.4,146.88,
DILANTIN LEVEL,5001414,CDM,301,RC,80185,HCPCS,Outpatient,,,144,108,,112.32,78,,89.856,percent of total billed charges,78% of total billed charges,16.67,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,17.5,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,96.88,67.275,,77.504,percent of total billed charges,67.275% of total billed charges,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,13.38,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,88.91,61.74,,71.128,percent of total billed charges,61.74% of total billed charges,17,102,,,Fee Schedule,102% of GA Medicaid Rate,13.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.25,129.6,
DIGOXIN,5001425,CDM,301,RC,80162,HCPCS,Outpatient,,,144,108,,112.32,78,,89.856,percent of total billed charges,78% of total billed charges,16.7,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.28,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.28,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,17.54,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,96.88,67.275,,77.504,percent of total billed charges,67.275% of total billed charges,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,13.41,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,88.91,61.74,,71.128,percent of total billed charges,61.74% of total billed charges,17.03,102,,,Fee Schedule,102% of GA Medicaid Rate,13.28,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.28,129.6,
PLASMA RENIN ACTIVITY,5001889,CDM,301,RC,84244,HCPCS,Outpatient,,,144,108,,112.32,78,,89.856,percent of total billed charges,78% of total billed charges,27.66,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,21.99,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,21.99,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,29.04,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,96.88,67.275,,77.504,percent of total billed charges,67.275% of total billed charges,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,22.21,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,88.91,61.74,,71.128,percent of total billed charges,61.74% of total billed charges,28.21,102,,,Fee Schedule,102% of GA Medicaid Rate,21.99,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,21.99,129.6,
ORTHO TREATMENT UNSPEC,1001089,CDM,450,RC,,,Outpatient,,,145,108.75,,113.1,78,,90.48,percent of total billed charges,78% of total billed charges,91.35,63,,73.08,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,55.1,38,,44.08,percent of total billed charges,38% of total billed charges,55.1,38,,44.08,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,130.5,90,,104.4,percent of total billed charges,90% of total billed charges,50.75,35,,40.6,percent of total billed charges,35% of total billed charges,97.55,67.275,,78.04,percent of total billed charges,67.275% of total billed charges,116,80,,92.8,percent of total billed charges,80% of total billed charges,55.65,38.38,,44.52,percent of total billed charges,38.38% of total billed charges,116,80,,92.8,percent of total billed charges,80% of total billed charges,89.52,61.74,,71.616,percent of total billed charges,61.74% of total billed charges,147.9,102,,118.32,percent of total billed charges,102% of total billed charges,55.1,38,,44.08,percent of total billed charges,38% of total billed charges,50.75,147.9,
Blood test to measure an enzyme in the blood,5001714,CDM,301,RC,82627,HCPCS,Outpatient,,,145,108.75,,113.1,78,,90.48,percent of total billed charges,78% of total billed charges,27.96,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,22.23,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,22.23,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,130.5,90,,104.4,percent of total billed charges,90% of total billed charges,29.36,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,97.55,67.275,,78.04,percent of total billed charges,67.275% of total billed charges,116,80,,92.8,percent of total billed charges,80% of total billed charges,22.45,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,116,80,,92.8,percent of total billed charges,80% of total billed charges,89.52,61.74,,71.616,percent of total billed charges,61.74% of total billed charges,28.52,102,,,Fee Schedule,102% of GA Medicaid Rate,22.23,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,22.23,130.5,
INSULIN AUTO Ab,5001801,CDM,302,RC,86337,HCPCS,Outpatient,,,145,108.75,,113.1,78,,90.48,percent of total billed charges,78% of total billed charges,26.93,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,21.41,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,21.41,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,130.5,90,,104.4,percent of total billed charges,90% of total billed charges,28.28,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,97.55,67.275,,78.04,percent of total billed charges,67.275% of total billed charges,116,80,,92.8,percent of total billed charges,80% of total billed charges,21.62,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,116,80,,92.8,percent of total billed charges,80% of total billed charges,89.52,61.74,,71.616,percent of total billed charges,61.74% of total billed charges,27.47,102,,,Fee Schedule,102% of GA Medicaid Rate,21.41,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,21.41,130.5,
DIRECT LDL,5000244,CDM,301,RC,83721,HCPCS,Outpatient,,,146,109.5,,113.88,78,,91.104,percent of total billed charges,78% of total billed charges,12,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,10.5,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.5,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,131.4,90,,105.12,percent of total billed charges,90% of total billed charges,12.6,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,98.22,67.275,,78.576,percent of total billed charges,67.275% of total billed charges,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,10.61,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,90.14,61.74,,72.112,percent of total billed charges,61.74% of total billed charges,12.24,102,,,Fee Schedule,102% of GA Medicaid Rate,10.5,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.5,131.4,
ALA DEHYDRATASE,5000759,CDM,301,RC,82657,HCPCS,Outpatient,,,146,109.5,,113.88,78,,91.104,percent of total billed charges,78% of total billed charges,7.55,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,22.17,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,22.17,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,131.4,90,,105.12,percent of total billed charges,90% of total billed charges,7.93,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,98.22,67.275,,78.576,percent of total billed charges,67.275% of total billed charges,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,22.39,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,90.14,61.74,,72.112,percent of total billed charges,61.74% of total billed charges,7.7,102,,,Fee Schedule,102% of GA Medicaid Rate,22.17,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.55,131.4,
UROPORPHYRINOGEN III SYNTASE,5001853,CDM,301,RC,82657,HCPCS,Outpatient,,,146,109.5,,113.88,78,,91.104,percent of total billed charges,78% of total billed charges,7.55,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,22.17,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,22.17,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,131.4,90,,105.12,percent of total billed charges,90% of total billed charges,7.93,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,98.22,67.275,,78.576,percent of total billed charges,67.275% of total billed charges,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,22.39,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,90.14,61.74,,72.112,percent of total billed charges,61.74% of total billed charges,7.7,102,,,Fee Schedule,102% of GA Medicaid Rate,22.17,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.55,131.4,
PHOSPHATIDYLSERINE Ab IgG,5002072,CDM,302,RC,86148,HCPCS,Outpatient,,,146,109.5,,113.88,78,,91.104,percent of total billed charges,78% of total billed charges,20.2,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.07,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.07,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,131.4,90,,105.12,percent of total billed charges,90% of total billed charges,21.21,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,98.22,67.275,,78.576,percent of total billed charges,67.275% of total billed charges,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,16.23,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,90.14,61.74,,72.112,percent of total billed charges,61.74% of total billed charges,20.6,102,,,Fee Schedule,102% of GA Medicaid Rate,16.07,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.07,131.4,
PHOSPHATIDYLSERINE Ab IgA,5002073,CDM,302,RC,86148,HCPCS,Outpatient,,,146,109.5,,113.88,78,,91.104,percent of total billed charges,78% of total billed charges,20.2,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.07,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.07,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,131.4,90,,105.12,percent of total billed charges,90% of total billed charges,21.21,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,98.22,67.275,,78.576,percent of total billed charges,67.275% of total billed charges,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,16.23,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,90.14,61.74,,72.112,percent of total billed charges,61.74% of total billed charges,20.6,102,,,Fee Schedule,102% of GA Medicaid Rate,16.07,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.07,131.4,
PHOSPHATIDYLSERINE Ab IgM,5002074,CDM,302,RC,86148,HCPCS,Outpatient,,,146,109.5,,113.88,78,,91.104,percent of total billed charges,78% of total billed charges,20.2,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.07,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.07,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,131.4,90,,105.12,percent of total billed charges,90% of total billed charges,21.21,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,98.22,67.275,,78.576,percent of total billed charges,67.275% of total billed charges,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,16.23,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,90.14,61.74,,72.112,percent of total billed charges,61.74% of total billed charges,20.6,102,,,Fee Schedule,102% of GA Medicaid Rate,16.07,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.07,131.4,
NASAL PACKING - XLARGE,3001537,CDM,270,RC,,,Outpatient,,,146.55,109.91,,114.31,78,,91.448,percent of total billed charges,78% of total billed charges,92.33,63,,73.864,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,55.69,38,,44.552,percent of total billed charges,38% of total billed charges,55.69,38,,44.552,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,131.9,90,,105.52,percent of total billed charges,90% of total billed charges,51.29,35,,41.032,percent of total billed charges,35% of total billed charges,98.59,67.275,,78.872,percent of total billed charges,67.275% of total billed charges,117.24,80,,93.792,percent of total billed charges,80% of total billed charges,56.25,38.38,,45,percent of total billed charges,38.38% of total billed charges,117.24,80,,93.792,percent of total billed charges,80% of total billed charges,90.48,61.74,,72.384,percent of total billed charges,61.74% of total billed charges,149.48,102,,119.584,percent of total billed charges,102% of total billed charges,55.69,38,,44.552,percent of total billed charges,38% of total billed charges,51.29,149.48,
SCREW - 4.0 X 14MM,3005073,CDM,270,RC,,,Outpatient,,,147.6,110.7,,115.13,78,,92.104,percent of total billed charges,78% of total billed charges,92.99,63,,74.392,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,56.09,38,,44.872,percent of total billed charges,38% of total billed charges,56.09,38,,44.872,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,132.84,90,,106.272,percent of total billed charges,90% of total billed charges,51.66,35,,41.328,percent of total billed charges,35% of total billed charges,99.3,67.275,,79.44,percent of total billed charges,67.275% of total billed charges,118.08,80,,94.464,percent of total billed charges,80% of total billed charges,56.65,38.38,,45.32,percent of total billed charges,38.38% of total billed charges,118.08,80,,94.464,percent of total billed charges,80% of total billed charges,91.13,61.74,,72.904,percent of total billed charges,61.74% of total billed charges,150.55,102,,120.44,percent of total billed charges,102% of total billed charges,56.09,38,,44.872,percent of total billed charges,38% of total billed charges,51.66,150.55,
MODULE IV PINK/RED,3000034,CDM,270,RC,,,Outpatient,,,147.92,110.94,,115.38,78,,92.304,percent of total billed charges,78% of total billed charges,93.19,63,,74.552,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,56.21,38,,44.968,percent of total billed charges,38% of total billed charges,56.21,38,,44.968,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,133.13,90,,106.504,percent of total billed charges,90% of total billed charges,51.77,35,,41.416,percent of total billed charges,35% of total billed charges,99.51,67.275,,79.608,percent of total billed charges,67.275% of total billed charges,118.34,80,,94.672,percent of total billed charges,80% of total billed charges,56.77,38.38,,45.416,percent of total billed charges,38.38% of total billed charges,118.34,80,,94.672,percent of total billed charges,80% of total billed charges,91.33,61.74,,73.064,percent of total billed charges,61.74% of total billed charges,150.88,102,,120.704,percent of total billed charges,102% of total billed charges,56.21,38,,44.968,percent of total billed charges,38% of total billed charges,51.77,150.88,
MODULE IV ORANGE,3000043,CDM,270,RC,,,Outpatient,,,147.92,110.94,,115.38,78,,92.304,percent of total billed charges,78% of total billed charges,93.19,63,,74.552,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,56.21,38,,44.968,percent of total billed charges,38% of total billed charges,56.21,38,,44.968,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,133.13,90,,106.504,percent of total billed charges,90% of total billed charges,51.77,35,,41.416,percent of total billed charges,35% of total billed charges,99.51,67.275,,79.608,percent of total billed charges,67.275% of total billed charges,118.34,80,,94.672,percent of total billed charges,80% of total billed charges,56.77,38.38,,45.416,percent of total billed charges,38.38% of total billed charges,118.34,80,,94.672,percent of total billed charges,80% of total billed charges,91.33,61.74,,73.064,percent of total billed charges,61.74% of total billed charges,150.88,102,,120.704,percent of total billed charges,102% of total billed charges,56.21,38,,44.968,percent of total billed charges,38% of total billed charges,51.77,150.88,
MODULE IV YELLOW,3000046,CDM,270,RC,,,Outpatient,,,147.92,110.94,,115.38,78,,92.304,percent of total billed charges,78% of total billed charges,93.19,63,,74.552,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,56.21,38,,44.968,percent of total billed charges,38% of total billed charges,56.21,38,,44.968,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,133.13,90,,106.504,percent of total billed charges,90% of total billed charges,51.77,35,,41.416,percent of total billed charges,35% of total billed charges,99.51,67.275,,79.608,percent of total billed charges,67.275% of total billed charges,118.34,80,,94.672,percent of total billed charges,80% of total billed charges,56.77,38.38,,45.416,percent of total billed charges,38.38% of total billed charges,118.34,80,,94.672,percent of total billed charges,80% of total billed charges,91.33,61.74,,73.064,percent of total billed charges,61.74% of total billed charges,150.88,102,,120.704,percent of total billed charges,102% of total billed charges,56.21,38,,44.968,percent of total billed charges,38% of total billed charges,51.77,150.88,
MODULE IV WHITE,3000049,CDM,270,RC,,,Outpatient,,,147.92,110.94,,115.38,78,,92.304,percent of total billed charges,78% of total billed charges,93.19,63,,74.552,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,56.21,38,,44.968,percent of total billed charges,38% of total billed charges,56.21,38,,44.968,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,133.13,90,,106.504,percent of total billed charges,90% of total billed charges,51.77,35,,41.416,percent of total billed charges,35% of total billed charges,99.51,67.275,,79.608,percent of total billed charges,67.275% of total billed charges,118.34,80,,94.672,percent of total billed charges,80% of total billed charges,56.77,38.38,,45.416,percent of total billed charges,38.38% of total billed charges,118.34,80,,94.672,percent of total billed charges,80% of total billed charges,91.33,61.74,,73.064,percent of total billed charges,61.74% of total billed charges,150.88,102,,120.704,percent of total billed charges,102% of total billed charges,56.21,38,,44.968,percent of total billed charges,38% of total billed charges,51.77,150.88,
MODULE IV BLUE,3000053,CDM,270,RC,,,Outpatient,,,147.92,110.94,,115.38,78,,92.304,percent of total billed charges,78% of total billed charges,93.19,63,,74.552,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,56.21,38,,44.968,percent of total billed charges,38% of total billed charges,56.21,38,,44.968,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,133.13,90,,106.504,percent of total billed charges,90% of total billed charges,51.77,35,,41.416,percent of total billed charges,35% of total billed charges,99.51,67.275,,79.608,percent of total billed charges,67.275% of total billed charges,118.34,80,,94.672,percent of total billed charges,80% of total billed charges,56.77,38.38,,45.416,percent of total billed charges,38.38% of total billed charges,118.34,80,,94.672,percent of total billed charges,80% of total billed charges,91.33,61.74,,73.064,percent of total billed charges,61.74% of total billed charges,150.88,102,,120.704,percent of total billed charges,102% of total billed charges,56.21,38,,44.968,percent of total billed charges,38% of total billed charges,51.77,150.88,
MODULE IV GREEN,3000057,CDM,270,RC,,,Outpatient,,,147.92,110.94,,115.38,78,,92.304,percent of total billed charges,78% of total billed charges,93.19,63,,74.552,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,56.21,38,,44.968,percent of total billed charges,38% of total billed charges,56.21,38,,44.968,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,133.13,90,,106.504,percent of total billed charges,90% of total billed charges,51.77,35,,41.416,percent of total billed charges,35% of total billed charges,99.51,67.275,,79.608,percent of total billed charges,67.275% of total billed charges,118.34,80,,94.672,percent of total billed charges,80% of total billed charges,56.77,38.38,,45.416,percent of total billed charges,38.38% of total billed charges,118.34,80,,94.672,percent of total billed charges,80% of total billed charges,91.33,61.74,,73.064,percent of total billed charges,61.74% of total billed charges,150.88,102,,120.704,percent of total billed charges,102% of total billed charges,56.21,38,,44.968,percent of total billed charges,38% of total billed charges,51.77,150.88,
ANAL/RECTAL PROCEDURE,1001112,CDM,450,RC,,,Outpatient,,,148,111,,115.44,78,,92.352,percent of total billed charges,78% of total billed charges,93.24,63,,74.592,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,56.24,38,,44.992,percent of total billed charges,38% of total billed charges,56.24,38,,44.992,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,133.2,90,,106.56,percent of total billed charges,90% of total billed charges,51.8,35,,41.44,percent of total billed charges,35% of total billed charges,99.57,67.275,,79.656,percent of total billed charges,67.275% of total billed charges,118.4,80,,94.72,percent of total billed charges,80% of total billed charges,56.8,38.38,,45.44,percent of total billed charges,38.38% of total billed charges,118.4,80,,94.72,percent of total billed charges,80% of total billed charges,91.38,61.74,,73.104,percent of total billed charges,61.74% of total billed charges,150.96,102,,120.768,percent of total billed charges,102% of total billed charges,56.24,38,,44.992,percent of total billed charges,38% of total billed charges,51.8,150.96,
BLADE ARTHROSCOPY FULL RADIUS,3002999,CDM,270,RC,,,Outpatient,,,148,111,,115.44,78,,92.352,percent of total billed charges,78% of total billed charges,93.24,63,,74.592,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,56.24,38,,44.992,percent of total billed charges,38% of total billed charges,56.24,38,,44.992,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,133.2,90,,106.56,percent of total billed charges,90% of total billed charges,51.8,35,,41.44,percent of total billed charges,35% of total billed charges,99.57,67.275,,79.656,percent of total billed charges,67.275% of total billed charges,118.4,80,,94.72,percent of total billed charges,80% of total billed charges,56.8,38.38,,45.44,percent of total billed charges,38.38% of total billed charges,118.4,80,,94.72,percent of total billed charges,80% of total billed charges,91.38,61.74,,73.104,percent of total billed charges,61.74% of total billed charges,150.96,102,,120.768,percent of total billed charges,102% of total billed charges,56.24,38,,44.992,percent of total billed charges,38% of total billed charges,51.8,150.96,
CH-50 COMPLEMENT,5001973,CDM,302,RC,86162,HCPCS,Outpatient,,,148,111,,115.44,78,,92.352,percent of total billed charges,78% of total billed charges,25.55,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,20.32,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.32,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,133.2,90,,106.56,percent of total billed charges,90% of total billed charges,26.83,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,99.57,67.275,,79.656,percent of total billed charges,67.275% of total billed charges,118.4,80,,94.72,percent of total billed charges,80% of total billed charges,20.52,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,118.4,80,,94.72,percent of total billed charges,80% of total billed charges,91.38,61.74,,73.104,percent of total billed charges,61.74% of total billed charges,26.06,102,,,Fee Schedule,102% of GA Medicaid Rate,20.32,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.32,133.2,
OT RE-EVALUATION AND PLAN OF CARE,9000260,CDM,420,RC,97168,HCPCS,Outpatient,,,148,111,,115.44,78,,92.352,percent of total billed charges,78% of total billed charges,93.24,63,,74.592,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,56.24,38,,44.992,percent of total billed charges,38% of total billed charges,56.24,38,,44.992,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,133.2,90,,106.56,percent of total billed charges,90% of total billed charges,51.8,35,,41.44,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,118.4,80,,94.72,percent of total billed charges,80% of total billed charges,56.8,38.38,,45.44,percent of total billed charges,38.38% of total billed charges,118.4,80,,94.72,percent of total billed charges,80% of total billed charges,91.38,61.74,,73.104,percent of total billed charges,61.74% of total billed charges,150.96,102,,120.768,percent of total billed charges,102% of total billed charges,56.24,38,,44.992,percent of total billed charges,38% of total billed charges,51.8,150.96,
HIV 1/2 4TH-GEN SCREEN,5000023,CDM,300,RC,87806,HCPCS,Outpatient,,,149,111.75,,116.22,78,,92.976,percent of total billed charges,78% of total billed charges,18.25,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,32.77,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,32.77,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,19.16,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,100.24,67.275,,80.192,percent of total billed charges,67.275% of total billed charges,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,33.1,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,91.99,61.74,,73.592,percent of total billed charges,61.74% of total billed charges,18.62,102,,,Fee Schedule,102% of GA Medicaid Rate,32.77,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.25,134.1,
WALKER PLATFORM ATTACHMENT,3009000,CDM,270,RC,,,Outpatient,,,149.92,112.44,,116.94,78,,93.552,percent of total billed charges,78% of total billed charges,94.45,63,,75.56,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,56.97,38,,45.576,percent of total billed charges,38% of total billed charges,56.97,38,,45.576,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,134.93,90,,107.944,percent of total billed charges,90% of total billed charges,52.47,35,,41.976,percent of total billed charges,35% of total billed charges,100.86,67.275,,80.688,percent of total billed charges,67.275% of total billed charges,119.94,80,,95.952,percent of total billed charges,80% of total billed charges,57.54,38.38,,46.032,percent of total billed charges,38.38% of total billed charges,119.94,80,,95.952,percent of total billed charges,80% of total billed charges,92.56,61.74,,74.048,percent of total billed charges,61.74% of total billed charges,152.92,102,,122.336,percent of total billed charges,102% of total billed charges,56.97,38,,45.576,percent of total billed charges,38% of total billed charges,52.47,152.92,
ARTHOCENT/ASP/INJ JOINT,1001128,CDM,450,RC,,,Outpatient,,,150,112.5,,117,78,,93.6,percent of total billed charges,78% of total billed charges,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,57,38,,45.6,percent of total billed charges,38% of total billed charges,57,38,,45.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,135,90,,108,percent of total billed charges,90% of total billed charges,52.5,35,,42,percent of total billed charges,35% of total billed charges,100.91,67.275,,80.728,percent of total billed charges,67.275% of total billed charges,120,80,,96,percent of total billed charges,80% of total billed charges,57.57,38.38,,46.056,percent of total billed charges,38.38% of total billed charges,120,80,,96,percent of total billed charges,80% of total billed charges,92.61,61.74,,74.088,percent of total billed charges,61.74% of total billed charges,153,102,,122.4,percent of total billed charges,102% of total billed charges,57,38,,45.6,percent of total billed charges,38% of total billed charges,52.5,153,
. DRUG SCREEN SERUM,5000241,CDM,301,RC,80100,HCPCS,Outpatient,,,150,112.5,,117,78,,93.6,percent of total billed charges,78% of total billed charges,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,57,38,,45.6,percent of total billed charges,38% of total billed charges,57,38,,45.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,135,90,,108,percent of total billed charges,90% of total billed charges,52.5,35,,42,percent of total billed charges,35% of total billed charges,100.91,67.275,,80.728,percent of total billed charges,67.275% of total billed charges,120,80,,96,percent of total billed charges,80% of total billed charges,57.57,38.38,,46.056,percent of total billed charges,38.38% of total billed charges,120,80,,96,percent of total billed charges,80% of total billed charges,92.61,61.74,,74.088,percent of total billed charges,61.74% of total billed charges,153,102,,122.4,percent of total billed charges,102% of total billed charges,57,38,,45.6,percent of total billed charges,38% of total billed charges,52.5,153,
PHENYTOIN FREE,5001627,CDM,301,RC,80186,HCPCS,Outpatient,,,150,112.5,,117,78,,93.6,percent of total billed charges,78% of total billed charges,17.31,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.76,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.76,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,135,90,,108,percent of total billed charges,90% of total billed charges,18.18,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,100.91,67.275,,80.728,percent of total billed charges,67.275% of total billed charges,120,80,,96,percent of total billed charges,80% of total billed charges,13.9,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,120,80,,96,percent of total billed charges,80% of total billed charges,92.61,61.74,,74.088,percent of total billed charges,61.74% of total billed charges,17.66,102,,,Fee Schedule,102% of GA Medicaid Rate,13.76,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.76,135,
AMBU BAG PEDIATRIC,3003024,CDM,270,RC,,,Outpatient,,,150.52,112.89,,117.41,78,,93.928,percent of total billed charges,78% of total billed charges,94.83,63,,75.864,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,57.2,38,,45.76,percent of total billed charges,38% of total billed charges,57.2,38,,45.76,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,135.47,90,,108.376,percent of total billed charges,90% of total billed charges,52.68,35,,42.144,percent of total billed charges,35% of total billed charges,101.26,67.275,,81.008,percent of total billed charges,67.275% of total billed charges,120.42,80,,96.336,percent of total billed charges,80% of total billed charges,57.77,38.38,,46.216,percent of total billed charges,38.38% of total billed charges,120.42,80,,96.336,percent of total billed charges,80% of total billed charges,92.93,61.74,,74.344,percent of total billed charges,61.74% of total billed charges,153.53,102,,122.824,percent of total billed charges,102% of total billed charges,57.2,38,,45.76,percent of total billed charges,38% of total billed charges,52.68,153.53,
SURGICEL,3001734,CDM,270,RC,,,Outpatient,,,150.68,113.01,,117.53,78,,94.024,percent of total billed charges,78% of total billed charges,94.93,63,,75.944,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,57.26,38,,45.808,percent of total billed charges,38% of total billed charges,57.26,38,,45.808,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,135.61,90,,108.488,percent of total billed charges,90% of total billed charges,52.74,35,,42.192,percent of total billed charges,35% of total billed charges,101.37,67.275,,81.096,percent of total billed charges,67.275% of total billed charges,120.54,80,,96.432,percent of total billed charges,80% of total billed charges,57.83,38.38,,46.264,percent of total billed charges,38.38% of total billed charges,120.54,80,,96.432,percent of total billed charges,80% of total billed charges,93.03,61.74,,74.424,percent of total billed charges,61.74% of total billed charges,153.69,102,,122.952,percent of total billed charges,102% of total billed charges,57.26,38,,45.808,percent of total billed charges,38% of total billed charges,52.74,153.69,
CLOSED FRACT WITH MANIP,1001076,CDM,450,RC,,,Outpatient,,,151,113.25,,117.78,78,,94.224,percent of total billed charges,78% of total billed charges,95.13,63,,76.104,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,57.38,38,,45.904,percent of total billed charges,38% of total billed charges,57.38,38,,45.904,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,135.9,90,,108.72,percent of total billed charges,90% of total billed charges,52.85,35,,42.28,percent of total billed charges,35% of total billed charges,101.59,67.275,,81.272,percent of total billed charges,67.275% of total billed charges,120.8,80,,96.64,percent of total billed charges,80% of total billed charges,57.95,38.38,,46.36,percent of total billed charges,38.38% of total billed charges,120.8,80,,96.64,percent of total billed charges,80% of total billed charges,93.23,61.74,,74.584,percent of total billed charges,61.74% of total billed charges,154.02,102,,123.216,percent of total billed charges,102% of total billed charges,57.38,38,,45.904,percent of total billed charges,38% of total billed charges,52.85,154.02,
CADMIUM,5003742,CDM,301,RC,82300,HCPCS,Outpatient,,,151,113.25,,117.78,78,,94.224,percent of total billed charges,78% of total billed charges,29.1,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,23.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,23.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,135.9,90,,108.72,percent of total billed charges,90% of total billed charges,30.56,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,101.59,67.275,,81.272,percent of total billed charges,67.275% of total billed charges,120.8,80,,96.64,percent of total billed charges,80% of total billed charges,23.88,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,120.8,80,,96.64,percent of total billed charges,80% of total billed charges,93.23,61.74,,74.584,percent of total billed charges,61.74% of total billed charges,29.68,102,,,Fee Schedule,102% of GA Medicaid Rate,23.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,23.64,135.9,
BB  PRETREAT/CHEMICAL,5200015,CDM,300,RC,86970,HCPCS,Outpatient,,,151,113.25,,117.78,78,,94.224,percent of total billed charges,78% of total billed charges,95.13,63,,76.104,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,57.38,38,,45.904,percent of total billed charges,38% of total billed charges,57.38,38,,45.904,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,135.9,90,,108.72,percent of total billed charges,90% of total billed charges,52.85,35,,42.28,percent of total billed charges,35% of total billed charges,101.59,67.275,,81.272,percent of total billed charges,67.275% of total billed charges,120.8,80,,96.64,percent of total billed charges,80% of total billed charges,57.95,38.38,,46.36,percent of total billed charges,38.38% of total billed charges,120.8,80,,96.64,percent of total billed charges,80% of total billed charges,93.23,61.74,,74.584,percent of total billed charges,61.74% of total billed charges,154.02,102,,123.216,percent of total billed charges,102% of total billed charges,57.38,38,,45.904,percent of total billed charges,38% of total billed charges,52.85,154.02,
BB DIFF/AUTO ABSORPTION,5200021,CDM,300,RC,86978,HCPCS,Outpatient,,,151,113.25,,117.78,78,,94.224,percent of total billed charges,78% of total billed charges,95.13,63,,76.104,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,57.38,38,,45.904,percent of total billed charges,38% of total billed charges,57.38,38,,45.904,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,135.9,90,,108.72,percent of total billed charges,90% of total billed charges,52.85,35,,42.28,percent of total billed charges,35% of total billed charges,101.59,67.275,,81.272,percent of total billed charges,67.275% of total billed charges,120.8,80,,96.64,percent of total billed charges,80% of total billed charges,57.95,38.38,,46.36,percent of total billed charges,38.38% of total billed charges,120.8,80,,96.64,percent of total billed charges,80% of total billed charges,93.23,61.74,,74.584,percent of total billed charges,61.74% of total billed charges,154.02,102,,123.216,percent of total billed charges,102% of total billed charges,57.38,38,,45.904,percent of total billed charges,38% of total billed charges,52.85,154.02,
BB PRETREAT SERUM-CHEMICAL,5200023,CDM,300,RC,86975,HCPCS,Outpatient,,,151,113.25,,117.78,78,,94.224,percent of total billed charges,78% of total billed charges,95.13,63,,76.104,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,57.38,38,,45.904,percent of total billed charges,38% of total billed charges,57.38,38,,45.904,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,135.9,90,,108.72,percent of total billed charges,90% of total billed charges,52.85,35,,42.28,percent of total billed charges,35% of total billed charges,101.59,67.275,,81.272,percent of total billed charges,67.275% of total billed charges,120.8,80,,96.64,percent of total billed charges,80% of total billed charges,57.95,38.38,,46.36,percent of total billed charges,38.38% of total billed charges,120.8,80,,96.64,percent of total billed charges,80% of total billed charges,93.23,61.74,,74.584,percent of total billed charges,61.74% of total billed charges,154.02,102,,123.216,percent of total billed charges,102% of total billed charges,57.38,38,,45.904,percent of total billed charges,38% of total billed charges,52.85,154.02,
EASTERN EQUINE ENCEPHALITIS,5000243,CDM,302,RC,86652,HCPCS,Outpatient,,,152,114,,118.56,78,,94.848,percent of total billed charges,78% of total billed charges,16.59,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.19,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.19,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,17.42,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,102.26,67.275,,81.808,percent of total billed charges,67.275% of total billed charges,121.6,80,,97.28,percent of total billed charges,80% of total billed charges,13.32,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,121.6,80,,97.28,percent of total billed charges,80% of total billed charges,93.84,61.74,,75.072,percent of total billed charges,61.74% of total billed charges,16.92,102,,,Fee Schedule,102% of GA Medicaid Rate,13.19,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.19,136.8,
HISTOPLASMA Ag URINE,5000830,CDM,301,RC,87385,HCPCS,Outpatient,,,152,114,,118.56,78,,94.848,percent of total billed charges,78% of total billed charges,15.08,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,15.83,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,102.26,67.275,,81.808,percent of total billed charges,67.275% of total billed charges,121.6,80,,97.28,percent of total billed charges,80% of total billed charges,13.38,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,121.6,80,,97.28,percent of total billed charges,80% of total billed charges,93.84,61.74,,75.072,percent of total billed charges,61.74% of total billed charges,15.38,102,,,Fee Schedule,102% of GA Medicaid Rate,13.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.25,136.8,
ARBOVIRUS AB,5001816,CDM,302,RC,86652,HCPCS,Outpatient,,,152,114,,118.56,78,,94.848,percent of total billed charges,78% of total billed charges,16.59,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.19,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.19,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,17.42,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,102.26,67.275,,81.808,percent of total billed charges,67.275% of total billed charges,121.6,80,,97.28,percent of total billed charges,80% of total billed charges,13.32,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,121.6,80,,97.28,percent of total billed charges,80% of total billed charges,93.84,61.74,,75.072,percent of total billed charges,61.74% of total billed charges,16.92,102,,,Fee Schedule,102% of GA Medicaid Rate,13.19,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.19,136.8,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on",1001123,CDM,450,RC,96375,HCPCS,Outpatient,,,153,114.75,,119.34,78,,95.472,percent of total billed charges,78% of total billed charges,96.39,63,,77.112,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,58.14,38,,46.512,percent of total billed charges,38% of total billed charges,58.14,38,,46.512,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,137.7,90,,110.16,percent of total billed charges,90% of total billed charges,53.55,35,,42.84,percent of total billed charges,35% of total billed charges,102.93,67.275,,82.344,percent of total billed charges,67.275% of total billed charges,122.4,80,,97.92,percent of total billed charges,80% of total billed charges,58.72,38.38,,46.976,percent of total billed charges,38.38% of total billed charges,122.4,80,,97.92,percent of total billed charges,80% of total billed charges,94.46,61.74,,75.568,percent of total billed charges,61.74% of total billed charges,156.06,102,,124.848,percent of total billed charges,102% of total billed charges,58.14,38,,46.512,percent of total billed charges,38% of total billed charges,53.55,156.06,
CREATININE CLEARANCE,5001710,CDM,300,RC,82575,HCPCS,Outpatient,,,153,114.75,,119.34,78,,95.472,percent of total billed charges,78% of total billed charges,11.88,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,9.46,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,9.46,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,137.7,90,,110.16,percent of total billed charges,90% of total billed charges,12.47,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,102.93,67.275,,82.344,percent of total billed charges,67.275% of total billed charges,122.4,80,,97.92,percent of total billed charges,80% of total billed charges,9.55,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,122.4,80,,97.92,percent of total billed charges,80% of total billed charges,94.46,61.74,,75.568,percent of total billed charges,61.74% of total billed charges,12.12,102,,,Fee Schedule,102% of GA Medicaid Rate,9.46,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,9.46,137.7,
Test for HIV,5001910,CDM,302,RC,87389,HCPCS,Outpatient,,,153,114.75,,119.34,78,,95.472,percent of total billed charges,78% of total billed charges,27.3,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,24.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,24.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,137.7,90,,110.16,percent of total billed charges,90% of total billed charges,28.67,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,102.93,67.275,,82.344,percent of total billed charges,67.275% of total billed charges,122.4,80,,97.92,percent of total billed charges,80% of total billed charges,24.32,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,122.4,80,,97.92,percent of total billed charges,80% of total billed charges,94.46,61.74,,75.568,percent of total billed charges,61.74% of total billed charges,27.85,102,,,Fee Schedule,102% of GA Medicaid Rate,24.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,24.08,137.7,
SKIN STAPLER REFLEX 35W  PXW35,3001758,CDM,270,RC,,,Outpatient,,,153.28,114.96,,119.56,78,,95.648,percent of total billed charges,78% of total billed charges,96.57,63,,77.256,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,58.25,38,,46.6,percent of total billed charges,38% of total billed charges,58.25,38,,46.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,137.95,90,,110.36,percent of total billed charges,90% of total billed charges,53.65,35,,42.92,percent of total billed charges,35% of total billed charges,103.12,67.275,,82.496,percent of total billed charges,67.275% of total billed charges,122.62,80,,98.096,percent of total billed charges,80% of total billed charges,58.83,38.38,,47.064,percent of total billed charges,38.38% of total billed charges,122.62,80,,98.096,percent of total billed charges,80% of total billed charges,94.64,61.74,,75.712,percent of total billed charges,61.74% of total billed charges,156.35,102,,125.08,percent of total billed charges,102% of total billed charges,58.25,38,,46.6,percent of total billed charges,38% of total billed charges,53.65,156.35,
XCEL TROCAR BLADELESS 5MM B5LT,3004068,CDM,270,RC,,,Outpatient,,,153.33,115,,119.6,78,,95.68,percent of total billed charges,78% of total billed charges,96.6,63,,77.28,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,58.27,38,,46.616,percent of total billed charges,38% of total billed charges,58.27,38,,46.616,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,138,90,,110.4,percent of total billed charges,90% of total billed charges,53.67,35,,42.936,percent of total billed charges,35% of total billed charges,103.15,67.275,,82.52,percent of total billed charges,67.275% of total billed charges,122.66,80,,98.128,percent of total billed charges,80% of total billed charges,58.85,38.38,,47.08,percent of total billed charges,38.38% of total billed charges,122.66,80,,98.128,percent of total billed charges,80% of total billed charges,94.67,61.74,,75.736,percent of total billed charges,61.74% of total billed charges,156.4,102,,125.12,percent of total billed charges,102% of total billed charges,58.27,38,,46.616,percent of total billed charges,38% of total billed charges,53.67,156.4,
THEOPHYLLINE LEVEL,5001435,CDM,301,RC,80198,HCPCS,Outpatient,,,154,115.5,,120.12,78,,96.096,percent of total billed charges,78% of total billed charges,17.79,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.14,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.14,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,138.6,90,,110.88,percent of total billed charges,90% of total billed charges,18.68,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,103.6,67.275,,82.88,percent of total billed charges,67.275% of total billed charges,123.2,80,,98.56,percent of total billed charges,80% of total billed charges,14.28,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,123.2,80,,98.56,percent of total billed charges,80% of total billed charges,95.08,61.74,,76.064,percent of total billed charges,61.74% of total billed charges,18.15,102,,,Fee Schedule,102% of GA Medicaid Rate,14.14,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.14,138.6,
"PROTEIN C ACTIVITY,REFLEX",5001832,CDM,305,RC,85303,HCPCS,Outpatient,,,154,115.5,,120.12,78,,96.096,percent of total billed charges,78% of total billed charges,17.39,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.84,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.84,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,138.6,90,,110.88,percent of total billed charges,90% of total billed charges,18.26,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,103.6,67.275,,82.88,percent of total billed charges,67.275% of total billed charges,123.2,80,,98.56,percent of total billed charges,80% of total billed charges,13.98,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,123.2,80,,98.56,percent of total billed charges,80% of total billed charges,95.08,61.74,,76.064,percent of total billed charges,61.74% of total billed charges,17.74,102,,,Fee Schedule,102% of GA Medicaid Rate,13.84,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.84,138.6,
PROSTHETIC SHRINKER - BELOW KNEE,3005100,CDM,270,RC,,,Outpatient,,,154.08,115.56,,120.18,78,,96.144,percent of total billed charges,78% of total billed charges,97.07,63,,77.656,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,58.55,38,,46.84,percent of total billed charges,38% of total billed charges,58.55,38,,46.84,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,138.67,90,,110.936,percent of total billed charges,90% of total billed charges,53.93,35,,43.144,percent of total billed charges,35% of total billed charges,103.66,67.275,,82.928,percent of total billed charges,67.275% of total billed charges,123.26,80,,98.608,percent of total billed charges,80% of total billed charges,59.14,38.38,,47.312,percent of total billed charges,38.38% of total billed charges,123.26,80,,98.608,percent of total billed charges,80% of total billed charges,95.13,61.74,,76.104,percent of total billed charges,61.74% of total billed charges,157.16,102,,125.728,percent of total billed charges,102% of total billed charges,58.55,38,,46.84,percent of total billed charges,38% of total billed charges,53.93,157.16,
NICOTINE AND METABOLITE,5000306,CDM,301,RC,80323,HCPCS,Outpatient,,,155,116.25,,120.9,78,,96.72,percent of total billed charges,78% of total billed charges,37.75,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,58.9,38,,47.12,percent of total billed charges,38% of total billed charges,58.9,38,,47.12,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,39.64,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,104.28,67.275,,83.424,percent of total billed charges,67.275% of total billed charges,124,80,,99.2,percent of total billed charges,80% of total billed charges,59.49,38.38,,47.592,percent of total billed charges,38.38% of total billed charges,124,80,,99.2,percent of total billed charges,80% of total billed charges,95.7,61.74,,76.56,percent of total billed charges,61.74% of total billed charges,38.51,102,,,Fee Schedule,102% of GA Medicaid Rate,58.9,38,,47.12,percent of total billed charges,38% of total billed charges,37.75,139.5,
LSD SCREEN,5002019,CDM,301,RC,80323,HCPCS,Outpatient,,,155,116.25,,120.9,78,,96.72,percent of total billed charges,78% of total billed charges,37.75,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,58.9,38,,47.12,percent of total billed charges,38% of total billed charges,58.9,38,,47.12,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,39.64,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,104.28,67.275,,83.424,percent of total billed charges,67.275% of total billed charges,124,80,,99.2,percent of total billed charges,80% of total billed charges,59.49,38.38,,47.592,percent of total billed charges,38.38% of total billed charges,124,80,,99.2,percent of total billed charges,80% of total billed charges,95.7,61.74,,76.56,percent of total billed charges,61.74% of total billed charges,38.51,102,,,Fee Schedule,102% of GA Medicaid Rate,58.9,38,,47.12,percent of total billed charges,38% of total billed charges,37.75,139.5,
Single view,7000205,CDM,320,RC,71045,HCPCS,Outpatient,,,155,116.25,,120.9,78,,96.72,percent of total billed charges,78% of total billed charges,97.65,63,,78.12,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,58.9,38,,47.12,percent of total billed charges,38% of total billed charges,58.9,38,,47.12,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,54.25,35,,43.4,percent of total billed charges,35% of total billed charges,104.28,67.275,,83.424,percent of total billed charges,67.275% of total billed charges,124,80,,99.2,percent of total billed charges,80% of total billed charges,59.49,38.38,,47.592,percent of total billed charges,38.38% of total billed charges,124,80,,99.2,percent of total billed charges,80% of total billed charges,95.7,61.74,,76.56,percent of total billed charges,61.74% of total billed charges,158.1,102,,126.48,percent of total billed charges,102% of total billed charges,58.9,38,,47.12,percent of total billed charges,38% of total billed charges,54.25,158.1,
Single view,7000211,CDM,320,RC,71045,HCPCS,Outpatient,,,155,116.25,,120.9,78,,96.72,percent of total billed charges,78% of total billed charges,97.65,63,,78.12,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,58.9,38,,47.12,percent of total billed charges,38% of total billed charges,58.9,38,,47.12,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,54.25,35,,43.4,percent of total billed charges,35% of total billed charges,104.28,67.275,,83.424,percent of total billed charges,67.275% of total billed charges,124,80,,99.2,percent of total billed charges,80% of total billed charges,59.49,38.38,,47.592,percent of total billed charges,38.38% of total billed charges,124,80,,99.2,percent of total billed charges,80% of total billed charges,95.7,61.74,,76.56,percent of total billed charges,61.74% of total billed charges,158.1,102,,126.48,percent of total billed charges,102% of total billed charges,58.9,38,,47.12,percent of total billed charges,38% of total billed charges,54.25,158.1,
SHOULDER 1 VIEW-RT,7000305,CDM,320,RC,73020,HCPCS,Outpatient,,,155,116.25,,120.9,78,,96.72,percent of total billed charges,78% of total billed charges,97.65,63,,78.12,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,58.9,38,,47.12,percent of total billed charges,38% of total billed charges,58.9,38,,47.12,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,54.25,35,,43.4,percent of total billed charges,35% of total billed charges,104.28,67.275,,83.424,percent of total billed charges,67.275% of total billed charges,124,80,,99.2,percent of total billed charges,80% of total billed charges,59.49,38.38,,47.592,percent of total billed charges,38.38% of total billed charges,124,80,,99.2,percent of total billed charges,80% of total billed charges,95.7,61.74,,76.56,percent of total billed charges,61.74% of total billed charges,158.1,102,,126.48,percent of total billed charges,102% of total billed charges,58.9,38,,47.12,percent of total billed charges,38% of total billed charges,54.25,158.1,
LEG FEMUR 1 VIEW LEFT,7000757,CDM,320,RC,73551,HCPCS,Outpatient,,,155,116.25,,120.9,78,,96.72,percent of total billed charges,78% of total billed charges,97.65,63,,78.12,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,58.9,38,,47.12,percent of total billed charges,38% of total billed charges,58.9,38,,47.12,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,54.25,35,,43.4,percent of total billed charges,35% of total billed charges,104.28,67.275,,83.424,percent of total billed charges,67.275% of total billed charges,124,80,,99.2,percent of total billed charges,80% of total billed charges,59.49,38.38,,47.592,percent of total billed charges,38.38% of total billed charges,124,80,,99.2,percent of total billed charges,80% of total billed charges,95.7,61.74,,76.56,percent of total billed charges,61.74% of total billed charges,158.1,102,,126.48,percent of total billed charges,102% of total billed charges,58.9,38,,47.12,percent of total billed charges,38% of total billed charges,54.25,158.1,
LEG FEMUR 1 VIEW RIGHT,7000758,CDM,320,RC,73551,HCPCS,Outpatient,,,155,116.25,,120.9,78,,96.72,percent of total billed charges,78% of total billed charges,97.65,63,,78.12,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,58.9,38,,47.12,percent of total billed charges,38% of total billed charges,58.9,38,,47.12,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,54.25,35,,43.4,percent of total billed charges,35% of total billed charges,104.28,67.275,,83.424,percent of total billed charges,67.275% of total billed charges,124,80,,99.2,percent of total billed charges,80% of total billed charges,59.49,38.38,,47.592,percent of total billed charges,38.38% of total billed charges,124,80,,99.2,percent of total billed charges,80% of total billed charges,95.7,61.74,,76.56,percent of total billed charges,61.74% of total billed charges,158.1,102,,126.48,percent of total billed charges,102% of total billed charges,58.9,38,,47.12,percent of total billed charges,38% of total billed charges,54.25,158.1,
SHOULDER 1 VIEW-LT,7300306,CDM,320,RC,73020,HCPCS,Outpatient,,,155,116.25,,120.9,78,,96.72,percent of total billed charges,78% of total billed charges,97.65,63,,78.12,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,58.9,38,,47.12,percent of total billed charges,38% of total billed charges,58.9,38,,47.12,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,54.25,35,,43.4,percent of total billed charges,35% of total billed charges,104.28,67.275,,83.424,percent of total billed charges,67.275% of total billed charges,124,80,,99.2,percent of total billed charges,80% of total billed charges,59.49,38.38,,47.592,percent of total billed charges,38.38% of total billed charges,124,80,,99.2,percent of total billed charges,80% of total billed charges,95.7,61.74,,76.56,percent of total billed charges,61.74% of total billed charges,158.1,102,,126.48,percent of total billed charges,102% of total billed charges,58.9,38,,47.12,percent of total billed charges,38% of total billed charges,54.25,158.1,
"Radiologic examination, elbow; 2 views",7400946,CDM,320,RC,73070,HCPCS,Outpatient,,,155,116.25,,120.9,78,,96.72,percent of total billed charges,78% of total billed charges,97.65,63,,78.12,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,58.9,38,,47.12,percent of total billed charges,38% of total billed charges,58.9,38,,47.12,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,54.25,35,,43.4,percent of total billed charges,35% of total billed charges,104.28,67.275,,83.424,percent of total billed charges,67.275% of total billed charges,124,80,,99.2,percent of total billed charges,80% of total billed charges,59.49,38.38,,47.592,percent of total billed charges,38.38% of total billed charges,124,80,,99.2,percent of total billed charges,80% of total billed charges,95.7,61.74,,76.56,percent of total billed charges,61.74% of total billed charges,158.1,102,,126.48,percent of total billed charges,102% of total billed charges,58.9,38,,47.12,percent of total billed charges,38% of total billed charges,54.25,158.1,
DIAGNOSTIC ANOSCOPY,1001106,CDM,450,RC,,,Outpatient,,,156,117,,121.68,78,,97.344,percent of total billed charges,78% of total billed charges,98.28,63,,78.624,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,59.28,38,,47.424,percent of total billed charges,38% of total billed charges,59.28,38,,47.424,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,140.4,90,,112.32,percent of total billed charges,90% of total billed charges,54.6,35,,43.68,percent of total billed charges,35% of total billed charges,104.95,67.275,,83.96,percent of total billed charges,67.275% of total billed charges,124.8,80,,99.84,percent of total billed charges,80% of total billed charges,59.87,38.38,,47.896,percent of total billed charges,38.38% of total billed charges,124.8,80,,99.84,percent of total billed charges,80% of total billed charges,96.31,61.74,,77.048,percent of total billed charges,61.74% of total billed charges,159.12,102,,127.296,percent of total billed charges,102% of total billed charges,59.28,38,,47.424,percent of total billed charges,38% of total billed charges,54.6,159.12,
KEPPRA,5000191,CDM,301,RC,80299,HCPCS,Outpatient,,,156,117,,121.68,78,,97.344,percent of total billed charges,78% of total billed charges,15.14,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,140.4,90,,112.32,percent of total billed charges,90% of total billed charges,15.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,104.95,67.275,,83.96,percent of total billed charges,67.275% of total billed charges,124.8,80,,99.84,percent of total billed charges,80% of total billed charges,18.83,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,124.8,80,,99.84,percent of total billed charges,80% of total billed charges,96.31,61.74,,77.048,percent of total billed charges,61.74% of total billed charges,15.44,102,,,Fee Schedule,102% of GA Medicaid Rate,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.14,140.4,
HALDOL,5000231,CDM,301,RC,80299,HCPCS,Outpatient,,,156,117,,121.68,78,,97.344,percent of total billed charges,78% of total billed charges,15.14,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,140.4,90,,112.32,percent of total billed charges,90% of total billed charges,15.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,104.95,67.275,,83.96,percent of total billed charges,67.275% of total billed charges,124.8,80,,99.84,percent of total billed charges,80% of total billed charges,18.83,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,124.8,80,,99.84,percent of total billed charges,80% of total billed charges,96.31,61.74,,77.048,percent of total billed charges,61.74% of total billed charges,15.44,102,,,Fee Schedule,102% of GA Medicaid Rate,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.14,140.4,
LAMOTRIGINE,5000234,CDM,301,RC,80299,HCPCS,Outpatient,,,156,117,,121.68,78,,97.344,percent of total billed charges,78% of total billed charges,15.14,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,140.4,90,,112.32,percent of total billed charges,90% of total billed charges,15.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,104.95,67.275,,83.96,percent of total billed charges,67.275% of total billed charges,124.8,80,,99.84,percent of total billed charges,80% of total billed charges,18.83,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,124.8,80,,99.84,percent of total billed charges,80% of total billed charges,96.31,61.74,,77.048,percent of total billed charges,61.74% of total billed charges,15.44,102,,,Fee Schedule,102% of GA Medicaid Rate,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.14,140.4,
ZONEGRAN,5000250,CDM,301,RC,80299,HCPCS,Outpatient,,,156,117,,121.68,78,,97.344,percent of total billed charges,78% of total billed charges,15.14,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,140.4,90,,112.32,percent of total billed charges,90% of total billed charges,15.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,104.95,67.275,,83.96,percent of total billed charges,67.275% of total billed charges,124.8,80,,99.84,percent of total billed charges,80% of total billed charges,18.83,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,124.8,80,,99.84,percent of total billed charges,80% of total billed charges,96.31,61.74,,77.048,percent of total billed charges,61.74% of total billed charges,15.44,102,,,Fee Schedule,102% of GA Medicaid Rate,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.14,140.4,
DERMABOND WITH PEN (ER),3004001,CDM,270,RC,,,Outpatient,,,156.27,117.2,,121.89,78,,97.512,percent of total billed charges,78% of total billed charges,98.45,63,,78.76,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,59.38,38,,47.504,percent of total billed charges,38% of total billed charges,59.38,38,,47.504,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,140.64,90,,112.512,percent of total billed charges,90% of total billed charges,54.69,35,,43.752,percent of total billed charges,35% of total billed charges,105.13,67.275,,84.104,percent of total billed charges,67.275% of total billed charges,125.02,80,,100.016,percent of total billed charges,80% of total billed charges,59.98,38.38,,47.984,percent of total billed charges,38.38% of total billed charges,125.02,80,,100.016,percent of total billed charges,80% of total billed charges,96.48,61.74,,77.184,percent of total billed charges,61.74% of total billed charges,159.4,102,,127.52,percent of total billed charges,102% of total billed charges,59.38,38,,47.504,percent of total billed charges,38% of total billed charges,54.69,159.4,
PARACENTESIS,1001258,CDM,450,RC,49080,HCPCS,Outpatient,,,157,117.75,,122.46,78,,97.968,percent of total billed charges,78% of total billed charges,98.91,63,,79.128,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,59.66,38,,47.728,percent of total billed charges,38% of total billed charges,59.66,38,,47.728,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,54.95,35,,43.96,percent of total billed charges,35% of total billed charges,105.62,67.275,,84.496,percent of total billed charges,67.275% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,60.26,38.38,,48.208,percent of total billed charges,38.38% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,96.93,61.74,,77.544,percent of total billed charges,61.74% of total billed charges,160.14,102,,128.112,percent of total billed charges,102% of total billed charges,59.66,38,,47.728,percent of total billed charges,38% of total billed charges,54.95,160.14,
EHRLICHIA ANTIBODY,5001970,CDM,302,RC,86666,HCPCS,Outpatient,,,157,117.75,,122.46,78,,97.968,percent of total billed charges,78% of total billed charges,12.8,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,10.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,13.44,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,105.62,67.275,,84.496,percent of total billed charges,67.275% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,10.28,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,96.93,61.74,,77.544,percent of total billed charges,61.74% of total billed charges,13.06,102,,,Fee Schedule,102% of GA Medicaid Rate,10.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.18,141.3,
THYROID STIMULATING IMMUNOGLOBIN,5002063,CDM,301,RC,84445,HCPCS,Outpatient,,,157,117.75,,122.46,78,,97.968,percent of total billed charges,78% of total billed charges,10.65,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,50.86,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,50.86,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,11.18,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,105.62,67.275,,84.496,percent of total billed charges,67.275% of total billed charges,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,51.37,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,96.93,61.74,,77.544,percent of total billed charges,61.74% of total billed charges,10.86,102,,,Fee Schedule,102% of GA Medicaid Rate,50.86,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.65,141.3,
VON WILLEBRAND FACTOR AG,5000518,CDM,305,RC,85246,HCPCS,Outpatient,,,158,118.5,,123.24,78,,98.592,percent of total billed charges,78% of total billed charges,28.85,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,22.94,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,22.94,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,142.2,90,,113.76,percent of total billed charges,90% of total billed charges,30.29,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,106.29,67.275,,85.032,percent of total billed charges,67.275% of total billed charges,126.4,80,,101.12,percent of total billed charges,80% of total billed charges,23.17,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,126.4,80,,101.12,percent of total billed charges,80% of total billed charges,97.55,61.74,,78.04,percent of total billed charges,61.74% of total billed charges,29.43,102,,,Fee Schedule,102% of GA Medicaid Rate,22.94,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,22.94,142.2,
CARBAMAZEPINE,5001640,CDM,301,RC,80156,HCPCS,Outpatient,,,158,118.5,,123.24,78,,98.592,percent of total billed charges,78% of total billed charges,18.31,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,142.2,90,,113.76,percent of total billed charges,90% of total billed charges,19.23,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,106.29,67.275,,85.032,percent of total billed charges,67.275% of total billed charges,126.4,80,,101.12,percent of total billed charges,80% of total billed charges,14.72,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,126.4,80,,101.12,percent of total billed charges,80% of total billed charges,97.55,61.74,,78.04,percent of total billed charges,61.74% of total billed charges,18.68,102,,,Fee Schedule,102% of GA Medicaid Rate,14.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.57,142.2,
ESTRIOL,5001723,CDM,301,RC,82677,HCPCS,Outpatient,,,158,118.5,,123.24,78,,98.592,percent of total billed charges,78% of total billed charges,30.41,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,24.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,24.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,142.2,90,,113.76,percent of total billed charges,90% of total billed charges,31.93,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,106.29,67.275,,85.032,percent of total billed charges,67.275% of total billed charges,126.4,80,,101.12,percent of total billed charges,80% of total billed charges,24.42,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,126.4,80,,101.12,percent of total billed charges,80% of total billed charges,97.55,61.74,,78.04,percent of total billed charges,61.74% of total billed charges,31.02,102,,,Fee Schedule,102% of GA Medicaid Rate,24.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,24.18,142.2,
PATH-PAP BRUSH 1-2,5002017,CDM,311,RC,88160,HCPCS,Outpatient,,,158,118.5,,123.24,78,,98.592,percent of total billed charges,78% of total billed charges,46.13,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,60.04,38,,48.032,percent of total billed charges,38% of total billed charges,60.04,38,,48.032,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,142.2,90,,113.76,percent of total billed charges,90% of total billed charges,48.44,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,106.29,67.275,,85.032,percent of total billed charges,67.275% of total billed charges,126.4,80,,101.12,percent of total billed charges,80% of total billed charges,60.64,38.38,,48.512,percent of total billed charges,38.38% of total billed charges,126.4,80,,101.12,percent of total billed charges,80% of total billed charges,97.55,61.74,,78.04,percent of total billed charges,61.74% of total billed charges,47.05,102,,,Fee Schedule,102% of GA Medicaid Rate,60.04,38,,48.032,percent of total billed charges,38% of total billed charges,46.13,142.2,
PATH CYTOSPIN,5002105,CDM,312,RC,88108,HCPCS,Outpatient,,,158,118.5,,123.24,78,,98.592,percent of total billed charges,78% of total billed charges,45.74,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,60.04,38,,48.032,percent of total billed charges,38% of total billed charges,60.04,38,,48.032,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,142.2,90,,113.76,percent of total billed charges,90% of total billed charges,48.03,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,106.29,67.275,,85.032,percent of total billed charges,67.275% of total billed charges,126.4,80,,101.12,percent of total billed charges,80% of total billed charges,60.64,38.38,,48.512,percent of total billed charges,38.38% of total billed charges,126.4,80,,101.12,percent of total billed charges,80% of total billed charges,97.55,61.74,,78.04,percent of total billed charges,61.74% of total billed charges,46.65,102,,,Fee Schedule,102% of GA Medicaid Rate,60.04,38,,48.032,percent of total billed charges,38% of total billed charges,45.74,142.2,
PATH THIN PREP,5002108,CDM,319,RC,88161,HCPCS,Outpatient,,,158,118.5,,123.24,78,,98.592,percent of total billed charges,78% of total billed charges,34.89,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,60.04,38,,48.032,percent of total billed charges,38% of total billed charges,60.04,38,,48.032,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,142.2,90,,113.76,percent of total billed charges,90% of total billed charges,36.63,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,106.29,67.275,,85.032,percent of total billed charges,67.275% of total billed charges,126.4,80,,101.12,percent of total billed charges,80% of total billed charges,60.64,38.38,,48.512,percent of total billed charges,38.38% of total billed charges,126.4,80,,101.12,percent of total billed charges,80% of total billed charges,97.55,61.74,,78.04,percent of total billed charges,61.74% of total billed charges,35.59,102,,,Fee Schedule,102% of GA Medicaid Rate,60.04,38,,48.032,percent of total billed charges,38% of total billed charges,34.89,142.2,
PATH SMEAR / BRUSHES FOR CYTO,5002152,CDM,310,RC,88104,HCPCS,Outpatient,,,158,118.5,,123.24,78,,98.592,percent of total billed charges,78% of total billed charges,42.68,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,60.04,38,,48.032,percent of total billed charges,38% of total billed charges,60.04,38,,48.032,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,142.2,90,,113.76,percent of total billed charges,90% of total billed charges,44.81,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,106.29,67.275,,85.032,percent of total billed charges,67.275% of total billed charges,126.4,80,,101.12,percent of total billed charges,80% of total billed charges,60.64,38.38,,48.512,percent of total billed charges,38.38% of total billed charges,126.4,80,,101.12,percent of total billed charges,80% of total billed charges,97.55,61.74,,78.04,percent of total billed charges,61.74% of total billed charges,43.53,102,,,Fee Schedule,102% of GA Medicaid Rate,60.04,38,,48.032,percent of total billed charges,38% of total billed charges,42.68,142.2,
QUINIDINE,5001765,CDM,301,RC,80194,HCPCS,Outpatient,,,159,119.25,,124.02,78,,99.216,percent of total billed charges,78% of total billed charges,18.35,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,143.1,90,,114.48,percent of total billed charges,90% of total billed charges,19.27,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,106.97,67.275,,85.576,percent of total billed charges,67.275% of total billed charges,127.2,80,,101.76,percent of total billed charges,80% of total billed charges,14.75,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,127.2,80,,101.76,percent of total billed charges,80% of total billed charges,98.17,61.74,,78.536,percent of total billed charges,61.74% of total billed charges,18.72,102,,,Fee Schedule,102% of GA Medicaid Rate,14.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.6,143.1,
ACAPELLA  W/MOUTHPIECE - GREEN,3000911,CDM,270,RC,,,Outpatient,,,159.3,119.48,,124.25,78,,99.4,percent of total billed charges,78% of total billed charges,100.36,63,,80.288,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,60.53,38,,48.424,percent of total billed charges,38% of total billed charges,60.53,38,,48.424,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,143.37,90,,114.696,percent of total billed charges,90% of total billed charges,55.76,35,,44.608,percent of total billed charges,35% of total billed charges,107.17,67.275,,85.736,percent of total billed charges,67.275% of total billed charges,127.44,80,,101.952,percent of total billed charges,80% of total billed charges,61.14,38.38,,48.912,percent of total billed charges,38.38% of total billed charges,127.44,80,,101.952,percent of total billed charges,80% of total billed charges,98.35,61.74,,78.68,percent of total billed charges,61.74% of total billed charges,162.49,102,,129.992,percent of total billed charges,102% of total billed charges,60.53,38,,48.424,percent of total billed charges,38% of total billed charges,55.76,162.49,
SCREW CORTICAL 16MM X 2.7MM - TITANIUM,3006120,CDM,270,RC,,,Outpatient,,,159.43,119.57,,124.36,78,,99.488,percent of total billed charges,78% of total billed charges,100.44,63,,80.352,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,60.58,38,,48.464,percent of total billed charges,38% of total billed charges,60.58,38,,48.464,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,143.49,90,,114.792,percent of total billed charges,90% of total billed charges,55.8,35,,44.64,percent of total billed charges,35% of total billed charges,107.26,67.275,,85.808,percent of total billed charges,67.275% of total billed charges,127.54,80,,102.032,percent of total billed charges,80% of total billed charges,61.19,38.38,,48.952,percent of total billed charges,38.38% of total billed charges,127.54,80,,102.032,percent of total billed charges,80% of total billed charges,98.43,61.74,,78.744,percent of total billed charges,61.74% of total billed charges,162.62,102,,130.096,percent of total billed charges,102% of total billed charges,60.58,38,,48.464,percent of total billed charges,38% of total billed charges,55.8,162.62,
LIDOCAINE,5001755,CDM,301,RC,80176,HCPCS,Outpatient,,,160,120,,124.8,78,,99.84,percent of total billed charges,78% of total billed charges,18.47,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.69,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.69,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,144,90,,115.2,percent of total billed charges,90% of total billed charges,19.39,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,107.64,67.275,,86.112,percent of total billed charges,67.275% of total billed charges,128,80,,102.4,percent of total billed charges,80% of total billed charges,14.84,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,128,80,,102.4,percent of total billed charges,80% of total billed charges,98.78,61.74,,79.024,percent of total billed charges,61.74% of total billed charges,18.84,102,,,Fee Schedule,102% of GA Medicaid Rate,14.69,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.69,144,
URINE HISTOPLASMA Ag,5001999,CDM,306,RC,87385,HCPCS,Outpatient,,,160,120,,124.8,78,,99.84,percent of total billed charges,78% of total billed charges,15.08,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,144,90,,115.2,percent of total billed charges,90% of total billed charges,15.83,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,107.64,67.275,,86.112,percent of total billed charges,67.275% of total billed charges,128,80,,102.4,percent of total billed charges,80% of total billed charges,13.38,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,128,80,,102.4,percent of total billed charges,80% of total billed charges,98.78,61.74,,79.024,percent of total billed charges,61.74% of total billed charges,15.38,102,,,Fee Schedule,102% of GA Medicaid Rate,13.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.25,144,
PATH FINE NDLE ASP SLD INTERP&,5002104,CDM,311,RC,88173,HCPCS,Outpatient,,,160,120,,124.8,78,,99.84,percent of total billed charges,78% of total billed charges,91.58,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,60.8,38,,48.64,percent of total billed charges,38% of total billed charges,60.8,38,,48.64,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,144,90,,115.2,percent of total billed charges,90% of total billed charges,96.16,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,107.64,67.275,,86.112,percent of total billed charges,67.275% of total billed charges,128,80,,102.4,percent of total billed charges,80% of total billed charges,61.41,38.38,,49.128,percent of total billed charges,38.38% of total billed charges,128,80,,102.4,percent of total billed charges,80% of total billed charges,98.78,61.74,,79.024,percent of total billed charges,61.74% of total billed charges,93.41,102,,,Fee Schedule,102% of GA Medicaid Rate,60.8,38,,48.64,percent of total billed charges,38% of total billed charges,60.8,144,
HGB ELECTROPHORESIS,5001825,CDM,301,RC,83020,HCPCS,Outpatient,,,161,120.75,,125.58,78,,100.464,percent of total billed charges,78% of total billed charges,12.29,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,144.9,90,,115.92,percent of total billed charges,90% of total billed charges,12.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,108.31,67.275,,86.648,percent of total billed charges,67.275% of total billed charges,128.8,80,,103.04,percent of total billed charges,80% of total billed charges,13,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,128.8,80,,103.04,percent of total billed charges,80% of total billed charges,99.4,61.74,,79.52,percent of total billed charges,61.74% of total billed charges,12.54,102,,,Fee Schedule,102% of GA Medicaid Rate,12.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.29,144.9,
RESTING SPLINT - MD RIGHT,3003042,CDM,270,RC,,,Outpatient,,,161.88,121.41,,126.27,78,,101.016,percent of total billed charges,78% of total billed charges,101.98,63,,81.584,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,61.51,38,,49.208,percent of total billed charges,38% of total billed charges,61.51,38,,49.208,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,145.69,90,,116.552,percent of total billed charges,90% of total billed charges,56.66,35,,45.328,percent of total billed charges,35% of total billed charges,108.9,67.275,,87.12,percent of total billed charges,67.275% of total billed charges,129.5,80,,103.6,percent of total billed charges,80% of total billed charges,62.13,38.38,,49.704,percent of total billed charges,38.38% of total billed charges,129.5,80,,103.6,percent of total billed charges,80% of total billed charges,99.94,61.74,,79.952,percent of total billed charges,61.74% of total billed charges,165.12,102,,132.096,percent of total billed charges,102% of total billed charges,61.51,38,,49.208,percent of total billed charges,38% of total billed charges,56.66,165.12,
VAP CHOLESTEROL,5000719,CDM,301,RC,83701,HCPCS,Outpatient,,,162,121.5,,126.36,78,,101.088,percent of total billed charges,78% of total billed charges,31.21,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,33.86,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,33.86,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,145.8,90,,116.64,percent of total billed charges,90% of total billed charges,32.77,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,108.99,67.275,,87.192,percent of total billed charges,67.275% of total billed charges,129.6,80,,103.68,percent of total billed charges,80% of total billed charges,34.2,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,129.6,80,,103.68,percent of total billed charges,80% of total billed charges,100.02,61.74,,80.016,percent of total billed charges,61.74% of total billed charges,31.83,102,,,Fee Schedule,102% of GA Medicaid Rate,33.86,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,31.21,145.8,
Chemical test of the blood to measure presence or concentration of a substance in the blood,5001838,CDM,302,RC,83516,HCPCS,Outpatient,,,162,121.5,,126.36,78,,101.088,percent of total billed charges,78% of total billed charges,13.45,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,11.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,145.8,90,,116.64,percent of total billed charges,90% of total billed charges,14.12,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,108.99,67.275,,87.192,percent of total billed charges,67.275% of total billed charges,129.6,80,,103.68,percent of total billed charges,80% of total billed charges,11.65,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,129.6,80,,103.68,percent of total billed charges,80% of total billed charges,100.02,61.74,,80.016,percent of total billed charges,61.74% of total billed charges,13.72,102,,,Fee Schedule,102% of GA Medicaid Rate,11.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.53,145.8,
ASPERGILLUS FUMIGATUS AB,5001943,CDM,302,RC,86606,HCPCS,Outpatient,,,162,121.5,,126.36,78,,101.088,percent of total billed charges,78% of total billed charges,18.93,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,15.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,145.8,90,,116.64,percent of total billed charges,90% of total billed charges,19.88,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,108.99,67.275,,87.192,percent of total billed charges,67.275% of total billed charges,129.6,80,,103.68,percent of total billed charges,80% of total billed charges,15.2,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,129.6,80,,103.68,percent of total billed charges,80% of total billed charges,100.02,61.74,,80.016,percent of total billed charges,61.74% of total billed charges,19.31,102,,,Fee Schedule,102% of GA Medicaid Rate,15.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.05,145.8,
ASPERGILLUS FLAVUS AB,5001944,CDM,302,RC,86606,HCPCS,Outpatient,,,162,121.5,,126.36,78,,101.088,percent of total billed charges,78% of total billed charges,18.93,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,15.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,145.8,90,,116.64,percent of total billed charges,90% of total billed charges,19.88,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,108.99,67.275,,87.192,percent of total billed charges,67.275% of total billed charges,129.6,80,,103.68,percent of total billed charges,80% of total billed charges,15.2,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,129.6,80,,103.68,percent of total billed charges,80% of total billed charges,100.02,61.74,,80.016,percent of total billed charges,61.74% of total billed charges,19.31,102,,,Fee Schedule,102% of GA Medicaid Rate,15.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.05,145.8,
ESTRONE,5000831,CDM,301,RC,82679,HCPCS,Outpatient,,,163,122.25,,127.14,78,,101.712,percent of total billed charges,78% of total billed charges,31.39,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,24.95,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,24.95,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,146.7,90,,117.36,percent of total billed charges,90% of total billed charges,32.96,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,109.66,67.275,,87.728,percent of total billed charges,67.275% of total billed charges,130.4,80,,104.32,percent of total billed charges,80% of total billed charges,25.2,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,130.4,80,,104.32,percent of total billed charges,80% of total billed charges,100.64,61.74,,80.512,percent of total billed charges,61.74% of total billed charges,32.02,102,,,Fee Schedule,102% of GA Medicaid Rate,24.95,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,24.95,146.7,
TOBRAMYCIN PEAK,5001620,CDM,301,RC,80200,HCPCS,Outpatient,,,163,122.25,,127.14,78,,101.712,percent of total billed charges,78% of total billed charges,18.84,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.13,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.13,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,146.7,90,,117.36,percent of total billed charges,90% of total billed charges,19.78,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,109.66,67.275,,87.728,percent of total billed charges,67.275% of total billed charges,130.4,80,,104.32,percent of total billed charges,80% of total billed charges,16.29,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,130.4,80,,104.32,percent of total billed charges,80% of total billed charges,100.64,61.74,,80.512,percent of total billed charges,61.74% of total billed charges,19.22,102,,,Fee Schedule,102% of GA Medicaid Rate,16.13,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.13,146.7,
TOBRAMYCIN TROUGH,5001621,CDM,301,RC,80200,HCPCS,Outpatient,,,163,122.25,,127.14,78,,101.712,percent of total billed charges,78% of total billed charges,18.84,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.13,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.13,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,146.7,90,,117.36,percent of total billed charges,90% of total billed charges,19.78,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,109.66,67.275,,87.728,percent of total billed charges,67.275% of total billed charges,130.4,80,,104.32,percent of total billed charges,80% of total billed charges,16.29,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,130.4,80,,104.32,percent of total billed charges,80% of total billed charges,100.64,61.74,,80.512,percent of total billed charges,61.74% of total billed charges,19.22,102,,,Fee Schedule,102% of GA Medicaid Rate,16.13,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.13,146.7,
TOBRAMYCIN RANDOM,5001622,CDM,301,RC,80200,HCPCS,Outpatient,,,163,122.25,,127.14,78,,101.712,percent of total billed charges,78% of total billed charges,18.84,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.13,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.13,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,146.7,90,,117.36,percent of total billed charges,90% of total billed charges,19.78,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,109.66,67.275,,87.728,percent of total billed charges,67.275% of total billed charges,130.4,80,,104.32,percent of total billed charges,80% of total billed charges,16.29,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,130.4,80,,104.32,percent of total billed charges,80% of total billed charges,100.64,61.74,,80.512,percent of total billed charges,61.74% of total billed charges,19.22,102,,,Fee Schedule,102% of GA Medicaid Rate,16.13,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.13,146.7,
CERULOPLASM,5000237,CDM,301,RC,82390,HCPCS,Outpatient,,,164,123,,127.92,78,,102.336,percent of total billed charges,78% of total billed charges,13.51,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,10.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,147.6,90,,118.08,percent of total billed charges,90% of total billed charges,14.19,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,110.33,67.275,,88.264,percent of total billed charges,67.275% of total billed charges,131.2,80,,104.96,percent of total billed charges,80% of total billed charges,10.85,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,131.2,80,,104.96,percent of total billed charges,80% of total billed charges,101.25,61.74,,81,percent of total billed charges,61.74% of total billed charges,13.78,102,,,Fee Schedule,102% of GA Medicaid Rate,10.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.74,147.6,
AMIKACIN,5001630,CDM,301,RC,80150,HCPCS,Outpatient,,,164,123,,127.92,78,,102.336,percent of total billed charges,78% of total billed charges,18.95,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,15.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,147.6,90,,118.08,percent of total billed charges,90% of total billed charges,19.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,110.33,67.275,,88.264,percent of total billed charges,67.275% of total billed charges,131.2,80,,104.96,percent of total billed charges,80% of total billed charges,15.23,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,131.2,80,,104.96,percent of total billed charges,80% of total billed charges,101.25,61.74,,81,percent of total billed charges,61.74% of total billed charges,19.33,102,,,Fee Schedule,102% of GA Medicaid Rate,15.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.08,147.6,
WALKER BOOT- SHORT LARGE - 01-AL,3000705,CDM,270,RC,,,Outpatient,,,164.48,123.36,,128.29,78,,102.632,percent of total billed charges,78% of total billed charges,103.62,63,,82.896,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,62.5,38,,50,percent of total billed charges,38% of total billed charges,62.5,38,,50,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,148.03,90,,118.424,percent of total billed charges,90% of total billed charges,57.57,35,,46.056,percent of total billed charges,35% of total billed charges,110.65,67.275,,88.52,percent of total billed charges,67.275% of total billed charges,131.58,80,,105.264,percent of total billed charges,80% of total billed charges,63.13,38.38,,50.504,percent of total billed charges,38.38% of total billed charges,131.58,80,,105.264,percent of total billed charges,80% of total billed charges,101.55,61.74,,81.24,percent of total billed charges,61.74% of total billed charges,167.77,102,,134.216,percent of total billed charges,102% of total billed charges,62.5,38,,50,percent of total billed charges,38% of total billed charges,57.57,167.77,
"CATECHOLAMINES, PLASMA",5001917,CDM,301,RC,82384,HCPCS,Outpatient,,,165,123.75,,128.7,78,,102.96,percent of total billed charges,78% of total billed charges,31.75,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,25.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,25.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,148.5,90,,118.8,percent of total billed charges,90% of total billed charges,33.34,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,111,67.275,,88.8,percent of total billed charges,67.275% of total billed charges,132,80,,105.6,percent of total billed charges,80% of total billed charges,25.5,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,132,80,,105.6,percent of total billed charges,80% of total billed charges,101.87,61.74,,81.496,percent of total billed charges,61.74% of total billed charges,32.39,102,,,Fee Schedule,102% of GA Medicaid Rate,25.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,25.25,148.5,
CATECHOLAMINES FRACT,5001922,CDM,301,RC,82384,HCPCS,Outpatient,,,165,123.75,,128.7,78,,102.96,percent of total billed charges,78% of total billed charges,31.75,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,25.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,25.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,148.5,90,,118.8,percent of total billed charges,90% of total billed charges,33.34,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,111,67.275,,88.8,percent of total billed charges,67.275% of total billed charges,132,80,,105.6,percent of total billed charges,80% of total billed charges,25.5,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,132,80,,105.6,percent of total billed charges,80% of total billed charges,101.87,61.74,,81.496,percent of total billed charges,61.74% of total billed charges,32.39,102,,,Fee Schedule,102% of GA Medicaid Rate,25.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,25.25,148.5,
ENDOPATH XCEL TROCAR SLEEVE 12MM,3004268,CDM,270,RC,,,Outpatient,,,165.48,124.11,,129.07,78,,103.256,percent of total billed charges,78% of total billed charges,104.25,63,,83.4,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,62.88,38,,50.304,percent of total billed charges,38% of total billed charges,62.88,38,,50.304,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,148.93,90,,119.144,percent of total billed charges,90% of total billed charges,57.92,35,,46.336,percent of total billed charges,35% of total billed charges,111.33,67.275,,89.064,percent of total billed charges,67.275% of total billed charges,132.38,80,,105.904,percent of total billed charges,80% of total billed charges,63.51,38.38,,50.808,percent of total billed charges,38.38% of total billed charges,132.38,80,,105.904,percent of total billed charges,80% of total billed charges,102.17,61.74,,81.736,percent of total billed charges,61.74% of total billed charges,168.79,102,,135.032,percent of total billed charges,102% of total billed charges,62.88,38,,50.304,percent of total billed charges,38% of total billed charges,57.92,168.79,
GASTROSTOMY TUBE 16FR,3001617,CDM,270,RC,,,Outpatient,,,165.8,124.35,,129.32,78,,103.456,percent of total billed charges,78% of total billed charges,104.45,63,,83.56,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,63,38,,50.4,percent of total billed charges,38% of total billed charges,63,38,,50.4,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,149.22,90,,119.376,percent of total billed charges,90% of total billed charges,58.03,35,,46.424,percent of total billed charges,35% of total billed charges,111.54,67.275,,89.232,percent of total billed charges,67.275% of total billed charges,132.64,80,,106.112,percent of total billed charges,80% of total billed charges,63.63,38.38,,50.904,percent of total billed charges,38.38% of total billed charges,132.64,80,,106.112,percent of total billed charges,80% of total billed charges,102.36,61.74,,81.888,percent of total billed charges,61.74% of total billed charges,169.12,102,,135.296,percent of total billed charges,102% of total billed charges,63,38,,50.4,percent of total billed charges,38% of total billed charges,58.03,169.12,
CLOSE DISL EXC FIN/TOE/TR,1001072,CDM,450,RC,,,Outpatient,,,166,124.5,,129.48,78,,103.584,percent of total billed charges,78% of total billed charges,104.58,63,,83.664,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,63.08,38,,50.464,percent of total billed charges,38% of total billed charges,63.08,38,,50.464,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,58.1,35,,46.48,percent of total billed charges,35% of total billed charges,111.68,67.275,,89.344,percent of total billed charges,67.275% of total billed charges,132.8,80,,106.24,percent of total billed charges,80% of total billed charges,63.71,38.38,,50.968,percent of total billed charges,38.38% of total billed charges,132.8,80,,106.24,percent of total billed charges,80% of total billed charges,102.49,61.74,,81.992,percent of total billed charges,61.74% of total billed charges,169.32,102,,135.456,percent of total billed charges,102% of total billed charges,63.08,38,,50.464,percent of total billed charges,38% of total billed charges,58.1,169.32,
REMOVAL OF FB EYE,1001222,CDM,450,RC,,,Outpatient,,,166,124.5,,129.48,78,,103.584,percent of total billed charges,78% of total billed charges,104.58,63,,83.664,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,63.08,38,,50.464,percent of total billed charges,38% of total billed charges,63.08,38,,50.464,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,58.1,35,,46.48,percent of total billed charges,35% of total billed charges,111.68,67.275,,89.344,percent of total billed charges,67.275% of total billed charges,132.8,80,,106.24,percent of total billed charges,80% of total billed charges,63.71,38.38,,50.968,percent of total billed charges,38.38% of total billed charges,132.8,80,,106.24,percent of total billed charges,80% of total billed charges,102.49,61.74,,81.992,percent of total billed charges,61.74% of total billed charges,169.32,102,,135.456,percent of total billed charges,102% of total billed charges,63.08,38,,50.464,percent of total billed charges,38% of total billed charges,58.1,169.32,
CERVICAL COLLAR-MIAMI J LARGE,3000233,CDM,270,RC,,,Outpatient,,,166,124.5,,129.48,78,,103.584,percent of total billed charges,78% of total billed charges,104.58,63,,83.664,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,63.08,38,,50.464,percent of total billed charges,38% of total billed charges,63.08,38,,50.464,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,58.1,35,,46.48,percent of total billed charges,35% of total billed charges,111.68,67.275,,89.344,percent of total billed charges,67.275% of total billed charges,132.8,80,,106.24,percent of total billed charges,80% of total billed charges,63.71,38.38,,50.968,percent of total billed charges,38.38% of total billed charges,132.8,80,,106.24,percent of total billed charges,80% of total billed charges,102.49,61.74,,81.992,percent of total billed charges,61.74% of total billed charges,169.32,102,,135.456,percent of total billed charges,102% of total billed charges,63.08,38,,50.464,percent of total billed charges,38% of total billed charges,58.1,169.32,
GUIDEWIRE 1.6MM,3006023,CDM,270,RC,,,Outpatient,,,166,124.5,,129.48,78,,103.584,percent of total billed charges,78% of total billed charges,104.58,63,,83.664,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,63.08,38,,50.464,percent of total billed charges,38% of total billed charges,63.08,38,,50.464,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,58.1,35,,46.48,percent of total billed charges,35% of total billed charges,111.68,67.275,,89.344,percent of total billed charges,67.275% of total billed charges,132.8,80,,106.24,percent of total billed charges,80% of total billed charges,63.71,38.38,,50.968,percent of total billed charges,38.38% of total billed charges,132.8,80,,106.24,percent of total billed charges,80% of total billed charges,102.49,61.74,,81.992,percent of total billed charges,61.74% of total billed charges,169.32,102,,135.456,percent of total billed charges,102% of total billed charges,63.08,38,,50.464,percent of total billed charges,38% of total billed charges,58.1,169.32,
.PROTHROMBIN 30326G,5000449,CDM,301,RC,,,Outpatient,,,166,124.5,,129.48,78,,103.584,percent of total billed charges,78% of total billed charges,104.58,63,,83.664,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,63.08,38,,50.464,percent of total billed charges,38% of total billed charges,63.08,38,,50.464,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,58.1,35,,46.48,percent of total billed charges,35% of total billed charges,111.68,67.275,,89.344,percent of total billed charges,67.275% of total billed charges,132.8,80,,106.24,percent of total billed charges,80% of total billed charges,63.71,38.38,,50.968,percent of total billed charges,38.38% of total billed charges,132.8,80,,106.24,percent of total billed charges,80% of total billed charges,102.49,61.74,,81.992,percent of total billed charges,61.74% of total billed charges,169.32,102,,135.456,percent of total billed charges,102% of total billed charges,63.08,38,,50.464,percent of total billed charges,38% of total billed charges,58.1,169.32,
ANTIPHOSPHOLIPID,5001668,CDM,302,RC,86146,HCPCS,Outpatient,,,166,124.5,,129.48,78,,103.584,percent of total billed charges,78% of total billed charges,31.99,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,25.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,25.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,33.59,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,111.68,67.275,,89.344,percent of total billed charges,67.275% of total billed charges,132.8,80,,106.24,percent of total billed charges,80% of total billed charges,25.7,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,132.8,80,,106.24,percent of total billed charges,80% of total billed charges,102.49,61.74,,81.992,percent of total billed charges,61.74% of total billed charges,32.63,102,,,Fee Schedule,102% of GA Medicaid Rate,25.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,25.45,149.4,
TESTOSTERONE FREE & TOTAL,5001729,CDM,301,RC,84402,HCPCS,Outpatient,,,166,124.5,,129.48,78,,103.584,percent of total billed charges,78% of total billed charges,32.01,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,25.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,25.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,33.61,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,111.68,67.275,,89.344,percent of total billed charges,67.275% of total billed charges,132.8,80,,106.24,percent of total billed charges,80% of total billed charges,25.72,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,132.8,80,,106.24,percent of total billed charges,80% of total billed charges,102.49,61.74,,81.992,percent of total billed charges,61.74% of total billed charges,32.65,102,,,Fee Schedule,102% of GA Medicaid Rate,25.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,25.47,149.4,
K-WIRE 3.2MM,3007003,CDM,270,RC,,,Outpatient,,,166.48,124.86,,129.85,78,,103.88,percent of total billed charges,78% of total billed charges,104.88,63,,83.904,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,63.26,38,,50.608,percent of total billed charges,38% of total billed charges,63.26,38,,50.608,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,149.83,90,,119.864,percent of total billed charges,90% of total billed charges,58.27,35,,46.616,percent of total billed charges,35% of total billed charges,112,67.275,,89.6,percent of total billed charges,67.275% of total billed charges,133.18,80,,106.544,percent of total billed charges,80% of total billed charges,63.9,38.38,,51.12,percent of total billed charges,38.38% of total billed charges,133.18,80,,106.544,percent of total billed charges,80% of total billed charges,102.78,61.74,,82.224,percent of total billed charges,61.74% of total billed charges,169.81,102,,135.848,percent of total billed charges,102% of total billed charges,63.26,38,,50.608,percent of total billed charges,38% of total billed charges,58.27,169.81,
LACTATE,5000002,CDM,301,RC,83605,HCPCS,Outpatient,,,167,125.25,,130.26,78,,104.208,percent of total billed charges,78% of total billed charges,13.43,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,11.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,150.3,90,,120.24,percent of total billed charges,90% of total billed charges,14.1,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,112.35,67.275,,89.88,percent of total billed charges,67.275% of total billed charges,133.6,80,,106.88,percent of total billed charges,80% of total billed charges,11.69,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,133.6,80,,106.88,percent of total billed charges,80% of total billed charges,103.11,61.74,,82.488,percent of total billed charges,61.74% of total billed charges,13.7,102,,,Fee Schedule,102% of GA Medicaid Rate,11.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.57,150.3,
WALKER BOOT - SHORT X- LARGE - 01-AXL,3002101,CDM,270,RC,,,Outpatient,,,167.8,125.85,,130.88,78,,104.704,percent of total billed charges,78% of total billed charges,105.71,63,,84.568,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,63.76,38,,51.008,percent of total billed charges,38% of total billed charges,63.76,38,,51.008,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,151.02,90,,120.816,percent of total billed charges,90% of total billed charges,58.73,35,,46.984,percent of total billed charges,35% of total billed charges,112.89,67.275,,90.312,percent of total billed charges,67.275% of total billed charges,134.24,80,,107.392,percent of total billed charges,80% of total billed charges,64.4,38.38,,51.52,percent of total billed charges,38.38% of total billed charges,134.24,80,,107.392,percent of total billed charges,80% of total billed charges,103.6,61.74,,82.88,percent of total billed charges,61.74% of total billed charges,171.16,102,,136.928,percent of total billed charges,102% of total billed charges,63.76,38,,51.008,percent of total billed charges,38% of total billed charges,58.73,171.16,
".DRUG SCREEN, SERUM",5000520,CDM,301,RC,80101,HCPCS,Outpatient,,,167.9,125.93,,130.96,78,,104.768,percent of total billed charges,78% of total billed charges,105.78,63,,84.624,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,63.8,38,,51.04,percent of total billed charges,38% of total billed charges,63.8,38,,51.04,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,151.11,90,,120.888,percent of total billed charges,90% of total billed charges,58.77,35,,47.016,percent of total billed charges,35% of total billed charges,112.95,67.275,,90.36,percent of total billed charges,67.275% of total billed charges,134.32,80,,107.456,percent of total billed charges,80% of total billed charges,64.44,38.38,,51.552,percent of total billed charges,38.38% of total billed charges,134.32,80,,107.456,percent of total billed charges,80% of total billed charges,103.66,61.74,,82.928,percent of total billed charges,61.74% of total billed charges,171.26,102,,137.008,percent of total billed charges,102% of total billed charges,63.8,38,,51.04,percent of total billed charges,38% of total billed charges,58.77,171.26,
WIRE FIXATION BOLT SLOTTED,3006012,CDM,270,RC,,,Outpatient,,,168,126,,131.04,78,,104.832,percent of total billed charges,78% of total billed charges,105.84,63,,84.672,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,63.84,38,,51.072,percent of total billed charges,38% of total billed charges,63.84,38,,51.072,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,151.2,90,,120.96,percent of total billed charges,90% of total billed charges,58.8,35,,47.04,percent of total billed charges,35% of total billed charges,113.02,67.275,,90.416,percent of total billed charges,67.275% of total billed charges,134.4,80,,107.52,percent of total billed charges,80% of total billed charges,64.48,38.38,,51.584,percent of total billed charges,38.38% of total billed charges,134.4,80,,107.52,percent of total billed charges,80% of total billed charges,103.72,61.74,,82.976,percent of total billed charges,61.74% of total billed charges,171.36,102,,137.088,percent of total billed charges,102% of total billed charges,63.84,38,,51.072,percent of total billed charges,38% of total billed charges,58.8,171.36,
SCREW CORTEX 3.5MMX18MM,3006027,CDM,270,RC,,,Outpatient,,,168,126,,131.04,78,,104.832,percent of total billed charges,78% of total billed charges,105.84,63,,84.672,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,63.84,38,,51.072,percent of total billed charges,38% of total billed charges,63.84,38,,51.072,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,151.2,90,,120.96,percent of total billed charges,90% of total billed charges,58.8,35,,47.04,percent of total billed charges,35% of total billed charges,113.02,67.275,,90.416,percent of total billed charges,67.275% of total billed charges,134.4,80,,107.52,percent of total billed charges,80% of total billed charges,64.48,38.38,,51.584,percent of total billed charges,38.38% of total billed charges,134.4,80,,107.52,percent of total billed charges,80% of total billed charges,103.72,61.74,,82.976,percent of total billed charges,61.74% of total billed charges,171.36,102,,137.088,percent of total billed charges,102% of total billed charges,63.84,38,,51.072,percent of total billed charges,38% of total billed charges,58.8,171.36,
ACAPELLA  W/MOUTHPIECE - BLUE,3000910,CDM,270,RC,,,Outpatient,,,168.2,126.15,,131.2,78,,104.96,percent of total billed charges,78% of total billed charges,105.97,63,,84.776,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,63.92,38,,51.136,percent of total billed charges,38% of total billed charges,63.92,38,,51.136,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,151.38,90,,121.104,percent of total billed charges,90% of total billed charges,58.87,35,,47.096,percent of total billed charges,35% of total billed charges,113.16,67.275,,90.528,percent of total billed charges,67.275% of total billed charges,134.56,80,,107.648,percent of total billed charges,80% of total billed charges,64.56,38.38,,51.648,percent of total billed charges,38.38% of total billed charges,134.56,80,,107.648,percent of total billed charges,80% of total billed charges,103.85,61.74,,83.08,percent of total billed charges,61.74% of total billed charges,171.56,102,,137.248,percent of total billed charges,102% of total billed charges,63.92,38,,51.136,percent of total billed charges,38% of total billed charges,58.87,171.56,
TRACHEOSTOMY DISP 4DCFS,3004102,CDM,270,RC,,,Outpatient,,,168.44,126.33,,131.38,78,,105.104,percent of total billed charges,78% of total billed charges,106.12,63,,84.896,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,64.01,38,,51.208,percent of total billed charges,38% of total billed charges,64.01,38,,51.208,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,151.6,90,,121.28,percent of total billed charges,90% of total billed charges,58.95,35,,47.16,percent of total billed charges,35% of total billed charges,113.32,67.275,,90.656,percent of total billed charges,67.275% of total billed charges,134.75,80,,107.8,percent of total billed charges,80% of total billed charges,64.65,38.38,,51.72,percent of total billed charges,38.38% of total billed charges,134.75,80,,107.8,percent of total billed charges,80% of total billed charges,103.99,61.74,,83.192,percent of total billed charges,61.74% of total billed charges,171.81,102,,137.448,percent of total billed charges,102% of total billed charges,64.01,38,,51.208,percent of total billed charges,38% of total billed charges,58.95,171.81,
TRACHEOSTOMY DISP 6DCFS,3004103,CDM,270,RC,,,Outpatient,,,168.44,126.33,,131.38,78,,105.104,percent of total billed charges,78% of total billed charges,106.12,63,,84.896,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,64.01,38,,51.208,percent of total billed charges,38% of total billed charges,64.01,38,,51.208,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,151.6,90,,121.28,percent of total billed charges,90% of total billed charges,58.95,35,,47.16,percent of total billed charges,35% of total billed charges,113.32,67.275,,90.656,percent of total billed charges,67.275% of total billed charges,134.75,80,,107.8,percent of total billed charges,80% of total billed charges,64.65,38.38,,51.72,percent of total billed charges,38.38% of total billed charges,134.75,80,,107.8,percent of total billed charges,80% of total billed charges,103.99,61.74,,83.192,percent of total billed charges,61.74% of total billed charges,171.81,102,,137.448,percent of total billed charges,102% of total billed charges,64.01,38,,51.208,percent of total billed charges,38% of total billed charges,58.95,171.81,
CYCLIC AMP,5001919,CDM,301,RC,82030,HCPCS,Outpatient,,,169,126.75,,131.82,78,,105.456,percent of total billed charges,78% of total billed charges,32.45,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,25.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,25.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,152.1,90,,121.68,percent of total billed charges,90% of total billed charges,34.07,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,113.69,67.275,,90.952,percent of total billed charges,67.275% of total billed charges,135.2,80,,108.16,percent of total billed charges,80% of total billed charges,26.06,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,135.2,80,,108.16,percent of total billed charges,80% of total billed charges,104.34,61.74,,83.472,percent of total billed charges,61.74% of total billed charges,33.1,102,,,Fee Schedule,102% of GA Medicaid Rate,25.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,25.8,152.1,
SCREW -3.5  14MM,3005074,CDM,270,RC,,,Outpatient,,,169.2,126.9,,131.98,78,,105.584,percent of total billed charges,78% of total billed charges,106.6,63,,85.28,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,64.3,38,,51.44,percent of total billed charges,38% of total billed charges,64.3,38,,51.44,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,152.28,90,,121.824,percent of total billed charges,90% of total billed charges,59.22,35,,47.376,percent of total billed charges,35% of total billed charges,113.83,67.275,,91.064,percent of total billed charges,67.275% of total billed charges,135.36,80,,108.288,percent of total billed charges,80% of total billed charges,64.94,38.38,,51.952,percent of total billed charges,38.38% of total billed charges,135.36,80,,108.288,percent of total billed charges,80% of total billed charges,104.46,61.74,,83.568,percent of total billed charges,61.74% of total billed charges,172.58,102,,138.064,percent of total billed charges,102% of total billed charges,64.3,38,,51.44,percent of total billed charges,38% of total billed charges,59.22,172.58,
AMBULATING  AFO BOOT -  SMALL,3004503,CDM,270,RC,,,Outpatient,,,170.36,127.77,,132.88,78,,106.304,percent of total billed charges,78% of total billed charges,107.33,63,,85.864,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,64.74,38,,51.792,percent of total billed charges,38% of total billed charges,64.74,38,,51.792,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,153.32,90,,122.656,percent of total billed charges,90% of total billed charges,59.63,35,,47.704,percent of total billed charges,35% of total billed charges,114.61,67.275,,91.688,percent of total billed charges,67.275% of total billed charges,136.29,80,,109.032,percent of total billed charges,80% of total billed charges,65.38,38.38,,52.304,percent of total billed charges,38.38% of total billed charges,136.29,80,,109.032,percent of total billed charges,80% of total billed charges,105.18,61.74,,84.144,percent of total billed charges,61.74% of total billed charges,173.77,102,,139.016,percent of total billed charges,102% of total billed charges,64.74,38,,51.792,percent of total billed charges,38% of total billed charges,59.63,173.77,
HYPERSENSITIVITY PNEUMONITIS SCREEN,5000255,CDM,302,RC,86606,HCPCS,Outpatient,,,171,128.25,,133.38,78,,106.704,percent of total billed charges,78% of total billed charges,18.93,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,15.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,153.9,90,,123.12,percent of total billed charges,90% of total billed charges,19.88,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,115.04,67.275,,92.032,percent of total billed charges,67.275% of total billed charges,136.8,80,,109.44,percent of total billed charges,80% of total billed charges,15.2,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,136.8,80,,109.44,percent of total billed charges,80% of total billed charges,105.58,61.74,,84.464,percent of total billed charges,61.74% of total billed charges,19.31,102,,,Fee Schedule,102% of GA Medicaid Rate,15.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.05,153.9,
FACIAL BONES 2 VIEWS,7000111,CDM,320,RC,70140,HCPCS,Outpatient,,,172,129,,134.16,78,,107.328,percent of total billed charges,78% of total billed charges,108.36,63,,86.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,60.2,35,,48.16,percent of total billed charges,35% of total billed charges,115.71,67.275,,92.568,percent of total billed charges,67.275% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,66.01,38.38,,52.808,percent of total billed charges,38.38% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,106.19,61.74,,84.952,percent of total billed charges,61.74% of total billed charges,175.44,102,,140.352,percent of total billed charges,102% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,60.2,175.44,
SINUSES COMP MIN 3V,7000140,CDM,320,RC,70220,HCPCS,Outpatient,,,172,129,,134.16,78,,107.328,percent of total billed charges,78% of total billed charges,108.36,63,,86.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,60.2,35,,48.16,percent of total billed charges,35% of total billed charges,115.71,67.275,,92.568,percent of total billed charges,67.275% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,66.01,38.38,,52.808,percent of total billed charges,38.38% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,106.19,61.74,,84.952,percent of total billed charges,61.74% of total billed charges,175.44,102,,140.352,percent of total billed charges,102% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,60.2,175.44,
TEMPOROMANDIBULAR JTS BIL,7000150,CDM,320,RC,70330,HCPCS,Outpatient,,,172,129,,134.16,78,,107.328,percent of total billed charges,78% of total billed charges,108.36,63,,86.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,60.2,35,,48.16,percent of total billed charges,35% of total billed charges,115.71,67.275,,92.568,percent of total billed charges,67.275% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,66.01,38.38,,52.808,percent of total billed charges,38.38% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,106.19,61.74,,84.952,percent of total billed charges,61.74% of total billed charges,175.44,102,,140.352,percent of total billed charges,102% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,60.2,175.44,
NECK SOFT TISSUE,7000151,CDM,320,RC,70360,HCPCS,Outpatient,,,172,129,,134.16,78,,107.328,percent of total billed charges,78% of total billed charges,108.36,63,,86.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,60.2,35,,48.16,percent of total billed charges,35% of total billed charges,115.71,67.275,,92.568,percent of total billed charges,67.275% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,66.01,38.38,,52.808,percent of total billed charges,38.38% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,106.19,61.74,,84.952,percent of total billed charges,61.74% of total billed charges,175.44,102,,140.352,percent of total billed charges,102% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,60.2,175.44,
STERNUM MIN 2 VIEWS,7000225,CDM,320,RC,71120,HCPCS,Outpatient,,,172,129,,134.16,78,,107.328,percent of total billed charges,78% of total billed charges,108.36,63,,86.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,60.2,35,,48.16,percent of total billed charges,35% of total billed charges,115.71,67.275,,92.568,percent of total billed charges,67.275% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,66.01,38.38,,52.808,percent of total billed charges,38.38% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,106.19,61.74,,84.952,percent of total billed charges,61.74% of total billed charges,175.44,102,,140.352,percent of total billed charges,102% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,60.2,175.44,
ACROMIOCLAVICULAR JOINTS,7000315,CDM,320,RC,73050,HCPCS,Outpatient,,,172,129,,134.16,78,,107.328,percent of total billed charges,78% of total billed charges,108.36,63,,86.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,60.2,35,,48.16,percent of total billed charges,35% of total billed charges,115.71,67.275,,92.568,percent of total billed charges,67.275% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,66.01,38.38,,52.808,percent of total billed charges,38.38% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,106.19,61.74,,84.952,percent of total billed charges,61.74% of total billed charges,175.44,102,,140.352,percent of total billed charges,102% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,60.2,175.44,
ABDOMEN 1 VIEW,7000505,CDM,320,RC,74018,HCPCS,Outpatient,,,172,129,,134.16,78,,107.328,percent of total billed charges,78% of total billed charges,108.36,63,,86.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,60.2,35,,48.16,percent of total billed charges,35% of total billed charges,115.71,67.275,,92.568,percent of total billed charges,67.275% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,66.01,38.38,,52.808,percent of total billed charges,38.38% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,106.19,61.74,,84.952,percent of total billed charges,61.74% of total billed charges,175.44,102,,140.352,percent of total billed charges,102% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,60.2,175.44,
KUB SUPINE 1 VIEW,7000506,CDM,320,RC,74018,HCPCS,Outpatient,,,172,129,,134.16,78,,107.328,percent of total billed charges,78% of total billed charges,108.36,63,,86.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,60.2,35,,48.16,percent of total billed charges,35% of total billed charges,115.71,67.275,,92.568,percent of total billed charges,67.275% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,66.01,38.38,,52.808,percent of total billed charges,38.38% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,106.19,61.74,,84.952,percent of total billed charges,61.74% of total billed charges,175.44,102,,140.352,percent of total billed charges,102% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,60.2,175.44,
ABDOMEN LATERAL DECUBITUS,7000511,CDM,320,RC,74018,HCPCS,Outpatient,,,172,129,,134.16,78,,107.328,percent of total billed charges,78% of total billed charges,108.36,63,,86.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,60.2,35,,48.16,percent of total billed charges,35% of total billed charges,115.71,67.275,,92.568,percent of total billed charges,67.275% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,66.01,38.38,,52.808,percent of total billed charges,38.38% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,106.19,61.74,,84.952,percent of total billed charges,61.74% of total billed charges,175.44,102,,140.352,percent of total billed charges,102% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,60.2,175.44,
HIP 2-3 VIEWS W/ PELVIS RIGHT,7000540,CDM,320,RC,73502,HCPCS,Outpatient,,,172,129,,134.16,78,,107.328,percent of total billed charges,78% of total billed charges,108.36,63,,86.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,60.2,35,,48.16,percent of total billed charges,35% of total billed charges,115.71,67.275,,92.568,percent of total billed charges,67.275% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,66.01,38.38,,52.808,percent of total billed charges,38.38% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,106.19,61.74,,84.952,percent of total billed charges,61.74% of total billed charges,175.44,102,,140.352,percent of total billed charges,102% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,60.2,175.44,
HIP 2-3 VIEWS W/ PELVIS LEFT,7000541,CDM,320,RC,73502,HCPCS,Outpatient,,,172,129,,134.16,78,,107.328,percent of total billed charges,78% of total billed charges,108.36,63,,86.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,60.2,35,,48.16,percent of total billed charges,35% of total billed charges,115.71,67.275,,92.568,percent of total billed charges,67.275% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,66.01,38.38,,52.808,percent of total billed charges,38.38% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,106.19,61.74,,84.952,percent of total billed charges,61.74% of total billed charges,175.44,102,,140.352,percent of total billed charges,102% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,60.2,175.44,
Radiologic examination of the knee with 1 or 2 views,7000703,CDM,320,RC,73560,HCPCS,Outpatient,,,172,129,,134.16,78,,107.328,percent of total billed charges,78% of total billed charges,108.36,63,,86.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,60.2,35,,48.16,percent of total billed charges,35% of total billed charges,115.71,67.275,,92.568,percent of total billed charges,67.275% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,66.01,38.38,,52.808,percent of total billed charges,38.38% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,106.19,61.74,,84.952,percent of total billed charges,61.74% of total billed charges,175.44,102,,140.352,percent of total billed charges,102% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,60.2,175.44,
Radiologic examination of the ankle with 3 views,7000705,CDM,320,RC,73610,HCPCS,Outpatient,,,172,129,,134.16,78,,107.328,percent of total billed charges,78% of total billed charges,108.36,63,,86.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,60.2,35,,48.16,percent of total billed charges,35% of total billed charges,115.71,67.275,,92.568,percent of total billed charges,67.275% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,66.01,38.38,,52.808,percent of total billed charges,38.38% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,106.19,61.74,,84.952,percent of total billed charges,61.74% of total billed charges,175.44,102,,140.352,percent of total billed charges,102% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,60.2,175.44,
Radiologic examination of the ankle with 3 views,7000707,CDM,320,RC,73610,HCPCS,Outpatient,,,172,129,,134.16,78,,107.328,percent of total billed charges,78% of total billed charges,108.36,63,,86.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,60.2,35,,48.16,percent of total billed charges,35% of total billed charges,115.71,67.275,,92.568,percent of total billed charges,67.275% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,66.01,38.38,,52.808,percent of total billed charges,38.38% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,106.19,61.74,,84.952,percent of total billed charges,61.74% of total billed charges,175.44,102,,140.352,percent of total billed charges,102% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,60.2,175.44,
Radiologic examination of the knee with 1 or 2 views,7000713,CDM,320,RC,73560,HCPCS,Outpatient,,,172,129,,134.16,78,,107.328,percent of total billed charges,78% of total billed charges,108.36,63,,86.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,60.2,35,,48.16,percent of total billed charges,35% of total billed charges,115.71,67.275,,92.568,percent of total billed charges,67.275% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,66.01,38.38,,52.808,percent of total billed charges,38.38% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,106.19,61.74,,84.952,percent of total billed charges,61.74% of total billed charges,175.44,102,,140.352,percent of total billed charges,102% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,60.2,175.44,
Radiologic examination of the forearm,7000730,CDM,320,RC,73090,HCPCS,Outpatient,,,172,129,,134.16,78,,107.328,percent of total billed charges,78% of total billed charges,108.36,63,,86.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,60.2,35,,48.16,percent of total billed charges,35% of total billed charges,115.71,67.275,,92.568,percent of total billed charges,67.275% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,66.01,38.38,,52.808,percent of total billed charges,38.38% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,106.19,61.74,,84.952,percent of total billed charges,61.74% of total billed charges,175.44,102,,140.352,percent of total billed charges,102% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,60.2,175.44,
Radiologic examination of the forearm,7000732,CDM,320,RC,73090,HCPCS,Outpatient,,,172,129,,134.16,78,,107.328,percent of total billed charges,78% of total billed charges,108.36,63,,86.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,60.2,35,,48.16,percent of total billed charges,35% of total billed charges,115.71,67.275,,92.568,percent of total billed charges,67.275% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,66.01,38.38,,52.808,percent of total billed charges,38.38% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,106.19,61.74,,84.952,percent of total billed charges,61.74% of total billed charges,175.44,102,,140.352,percent of total billed charges,102% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,60.2,175.44,
LEG FEMUR 2 VIEW RIGHT,7000740,CDM,320,RC,73552,HCPCS,Outpatient,,,172,129,,134.16,78,,107.328,percent of total billed charges,78% of total billed charges,108.36,63,,86.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,60.2,35,,48.16,percent of total billed charges,35% of total billed charges,115.71,67.275,,92.568,percent of total billed charges,67.275% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,66.01,38.38,,52.808,percent of total billed charges,38.38% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,106.19,61.74,,84.952,percent of total billed charges,61.74% of total billed charges,175.44,102,,140.352,percent of total billed charges,102% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,60.2,175.44,
LEG FEMUR 2 VIEW LEFT,7000742,CDM,320,RC,73552,HCPCS,Outpatient,,,172,129,,134.16,78,,107.328,percent of total billed charges,78% of total billed charges,108.36,63,,86.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,60.2,35,,48.16,percent of total billed charges,35% of total billed charges,115.71,67.275,,92.568,percent of total billed charges,67.275% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,66.01,38.38,,52.808,percent of total billed charges,38.38% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,106.19,61.74,,84.952,percent of total billed charges,61.74% of total billed charges,175.44,102,,140.352,percent of total billed charges,102% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,60.2,175.44,
Radiologic examination of the lower leg,7000744,CDM,320,RC,73590,HCPCS,Outpatient,,,172,129,,134.16,78,,107.328,percent of total billed charges,78% of total billed charges,108.36,63,,86.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,60.2,35,,48.16,percent of total billed charges,35% of total billed charges,115.71,67.275,,92.568,percent of total billed charges,67.275% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,66.01,38.38,,52.808,percent of total billed charges,38.38% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,106.19,61.74,,84.952,percent of total billed charges,61.74% of total billed charges,175.44,102,,140.352,percent of total billed charges,102% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,60.2,175.44,
X-ray of the hand with 3 or more views,7000745,CDM,320,RC,73130,HCPCS,Outpatient,,,172,129,,134.16,78,,107.328,percent of total billed charges,78% of total billed charges,108.36,63,,86.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,60.2,35,,48.16,percent of total billed charges,35% of total billed charges,115.71,67.275,,92.568,percent of total billed charges,67.275% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,66.01,38.38,,52.808,percent of total billed charges,38.38% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,106.19,61.74,,84.952,percent of total billed charges,61.74% of total billed charges,175.44,102,,140.352,percent of total billed charges,102% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,60.2,175.44,
X-ray of the hand with 3 or more views,7000747,CDM,320,RC,73130,HCPCS,Outpatient,,,172,129,,134.16,78,,107.328,percent of total billed charges,78% of total billed charges,108.36,63,,86.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,60.2,35,,48.16,percent of total billed charges,35% of total billed charges,115.71,67.275,,92.568,percent of total billed charges,67.275% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,66.01,38.38,,52.808,percent of total billed charges,38.38% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,106.19,61.74,,84.952,percent of total billed charges,61.74% of total billed charges,175.44,102,,140.352,percent of total billed charges,102% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,60.2,175.44,
Radiologic examination of the lower leg,7000754,CDM,320,RC,73590,HCPCS,Outpatient,,,172,129,,134.16,78,,107.328,percent of total billed charges,78% of total billed charges,108.36,63,,86.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,60.2,35,,48.16,percent of total billed charges,35% of total billed charges,115.71,67.275,,92.568,percent of total billed charges,67.275% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,66.01,38.38,,52.808,percent of total billed charges,38.38% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,106.19,61.74,,84.952,percent of total billed charges,61.74% of total billed charges,175.44,102,,140.352,percent of total billed charges,102% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,60.2,175.44,
ZYGOMATIC ARCH-RT,7000847,CDM,320,RC,70140,HCPCS,Outpatient,,,172,129,,134.16,78,,107.328,percent of total billed charges,78% of total billed charges,108.36,63,,86.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,60.2,35,,48.16,percent of total billed charges,35% of total billed charges,115.71,67.275,,92.568,percent of total billed charges,67.275% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,66.01,38.38,,52.808,percent of total billed charges,38.38% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,106.19,61.74,,84.952,percent of total billed charges,61.74% of total billed charges,175.44,102,,140.352,percent of total billed charges,102% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,60.2,175.44,
ZYGOMATIC ARCH-LT,7600904,CDM,320,RC,70140,HCPCS,Outpatient,,,172,129,,134.16,78,,107.328,percent of total billed charges,78% of total billed charges,108.36,63,,86.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,60.2,35,,48.16,percent of total billed charges,35% of total billed charges,115.71,67.275,,92.568,percent of total billed charges,67.275% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,66.01,38.38,,52.808,percent of total billed charges,38.38% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,106.19,61.74,,84.952,percent of total billed charges,61.74% of total billed charges,175.44,102,,140.352,percent of total billed charges,102% of total billed charges,65.36,38,,52.288,percent of total billed charges,38% of total billed charges,60.2,175.44,
WALKER BOOT - SHORT MED  01A-M,3001309,CDM,270,RC,,,Outpatient,,,172.96,129.72,,134.91,78,,107.928,percent of total billed charges,78% of total billed charges,108.96,63,,87.168,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,65.72,38,,52.576,percent of total billed charges,38% of total billed charges,65.72,38,,52.576,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,155.66,90,,124.528,percent of total billed charges,90% of total billed charges,60.54,35,,48.432,percent of total billed charges,35% of total billed charges,116.36,67.275,,93.088,percent of total billed charges,67.275% of total billed charges,138.37,80,,110.696,percent of total billed charges,80% of total billed charges,66.38,38.38,,53.104,percent of total billed charges,38.38% of total billed charges,138.37,80,,110.696,percent of total billed charges,80% of total billed charges,106.79,61.74,,85.432,percent of total billed charges,61.74% of total billed charges,176.42,102,,141.136,percent of total billed charges,102% of total billed charges,65.72,38,,52.576,percent of total billed charges,38% of total billed charges,60.54,176.42,
WALKER BOOT - LONG MED  01-FM,3001826,CDM,270,RC,,,Outpatient,,,172.96,129.72,,134.91,78,,107.928,percent of total billed charges,78% of total billed charges,108.96,63,,87.168,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,65.72,38,,52.576,percent of total billed charges,38% of total billed charges,65.72,38,,52.576,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,155.66,90,,124.528,percent of total billed charges,90% of total billed charges,60.54,35,,48.432,percent of total billed charges,35% of total billed charges,116.36,67.275,,93.088,percent of total billed charges,67.275% of total billed charges,138.37,80,,110.696,percent of total billed charges,80% of total billed charges,66.38,38.38,,53.104,percent of total billed charges,38.38% of total billed charges,138.37,80,,110.696,percent of total billed charges,80% of total billed charges,106.79,61.74,,85.432,percent of total billed charges,61.74% of total billed charges,176.42,102,,141.136,percent of total billed charges,102% of total billed charges,65.72,38,,52.576,percent of total billed charges,38% of total billed charges,60.54,176.42,
SPINAL FLUID TAP DIAG,1001250,CDM,450,RC,,,Outpatient,,,173,129.75,,134.94,78,,107.952,percent of total billed charges,78% of total billed charges,108.99,63,,87.192,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,65.74,38,,52.592,percent of total billed charges,38% of total billed charges,65.74,38,,52.592,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,155.7,90,,124.56,percent of total billed charges,90% of total billed charges,60.55,35,,48.44,percent of total billed charges,35% of total billed charges,116.39,67.275,,93.112,percent of total billed charges,67.275% of total billed charges,138.4,80,,110.72,percent of total billed charges,80% of total billed charges,66.4,38.38,,53.12,percent of total billed charges,38.38% of total billed charges,138.4,80,,110.72,percent of total billed charges,80% of total billed charges,106.81,61.74,,85.448,percent of total billed charges,61.74% of total billed charges,176.46,102,,141.168,percent of total billed charges,102% of total billed charges,65.74,38,,52.592,percent of total billed charges,38% of total billed charges,60.55,176.46,
THORACENTESIS/LAVAGE,1001252,CDM,450,RC,32421,HCPCS,Outpatient,,,173,129.75,,134.94,78,,107.952,percent of total billed charges,78% of total billed charges,108.99,63,,87.192,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,65.74,38,,52.592,percent of total billed charges,38% of total billed charges,65.74,38,,52.592,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,155.7,90,,124.56,percent of total billed charges,90% of total billed charges,60.55,35,,48.44,percent of total billed charges,35% of total billed charges,116.39,67.275,,93.112,percent of total billed charges,67.275% of total billed charges,138.4,80,,110.72,percent of total billed charges,80% of total billed charges,66.4,38.38,,53.12,percent of total billed charges,38.38% of total billed charges,138.4,80,,110.72,percent of total billed charges,80% of total billed charges,106.81,61.74,,85.448,percent of total billed charges,61.74% of total billed charges,176.46,102,,141.168,percent of total billed charges,102% of total billed charges,65.74,38,,52.592,percent of total billed charges,38% of total billed charges,60.55,176.46,
T-HELPER CELLS,5001911,CDM,302,RC,86359,HCPCS,Outpatient,,,173,129.75,,134.94,78,,107.952,percent of total billed charges,78% of total billed charges,29.62,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,37.73,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,37.73,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,155.7,90,,124.56,percent of total billed charges,90% of total billed charges,31.1,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,116.39,67.275,,93.112,percent of total billed charges,67.275% of total billed charges,138.4,80,,110.72,percent of total billed charges,80% of total billed charges,38.11,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,138.4,80,,110.72,percent of total billed charges,80% of total billed charges,106.81,61.74,,85.448,percent of total billed charges,61.74% of total billed charges,30.21,102,,,Fee Schedule,102% of GA Medicaid Rate,37.73,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,29.62,155.7,
INSULIN LEVEL,5001895,CDM,301,RC,83525,HCPCS,Outpatient,,,174,130.5,,135.72,78,,108.576,percent of total billed charges,78% of total billed charges,14.38,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,11.43,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.43,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,156.6,90,,125.28,percent of total billed charges,90% of total billed charges,15.1,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,117.06,67.275,,93.648,percent of total billed charges,67.275% of total billed charges,139.2,80,,111.36,percent of total billed charges,80% of total billed charges,11.54,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,139.2,80,,111.36,percent of total billed charges,80% of total billed charges,107.43,61.74,,85.944,percent of total billed charges,61.74% of total billed charges,14.67,102,,,Fee Schedule,102% of GA Medicaid Rate,11.43,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.43,156.6,
ZINC,5001925,CDM,301,RC,84630,HCPCS,Outpatient,,,174,130.5,,135.72,78,,108.576,percent of total billed charges,78% of total billed charges,14.32,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,11.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,156.6,90,,125.28,percent of total billed charges,90% of total billed charges,15.04,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,117.06,67.275,,93.648,percent of total billed charges,67.275% of total billed charges,139.2,80,,111.36,percent of total billed charges,80% of total billed charges,11.5,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,139.2,80,,111.36,percent of total billed charges,80% of total billed charges,107.43,61.74,,85.944,percent of total billed charges,61.74% of total billed charges,14.61,102,,,Fee Schedule,102% of GA Medicaid Rate,11.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.39,156.6,
PROCALCITONIN,5001456,CDM,301,RC,84145,HCPCS,Outpatient,,,175,131.25,,136.5,78,,109.2,percent of total billed charges,78% of total billed charges,24.06,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,27.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,27.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,157.5,90,,126,percent of total billed charges,90% of total billed charges,25.26,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,117.73,67.275,,94.184,percent of total billed charges,67.275% of total billed charges,140,80,,112,percent of total billed charges,80% of total billed charges,27.49,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,140,80,,112,percent of total billed charges,80% of total billed charges,108.05,61.74,,86.44,percent of total billed charges,61.74% of total billed charges,24.54,102,,,Fee Schedule,102% of GA Medicaid Rate,27.22,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,24.06,157.5,
COCCIDIOIDES ANTIBODY,5001940,CDM,302,RC,86635,HCPCS,Outpatient,,,175,131.25,,136.5,78,,109.2,percent of total billed charges,78% of total billed charges,14.43,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,11.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,157.5,90,,126,percent of total billed charges,90% of total billed charges,15.15,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,117.73,67.275,,94.184,percent of total billed charges,67.275% of total billed charges,140,80,,112,percent of total billed charges,80% of total billed charges,11.58,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,140,80,,112,percent of total billed charges,80% of total billed charges,108.05,61.74,,86.44,percent of total billed charges,61.74% of total billed charges,14.72,102,,,Fee Schedule,102% of GA Medicaid Rate,11.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.47,157.5,
VITAMIN A,5002006,CDM,301,RC,84590,HCPCS,Outpatient,,,176,132,,137.28,78,,109.824,percent of total billed charges,78% of total billed charges,14.58,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,11.61,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.61,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,158.4,90,,126.72,percent of total billed charges,90% of total billed charges,15.31,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,118.4,67.275,,94.72,percent of total billed charges,67.275% of total billed charges,140.8,80,,112.64,percent of total billed charges,80% of total billed charges,11.73,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,140.8,80,,112.64,percent of total billed charges,80% of total billed charges,108.66,61.74,,86.928,percent of total billed charges,61.74% of total billed charges,14.87,102,,,Fee Schedule,102% of GA Medicaid Rate,11.61,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.61,158.4,
ST DYSPHAGIA EVALUATION,9000110,CDM,444,RC,92610,HCPCS,Outpatient,,,177,132.75,,138.06,78,,110.448,percent of total billed charges,78% of total billed charges,111.51,63,,89.208,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,67.26,38,,53.808,percent of total billed charges,38% of total billed charges,67.26,38,,53.808,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,61.95,35,,49.56,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,141.6,80,,113.28,percent of total billed charges,80% of total billed charges,67.93,38.38,,54.344,percent of total billed charges,38.38% of total billed charges,141.6,80,,113.28,percent of total billed charges,80% of total billed charges,109.28,61.74,,87.424,percent of total billed charges,61.74% of total billed charges,180.54,102,,144.432,percent of total billed charges,102% of total billed charges,67.26,38,,53.808,percent of total billed charges,38% of total billed charges,61.95,180.54,
"New patient office or other outpatient visit, typically 10 minutes",1001022,CDM,510,RC,99202,HCPCS,Outpatient,,,178,133.5,,138.84,78,,111.072,percent of total billed charges,78% of total billed charges,112.14,63,,89.712,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,67.64,38,,54.112,percent of total billed charges,38% of total billed charges,67.64,38,,54.112,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,160.2,90,,128.16,percent of total billed charges,90% of total billed charges,62.3,35,,49.84,percent of total billed charges,35% of total billed charges,133.52,67.275,,106.816,percent of total billed charges,67.275% of total billed charges,142.4,80,,113.92,percent of total billed charges,80% of total billed charges,68.32,38.38,,54.656,percent of total billed charges,38.38% of total billed charges,142.4,80,,113.92,percent of total billed charges,80% of total billed charges,109.9,61.74,,87.92,percent of total billed charges,61.74% of total billed charges,181.56,102,,145.248,percent of total billed charges,102% of total billed charges,67.64,38,,54.112,percent of total billed charges,38% of total billed charges,62.3,181.56,
ETHOSUXIMIDE (ZARONTIN),5001436,CDM,301,RC,80168,HCPCS,Outpatient,,,178,133.5,,138.84,78,,111.072,percent of total billed charges,78% of total billed charges,20.55,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.34,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.34,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,160.2,90,,128.16,percent of total billed charges,90% of total billed charges,21.58,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,119.75,67.275,,95.8,percent of total billed charges,67.275% of total billed charges,142.4,80,,113.92,percent of total billed charges,80% of total billed charges,16.5,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,142.4,80,,113.92,percent of total billed charges,80% of total billed charges,109.9,61.74,,87.92,percent of total billed charges,61.74% of total billed charges,20.96,102,,,Fee Schedule,102% of GA Medicaid Rate,16.34,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.34,160.2,
GENTAMICIN PEAK,5001625,CDM,301,RC,80170,HCPCS,Outpatient,,,178,133.5,,138.84,78,,111.072,percent of total billed charges,78% of total billed charges,20.61,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.38,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.38,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,160.2,90,,128.16,percent of total billed charges,90% of total billed charges,21.64,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,119.75,67.275,,95.8,percent of total billed charges,67.275% of total billed charges,142.4,80,,113.92,percent of total billed charges,80% of total billed charges,16.54,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,142.4,80,,113.92,percent of total billed charges,80% of total billed charges,109.9,61.74,,87.92,percent of total billed charges,61.74% of total billed charges,21.02,102,,,Fee Schedule,102% of GA Medicaid Rate,16.38,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.38,160.2,
GENTAMICIN TROUGH,5001626,CDM,301,RC,80170,HCPCS,Outpatient,,,178,133.5,,138.84,78,,111.072,percent of total billed charges,78% of total billed charges,20.61,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.38,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.38,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,160.2,90,,128.16,percent of total billed charges,90% of total billed charges,21.64,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,119.75,67.275,,95.8,percent of total billed charges,67.275% of total billed charges,142.4,80,,113.92,percent of total billed charges,80% of total billed charges,16.54,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,142.4,80,,113.92,percent of total billed charges,80% of total billed charges,109.9,61.74,,87.92,percent of total billed charges,61.74% of total billed charges,21.02,102,,,Fee Schedule,102% of GA Medicaid Rate,16.38,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.38,160.2,
17-HYDROXYPROGESTERONE,5001727,CDM,301,RC,83498,HCPCS,Outpatient,,,178,133.5,,138.84,78,,111.072,percent of total billed charges,78% of total billed charges,34.16,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,27.17,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,27.17,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,160.2,90,,128.16,percent of total billed charges,90% of total billed charges,35.87,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,119.75,67.275,,95.8,percent of total billed charges,67.275% of total billed charges,142.4,80,,113.92,percent of total billed charges,80% of total billed charges,27.44,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,142.4,80,,113.92,percent of total billed charges,80% of total billed charges,109.9,61.74,,87.92,percent of total billed charges,61.74% of total billed charges,34.84,102,,,Fee Schedule,102% of GA Medicaid Rate,27.17,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,27.17,160.2,
TOXOPLASMA IGG ANTIBODY,5001960,CDM,302,RC,86777,HCPCS,Outpatient,,,178,133.5,,138.84,78,,111.072,percent of total billed charges,78% of total billed charges,14.63,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,160.2,90,,128.16,percent of total billed charges,90% of total billed charges,15.36,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,119.75,67.275,,95.8,percent of total billed charges,67.275% of total billed charges,142.4,80,,113.92,percent of total billed charges,80% of total billed charges,14.53,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,142.4,80,,113.92,percent of total billed charges,80% of total billed charges,109.9,61.74,,87.92,percent of total billed charges,61.74% of total billed charges,14.92,102,,,Fee Schedule,102% of GA Medicaid Rate,14.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.39,160.2,
PATH FLOW CYTO 9-15 MARKER,5003136,CDM,319,RC,88188,HCPCS,Outpatient,,,178,133.5,,138.84,78,,111.072,percent of total billed charges,78% of total billed charges,74.6,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,67.64,38,,54.112,percent of total billed charges,38% of total billed charges,67.64,38,,54.112,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,160.2,90,,128.16,percent of total billed charges,90% of total billed charges,78.33,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,119.75,67.275,,95.8,percent of total billed charges,67.275% of total billed charges,142.4,80,,113.92,percent of total billed charges,80% of total billed charges,68.32,38.38,,54.656,percent of total billed charges,38.38% of total billed charges,142.4,80,,113.92,percent of total billed charges,80% of total billed charges,109.9,61.74,,87.92,percent of total billed charges,61.74% of total billed charges,76.09,102,,,Fee Schedule,102% of GA Medicaid Rate,67.64,38,,54.112,percent of total billed charges,38% of total billed charges,67.64,160.2,
TRACHEOSTOMY DISP 4CFS,3001801,CDM,270,RC,,,Outpatient,,,178.52,133.89,,139.25,78,,111.4,percent of total billed charges,78% of total billed charges,112.47,63,,89.976,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,67.84,38,,54.272,percent of total billed charges,38% of total billed charges,67.84,38,,54.272,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,160.67,90,,128.536,percent of total billed charges,90% of total billed charges,62.48,35,,49.984,percent of total billed charges,35% of total billed charges,120.1,67.275,,96.08,percent of total billed charges,67.275% of total billed charges,142.82,80,,114.256,percent of total billed charges,80% of total billed charges,68.52,38.38,,54.816,percent of total billed charges,38.38% of total billed charges,142.82,80,,114.256,percent of total billed charges,80% of total billed charges,110.22,61.74,,88.176,percent of total billed charges,61.74% of total billed charges,182.09,102,,145.672,percent of total billed charges,102% of total billed charges,67.84,38,,54.272,percent of total billed charges,38% of total billed charges,62.48,182.09,
TRACHEOSTOMY DISP 6CFS,3004216,CDM,270,RC,,,Outpatient,,,178.52,133.89,,139.25,78,,111.4,percent of total billed charges,78% of total billed charges,112.47,63,,89.976,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,67.84,38,,54.272,percent of total billed charges,38% of total billed charges,67.84,38,,54.272,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,160.67,90,,128.536,percent of total billed charges,90% of total billed charges,62.48,35,,49.984,percent of total billed charges,35% of total billed charges,120.1,67.275,,96.08,percent of total billed charges,67.275% of total billed charges,142.82,80,,114.256,percent of total billed charges,80% of total billed charges,68.52,38.38,,54.816,percent of total billed charges,38.38% of total billed charges,142.82,80,,114.256,percent of total billed charges,80% of total billed charges,110.22,61.74,,88.176,percent of total billed charges,61.74% of total billed charges,182.09,102,,145.672,percent of total billed charges,102% of total billed charges,67.84,38,,54.272,percent of total billed charges,38% of total billed charges,62.48,182.09,
MODULE IO YELLOW,3000045,CDM,270,RC,,,Outpatient,,,180,135,,140.4,78,,112.32,percent of total billed charges,78% of total billed charges,113.4,63,,90.72,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,68.4,38,,54.72,percent of total billed charges,38% of total billed charges,68.4,38,,54.72,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,162,90,,129.6,percent of total billed charges,90% of total billed charges,63,35,,50.4,percent of total billed charges,35% of total billed charges,121.1,67.275,,96.88,percent of total billed charges,67.275% of total billed charges,144,80,,115.2,percent of total billed charges,80% of total billed charges,69.08,38.38,,55.264,percent of total billed charges,38.38% of total billed charges,144,80,,115.2,percent of total billed charges,80% of total billed charges,111.13,61.74,,88.904,percent of total billed charges,61.74% of total billed charges,183.6,102,,146.88,percent of total billed charges,102% of total billed charges,68.4,38,,54.72,percent of total billed charges,38% of total billed charges,63,183.6,
MODULE IO BLUE,3000052,CDM,270,RC,,,Outpatient,,,180,135,,140.4,78,,112.32,percent of total billed charges,78% of total billed charges,113.4,63,,90.72,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,68.4,38,,54.72,percent of total billed charges,38% of total billed charges,68.4,38,,54.72,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,162,90,,129.6,percent of total billed charges,90% of total billed charges,63,35,,50.4,percent of total billed charges,35% of total billed charges,121.1,67.275,,96.88,percent of total billed charges,67.275% of total billed charges,144,80,,115.2,percent of total billed charges,80% of total billed charges,69.08,38.38,,55.264,percent of total billed charges,38.38% of total billed charges,144,80,,115.2,percent of total billed charges,80% of total billed charges,111.13,61.74,,88.904,percent of total billed charges,61.74% of total billed charges,183.6,102,,146.88,percent of total billed charges,102% of total billed charges,68.4,38,,54.72,percent of total billed charges,38% of total billed charges,63,183.6,
MODULE IO GREEN,3000056,CDM,270,RC,,,Outpatient,,,180,135,,140.4,78,,112.32,percent of total billed charges,78% of total billed charges,113.4,63,,90.72,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,68.4,38,,54.72,percent of total billed charges,38% of total billed charges,68.4,38,,54.72,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,162,90,,129.6,percent of total billed charges,90% of total billed charges,63,35,,50.4,percent of total billed charges,35% of total billed charges,121.1,67.275,,96.88,percent of total billed charges,67.275% of total billed charges,144,80,,115.2,percent of total billed charges,80% of total billed charges,69.08,38.38,,55.264,percent of total billed charges,38.38% of total billed charges,144,80,,115.2,percent of total billed charges,80% of total billed charges,111.13,61.74,,88.904,percent of total billed charges,61.74% of total billed charges,183.6,102,,146.88,percent of total billed charges,102% of total billed charges,68.4,38,,54.72,percent of total billed charges,38% of total billed charges,63,183.6,
SPINE SCOLIOSIS EVALUATION 1 VIEW,7000416,CDM,320,RC,72081,HCPCS,Outpatient,,,180,135,,140.4,78,,112.32,percent of total billed charges,78% of total billed charges,113.4,63,,90.72,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,68.4,38,,54.72,percent of total billed charges,38% of total billed charges,68.4,38,,54.72,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,162,90,,129.6,percent of total billed charges,90% of total billed charges,63,35,,50.4,percent of total billed charges,35% of total billed charges,121.1,67.275,,96.88,percent of total billed charges,67.275% of total billed charges,144,80,,115.2,percent of total billed charges,80% of total billed charges,69.08,38.38,,55.264,percent of total billed charges,38.38% of total billed charges,144,80,,115.2,percent of total billed charges,80% of total billed charges,111.13,61.74,,88.904,percent of total billed charges,61.74% of total billed charges,183.6,102,,146.88,percent of total billed charges,102% of total billed charges,68.4,38,,54.72,percent of total billed charges,38% of total billed charges,63,183.6,
PRIMIDONE (MYSOLINE),5001967,CDM,301,RC,80188,HCPCS,Outpatient,,,181,135.75,,141.18,78,,112.944,percent of total billed charges,78% of total billed charges,20.86,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.59,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.59,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,162.9,90,,130.32,percent of total billed charges,90% of total billed charges,21.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,121.77,67.275,,97.416,percent of total billed charges,67.275% of total billed charges,144.8,80,,115.84,percent of total billed charges,80% of total billed charges,16.76,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,144.8,80,,115.84,percent of total billed charges,80% of total billed charges,111.75,61.74,,89.4,percent of total billed charges,61.74% of total billed charges,21.28,102,,,Fee Schedule,102% of GA Medicaid Rate,16.59,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.59,162.9,
ENDOLOOP VICRYL 0 EJ10G PAREL,3005018,CDM,270,RC,,,Outpatient,,,181.11,135.83,,141.27,78,,113.016,percent of total billed charges,78% of total billed charges,114.1,63,,91.28,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,68.82,38,,55.056,percent of total billed charges,38% of total billed charges,68.82,38,,55.056,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,163,90,,130.4,percent of total billed charges,90% of total billed charges,63.39,35,,50.712,percent of total billed charges,35% of total billed charges,121.84,67.275,,97.472,percent of total billed charges,67.275% of total billed charges,144.89,80,,115.912,percent of total billed charges,80% of total billed charges,69.51,38.38,,55.608,percent of total billed charges,38.38% of total billed charges,144.89,80,,115.912,percent of total billed charges,80% of total billed charges,111.82,61.74,,89.456,percent of total billed charges,61.74% of total billed charges,184.73,102,,147.784,percent of total billed charges,102% of total billed charges,68.82,38,,55.056,percent of total billed charges,38% of total billed charges,63.39,184.73,
MODULE IO PINK/RED,3000033,CDM,270,RC,,,Outpatient,,,181.92,136.44,,141.9,78,,113.52,percent of total billed charges,78% of total billed charges,114.61,63,,91.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,69.13,38,,55.304,percent of total billed charges,38% of total billed charges,69.13,38,,55.304,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,163.73,90,,130.984,percent of total billed charges,90% of total billed charges,63.67,35,,50.936,percent of total billed charges,35% of total billed charges,122.39,67.275,,97.912,percent of total billed charges,67.275% of total billed charges,145.54,80,,116.432,percent of total billed charges,80% of total billed charges,69.82,38.38,,55.856,percent of total billed charges,38.38% of total billed charges,145.54,80,,116.432,percent of total billed charges,80% of total billed charges,112.32,61.74,,89.856,percent of total billed charges,61.74% of total billed charges,185.56,102,,148.448,percent of total billed charges,102% of total billed charges,69.13,38,,55.304,percent of total billed charges,38% of total billed charges,63.67,185.56,
MODULE IO PURPLE,3000037,CDM,270,RC,,,Outpatient,,,181.92,136.44,,141.9,78,,113.52,percent of total billed charges,78% of total billed charges,114.61,63,,91.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,69.13,38,,55.304,percent of total billed charges,38% of total billed charges,69.13,38,,55.304,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,163.73,90,,130.984,percent of total billed charges,90% of total billed charges,63.67,35,,50.936,percent of total billed charges,35% of total billed charges,122.39,67.275,,97.912,percent of total billed charges,67.275% of total billed charges,145.54,80,,116.432,percent of total billed charges,80% of total billed charges,69.82,38.38,,55.856,percent of total billed charges,38.38% of total billed charges,145.54,80,,116.432,percent of total billed charges,80% of total billed charges,112.32,61.74,,89.856,percent of total billed charges,61.74% of total billed charges,185.56,102,,148.448,percent of total billed charges,102% of total billed charges,69.13,38,,55.304,percent of total billed charges,38% of total billed charges,63.67,185.56,
MODULE IO ORANGE,3000042,CDM,270,RC,,,Outpatient,,,181.92,136.44,,141.9,78,,113.52,percent of total billed charges,78% of total billed charges,114.61,63,,91.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,69.13,38,,55.304,percent of total billed charges,38% of total billed charges,69.13,38,,55.304,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,163.73,90,,130.984,percent of total billed charges,90% of total billed charges,63.67,35,,50.936,percent of total billed charges,35% of total billed charges,122.39,67.275,,97.912,percent of total billed charges,67.275% of total billed charges,145.54,80,,116.432,percent of total billed charges,80% of total billed charges,69.82,38.38,,55.856,percent of total billed charges,38.38% of total billed charges,145.54,80,,116.432,percent of total billed charges,80% of total billed charges,112.32,61.74,,89.856,percent of total billed charges,61.74% of total billed charges,185.56,102,,148.448,percent of total billed charges,102% of total billed charges,69.13,38,,55.304,percent of total billed charges,38% of total billed charges,63.67,185.56,
MODULE IO WHITE,3000048,CDM,270,RC,,,Outpatient,,,181.92,136.44,,141.9,78,,113.52,percent of total billed charges,78% of total billed charges,114.61,63,,91.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,69.13,38,,55.304,percent of total billed charges,38% of total billed charges,69.13,38,,55.304,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,163.73,90,,130.984,percent of total billed charges,90% of total billed charges,63.67,35,,50.936,percent of total billed charges,35% of total billed charges,122.39,67.275,,97.912,percent of total billed charges,67.275% of total billed charges,145.54,80,,116.432,percent of total billed charges,80% of total billed charges,69.82,38.38,,55.856,percent of total billed charges,38.38% of total billed charges,145.54,80,,116.432,percent of total billed charges,80% of total billed charges,112.32,61.74,,89.856,percent of total billed charges,61.74% of total billed charges,185.56,102,,148.448,percent of total billed charges,102% of total billed charges,69.13,38,,55.304,percent of total billed charges,38% of total billed charges,63.67,185.56,
GUIDE WIRE 2.0MMx300MM BLUNT,3006016,CDM,270,RC,,,Outpatient,,,182,136.5,,141.96,78,,113.568,percent of total billed charges,78% of total billed charges,114.66,63,,91.728,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,69.16,38,,55.328,percent of total billed charges,38% of total billed charges,69.16,38,,55.328,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,163.8,90,,131.04,percent of total billed charges,90% of total billed charges,63.7,35,,50.96,percent of total billed charges,35% of total billed charges,122.44,67.275,,97.952,percent of total billed charges,67.275% of total billed charges,145.6,80,,116.48,percent of total billed charges,80% of total billed charges,69.85,38.38,,55.88,percent of total billed charges,38.38% of total billed charges,145.6,80,,116.48,percent of total billed charges,80% of total billed charges,112.37,61.74,,89.896,percent of total billed charges,61.74% of total billed charges,185.64,102,,148.512,percent of total billed charges,102% of total billed charges,69.16,38,,55.328,percent of total billed charges,38% of total billed charges,63.7,185.64,
CRYPTOSPORIDIUM AG,5000193,CDM,306,RC,87272,HCPCS,Outpatient,,,182,136.5,,141.96,78,,113.568,percent of total billed charges,78% of total billed charges,15.08,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,11.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,163.8,90,,131.04,percent of total billed charges,90% of total billed charges,15.83,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,122.44,67.275,,97.952,percent of total billed charges,67.275% of total billed charges,145.6,80,,116.48,percent of total billed charges,80% of total billed charges,12.1,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,145.6,80,,116.48,percent of total billed charges,80% of total billed charges,112.37,61.74,,89.896,percent of total billed charges,61.74% of total billed charges,15.38,102,,,Fee Schedule,102% of GA Medicaid Rate,11.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.98,163.8,
CITRATE 24 HR URINE,5001851,CDM,301,RC,82507,HCPCS,Outpatient,,,182,136.5,,141.96,78,,113.568,percent of total billed charges,78% of total billed charges,34.97,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,27.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,27.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,163.8,90,,131.04,percent of total billed charges,90% of total billed charges,36.72,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,122.44,67.275,,97.952,percent of total billed charges,67.275% of total billed charges,145.6,80,,116.48,percent of total billed charges,80% of total billed charges,28.08,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,145.6,80,,116.48,percent of total billed charges,80% of total billed charges,112.37,61.74,,89.896,percent of total billed charges,61.74% of total billed charges,35.67,102,,,Fee Schedule,102% of GA Medicaid Rate,27.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,27.8,163.8,
PROCAINAMIDE,5001890,CDM,301,RC,80190,HCPCS,Outpatient,,,182,136.5,,141.96,78,,113.568,percent of total billed charges,78% of total billed charges,21.07,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,60,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,60,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,163.8,90,,131.04,percent of total billed charges,90% of total billed charges,22.12,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,122.44,67.275,,97.952,percent of total billed charges,67.275% of total billed charges,145.6,80,,116.48,percent of total billed charges,80% of total billed charges,60.6,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,145.6,80,,116.48,percent of total billed charges,80% of total billed charges,112.37,61.74,,89.896,percent of total billed charges,61.74% of total billed charges,21.49,102,,,Fee Schedule,102% of GA Medicaid Rate,60,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,21.07,163.8,
.N-ACETYL PROCAINAMIDE,5001891,CDM,301,RC,80192,HCPCS,Outpatient,,,182,136.5,,141.96,78,,113.568,percent of total billed charges,78% of total billed charges,21.07,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,163.8,90,,131.04,percent of total billed charges,90% of total billed charges,22.12,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,122.44,67.275,,97.952,percent of total billed charges,67.275% of total billed charges,145.6,80,,116.48,percent of total billed charges,80% of total billed charges,16.92,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,145.6,80,,116.48,percent of total billed charges,80% of total billed charges,112.37,61.74,,89.896,percent of total billed charges,61.74% of total billed charges,21.49,102,,,Fee Schedule,102% of GA Medicaid Rate,16.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.75,163.8,
"GIARDIA AG, STOOL",5001918,CDM,306,RC,87328,HCPCS,Outpatient,,,182,136.5,,141.96,78,,113.568,percent of total billed charges,78% of total billed charges,15.08,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.82,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.82,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,163.8,90,,131.04,percent of total billed charges,90% of total billed charges,15.83,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,122.44,67.275,,97.952,percent of total billed charges,67.275% of total billed charges,145.6,80,,116.48,percent of total billed charges,80% of total billed charges,13.96,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,145.6,80,,116.48,percent of total billed charges,80% of total billed charges,112.37,61.74,,89.896,percent of total billed charges,61.74% of total billed charges,15.38,102,,,Fee Schedule,102% of GA Medicaid Rate,13.82,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.82,163.8,
Blood test indicating infection with Hepatitis B,5001738,CDM,300,RC,86704,HCPCS,Outpatient,,,183,137.25,,142.74,78,,114.192,percent of total billed charges,78% of total billed charges,15.16,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,164.7,90,,131.76,percent of total billed charges,90% of total billed charges,15.92,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,123.11,67.275,,98.488,percent of total billed charges,67.275% of total billed charges,146.4,80,,117.12,percent of total billed charges,80% of total billed charges,12.17,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,146.4,80,,117.12,percent of total billed charges,80% of total billed charges,112.98,61.74,,90.384,percent of total billed charges,61.74% of total billed charges,15.46,102,,,Fee Schedule,102% of GA Medicaid Rate,12.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.05,164.7,
.COC DRUG SCREEN GBH XTC,5001759,CDM,301,RC,80101,HCPCS,Outpatient,,,183,137.25,,142.74,78,,114.192,percent of total billed charges,78% of total billed charges,115.29,63,,92.232,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,69.54,38,,55.632,percent of total billed charges,38% of total billed charges,69.54,38,,55.632,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,164.7,90,,131.76,percent of total billed charges,90% of total billed charges,64.05,35,,51.24,percent of total billed charges,35% of total billed charges,123.11,67.275,,98.488,percent of total billed charges,67.275% of total billed charges,146.4,80,,117.12,percent of total billed charges,80% of total billed charges,70.24,38.38,,56.192,percent of total billed charges,38.38% of total billed charges,146.4,80,,117.12,percent of total billed charges,80% of total billed charges,112.98,61.74,,90.384,percent of total billed charges,61.74% of total billed charges,186.66,102,,149.328,percent of total billed charges,102% of total billed charges,69.54,38,,55.632,percent of total billed charges,38% of total billed charges,64.05,186.66,
C-1 ESTERASE INHIBITOR,5001803,CDM,300,RC,86161,HCPCS,Outpatient,,,183,137.25,,142.74,78,,114.192,percent of total billed charges,78% of total billed charges,15.1,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,164.7,90,,131.76,percent of total billed charges,90% of total billed charges,15.86,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,123.11,67.275,,98.488,percent of total billed charges,67.275% of total billed charges,146.4,80,,117.12,percent of total billed charges,80% of total billed charges,12.12,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,146.4,80,,117.12,percent of total billed charges,80% of total billed charges,112.98,61.74,,90.384,percent of total billed charges,61.74% of total billed charges,15.4,102,,,Fee Schedule,102% of GA Medicaid Rate,12,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12,164.7,
WALKER BOOT - LONG LARGE  01F-L,3002337,CDM,270,RC,,,Outpatient,,,184.76,138.57,,144.11,78,,115.288,percent of total billed charges,78% of total billed charges,116.4,63,,93.12,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,70.21,38,,56.168,percent of total billed charges,38% of total billed charges,70.21,38,,56.168,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,166.28,90,,133.024,percent of total billed charges,90% of total billed charges,64.67,35,,51.736,percent of total billed charges,35% of total billed charges,124.3,67.275,,99.44,percent of total billed charges,67.275% of total billed charges,147.81,80,,118.248,percent of total billed charges,80% of total billed charges,70.91,38.38,,56.728,percent of total billed charges,38.38% of total billed charges,147.81,80,,118.248,percent of total billed charges,80% of total billed charges,114.07,61.74,,91.256,percent of total billed charges,61.74% of total billed charges,188.46,102,,150.768,percent of total billed charges,102% of total billed charges,70.21,38,,56.168,percent of total billed charges,38% of total billed charges,64.67,188.46,
DEBR SKIN/TISSUE/MUS/BONE,1001180,CDM,450,RC,,,Outpatient,,,185,138.75,,144.3,78,,115.44,percent of total billed charges,78% of total billed charges,116.55,63,,93.24,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,70.3,38,,56.24,percent of total billed charges,38% of total billed charges,70.3,38,,56.24,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,166.5,90,,133.2,percent of total billed charges,90% of total billed charges,64.75,35,,51.8,percent of total billed charges,35% of total billed charges,124.46,67.275,,99.568,percent of total billed charges,67.275% of total billed charges,148,80,,118.4,percent of total billed charges,80% of total billed charges,71,38.38,,56.8,percent of total billed charges,38.38% of total billed charges,148,80,,118.4,percent of total billed charges,80% of total billed charges,114.22,61.74,,91.376,percent of total billed charges,61.74% of total billed charges,188.7,102,,150.96,percent of total billed charges,102% of total billed charges,70.3,38,,56.24,percent of total billed charges,38% of total billed charges,64.75,188.7,
.DESIPIRAMINE,5002037,CDM,301,RC,80160,HCPCS,Outpatient,,,187,140.25,,145.86,78,,116.688,percent of total billed charges,78% of total billed charges,117.81,63,,94.248,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,71.06,38,,56.848,percent of total billed charges,38% of total billed charges,71.06,38,,56.848,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,168.3,90,,134.64,percent of total billed charges,90% of total billed charges,65.45,35,,52.36,percent of total billed charges,35% of total billed charges,125.8,67.275,,100.64,percent of total billed charges,67.275% of total billed charges,149.6,80,,119.68,percent of total billed charges,80% of total billed charges,71.77,38.38,,57.416,percent of total billed charges,38.38% of total billed charges,149.6,80,,119.68,percent of total billed charges,80% of total billed charges,115.45,61.74,,92.36,percent of total billed charges,61.74% of total billed charges,190.74,102,,152.592,percent of total billed charges,102% of total billed charges,71.06,38,,56.848,percent of total billed charges,38% of total billed charges,65.45,190.74,
ELBOW BRACE - HINGED - RIGHT,3001025,CDM,270,RC,,,Outpatient,,,187.96,140.97,,146.61,78,,117.288,percent of total billed charges,78% of total billed charges,118.41,63,,94.728,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,71.42,38,,57.136,percent of total billed charges,38% of total billed charges,71.42,38,,57.136,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,169.16,90,,135.328,percent of total billed charges,90% of total billed charges,65.79,35,,52.632,percent of total billed charges,35% of total billed charges,126.45,67.275,,101.16,percent of total billed charges,67.275% of total billed charges,150.37,80,,120.296,percent of total billed charges,80% of total billed charges,72.14,38.38,,57.712,percent of total billed charges,38.38% of total billed charges,150.37,80,,120.296,percent of total billed charges,80% of total billed charges,116.05,61.74,,92.84,percent of total billed charges,61.74% of total billed charges,191.72,102,,153.376,percent of total billed charges,102% of total billed charges,71.42,38,,57.136,percent of total billed charges,38% of total billed charges,65.79,191.72,
"New patient office or other outpatient visit, typically 30 min",1001023,CDM,510,RC,99203,HCPCS,Outpatient,,,188,141,,146.64,78,,117.312,percent of total billed charges,78% of total billed charges,118.44,63,,94.752,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,71.44,38,,57.152,percent of total billed charges,38% of total billed charges,71.44,38,,57.152,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,65.8,35,,52.64,percent of total billed charges,35% of total billed charges,133.52,67.275,,106.816,percent of total billed charges,67.275% of total billed charges,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,72.15,38.38,,57.72,percent of total billed charges,38.38% of total billed charges,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,116.07,61.74,,92.856,percent of total billed charges,61.74% of total billed charges,191.76,102,,153.408,percent of total billed charges,102% of total billed charges,71.44,38,,57.152,percent of total billed charges,38% of total billed charges,65.8,191.76,
FACTOR V (LEIDEN)MUTATION ANALYSI,5001927,CDM,300,RC,81241,HCPCS,Outpatient,,,189,141.75,,147.42,78,,117.936,percent of total billed charges,78% of total billed charges,40,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,73.37,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,73.37,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,170.1,90,,136.08,percent of total billed charges,90% of total billed charges,42,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,127.15,67.275,,101.72,percent of total billed charges,67.275% of total billed charges,151.2,80,,120.96,percent of total billed charges,80% of total billed charges,74.1,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,151.2,80,,120.96,percent of total billed charges,80% of total billed charges,116.69,61.74,,93.352,percent of total billed charges,61.74% of total billed charges,40.8,102,,,Fee Schedule,102% of GA Medicaid Rate,73.37,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,40,170.1,
CO2  KIT - MINDRAY,3005200,CDM,270,RC,,,Outpatient,,,189.98,142.49,,148.18,78,,118.544,percent of total billed charges,78% of total billed charges,119.69,63,,95.752,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,72.19,38,,57.752,percent of total billed charges,38% of total billed charges,72.19,38,,57.752,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,170.98,90,,136.784,percent of total billed charges,90% of total billed charges,66.49,35,,53.192,percent of total billed charges,35% of total billed charges,127.81,67.275,,102.248,percent of total billed charges,67.275% of total billed charges,151.98,80,,121.584,percent of total billed charges,80% of total billed charges,72.91,38.38,,58.328,percent of total billed charges,38.38% of total billed charges,151.98,80,,121.584,percent of total billed charges,80% of total billed charges,117.29,61.74,,93.832,percent of total billed charges,61.74% of total billed charges,193.78,102,,155.024,percent of total billed charges,102% of total billed charges,72.19,38,,57.752,percent of total billed charges,38% of total billed charges,66.49,193.78,
THORACENTESIS/CHEST TUBE,1001254,CDM,450,RC,,,Outpatient,,,190,142.5,,148.2,78,,118.56,percent of total billed charges,78% of total billed charges,119.7,63,,95.76,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,72.2,38,,57.76,percent of total billed charges,38% of total billed charges,72.2,38,,57.76,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,171,90,,136.8,percent of total billed charges,90% of total billed charges,66.5,35,,53.2,percent of total billed charges,35% of total billed charges,127.82,67.275,,102.256,percent of total billed charges,67.275% of total billed charges,152,80,,121.6,percent of total billed charges,80% of total billed charges,72.92,38.38,,58.336,percent of total billed charges,38.38% of total billed charges,152,80,,121.6,percent of total billed charges,80% of total billed charges,117.31,61.74,,93.848,percent of total billed charges,61.74% of total billed charges,193.8,102,,155.04,percent of total billed charges,102% of total billed charges,72.2,38,,57.76,percent of total billed charges,38% of total billed charges,66.5,193.8,
Therapy for speech or hearing,9000118,CDM,440,RC,92507,HCPCS,Outpatient,,,190,142.5,,148.2,78,,118.56,percent of total billed charges,78% of total billed charges,119.7,63,,95.76,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,72.2,38,,57.76,percent of total billed charges,38% of total billed charges,72.2,38,,57.76,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,171,90,,136.8,percent of total billed charges,90% of total billed charges,66.5,35,,53.2,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,152,80,,121.6,percent of total billed charges,80% of total billed charges,72.92,38.38,,58.336,percent of total billed charges,38.38% of total billed charges,152,80,,121.6,percent of total billed charges,80% of total billed charges,117.31,61.74,,93.848,percent of total billed charges,61.74% of total billed charges,193.8,102,,155.04,percent of total billed charges,102% of total billed charges,72.2,38,,57.76,percent of total billed charges,38% of total billed charges,66.5,193.8,
ANDROSTENEDIONE,5001681,CDM,301,RC,82157,HCPCS,Outpatient,,,191,143.25,,148.98,78,,119.184,percent of total billed charges,78% of total billed charges,36.81,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,29.28,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,29.28,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,171.9,90,,137.52,percent of total billed charges,90% of total billed charges,38.65,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,128.5,67.275,,102.8,percent of total billed charges,67.275% of total billed charges,152.8,80,,122.24,percent of total billed charges,80% of total billed charges,29.57,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,152.8,80,,122.24,percent of total billed charges,80% of total billed charges,117.92,61.74,,94.336,percent of total billed charges,61.74% of total billed charges,37.55,102,,,Fee Schedule,102% of GA Medicaid Rate,29.28,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,29.28,171.9,
TRACHEOSTOMY DISP 8CFS,3004217,CDM,270,RC,,,Outpatient,,,191.4,143.55,,149.29,78,,119.432,percent of total billed charges,78% of total billed charges,120.58,63,,96.464,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,72.73,38,,58.184,percent of total billed charges,38% of total billed charges,72.73,38,,58.184,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,172.26,90,,137.808,percent of total billed charges,90% of total billed charges,66.99,35,,53.592,percent of total billed charges,35% of total billed charges,128.76,67.275,,103.008,percent of total billed charges,67.275% of total billed charges,153.12,80,,122.496,percent of total billed charges,80% of total billed charges,73.46,38.38,,58.768,percent of total billed charges,38.38% of total billed charges,153.12,80,,122.496,percent of total billed charges,80% of total billed charges,118.17,61.74,,94.536,percent of total billed charges,61.74% of total billed charges,195.23,102,,156.184,percent of total billed charges,102% of total billed charges,72.73,38,,58.184,percent of total billed charges,38% of total billed charges,66.99,195.23,
KNEE SPREADER,3001112,CDM,270,RC,,,Outpatient,,,191.72,143.79,,149.54,78,,119.632,percent of total billed charges,78% of total billed charges,120.78,63,,96.624,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,72.85,38,,58.28,percent of total billed charges,38% of total billed charges,72.85,38,,58.28,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,172.55,90,,138.04,percent of total billed charges,90% of total billed charges,67.1,35,,53.68,percent of total billed charges,35% of total billed charges,128.98,67.275,,103.184,percent of total billed charges,67.275% of total billed charges,153.38,80,,122.704,percent of total billed charges,80% of total billed charges,73.58,38.38,,58.864,percent of total billed charges,38.38% of total billed charges,153.38,80,,122.704,percent of total billed charges,80% of total billed charges,118.37,61.74,,94.696,percent of total billed charges,61.74% of total billed charges,195.55,102,,156.44,percent of total billed charges,102% of total billed charges,72.85,38,,58.28,percent of total billed charges,38% of total billed charges,67.1,195.55,
I&D PILONIDAL CYST COMPL,1001166,CDM,450,RC,,,Outpatient,,,192,144,,149.76,78,,119.808,percent of total billed charges,78% of total billed charges,120.96,63,,96.768,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,72.96,38,,58.368,percent of total billed charges,38% of total billed charges,72.96,38,,58.368,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,172.8,90,,138.24,percent of total billed charges,90% of total billed charges,67.2,35,,53.76,percent of total billed charges,35% of total billed charges,129.17,67.275,,103.336,percent of total billed charges,67.275% of total billed charges,153.6,80,,122.88,percent of total billed charges,80% of total billed charges,73.69,38.38,,58.952,percent of total billed charges,38.38% of total billed charges,153.6,80,,122.88,percent of total billed charges,80% of total billed charges,118.54,61.74,,94.832,percent of total billed charges,61.74% of total billed charges,195.84,102,,156.672,percent of total billed charges,102% of total billed charges,72.96,38,,58.368,percent of total billed charges,38% of total billed charges,67.2,195.84,
IMMUNOFIXATION URINE,5002001,CDM,302,RC,86335,HCPCS,Outpatient,,,192,144,,149.76,78,,119.808,percent of total billed charges,78% of total billed charges,36.9,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,29.35,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,29.35,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,172.8,90,,138.24,percent of total billed charges,90% of total billed charges,38.75,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,129.17,67.275,,103.336,percent of total billed charges,67.275% of total billed charges,153.6,80,,122.88,percent of total billed charges,80% of total billed charges,29.64,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,153.6,80,,122.88,percent of total billed charges,80% of total billed charges,118.54,61.74,,94.832,percent of total billed charges,61.74% of total billed charges,37.64,102,,,Fee Schedule,102% of GA Medicaid Rate,29.35,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,29.35,172.8,
"EMG NEEDLE, NON-EXTREMITY",9600032,CDM,922,RC,95887,HCPCS,Outpatient,,,192,144,,149.76,78,,119.808,percent of total billed charges,78% of total billed charges,120.96,63,,96.768,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,72.96,38,,58.368,percent of total billed charges,38% of total billed charges,72.96,38,,58.368,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,172.8,90,,138.24,percent of total billed charges,90% of total billed charges,67.2,35,,53.76,percent of total billed charges,35% of total billed charges,129.17,67.275,,103.336,percent of total billed charges,67.275% of total billed charges,153.6,80,,122.88,percent of total billed charges,80% of total billed charges,73.69,38.38,,58.952,percent of total billed charges,38.38% of total billed charges,153.6,80,,122.88,percent of total billed charges,80% of total billed charges,118.54,61.74,,94.832,percent of total billed charges,61.74% of total billed charges,195.84,102,,156.672,percent of total billed charges,102% of total billed charges,72.96,38,,58.368,percent of total billed charges,38% of total billed charges,67.2,195.84,
XR60B STAPLE REFILL,3004186,CDM,270,RC,,,Outpatient,,,192.68,144.51,,150.29,78,,120.232,percent of total billed charges,78% of total billed charges,121.39,63,,97.112,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,73.22,38,,58.576,percent of total billed charges,38% of total billed charges,73.22,38,,58.576,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,173.41,90,,138.728,percent of total billed charges,90% of total billed charges,67.44,35,,53.952,percent of total billed charges,35% of total billed charges,129.63,67.275,,103.704,percent of total billed charges,67.275% of total billed charges,154.14,80,,123.312,percent of total billed charges,80% of total billed charges,73.95,38.38,,59.16,percent of total billed charges,38.38% of total billed charges,154.14,80,,123.312,percent of total billed charges,80% of total billed charges,118.96,61.74,,95.168,percent of total billed charges,61.74% of total billed charges,196.53,102,,157.224,percent of total billed charges,102% of total billed charges,73.22,38,,58.576,percent of total billed charges,38% of total billed charges,67.44,196.53,
Blood test to evaluate thyroid function,5000248,CDM,301,RC,84480,HCPCS,Outpatient,,,195,146.25,,152.1,78,,121.68,percent of total billed charges,78% of total billed charges,16.03,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,16.83,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,131.19,67.275,,104.952,percent of total billed charges,67.275% of total billed charges,156,80,,124.8,percent of total billed charges,80% of total billed charges,14.32,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,156,80,,124.8,percent of total billed charges,80% of total billed charges,120.39,61.74,,96.312,percent of total billed charges,61.74% of total billed charges,16.35,102,,,Fee Schedule,102% of GA Medicaid Rate,14.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.18,175.5,
VARICELLA ZOSTER AB IGG,5000507,CDM,302,RC,86787,HCPCS,Outpatient,,,196,147,,152.88,78,,122.304,percent of total billed charges,78% of total billed charges,16.2,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,176.4,90,,141.12,percent of total billed charges,90% of total billed charges,17.01,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,131.86,67.275,,105.488,percent of total billed charges,67.275% of total billed charges,156.8,80,,125.44,percent of total billed charges,80% of total billed charges,13.01,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,156.8,80,,125.44,percent of total billed charges,80% of total billed charges,121.01,61.74,,96.808,percent of total billed charges,61.74% of total billed charges,16.52,102,,,Fee Schedule,102% of GA Medicaid Rate,12.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.88,176.4,
VARICELLA ZOSTER AB IGM,5000521,CDM,302,RC,86787,HCPCS,Outpatient,,,196,147,,152.88,78,,122.304,percent of total billed charges,78% of total billed charges,16.2,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,176.4,90,,141.12,percent of total billed charges,90% of total billed charges,17.01,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,131.86,67.275,,105.488,percent of total billed charges,67.275% of total billed charges,156.8,80,,125.44,percent of total billed charges,80% of total billed charges,13.01,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,156.8,80,,125.44,percent of total billed charges,80% of total billed charges,121.01,61.74,,96.808,percent of total billed charges,61.74% of total billed charges,16.52,102,,,Fee Schedule,102% of GA Medicaid Rate,12.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.88,176.4,
BLASTOMYCES ANTIBODY,5001939,CDM,302,RC,86612,HCPCS,Outpatient,,,196,147,,152.88,78,,122.304,percent of total billed charges,78% of total billed charges,16.23,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.9,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.9,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,176.4,90,,141.12,percent of total billed charges,90% of total billed charges,17.04,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,131.86,67.275,,105.488,percent of total billed charges,67.275% of total billed charges,156.8,80,,125.44,percent of total billed charges,80% of total billed charges,13.03,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,156.8,80,,125.44,percent of total billed charges,80% of total billed charges,121.01,61.74,,96.808,percent of total billed charges,61.74% of total billed charges,16.55,102,,,Fee Schedule,102% of GA Medicaid Rate,12.9,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.9,176.4,
"FLUORO GUIDANCE,CENTR VENOUS ACCESS",7000812,CDM,320,RC,77001,HCPCS,Outpatient,,,196,147,,152.88,78,,122.304,percent of total billed charges,78% of total billed charges,123.48,63,,98.784,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,74.48,38,,59.584,percent of total billed charges,38% of total billed charges,74.48,38,,59.584,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,176.4,90,,141.12,percent of total billed charges,90% of total billed charges,68.6,35,,54.88,percent of total billed charges,35% of total billed charges,131.86,67.275,,105.488,percent of total billed charges,67.275% of total billed charges,156.8,80,,125.44,percent of total billed charges,80% of total billed charges,75.22,38.38,,60.176,percent of total billed charges,38.38% of total billed charges,156.8,80,,125.44,percent of total billed charges,80% of total billed charges,121.01,61.74,,96.808,percent of total billed charges,61.74% of total billed charges,199.92,102,,159.936,percent of total billed charges,102% of total billed charges,74.48,38,,59.584,percent of total billed charges,38% of total billed charges,68.6,199.92,
TRACHEOSTOMY DISP 4CFN,3004165,CDM,270,RC,,,Outpatient,,,196.72,147.54,,153.44,78,,122.752,percent of total billed charges,78% of total billed charges,123.93,63,,99.144,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,74.75,38,,59.8,percent of total billed charges,38% of total billed charges,74.75,38,,59.8,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,177.05,90,,141.64,percent of total billed charges,90% of total billed charges,68.85,35,,55.08,percent of total billed charges,35% of total billed charges,132.34,67.275,,105.872,percent of total billed charges,67.275% of total billed charges,157.38,80,,125.904,percent of total billed charges,80% of total billed charges,75.5,38.38,,60.4,percent of total billed charges,38.38% of total billed charges,157.38,80,,125.904,percent of total billed charges,80% of total billed charges,121.45,61.74,,97.16,percent of total billed charges,61.74% of total billed charges,200.65,102,,160.52,percent of total billed charges,102% of total billed charges,74.75,38,,59.8,percent of total billed charges,38% of total billed charges,68.85,200.65,
TRACHEOSTOMY DISP 8CFN,3004169,CDM,270,RC,,,Outpatient,,,196.72,147.54,,153.44,78,,122.752,percent of total billed charges,78% of total billed charges,123.93,63,,99.144,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,74.75,38,,59.8,percent of total billed charges,38% of total billed charges,74.75,38,,59.8,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,177.05,90,,141.64,percent of total billed charges,90% of total billed charges,68.85,35,,55.08,percent of total billed charges,35% of total billed charges,132.34,67.275,,105.872,percent of total billed charges,67.275% of total billed charges,157.38,80,,125.904,percent of total billed charges,80% of total billed charges,75.5,38.38,,60.4,percent of total billed charges,38.38% of total billed charges,157.38,80,,125.904,percent of total billed charges,80% of total billed charges,121.45,61.74,,97.16,percent of total billed charges,61.74% of total billed charges,200.65,102,,160.52,percent of total billed charges,102% of total billed charges,74.75,38,,59.8,percent of total billed charges,38% of total billed charges,68.85,200.65,
CULTURE HSV,5000199,CDM,306,RC,87255,HCPCS,Outpatient,,,198,148.5,,154.44,78,,123.552,percent of total billed charges,78% of total billed charges,38.04,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,33.86,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,33.86,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,178.2,90,,142.56,percent of total billed charges,90% of total billed charges,39.94,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,133.2,67.275,,106.56,percent of total billed charges,67.275% of total billed charges,158.4,80,,126.72,percent of total billed charges,80% of total billed charges,34.2,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,158.4,80,,126.72,percent of total billed charges,80% of total billed charges,122.25,61.74,,97.8,percent of total billed charges,61.74% of total billed charges,38.8,102,,,Fee Schedule,102% of GA Medicaid Rate,33.86,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,33.86,178.2,
CULTURE VARICELLA ZOSTER,5000299,CDM,306,RC,87254,HCPCS,Outpatient,,,198,148.5,,154.44,78,,123.552,percent of total billed charges,78% of total billed charges,6.15,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,19.56,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,19.56,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,178.2,90,,142.56,percent of total billed charges,90% of total billed charges,6.46,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,133.2,67.275,,106.56,percent of total billed charges,67.275% of total billed charges,158.4,80,,126.72,percent of total billed charges,80% of total billed charges,19.76,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,158.4,80,,126.72,percent of total billed charges,80% of total billed charges,122.25,61.74,,97.8,percent of total billed charges,61.74% of total billed charges,6.27,102,,,Fee Schedule,102% of GA Medicaid Rate,19.56,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.15,178.2,
CYCLOSPORINE A LEVEL,5001450,CDM,301,RC,80158,HCPCS,Outpatient,,,198,148.5,,154.44,78,,123.552,percent of total billed charges,78% of total billed charges,7.5,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,178.2,90,,142.56,percent of total billed charges,90% of total billed charges,7.88,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,133.2,67.275,,106.56,percent of total billed charges,67.275% of total billed charges,158.4,80,,126.72,percent of total billed charges,80% of total billed charges,18.23,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,158.4,80,,126.72,percent of total billed charges,80% of total billed charges,122.25,61.74,,97.8,percent of total billed charges,61.74% of total billed charges,7.65,102,,,Fee Schedule,102% of GA Medicaid Rate,18.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,7.5,178.2,
SUCTION IRRIGATOR,3000059,CDM,270,RC,,,Outpatient,,,198.04,148.53,,154.47,78,,123.576,percent of total billed charges,78% of total billed charges,124.77,63,,99.816,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,75.26,38,,60.208,percent of total billed charges,38% of total billed charges,75.26,38,,60.208,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,178.24,90,,142.592,percent of total billed charges,90% of total billed charges,69.31,35,,55.448,percent of total billed charges,35% of total billed charges,133.23,67.275,,106.584,percent of total billed charges,67.275% of total billed charges,158.43,80,,126.744,percent of total billed charges,80% of total billed charges,76.01,38.38,,60.808,percent of total billed charges,38.38% of total billed charges,158.43,80,,126.744,percent of total billed charges,80% of total billed charges,122.27,61.74,,97.816,percent of total billed charges,61.74% of total billed charges,202,102,,161.6,percent of total billed charges,102% of total billed charges,75.26,38,,60.208,percent of total billed charges,38% of total billed charges,69.31,202,
Blood test to monitor for cancer in the ovaries or testis,5001724,CDM,301,RC,86336,HCPCS,Outpatient,,,199,149.25,,155.22,78,,124.176,percent of total billed charges,78% of total billed charges,16.28,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,15.59,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.59,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,179.1,90,,143.28,percent of total billed charges,90% of total billed charges,17.09,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,133.88,67.275,,107.104,percent of total billed charges,67.275% of total billed charges,159.2,80,,127.36,percent of total billed charges,80% of total billed charges,15.75,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,159.2,80,,127.36,percent of total billed charges,80% of total billed charges,122.86,61.74,,98.288,percent of total billed charges,61.74% of total billed charges,16.61,102,,,Fee Schedule,102% of GA Medicaid Rate,15.59,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.59,179.1,
OR LEVEL 1 EA ADDL 15 MIN,400105,CDM,360,RC,,,Outpatient,,,200,150,,156,78,,124.8,percent of total billed charges,78% of total billed charges,126,63,,100.8,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,76,38,,60.8,percent of total billed charges,38% of total billed charges,76,38,,60.8,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,180,90,,144,percent of total billed charges,90% of total billed charges,70,35,,56,percent of total billed charges,35% of total billed charges,134.55,67.275,,107.64,percent of total billed charges,67.275% of total billed charges,160,80,,128,percent of total billed charges,80% of total billed charges,76.76,38.38,,61.408,percent of total billed charges,38.38% of total billed charges,160,80,,128,percent of total billed charges,80% of total billed charges,123.48,61.74,,98.784,percent of total billed charges,61.74% of total billed charges,204,102,,163.2,percent of total billed charges,102% of total billed charges,76,38,,60.8,percent of total billed charges,38% of total billed charges,70,204,
COVID-19 ANTIGEN (IN-HOUSE),5087426,CDM,306,RC,87426,HCPCS,Outpatient,,,200,150,,156,78,,124.8,percent of total billed charges,78% of total billed charges,36.18,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,35.33,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,35.33,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,180,90,,144,percent of total billed charges,90% of total billed charges,37.99,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,134.55,67.275,,107.64,percent of total billed charges,67.275% of total billed charges,160,80,,128,percent of total billed charges,80% of total billed charges,35.68,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,160,80,,128,percent of total billed charges,80% of total billed charges,123.48,61.74,,98.784,percent of total billed charges,61.74% of total billed charges,36.9,102,,,Fee Schedule,102% of GA Medicaid Rate,35.33,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,35.33,180,
COVID-19 PCR (SEND OUT),5087635,CDM,306,RC,87635,HCPCS,Outpatient,,,200,150,,156,78,,124.8,percent of total billed charges,78% of total billed charges,51.31,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,51.31,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,51.31,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,180,90,,144,percent of total billed charges,90% of total billed charges,53.88,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,134.55,67.275,,107.64,percent of total billed charges,67.275% of total billed charges,160,80,,128,percent of total billed charges,80% of total billed charges,51.82,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,160,80,,128,percent of total billed charges,80% of total billed charges,123.48,61.74,,98.784,percent of total billed charges,61.74% of total billed charges,52.34,102,,,Fee Schedule,102% of GA Medicaid Rate,51.31,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,51.31,180,
I&D REMOVAL OF FB,1001168,CDM,450,RC,,,Outpatient,,,201,150.75,,156.78,78,,125.424,percent of total billed charges,78% of total billed charges,126.63,63,,101.304,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,76.38,38,,61.104,percent of total billed charges,38% of total billed charges,76.38,38,,61.104,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,70.35,35,,56.28,percent of total billed charges,35% of total billed charges,135.22,67.275,,108.176,percent of total billed charges,67.275% of total billed charges,160.8,80,,128.64,percent of total billed charges,80% of total billed charges,77.14,38.38,,61.712,percent of total billed charges,38.38% of total billed charges,160.8,80,,128.64,percent of total billed charges,80% of total billed charges,124.1,61.74,,99.28,percent of total billed charges,61.74% of total billed charges,205.02,102,,164.016,percent of total billed charges,102% of total billed charges,76.38,38,,61.104,percent of total billed charges,38% of total billed charges,70.35,205.02,
ANKLE WALKER SMALL,3003201,CDM,270,RC,,,Outpatient,,,201.44,151.08,,157.12,78,,125.696,percent of total billed charges,78% of total billed charges,126.91,63,,101.528,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,76.55,38,,61.24,percent of total billed charges,38% of total billed charges,76.55,38,,61.24,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,181.3,90,,145.04,percent of total billed charges,90% of total billed charges,70.5,35,,56.4,percent of total billed charges,35% of total billed charges,135.52,67.275,,108.416,percent of total billed charges,67.275% of total billed charges,161.15,80,,128.92,percent of total billed charges,80% of total billed charges,77.31,38.38,,61.848,percent of total billed charges,38.38% of total billed charges,161.15,80,,128.92,percent of total billed charges,80% of total billed charges,124.37,61.74,,99.496,percent of total billed charges,61.74% of total billed charges,205.47,102,,164.376,percent of total billed charges,102% of total billed charges,76.55,38,,61.24,percent of total billed charges,38% of total billed charges,70.5,205.47,
ANKLE WALKER MEDIUM,3003561,CDM,270,RC,,,Outpatient,,,201.44,151.08,,157.12,78,,125.696,percent of total billed charges,78% of total billed charges,126.91,63,,101.528,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,76.55,38,,61.24,percent of total billed charges,38% of total billed charges,76.55,38,,61.24,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,181.3,90,,145.04,percent of total billed charges,90% of total billed charges,70.5,35,,56.4,percent of total billed charges,35% of total billed charges,135.52,67.275,,108.416,percent of total billed charges,67.275% of total billed charges,161.15,80,,128.92,percent of total billed charges,80% of total billed charges,77.31,38.38,,61.848,percent of total billed charges,38.38% of total billed charges,161.15,80,,128.92,percent of total billed charges,80% of total billed charges,124.37,61.74,,99.496,percent of total billed charges,61.74% of total billed charges,205.47,102,,164.376,percent of total billed charges,102% of total billed charges,76.55,38,,61.24,percent of total billed charges,38% of total billed charges,70.5,205.47,
ANKLE WALKER LARGE,3003789,CDM,270,RC,,,Outpatient,,,201.44,151.08,,157.12,78,,125.696,percent of total billed charges,78% of total billed charges,126.91,63,,101.528,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,76.55,38,,61.24,percent of total billed charges,38% of total billed charges,76.55,38,,61.24,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,181.3,90,,145.04,percent of total billed charges,90% of total billed charges,70.5,35,,56.4,percent of total billed charges,35% of total billed charges,135.52,67.275,,108.416,percent of total billed charges,67.275% of total billed charges,161.15,80,,128.92,percent of total billed charges,80% of total billed charges,77.31,38.38,,61.848,percent of total billed charges,38.38% of total billed charges,161.15,80,,128.92,percent of total billed charges,80% of total billed charges,124.37,61.74,,99.496,percent of total billed charges,61.74% of total billed charges,205.47,102,,164.376,percent of total billed charges,102% of total billed charges,76.55,38,,61.24,percent of total billed charges,38% of total billed charges,70.5,205.47,
Blood test to determine existence of certain bacterium that causes syphilis,5001930,CDM,306,RC,86780,HCPCS,Outpatient,,,202,151.5,,157.56,78,,126.048,percent of total billed charges,78% of total billed charges,127.26,63,,101.808,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,13.24,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.24,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,181.8,90,,145.44,percent of total billed charges,90% of total billed charges,70.7,35,,56.56,percent of total billed charges,35% of total billed charges,135.9,67.275,,108.72,percent of total billed charges,67.275% of total billed charges,161.6,80,,129.28,percent of total billed charges,80% of total billed charges,13.37,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,161.6,80,,129.28,percent of total billed charges,80% of total billed charges,124.71,61.74,,99.768,percent of total billed charges,61.74% of total billed charges,206.04,102,,164.832,percent of total billed charges,102% of total billed charges,13.24,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.24,206.04,
PT EVALUATION LOW COMPLEXITY,9000502,CDM,420,RC,97161,HCPCS,Outpatient,,,202,151.5,,157.56,78,,126.048,percent of total billed charges,78% of total billed charges,127.26,63,,101.808,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,76.76,38,,61.408,percent of total billed charges,38% of total billed charges,76.76,38,,61.408,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,181.8,90,,145.44,percent of total billed charges,90% of total billed charges,70.7,35,,56.56,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,161.6,80,,129.28,percent of total billed charges,80% of total billed charges,77.53,38.38,,62.024,percent of total billed charges,38.38% of total billed charges,161.6,80,,129.28,percent of total billed charges,80% of total billed charges,124.71,61.74,,99.768,percent of total billed charges,61.74% of total billed charges,206.04,102,,164.832,percent of total billed charges,102% of total billed charges,76.76,38,,61.408,percent of total billed charges,38% of total billed charges,70.7,206.04,
PT EVALUATION MODERATE COMPLEXITY,9000504,CDM,420,RC,97162,HCPCS,Outpatient,,,202,151.5,,157.56,78,,126.048,percent of total billed charges,78% of total billed charges,127.26,63,,101.808,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,76.76,38,,61.408,percent of total billed charges,38% of total billed charges,76.76,38,,61.408,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,181.8,90,,145.44,percent of total billed charges,90% of total billed charges,70.7,35,,56.56,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,161.6,80,,129.28,percent of total billed charges,80% of total billed charges,77.53,38.38,,62.024,percent of total billed charges,38.38% of total billed charges,161.6,80,,129.28,percent of total billed charges,80% of total billed charges,124.71,61.74,,99.768,percent of total billed charges,61.74% of total billed charges,206.04,102,,164.832,percent of total billed charges,102% of total billed charges,76.76,38,,61.408,percent of total billed charges,38% of total billed charges,70.7,206.04,
PT EVALUATION HIGH COMPLEXITY,9000506,CDM,420,RC,97163,HCPCS,Outpatient,,,202,151.5,,157.56,78,,126.048,percent of total billed charges,78% of total billed charges,127.26,63,,101.808,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,76.76,38,,61.408,percent of total billed charges,38% of total billed charges,76.76,38,,61.408,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,181.8,90,,145.44,percent of total billed charges,90% of total billed charges,70.7,35,,56.56,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,161.6,80,,129.28,percent of total billed charges,80% of total billed charges,77.53,38.38,,62.024,percent of total billed charges,38.38% of total billed charges,161.6,80,,129.28,percent of total billed charges,80% of total billed charges,124.71,61.74,,99.768,percent of total billed charges,61.74% of total billed charges,206.04,102,,164.832,percent of total billed charges,102% of total billed charges,76.76,38,,61.408,percent of total billed charges,38% of total billed charges,70.7,206.04,
TRACHEOSTOMY DISP 6CFN,3004166,CDM,270,RC,,,Outpatient,,,202.64,151.98,,158.06,78,,126.448,percent of total billed charges,78% of total billed charges,127.66,63,,102.128,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,77,38,,61.6,percent of total billed charges,38% of total billed charges,77,38,,61.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,182.38,90,,145.904,percent of total billed charges,90% of total billed charges,70.92,35,,56.736,percent of total billed charges,35% of total billed charges,136.33,67.275,,109.064,percent of total billed charges,67.275% of total billed charges,162.11,80,,129.688,percent of total billed charges,80% of total billed charges,77.77,38.38,,62.216,percent of total billed charges,38.38% of total billed charges,162.11,80,,129.688,percent of total billed charges,80% of total billed charges,125.11,61.74,,100.088,percent of total billed charges,61.74% of total billed charges,206.69,102,,165.352,percent of total billed charges,102% of total billed charges,77,38,,61.6,percent of total billed charges,38% of total billed charges,70.92,206.69,
MASK NASAL MEDIUM,3000279,CDM,270,RC,,,Outpatient,,,202.72,152.04,,158.12,78,,126.496,percent of total billed charges,78% of total billed charges,127.71,63,,102.168,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,77.03,38,,61.624,percent of total billed charges,38% of total billed charges,77.03,38,,61.624,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,182.45,90,,145.96,percent of total billed charges,90% of total billed charges,70.95,35,,56.76,percent of total billed charges,35% of total billed charges,136.38,67.275,,109.104,percent of total billed charges,67.275% of total billed charges,162.18,80,,129.744,percent of total billed charges,80% of total billed charges,77.8,38.38,,62.24,percent of total billed charges,38.38% of total billed charges,162.18,80,,129.744,percent of total billed charges,80% of total billed charges,125.16,61.74,,100.128,percent of total billed charges,61.74% of total billed charges,206.77,102,,165.416,percent of total billed charges,102% of total billed charges,77.03,38,,61.624,percent of total billed charges,38% of total billed charges,70.95,206.77,
"SEROTONIN, SERUM",5001232,CDM,301,RC,84260,HCPCS,Outpatient,,,203,152.25,,158.34,78,,126.672,percent of total billed charges,78% of total billed charges,38.95,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,30.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,30.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,182.7,90,,146.16,percent of total billed charges,90% of total billed charges,40.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,136.57,67.275,,109.256,percent of total billed charges,67.275% of total billed charges,162.4,80,,129.92,percent of total billed charges,80% of total billed charges,31.29,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,162.4,80,,129.92,percent of total billed charges,80% of total billed charges,125.33,61.74,,100.264,percent of total billed charges,61.74% of total billed charges,39.73,102,,,Fee Schedule,102% of GA Medicaid Rate,30.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,30.98,182.7,
THREADED SOCKET 40MM,3006003,CDM,270,RC,,,Outpatient,,,204,153,,159.12,78,,127.296,percent of total billed charges,78% of total billed charges,128.52,63,,102.816,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,77.52,38,,62.016,percent of total billed charges,38% of total billed charges,77.52,38,,62.016,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,71.4,35,,57.12,percent of total billed charges,35% of total billed charges,137.24,67.275,,109.792,percent of total billed charges,67.275% of total billed charges,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,78.3,38.38,,62.64,percent of total billed charges,38.38% of total billed charges,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,125.95,61.74,,100.76,percent of total billed charges,61.74% of total billed charges,208.08,102,,166.464,percent of total billed charges,102% of total billed charges,77.52,38,,62.016,percent of total billed charges,38% of total billed charges,71.4,208.08,
ELECTRODE CUTTING LOOP,3004999,CDM,270,RC,,,Outpatient,,,204.92,153.69,,159.84,78,,127.872,percent of total billed charges,78% of total billed charges,129.1,63,,103.28,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,77.87,38,,62.296,percent of total billed charges,38% of total billed charges,77.87,38,,62.296,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,184.43,90,,147.544,percent of total billed charges,90% of total billed charges,71.72,35,,57.376,percent of total billed charges,35% of total billed charges,137.86,67.275,,110.288,percent of total billed charges,67.275% of total billed charges,163.94,80,,131.152,percent of total billed charges,80% of total billed charges,78.65,38.38,,62.92,percent of total billed charges,38.38% of total billed charges,163.94,80,,131.152,percent of total billed charges,80% of total billed charges,126.52,61.74,,101.216,percent of total billed charges,61.74% of total billed charges,209.02,102,,167.216,percent of total billed charges,102% of total billed charges,77.87,38,,62.296,percent of total billed charges,38% of total billed charges,71.72,209.02,
ST DYSPHAGIA THERAPY EA 15 MIN,9000114,CDM,440,RC,92526,HCPCS,Outpatient,,,207,155.25,,161.46,78,,129.168,percent of total billed charges,78% of total billed charges,130.41,63,,104.328,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,78.66,38,,62.928,percent of total billed charges,38% of total billed charges,78.66,38,,62.928,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,186.3,90,,149.04,percent of total billed charges,90% of total billed charges,72.45,35,,57.96,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,165.6,80,,132.48,percent of total billed charges,80% of total billed charges,79.45,38.38,,63.56,percent of total billed charges,38.38% of total billed charges,165.6,80,,132.48,percent of total billed charges,80% of total billed charges,127.8,61.74,,102.24,percent of total billed charges,61.74% of total billed charges,211.14,102,,168.912,percent of total billed charges,102% of total billed charges,78.66,38,,62.928,percent of total billed charges,38% of total billed charges,72.45,211.14,
COMBITUBE 41FR TRACHEAL AIRWAY,3001802,CDM,270,RC,,,Outpatient,,,207.48,155.61,,161.83,78,,129.464,percent of total billed charges,78% of total billed charges,130.71,63,,104.568,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,78.84,38,,63.072,percent of total billed charges,38% of total billed charges,78.84,38,,63.072,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,186.73,90,,149.384,percent of total billed charges,90% of total billed charges,72.62,35,,58.096,percent of total billed charges,35% of total billed charges,139.58,67.275,,111.664,percent of total billed charges,67.275% of total billed charges,165.98,80,,132.784,percent of total billed charges,80% of total billed charges,79.63,38.38,,63.704,percent of total billed charges,38.38% of total billed charges,165.98,80,,132.784,percent of total billed charges,80% of total billed charges,128.1,61.74,,102.48,percent of total billed charges,61.74% of total billed charges,211.63,102,,169.304,percent of total billed charges,102% of total billed charges,78.84,38,,63.072,percent of total billed charges,38% of total billed charges,72.62,211.63,
Test of breath for a stomach bacterium,5000176,CDM,300,RC,83013,HCPCS,Outpatient,,,208,156,,162.24,78,,129.792,percent of total billed charges,78% of total billed charges,66.53,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,67.36,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,67.36,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,187.2,90,,149.76,percent of total billed charges,90% of total billed charges,69.86,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,139.93,67.275,,111.944,percent of total billed charges,67.275% of total billed charges,166.4,80,,133.12,percent of total billed charges,80% of total billed charges,68.03,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,166.4,80,,133.12,percent of total billed charges,80% of total billed charges,128.42,61.74,,102.736,percent of total billed charges,61.74% of total billed charges,67.86,102,,,Fee Schedule,102% of GA Medicaid Rate,67.36,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,66.53,187.2,
.FACTOR V HR2,5000448,CDM,301,RC,83896,HCPCS,Outpatient,,,208,156,,162.24,78,,129.792,percent of total billed charges,78% of total billed charges,131.04,63,,104.832,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,79.04,38,,63.232,percent of total billed charges,38% of total billed charges,79.04,38,,63.232,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,187.2,90,,149.76,percent of total billed charges,90% of total billed charges,72.8,35,,58.24,percent of total billed charges,35% of total billed charges,139.93,67.275,,111.944,percent of total billed charges,67.275% of total billed charges,166.4,80,,133.12,percent of total billed charges,80% of total billed charges,79.83,38.38,,63.864,percent of total billed charges,38.38% of total billed charges,166.4,80,,133.12,percent of total billed charges,80% of total billed charges,128.42,61.74,,102.736,percent of total billed charges,61.74% of total billed charges,212.16,102,,169.728,percent of total billed charges,102% of total billed charges,79.04,38,,63.232,percent of total billed charges,38% of total billed charges,72.8,212.16,
TXR60G STAPLES,3001830,CDM,270,RC,,,Outpatient,,,208.41,156.31,,162.56,78,,130.048,percent of total billed charges,78% of total billed charges,131.3,63,,105.04,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,79.2,38,,63.36,percent of total billed charges,38% of total billed charges,79.2,38,,63.36,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,187.57,90,,150.056,percent of total billed charges,90% of total billed charges,72.94,35,,58.352,percent of total billed charges,35% of total billed charges,140.21,67.275,,112.168,percent of total billed charges,67.275% of total billed charges,166.73,80,,133.384,percent of total billed charges,80% of total billed charges,79.99,38.38,,63.992,percent of total billed charges,38.38% of total billed charges,166.73,80,,133.384,percent of total billed charges,80% of total billed charges,128.67,61.74,,102.936,percent of total billed charges,61.74% of total billed charges,212.58,102,,170.064,percent of total billed charges,102% of total billed charges,79.2,38,,63.36,percent of total billed charges,38% of total billed charges,72.94,212.58,
CALCIUM IONIZED,5000714,CDM,301,RC,82330,HCPCS,Outpatient,,,209,156.75,,163.02,78,,130.416,percent of total billed charges,78% of total billed charges,17.18,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.68,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.68,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,188.1,90,,150.48,percent of total billed charges,90% of total billed charges,18.04,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,140.6,67.275,,112.48,percent of total billed charges,67.275% of total billed charges,167.2,80,,133.76,percent of total billed charges,80% of total billed charges,13.82,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,167.2,80,,133.76,percent of total billed charges,80% of total billed charges,129.04,61.74,,103.232,percent of total billed charges,61.74% of total billed charges,17.52,102,,,Fee Schedule,102% of GA Medicaid Rate,13.68,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.68,188.1,
TROCAR 5MM D5LT,3004051,CDM,270,RC,,,Outpatient,,,210.56,157.92,,164.24,78,,131.392,percent of total billed charges,78% of total billed charges,132.65,63,,106.12,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,80.01,38,,64.008,percent of total billed charges,38% of total billed charges,80.01,38,,64.008,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,189.5,90,,151.6,percent of total billed charges,90% of total billed charges,73.7,35,,58.96,percent of total billed charges,35% of total billed charges,141.65,67.275,,113.32,percent of total billed charges,67.275% of total billed charges,168.45,80,,134.76,percent of total billed charges,80% of total billed charges,80.81,38.38,,64.648,percent of total billed charges,38.38% of total billed charges,168.45,80,,134.76,percent of total billed charges,80% of total billed charges,130,61.74,,104,percent of total billed charges,61.74% of total billed charges,214.77,102,,171.816,percent of total billed charges,102% of total billed charges,80.01,38,,64.008,percent of total billed charges,38% of total billed charges,73.7,214.77,
RELOAD 55MM,3004313,CDM,270,RC,,,Outpatient,,,211.08,158.31,,164.64,78,,131.712,percent of total billed charges,78% of total billed charges,132.98,63,,106.384,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,80.21,38,,64.168,percent of total billed charges,38% of total billed charges,80.21,38,,64.168,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,189.97,90,,151.976,percent of total billed charges,90% of total billed charges,73.88,35,,59.104,percent of total billed charges,35% of total billed charges,142,67.275,,113.6,percent of total billed charges,67.275% of total billed charges,168.86,80,,135.088,percent of total billed charges,80% of total billed charges,81.01,38.38,,64.808,percent of total billed charges,38.38% of total billed charges,168.86,80,,135.088,percent of total billed charges,80% of total billed charges,130.32,61.74,,104.256,percent of total billed charges,61.74% of total billed charges,215.3,102,,172.24,percent of total billed charges,102% of total billed charges,80.21,38,,64.168,percent of total billed charges,38% of total billed charges,73.88,215.3,
ST SWALLOW FUNC CINERADIOGRAPHY,9000112,CDM,444,RC,92611,HCPCS,Outpatient,,,212,159,,165.36,78,,132.288,percent of total billed charges,78% of total billed charges,133.56,63,,106.848,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,80.56,38,,64.448,percent of total billed charges,38% of total billed charges,80.56,38,,64.448,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,190.8,90,,152.64,percent of total billed charges,90% of total billed charges,74.2,35,,59.36,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,169.6,80,,135.68,percent of total billed charges,80% of total billed charges,81.37,38.38,,65.096,percent of total billed charges,38.38% of total billed charges,169.6,80,,135.68,percent of total billed charges,80% of total billed charges,130.89,61.74,,104.712,percent of total billed charges,61.74% of total billed charges,216.24,102,,172.992,percent of total billed charges,102% of total billed charges,80.56,38,,64.448,percent of total billed charges,38% of total billed charges,74.2,216.24,
"B PERTUSSIS/PARA,DNA,QL",5000190,CDM,302,RC,87798,HCPCS,Outpatient,,,214,160.5,,166.92,78,,133.536,percent of total billed charges,78% of total billed charges,24.67,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,192.6,90,,154.08,percent of total billed charges,90% of total billed charges,25.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,143.97,67.275,,115.176,percent of total billed charges,67.275% of total billed charges,171.2,80,,136.96,percent of total billed charges,80% of total billed charges,35.44,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,171.2,80,,136.96,percent of total billed charges,80% of total billed charges,132.12,61.74,,105.696,percent of total billed charges,61.74% of total billed charges,25.16,102,,,Fee Schedule,102% of GA Medicaid Rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,24.67,192.6,
Test that detects Chlamydia,5000251,CDM,306,RC,87491,HCPCS,Outpatient,,,214,160.5,,166.92,78,,133.536,percent of total billed charges,78% of total billed charges,24.67,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,192.6,90,,154.08,percent of total billed charges,90% of total billed charges,25.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,143.97,67.275,,115.176,percent of total billed charges,67.275% of total billed charges,171.2,80,,136.96,percent of total billed charges,80% of total billed charges,35.44,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,171.2,80,,136.96,percent of total billed charges,80% of total billed charges,132.12,61.74,,105.696,percent of total billed charges,61.74% of total billed charges,25.16,102,,,Fee Schedule,102% of GA Medicaid Rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,24.67,192.6,
Test that detects Chlamydia,5000254,CDM,306,RC,87491,HCPCS,Outpatient,,,214,160.5,,166.92,78,,133.536,percent of total billed charges,78% of total billed charges,24.67,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,192.6,90,,154.08,percent of total billed charges,90% of total billed charges,25.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,143.97,67.275,,115.176,percent of total billed charges,67.275% of total billed charges,171.2,80,,136.96,percent of total billed charges,80% of total billed charges,35.44,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,171.2,80,,136.96,percent of total billed charges,80% of total billed charges,132.12,61.74,,105.696,percent of total billed charges,61.74% of total billed charges,25.16,102,,,Fee Schedule,102% of GA Medicaid Rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,24.67,192.6,
HPV,5001657,CDM,306,RC,87623,HCPCS,Outpatient,,,214,160.5,,166.92,78,,133.536,percent of total billed charges,78% of total billed charges,18.25,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,192.6,90,,154.08,percent of total billed charges,90% of total billed charges,19.16,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,143.97,67.275,,115.176,percent of total billed charges,67.275% of total billed charges,171.2,80,,136.96,percent of total billed charges,80% of total billed charges,35.44,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,171.2,80,,136.96,percent of total billed charges,80% of total billed charges,132.12,61.74,,105.696,percent of total billed charges,61.74% of total billed charges,18.62,102,,,Fee Schedule,102% of GA Medicaid Rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.25,192.6,
"HERPES VIRUS 1 & 2,PCR",5001869,CDM,306,RC,87529,HCPCS,Outpatient,,,214,160.5,,166.92,78,,133.536,percent of total billed charges,78% of total billed charges,24.67,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,192.6,90,,154.08,percent of total billed charges,90% of total billed charges,25.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,143.97,67.275,,115.176,percent of total billed charges,67.275% of total billed charges,171.2,80,,136.96,percent of total billed charges,80% of total billed charges,35.44,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,171.2,80,,136.96,percent of total billed charges,80% of total billed charges,132.12,61.74,,105.696,percent of total billed charges,61.74% of total billed charges,25.16,102,,,Fee Schedule,102% of GA Medicaid Rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,24.67,192.6,
HERPES SIMPLEX 1 DNA,5003702,CDM,302,RC,87529,HCPCS,Outpatient,,,214,160.5,,166.92,78,,133.536,percent of total billed charges,78% of total billed charges,24.67,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,192.6,90,,154.08,percent of total billed charges,90% of total billed charges,25.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,143.97,67.275,,115.176,percent of total billed charges,67.275% of total billed charges,171.2,80,,136.96,percent of total billed charges,80% of total billed charges,35.44,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,171.2,80,,136.96,percent of total billed charges,80% of total billed charges,132.12,61.74,,105.696,percent of total billed charges,61.74% of total billed charges,25.16,102,,,Fee Schedule,102% of GA Medicaid Rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,24.67,192.6,
HERPES SIMPLEX 2 DNA,5003703,CDM,302,RC,87529,HCPCS,Outpatient,,,214,160.5,,166.92,78,,133.536,percent of total billed charges,78% of total billed charges,24.67,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,192.6,90,,154.08,percent of total billed charges,90% of total billed charges,25.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,143.97,67.275,,115.176,percent of total billed charges,67.275% of total billed charges,171.2,80,,136.96,percent of total billed charges,80% of total billed charges,35.44,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,171.2,80,,136.96,percent of total billed charges,80% of total billed charges,132.12,61.74,,105.696,percent of total billed charges,61.74% of total billed charges,25.16,102,,,Fee Schedule,102% of GA Medicaid Rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,24.67,192.6,
ST BEHAVIORAL/QUALITATIVE ANALYSIS VOICE,9000126,CDM,440,RC,92524,HCPCS,Outpatient,,,214,160.5,,166.92,78,,133.536,percent of total billed charges,78% of total billed charges,134.82,63,,107.856,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,81.32,38,,65.056,percent of total billed charges,38% of total billed charges,81.32,38,,65.056,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,192.6,90,,154.08,percent of total billed charges,90% of total billed charges,74.9,35,,59.92,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,171.2,80,,136.96,percent of total billed charges,80% of total billed charges,82.13,38.38,,65.704,percent of total billed charges,38.38% of total billed charges,171.2,80,,136.96,percent of total billed charges,80% of total billed charges,132.12,61.74,,105.696,percent of total billed charges,61.74% of total billed charges,218.28,102,,174.624,percent of total billed charges,102% of total billed charges,81.32,38,,65.056,percent of total billed charges,38% of total billed charges,74.9,218.28,
RESTING SPLINT - SM- RT,3009050,CDM,270,RC,,,Outpatient,,,215,161.25,,167.7,78,,134.16,percent of total billed charges,78% of total billed charges,135.45,63,,108.36,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,81.7,38,,65.36,percent of total billed charges,38% of total billed charges,81.7,38,,65.36,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,193.5,90,,154.8,percent of total billed charges,90% of total billed charges,75.25,35,,60.2,percent of total billed charges,35% of total billed charges,144.64,67.275,,115.712,percent of total billed charges,67.275% of total billed charges,172,80,,137.6,percent of total billed charges,80% of total billed charges,82.52,38.38,,66.016,percent of total billed charges,38.38% of total billed charges,172,80,,137.6,percent of total billed charges,80% of total billed charges,132.74,61.74,,106.192,percent of total billed charges,61.74% of total billed charges,219.3,102,,175.44,percent of total billed charges,102% of total billed charges,81.7,38,,65.36,percent of total billed charges,38% of total billed charges,75.25,219.3,
RESTING SPLINT - LG - RT,3009051,CDM,270,RC,,,Outpatient,,,215,161.25,,167.7,78,,134.16,percent of total billed charges,78% of total billed charges,135.45,63,,108.36,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,81.7,38,,65.36,percent of total billed charges,38% of total billed charges,81.7,38,,65.36,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,193.5,90,,154.8,percent of total billed charges,90% of total billed charges,75.25,35,,60.2,percent of total billed charges,35% of total billed charges,144.64,67.275,,115.712,percent of total billed charges,67.275% of total billed charges,172,80,,137.6,percent of total billed charges,80% of total billed charges,82.52,38.38,,66.016,percent of total billed charges,38.38% of total billed charges,172,80,,137.6,percent of total billed charges,80% of total billed charges,132.74,61.74,,106.192,percent of total billed charges,61.74% of total billed charges,219.3,102,,175.44,percent of total billed charges,102% of total billed charges,81.7,38,,65.36,percent of total billed charges,38% of total billed charges,75.25,219.3,
RESTING SPLINT - SM- LT,3009052,CDM,270,RC,,,Outpatient,,,215,161.25,,167.7,78,,134.16,percent of total billed charges,78% of total billed charges,135.45,63,,108.36,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,81.7,38,,65.36,percent of total billed charges,38% of total billed charges,81.7,38,,65.36,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,193.5,90,,154.8,percent of total billed charges,90% of total billed charges,75.25,35,,60.2,percent of total billed charges,35% of total billed charges,144.64,67.275,,115.712,percent of total billed charges,67.275% of total billed charges,172,80,,137.6,percent of total billed charges,80% of total billed charges,82.52,38.38,,66.016,percent of total billed charges,38.38% of total billed charges,172,80,,137.6,percent of total billed charges,80% of total billed charges,132.74,61.74,,106.192,percent of total billed charges,61.74% of total billed charges,219.3,102,,175.44,percent of total billed charges,102% of total billed charges,81.7,38,,65.36,percent of total billed charges,38% of total billed charges,75.25,219.3,
RESTING SPLINT - LG - LEFT,3009055,CDM,270,RC,,,Outpatient,,,215,161.25,,167.7,78,,134.16,percent of total billed charges,78% of total billed charges,135.45,63,,108.36,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,81.7,38,,65.36,percent of total billed charges,38% of total billed charges,81.7,38,,65.36,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,193.5,90,,154.8,percent of total billed charges,90% of total billed charges,75.25,35,,60.2,percent of total billed charges,35% of total billed charges,144.64,67.275,,115.712,percent of total billed charges,67.275% of total billed charges,172,80,,137.6,percent of total billed charges,80% of total billed charges,82.52,38.38,,66.016,percent of total billed charges,38.38% of total billed charges,172,80,,137.6,percent of total billed charges,80% of total billed charges,132.74,61.74,,106.192,percent of total billed charges,61.74% of total billed charges,219.3,102,,175.44,percent of total billed charges,102% of total billed charges,81.7,38,,65.36,percent of total billed charges,38% of total billed charges,75.25,219.3,
RESTING SPLINT - XL - LEFT,3009056,CDM,270,RC,,,Outpatient,,,215,161.25,,167.7,78,,134.16,percent of total billed charges,78% of total billed charges,135.45,63,,108.36,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,81.7,38,,65.36,percent of total billed charges,38% of total billed charges,81.7,38,,65.36,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,193.5,90,,154.8,percent of total billed charges,90% of total billed charges,75.25,35,,60.2,percent of total billed charges,35% of total billed charges,144.64,67.275,,115.712,percent of total billed charges,67.275% of total billed charges,172,80,,137.6,percent of total billed charges,80% of total billed charges,82.52,38.38,,66.016,percent of total billed charges,38.38% of total billed charges,172,80,,137.6,percent of total billed charges,80% of total billed charges,132.74,61.74,,106.192,percent of total billed charges,61.74% of total billed charges,219.3,102,,175.44,percent of total billed charges,102% of total billed charges,81.7,38,,65.36,percent of total billed charges,38% of total billed charges,75.25,219.3,
CYSTIC FIB ANALY PCR,5001812,CDM,301,RC,81220,HCPCS,Outpatient,,,215,161.25,,167.7,78,,134.16,percent of total billed charges,78% of total billed charges,960,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,556.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,556.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,193.5,90,,154.8,percent of total billed charges,90% of total billed charges,1008,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,144.64,67.275,,115.712,percent of total billed charges,67.275% of total billed charges,172,80,,137.6,percent of total billed charges,80% of total billed charges,562.17,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,172,80,,137.6,percent of total billed charges,80% of total billed charges,132.74,61.74,,106.192,percent of total billed charges,61.74% of total billed charges,979.2,102,,,Fee Schedule,102% of GA Medicaid Rate,556.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,132.74,1008,
CYSTIC FIBROSIS CARRIER SCREEN,5001817,CDM,301,RC,81220,HCPCS,Outpatient,,,215,161.25,,167.7,78,,134.16,percent of total billed charges,78% of total billed charges,960,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,556.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,556.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,193.5,90,,154.8,percent of total billed charges,90% of total billed charges,1008,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,144.64,67.275,,115.712,percent of total billed charges,67.275% of total billed charges,172,80,,137.6,percent of total billed charges,80% of total billed charges,562.17,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,172,80,,137.6,percent of total billed charges,80% of total billed charges,132.74,61.74,,106.192,percent of total billed charges,61.74% of total billed charges,979.2,102,,,Fee Schedule,102% of GA Medicaid Rate,556.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,132.74,1008,
XCEL XL 5MM TROCAR,3004259,CDM,270,RC,,,Outpatient,,,215.64,161.73,,168.2,78,,134.56,percent of total billed charges,78% of total billed charges,135.85,63,,108.68,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,81.94,38,,65.552,percent of total billed charges,38% of total billed charges,81.94,38,,65.552,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,194.08,90,,155.264,percent of total billed charges,90% of total billed charges,75.47,35,,60.376,percent of total billed charges,35% of total billed charges,145.07,67.275,,116.056,percent of total billed charges,67.275% of total billed charges,172.51,80,,138.008,percent of total billed charges,80% of total billed charges,82.76,38.38,,66.208,percent of total billed charges,38.38% of total billed charges,172.51,80,,138.008,percent of total billed charges,80% of total billed charges,133.14,61.74,,106.512,percent of total billed charges,61.74% of total billed charges,219.95,102,,175.96,percent of total billed charges,102% of total billed charges,81.94,38,,65.552,percent of total billed charges,38% of total billed charges,75.47,219.95,
VITAMIN E,5002004,CDM,301,RC,84446,HCPCS,Outpatient,,,216,162,,168.48,78,,134.784,percent of total billed charges,78% of total billed charges,17.83,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,194.4,90,,155.52,percent of total billed charges,90% of total billed charges,18.72,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,145.31,67.275,,116.248,percent of total billed charges,67.275% of total billed charges,172.8,80,,138.24,percent of total billed charges,80% of total billed charges,14.32,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,172.8,80,,138.24,percent of total billed charges,80% of total billed charges,133.36,61.74,,106.688,percent of total billed charges,61.74% of total billed charges,18.19,102,,,Fee Schedule,102% of GA Medicaid Rate,14.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.18,194.4,
PATH IMMUNO EA ADDL,5003730,CDM,312,RC,88341,HCPCS,Outpatient,,,217,162.75,,169.26,78,,135.408,percent of total billed charges,78% of total billed charges,57.38,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,82.46,38,,65.968,percent of total billed charges,38% of total billed charges,82.46,38,,65.968,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,195.3,90,,156.24,percent of total billed charges,90% of total billed charges,60.25,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,145.99,67.275,,116.792,percent of total billed charges,67.275% of total billed charges,173.6,80,,138.88,percent of total billed charges,80% of total billed charges,83.28,38.38,,66.624,percent of total billed charges,38.38% of total billed charges,173.6,80,,138.88,percent of total billed charges,80% of total billed charges,133.98,61.74,,107.184,percent of total billed charges,61.74% of total billed charges,58.53,102,,,Fee Schedule,102% of GA Medicaid Rate,82.46,38,,65.968,percent of total billed charges,38% of total billed charges,57.38,195.3,
OT EVALUATION LOW COMPLEXITY,9000252,CDM,420,RC,97165,HCPCS,Outpatient,,,217,162.75,,169.26,78,,135.408,percent of total billed charges,78% of total billed charges,136.71,63,,109.368,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,82.46,38,,65.968,percent of total billed charges,38% of total billed charges,82.46,38,,65.968,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,195.3,90,,156.24,percent of total billed charges,90% of total billed charges,75.95,35,,60.76,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,173.6,80,,138.88,percent of total billed charges,80% of total billed charges,83.28,38.38,,66.624,percent of total billed charges,38.38% of total billed charges,173.6,80,,138.88,percent of total billed charges,80% of total billed charges,133.98,61.74,,107.184,percent of total billed charges,61.74% of total billed charges,221.34,102,,177.072,percent of total billed charges,102% of total billed charges,82.46,38,,65.968,percent of total billed charges,38% of total billed charges,75.95,221.34,
OT EVALUATION MODERATE COMPLEXITY,9000254,CDM,420,RC,97166,HCPCS,Outpatient,,,217,162.75,,169.26,78,,135.408,percent of total billed charges,78% of total billed charges,136.71,63,,109.368,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,82.46,38,,65.968,percent of total billed charges,38% of total billed charges,82.46,38,,65.968,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,195.3,90,,156.24,percent of total billed charges,90% of total billed charges,75.95,35,,60.76,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,173.6,80,,138.88,percent of total billed charges,80% of total billed charges,83.28,38.38,,66.624,percent of total billed charges,38.38% of total billed charges,173.6,80,,138.88,percent of total billed charges,80% of total billed charges,133.98,61.74,,107.184,percent of total billed charges,61.74% of total billed charges,221.34,102,,177.072,percent of total billed charges,102% of total billed charges,82.46,38,,65.968,percent of total billed charges,38% of total billed charges,75.95,221.34,
Test to assess for nerve damage,9600031,CDM,922,RC,95886,HCPCS,Outpatient,,,217,162.75,,169.26,78,,135.408,percent of total billed charges,78% of total billed charges,136.71,63,,109.368,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,82.46,38,,65.968,percent of total billed charges,38% of total billed charges,82.46,38,,65.968,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,195.3,90,,156.24,percent of total billed charges,90% of total billed charges,75.95,35,,60.76,percent of total billed charges,35% of total billed charges,145.99,67.275,,116.792,percent of total billed charges,67.275% of total billed charges,173.6,80,,138.88,percent of total billed charges,80% of total billed charges,83.28,38.38,,66.624,percent of total billed charges,38.38% of total billed charges,173.6,80,,138.88,percent of total billed charges,80% of total billed charges,133.98,61.74,,107.184,percent of total billed charges,61.74% of total billed charges,221.34,102,,177.072,percent of total billed charges,102% of total billed charges,82.46,38,,65.968,percent of total billed charges,38% of total billed charges,75.95,221.34,
CATAPRES LEVEL,5001438,CDM,301,RC,80299,HCPCS,Outpatient,,,218,163.5,,170.04,78,,136.032,percent of total billed charges,78% of total billed charges,15.14,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,15.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,146.66,67.275,,117.328,percent of total billed charges,67.275% of total billed charges,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,18.83,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,134.59,61.74,,107.672,percent of total billed charges,61.74% of total billed charges,15.44,102,,,Fee Schedule,102% of GA Medicaid Rate,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.14,196.2,
GABAPENTIN LEVEL,5001639,CDM,301,RC,80299,HCPCS,Outpatient,,,218,163.5,,170.04,78,,136.032,percent of total billed charges,78% of total billed charges,15.14,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,15.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,146.66,67.275,,117.328,percent of total billed charges,67.275% of total billed charges,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,18.83,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,134.59,61.74,,107.672,percent of total billed charges,61.74% of total billed charges,15.44,102,,,Fee Schedule,102% of GA Medicaid Rate,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.14,196.2,
MEXITITINE (MEXITIL),5001756,CDM,301,RC,80299,HCPCS,Outpatient,,,218,163.5,,170.04,78,,136.032,percent of total billed charges,78% of total billed charges,15.14,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,15.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,146.66,67.275,,117.328,percent of total billed charges,67.275% of total billed charges,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,18.83,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,134.59,61.74,,107.672,percent of total billed charges,61.74% of total billed charges,15.44,102,,,Fee Schedule,102% of GA Medicaid Rate,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.14,196.2,
OXCABAZEPINE(TRILEPTAL),5001757,CDM,301,RC,80299,HCPCS,Outpatient,,,218,163.5,,170.04,78,,136.032,percent of total billed charges,78% of total billed charges,15.14,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,15.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,146.66,67.275,,117.328,percent of total billed charges,67.275% of total billed charges,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,18.83,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,134.59,61.74,,107.672,percent of total billed charges,61.74% of total billed charges,15.44,102,,,Fee Schedule,102% of GA Medicaid Rate,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.14,196.2,
H PYLORI ANTIGEN STOOL,5001760,CDM,300,RC,87338,HCPCS,Outpatient,,,218,163.5,,170.04,78,,136.032,percent of total billed charges,78% of total billed charges,18.09,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.38,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.38,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,18.99,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,146.66,67.275,,117.328,percent of total billed charges,67.275% of total billed charges,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,14.52,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,134.59,61.74,,107.672,percent of total billed charges,61.74% of total billed charges,18.45,102,,,Fee Schedule,102% of GA Medicaid Rate,14.38,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.38,196.2,
IBUPROFEN,5001769,CDM,301,RC,80299,HCPCS,Outpatient,,,218,163.5,,170.04,78,,136.032,percent of total billed charges,78% of total billed charges,15.14,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,15.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,146.66,67.275,,117.328,percent of total billed charges,67.275% of total billed charges,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,18.83,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,134.59,61.74,,107.672,percent of total billed charges,61.74% of total billed charges,15.44,102,,,Fee Schedule,102% of GA Medicaid Rate,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.14,196.2,
PROZAC (FLUOXETINE),5001809,CDM,301,RC,80299,HCPCS,Outpatient,,,218,163.5,,170.04,78,,136.032,percent of total billed charges,78% of total billed charges,15.14,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,15.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,146.66,67.275,,117.328,percent of total billed charges,67.275% of total billed charges,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,18.83,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,134.59,61.74,,107.672,percent of total billed charges,61.74% of total billed charges,15.44,102,,,Fee Schedule,102% of GA Medicaid Rate,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.14,196.2,
AMIODARONE PROFILE,5001888,CDM,301,RC,80299,HCPCS,Outpatient,,,218,163.5,,170.04,78,,136.032,percent of total billed charges,78% of total billed charges,15.14,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,15.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,146.66,67.275,,117.328,percent of total billed charges,67.275% of total billed charges,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,18.83,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,134.59,61.74,,107.672,percent of total billed charges,61.74% of total billed charges,15.44,102,,,Fee Schedule,102% of GA Medicaid Rate,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.14,196.2,
CLONAZEPAM,5001912,CDM,301,RC,80299,HCPCS,Outpatient,,,218,163.5,,170.04,78,,136.032,percent of total billed charges,78% of total billed charges,15.14,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,15.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,146.66,67.275,,117.328,percent of total billed charges,67.275% of total billed charges,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,18.83,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,134.59,61.74,,107.672,percent of total billed charges,61.74% of total billed charges,15.44,102,,,Fee Schedule,102% of GA Medicaid Rate,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.14,196.2,
LEFLUNOMIDE METABOLITE,5002048,CDM,301,RC,80299,HCPCS,Outpatient,,,218,163.5,,170.04,78,,136.032,percent of total billed charges,78% of total billed charges,15.14,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,15.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,146.66,67.275,,117.328,percent of total billed charges,67.275% of total billed charges,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,18.83,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,134.59,61.74,,107.672,percent of total billed charges,61.74% of total billed charges,15.44,102,,,Fee Schedule,102% of GA Medicaid Rate,18.64,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.14,196.2,
WIRE 1.8 SMOOTH 400MM,3006009,CDM,270,RC,,,Outpatient,,,220,165,,171.6,78,,137.28,percent of total billed charges,78% of total billed charges,138.6,63,,110.88,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,83.6,38,,66.88,percent of total billed charges,38% of total billed charges,83.6,38,,66.88,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,198,90,,158.4,percent of total billed charges,90% of total billed charges,77,35,,61.6,percent of total billed charges,35% of total billed charges,148.01,67.275,,118.408,percent of total billed charges,67.275% of total billed charges,176,80,,140.8,percent of total billed charges,80% of total billed charges,84.44,38.38,,67.552,percent of total billed charges,38.38% of total billed charges,176,80,,140.8,percent of total billed charges,80% of total billed charges,135.83,61.74,,108.664,percent of total billed charges,61.74% of total billed charges,224.4,102,,179.52,percent of total billed charges,102% of total billed charges,83.6,38,,66.88,percent of total billed charges,38% of total billed charges,77,224.4,
TOXOPLASMA IGM ANTIBODY,5001961,CDM,302,RC,86778,HCPCS,Outpatient,,,220,165,,171.6,78,,137.28,percent of total billed charges,78% of total billed charges,18.11,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.41,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.41,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,198,90,,158.4,percent of total billed charges,90% of total billed charges,19.02,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,148.01,67.275,,118.408,percent of total billed charges,67.275% of total billed charges,176,80,,140.8,percent of total billed charges,80% of total billed charges,14.55,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,176,80,,140.8,percent of total billed charges,80% of total billed charges,135.83,61.74,,108.664,percent of total billed charges,61.74% of total billed charges,18.47,102,,,Fee Schedule,102% of GA Medicaid Rate,14.41,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.41,198,
INS NON-INDW BLDR CATH,1001103,CDM,450,RC,51701,HCPCS,Outpatient,,,221,165.75,,172.38,78,,137.904,percent of total billed charges,78% of total billed charges,139.23,63,,111.384,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,83.98,38,,67.184,percent of total billed charges,38% of total billed charges,83.98,38,,67.184,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,198.9,90,,159.12,percent of total billed charges,90% of total billed charges,77.35,35,,61.88,percent of total billed charges,35% of total billed charges,148.68,67.275,,118.944,percent of total billed charges,67.275% of total billed charges,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,84.82,38.38,,67.856,percent of total billed charges,38.38% of total billed charges,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,136.45,61.74,,109.16,percent of total billed charges,61.74% of total billed charges,225.42,102,,180.336,percent of total billed charges,102% of total billed charges,83.98,38,,67.184,percent of total billed charges,38% of total billed charges,77.35,225.42,
ARTERIAL PUNCTURE DIAG,1001130,CDM,450,RC,36600,HCPCS,Outpatient,,,221,165.75,,172.38,78,,137.904,percent of total billed charges,78% of total billed charges,139.23,63,,111.384,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,83.98,38,,67.184,percent of total billed charges,38% of total billed charges,83.98,38,,67.184,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,198.9,90,,159.12,percent of total billed charges,90% of total billed charges,77.35,35,,61.88,percent of total billed charges,35% of total billed charges,148.68,67.275,,118.944,percent of total billed charges,67.275% of total billed charges,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,84.82,38.38,,67.856,percent of total billed charges,38.38% of total billed charges,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,136.45,61.74,,109.16,percent of total billed charges,61.74% of total billed charges,225.42,102,,180.336,percent of total billed charges,102% of total billed charges,83.98,38,,67.184,percent of total billed charges,38% of total billed charges,77.35,225.42,
REMOVAL OF FB NASAL,1001220,CDM,450,RC,30300,HCPCS,Outpatient,,,221,165.75,,172.38,78,,137.904,percent of total billed charges,78% of total billed charges,139.23,63,,111.384,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,83.98,38,,67.184,percent of total billed charges,38% of total billed charges,83.98,38,,67.184,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,198.9,90,,159.12,percent of total billed charges,90% of total billed charges,77.35,35,,61.88,percent of total billed charges,35% of total billed charges,148.68,67.275,,118.944,percent of total billed charges,67.275% of total billed charges,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,84.82,38.38,,67.856,percent of total billed charges,38.38% of total billed charges,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,136.45,61.74,,109.16,percent of total billed charges,61.74% of total billed charges,225.42,102,,180.336,percent of total billed charges,102% of total billed charges,83.98,38,,67.184,percent of total billed charges,38% of total billed charges,77.35,225.42,
EVACUATION SUB HEMATOMA,1200142,CDM,981,RC,11740,HCPCS,Outpatient,,,221,165.75,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,34.53,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,34.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,34.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,34.53,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,34.53,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,30.88,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,34.85,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,133.72,61.74,,106.976,percent of total billed charges,61.74% of total billed charges,29.41,102,,,Fee Schedule,102% of GA Medicaid Rate,34.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,29.41,133.72,
NASAL HEMORRHAGE SIMPLE/ANTERIOR,1200162,CDM,981,RC,30901,HCPCS,Outpatient,,,221,165.75,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,64.11,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,64.11,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,64.11,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,64.11,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,64.11,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,84.77,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,67.51,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,133.72,61.74,,106.976,percent of total billed charges,61.74% of total billed charges,80.73,102,,,Fee Schedule,102% of GA Medicaid Rate,64.11,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,64.11,133.72,
NASAL HEMORRHAGE COMPLEX/ANTERIOR,1200163,CDM,981,RC,30903,HCPCS,Outpatient,,,221,165.75,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,87.8,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,87.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,87.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,87.8,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,87.8,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,106.96,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,91.85,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,133.72,61.74,,106.976,percent of total billed charges,61.74% of total billed charges,101.87,102,,,Fee Schedule,102% of GA Medicaid Rate,87.8,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,87.8,133.72,
NASAL HEMORRHAGE POSTERIOR,1200164,CDM,981,RC,30905,HCPCS,Outpatient,,,221,165.75,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,119.45,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,119.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,119.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,119.45,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,119.45,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,168.74,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,125.08,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,133.72,61.74,,106.976,percent of total billed charges,61.74% of total billed charges,160.7,102,,,Fee Schedule,102% of GA Medicaid Rate,119.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,119.45,168.74,
ANOSCOPY INITIAL,1200168,CDM,981,RC,46600,HCPCS,Outpatient,,,221,165.75,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,45.3,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,45.3,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,45.3,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,45.3,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,45.3,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,35.11,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.46,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,133.72,61.74,,106.976,percent of total billed charges,61.74% of total billed charges,33.44,102,,,Fee Schedule,102% of GA Medicaid Rate,45.3,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,33.44,133.72,
INTRANASAL/REMOVE FB,1200173,CDM,981,RC,30300,HCPCS,Outpatient,,,221,165.75,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,134.69,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,134.69,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,134.69,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,134.69,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,134.69,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,81.27,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,137.73,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,133.72,61.74,,106.976,percent of total billed charges,61.74% of total billed charges,77.4,102,,,Fee Schedule,102% of GA Medicaid Rate,134.69,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,77.4,137.73,
REMOVE FB CONJUNCTIVAL,1200176,CDM,981,RC,65205,HCPCS,Outpatient,,,221,165.75,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,32,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,32,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,32,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,32,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,32,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,124.74,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,33.01,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,133.72,61.74,,106.976,percent of total billed charges,61.74% of total billed charges,118.8,102,,,Fee Schedule,102% of GA Medicaid Rate,32,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,32,133.72,
EXTERNAL AUDITORY CANAL,1200178,CDM,981,RC,69200,HCPCS,Outpatient,,,221,165.75,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,52.54,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,52.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,52.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,52.54,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,52.54,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,54.98,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,54.6,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,133.72,61.74,,106.976,percent of total billed charges,61.74% of total billed charges,52.36,102,,,Fee Schedule,102% of GA Medicaid Rate,52.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,52.36,133.72,
SHORT ARM SPLINT,1200186,CDM,981,RC,29125,HCPCS,Outpatient,,,221,165.75,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,44.38,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,44.38,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,44.38,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,44.38,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,44.38,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,67.95,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,45.15,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,133.72,61.74,,106.976,percent of total billed charges,61.74% of total billed charges,64.71,102,,,Fee Schedule,102% of GA Medicaid Rate,44.38,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,44.38,133.72,
SHOULDER STRAPPING,1200189,CDM,981,RC,29240,HCPCS,Outpatient,,,221,165.75,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.45,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,20.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.45,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,20.45,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,52.33,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.28,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,133.72,61.74,,106.976,percent of total billed charges,61.74% of total billed charges,49.84,102,,,Fee Schedule,102% of GA Medicaid Rate,20.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.45,133.72,
"URINARY CATH, STRAIGHT",1200203,CDM,981,RC,51701,HCPCS,Outpatient,,,221,165.75,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.43,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,28.43,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,28.43,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,28.43,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,28.43,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,54.08,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,30.61,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,133.72,61.74,,106.976,percent of total billed charges,61.74% of total billed charges,51.5,102,,,Fee Schedule,102% of GA Medicaid Rate,28.43,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,28.43,133.72,
"URINARY CATH, FOLEY, SIMPLE",1200204,CDM,981,RC,51702,HCPCS,Outpatient,,,221,165.75,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.04,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,28.04,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,28.04,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,28.04,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,28.04,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,85.58,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,30.08,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,133.72,61.74,,106.976,percent of total billed charges,61.74% of total billed charges,81.5,102,,,Fee Schedule,102% of GA Medicaid Rate,28.04,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,28.04,133.72,
REMOVE CORNEAL FB/WITH SLIT LAMP,1200237,CDM,981,RC,65222,HCPCS,Outpatient,,,221,165.75,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,54.57,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,54.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,54.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,54.57,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,54.57,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,138,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,56.37,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,133.72,61.74,,106.976,percent of total billed charges,61.74% of total billed charges,131.43,102,,,Fee Schedule,102% of GA Medicaid Rate,54.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,54.57,138,
CULTURE VIRUS,5000214,CDM,306,RC,87252,HCPCS,Outpatient,,,221,165.75,,172.38,78,,137.904,percent of total billed charges,78% of total billed charges,27.8,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,26.07,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,26.07,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,198.9,90,,159.12,percent of total billed charges,90% of total billed charges,29.19,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,148.68,67.275,,118.944,percent of total billed charges,67.275% of total billed charges,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,26.33,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,136.45,61.74,,109.16,percent of total billed charges,61.74% of total billed charges,28.36,102,,,Fee Schedule,102% of GA Medicaid Rate,26.07,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,26.07,198.9,
PAP smear,5001279,CDM,300,RC,88142,HCPCS,Outpatient,,,221,165.75,,172.38,78,,137.904,percent of total billed charges,78% of total billed charges,25.48,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,20.26,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.26,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,198.9,90,,159.12,percent of total billed charges,90% of total billed charges,26.75,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,148.68,67.275,,118.944,percent of total billed charges,67.275% of total billed charges,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,20.46,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,136.45,61.74,,109.16,percent of total billed charges,61.74% of total billed charges,25.99,102,,,Fee Schedule,102% of GA Medicaid Rate,20.26,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.26,198.9,
THYROID PEROXIDASE,5001401,CDM,300,RC,86376,HCPCS,Outpatient,,,221,165.75,,172.38,78,,137.904,percent of total billed charges,78% of total billed charges,18.3,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.55,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.55,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,198.9,90,,159.12,percent of total billed charges,90% of total billed charges,19.22,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,148.68,67.275,,118.944,percent of total billed charges,67.275% of total billed charges,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,14.7,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,136.45,61.74,,109.16,percent of total billed charges,61.74% of total billed charges,18.67,102,,,Fee Schedule,102% of GA Medicaid Rate,14.55,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.55,198.9,
PAP smear,5001659,CDM,300,RC,88142,HCPCS,Outpatient,,,221,165.75,,172.38,78,,137.904,percent of total billed charges,78% of total billed charges,25.48,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,20.26,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.26,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,198.9,90,,159.12,percent of total billed charges,90% of total billed charges,26.75,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,148.68,67.275,,118.944,percent of total billed charges,67.275% of total billed charges,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,20.46,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,136.45,61.74,,109.16,percent of total billed charges,61.74% of total billed charges,25.99,102,,,Fee Schedule,102% of GA Medicaid Rate,20.26,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.26,198.9,
.ANTI-THYROID PEROXIDASE,5001837,CDM,302,RC,86376,HCPCS,Outpatient,,,221,165.75,,172.38,78,,137.904,percent of total billed charges,78% of total billed charges,18.3,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.55,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.55,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,198.9,90,,159.12,percent of total billed charges,90% of total billed charges,19.22,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,148.68,67.275,,118.944,percent of total billed charges,67.275% of total billed charges,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,14.7,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,136.45,61.74,,109.16,percent of total billed charges,61.74% of total billed charges,18.67,102,,,Fee Schedule,102% of GA Medicaid Rate,14.55,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.55,198.9,
LIVER KIDNEY MICROSOME,5003740,CDM,302,RC,86376,HCPCS,Outpatient,,,221,165.75,,172.38,78,,137.904,percent of total billed charges,78% of total billed charges,18.3,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.55,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.55,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,198.9,90,,159.12,percent of total billed charges,90% of total billed charges,19.22,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,148.68,67.275,,118.944,percent of total billed charges,67.275% of total billed charges,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,14.7,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,136.45,61.74,,109.16,percent of total billed charges,61.74% of total billed charges,18.67,102,,,Fee Schedule,102% of GA Medicaid Rate,14.55,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.55,198.9,
BB ABO GROUP,5200430,CDM,300,RC,86900,HCPCS,Outpatient,,,221,165.75,,172.38,78,,137.904,percent of total billed charges,78% of total billed charges,3.75,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,2.99,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,2.99,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,198.9,90,,159.12,percent of total billed charges,90% of total billed charges,3.94,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,148.68,67.275,,118.944,percent of total billed charges,67.275% of total billed charges,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,3.02,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,136.45,61.74,,109.16,percent of total billed charges,61.74% of total billed charges,3.83,102,,,Fee Schedule,102% of GA Medicaid Rate,2.99,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,2.99,198.9,
BB THERAPEUTIC PHLEBOTOMY,5200460,CDM,949,RC,99195,HCPCS,Outpatient,,,221,165.75,,172.38,78,,137.904,percent of total billed charges,78% of total billed charges,139.23,63,,111.384,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,83.98,38,,67.184,percent of total billed charges,38% of total billed charges,83.98,38,,67.184,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,198.9,90,,159.12,percent of total billed charges,90% of total billed charges,77.35,35,,61.88,percent of total billed charges,35% of total billed charges,148.68,67.275,,118.944,percent of total billed charges,67.275% of total billed charges,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,84.82,38.38,,67.856,percent of total billed charges,38.38% of total billed charges,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,136.45,61.74,,109.16,percent of total billed charges,61.74% of total billed charges,225.42,102,,180.336,percent of total billed charges,102% of total billed charges,83.98,38,,67.184,percent of total billed charges,38% of total billed charges,77.35,225.42,
"FLUORO GUIDANCE, NEEDLE PLACEMENT",7000822,CDM,320,RC,77002,HCPCS,Outpatient,,,221,165.75,,172.38,78,,137.904,percent of total billed charges,78% of total billed charges,139.23,63,,111.384,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,83.98,38,,67.184,percent of total billed charges,38% of total billed charges,83.98,38,,67.184,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,198.9,90,,159.12,percent of total billed charges,90% of total billed charges,77.35,35,,61.88,percent of total billed charges,35% of total billed charges,148.68,67.275,,118.944,percent of total billed charges,67.275% of total billed charges,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,84.82,38.38,,67.856,percent of total billed charges,38.38% of total billed charges,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,136.45,61.74,,109.16,percent of total billed charges,61.74% of total billed charges,225.42,102,,180.336,percent of total billed charges,102% of total billed charges,83.98,38,,67.184,percent of total billed charges,38% of total billed charges,77.35,225.42,
CHEST PT/PD,8000101,CDM,410,RC,94667,HCPCS,Outpatient,,,221,165.75,,172.38,78,,137.904,percent of total billed charges,78% of total billed charges,139.23,63,,111.384,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,83.98,38,,67.184,percent of total billed charges,38% of total billed charges,83.98,38,,67.184,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,198.9,90,,159.12,percent of total billed charges,90% of total billed charges,77.35,35,,61.88,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,84.82,38.38,,67.856,percent of total billed charges,38.38% of total billed charges,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,136.45,61.74,,109.16,percent of total billed charges,61.74% of total billed charges,225.42,102,,180.336,percent of total billed charges,102% of total billed charges,83.98,38,,67.184,percent of total billed charges,38% of total billed charges,77.35,225.42,
"MANIPULATION CHEST WALL, SUBSEQUENT",8000102,CDM,410,RC,94668,HCPCS,Outpatient,,,221,165.75,,172.38,78,,137.904,percent of total billed charges,78% of total billed charges,139.23,63,,111.384,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,83.98,38,,67.184,percent of total billed charges,38% of total billed charges,83.98,38,,67.184,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,198.9,90,,159.12,percent of total billed charges,90% of total billed charges,77.35,35,,61.88,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,84.82,38.38,,67.856,percent of total billed charges,38.38% of total billed charges,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,136.45,61.74,,109.16,percent of total billed charges,61.74% of total billed charges,225.42,102,,180.336,percent of total billed charges,102% of total billed charges,83.98,38,,67.184,percent of total billed charges,38% of total billed charges,77.35,225.42,
CHEST PHYSIOTHERAPY FIRST TREATMENT,8094667,CDM,410,RC,94667,HCPCS,Outpatient,,,221,165.75,,172.38,78,,137.904,percent of total billed charges,78% of total billed charges,139.23,63,,111.384,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,83.98,38,,67.184,percent of total billed charges,38% of total billed charges,83.98,38,,67.184,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,198.9,90,,159.12,percent of total billed charges,90% of total billed charges,77.35,35,,61.88,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,84.82,38.38,,67.856,percent of total billed charges,38.38% of total billed charges,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,136.45,61.74,,109.16,percent of total billed charges,61.74% of total billed charges,225.42,102,,180.336,percent of total billed charges,102% of total billed charges,83.98,38,,67.184,percent of total billed charges,38% of total billed charges,77.35,225.42,
CHEST PHYSIOTHERAPY TREATMENT EA  ADDL,8094668,CDM,410,RC,94668,HCPCS,Outpatient,,,221,165.75,,172.38,78,,137.904,percent of total billed charges,78% of total billed charges,139.23,63,,111.384,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,83.98,38,,67.184,percent of total billed charges,38% of total billed charges,83.98,38,,67.184,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,198.9,90,,159.12,percent of total billed charges,90% of total billed charges,77.35,35,,61.88,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,84.82,38.38,,67.856,percent of total billed charges,38.38% of total billed charges,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,136.45,61.74,,109.16,percent of total billed charges,61.74% of total billed charges,225.42,102,,180.336,percent of total billed charges,102% of total billed charges,83.98,38,,67.184,percent of total billed charges,38% of total billed charges,77.35,225.42,
OT EVALUATION HIGH COMPLEXITY,9000256,CDM,420,RC,97167,HCPCS,Outpatient,,,221,165.75,,172.38,78,,137.904,percent of total billed charges,78% of total billed charges,139.23,63,,111.384,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,83.98,38,,67.184,percent of total billed charges,38% of total billed charges,83.98,38,,67.184,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,198.9,90,,159.12,percent of total billed charges,90% of total billed charges,77.35,35,,61.88,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,84.82,38.38,,67.856,percent of total billed charges,38.38% of total billed charges,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,136.45,61.74,,109.16,percent of total billed charges,61.74% of total billed charges,225.42,102,,180.336,percent of total billed charges,102% of total billed charges,83.98,38,,67.184,percent of total billed charges,38% of total billed charges,77.35,225.42,
Test to measure electrical activity of muscles or nerves in 1 limb,9600010,CDM,922,RC,95860,HCPCS,Outpatient,,,221,165.75,,172.38,78,,137.904,percent of total billed charges,78% of total billed charges,139.23,63,,111.384,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,83.98,38,,67.184,percent of total billed charges,38% of total billed charges,83.98,38,,67.184,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,198.9,90,,159.12,percent of total billed charges,90% of total billed charges,77.35,35,,61.88,percent of total billed charges,35% of total billed charges,148.68,67.275,,118.944,percent of total billed charges,67.275% of total billed charges,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,84.82,38.38,,67.856,percent of total billed charges,38.38% of total billed charges,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,136.45,61.74,,109.16,percent of total billed charges,61.74% of total billed charges,225.42,102,,180.336,percent of total billed charges,102% of total billed charges,83.98,38,,67.184,percent of total billed charges,38% of total billed charges,77.35,225.42,
Test to measure electrical activity of muscles or nerves in 2 limb,9600011,CDM,922,RC,95861,HCPCS,Outpatient,,,221,165.75,,172.38,78,,137.904,percent of total billed charges,78% of total billed charges,139.23,63,,111.384,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,83.98,38,,67.184,percent of total billed charges,38% of total billed charges,83.98,38,,67.184,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,198.9,90,,159.12,percent of total billed charges,90% of total billed charges,77.35,35,,61.88,percent of total billed charges,35% of total billed charges,148.68,67.275,,118.944,percent of total billed charges,67.275% of total billed charges,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,84.82,38.38,,67.856,percent of total billed charges,38.38% of total billed charges,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,136.45,61.74,,109.16,percent of total billed charges,61.74% of total billed charges,225.42,102,,180.336,percent of total billed charges,102% of total billed charges,83.98,38,,67.184,percent of total billed charges,38% of total billed charges,77.35,225.42,
CLIP APPLIER MED,3000249,CDM,270,RC,,,Outpatient,,,221.32,165.99,,172.63,78,,138.104,percent of total billed charges,78% of total billed charges,139.43,63,,111.544,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,84.1,38,,67.28,percent of total billed charges,38% of total billed charges,84.1,38,,67.28,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,199.19,90,,159.352,percent of total billed charges,90% of total billed charges,77.46,35,,61.968,percent of total billed charges,35% of total billed charges,148.89,67.275,,119.112,percent of total billed charges,67.275% of total billed charges,177.06,80,,141.648,percent of total billed charges,80% of total billed charges,84.94,38.38,,67.952,percent of total billed charges,38.38% of total billed charges,177.06,80,,141.648,percent of total billed charges,80% of total billed charges,136.64,61.74,,109.312,percent of total billed charges,61.74% of total billed charges,225.75,102,,180.6,percent of total billed charges,102% of total billed charges,84.1,38,,67.28,percent of total billed charges,38% of total billed charges,77.46,225.75,
ANTI DIURECTIC HORMONE,5001907,CDM,301,RC,84588,HCPCS,Outpatient,,,222,166.5,,173.16,78,,138.528,percent of total billed charges,78% of total billed charges,42.69,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,33.94,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,33.94,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,199.8,90,,159.84,percent of total billed charges,90% of total billed charges,44.82,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,149.35,67.275,,119.48,percent of total billed charges,67.275% of total billed charges,177.6,80,,142.08,percent of total billed charges,80% of total billed charges,34.28,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,177.6,80,,142.08,percent of total billed charges,80% of total billed charges,137.06,61.74,,109.648,percent of total billed charges,61.74% of total billed charges,43.54,102,,,Fee Schedule,102% of GA Medicaid Rate,33.94,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,33.94,199.8,
PLAC,5002021,CDM,301,RC,83698,HCPCS,Outpatient,,,222,166.5,,173.16,78,,138.528,percent of total billed charges,78% of total billed charges,42.69,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,46.31,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,46.31,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,199.8,90,,159.84,percent of total billed charges,90% of total billed charges,44.82,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,149.35,67.275,,119.48,percent of total billed charges,67.275% of total billed charges,177.6,80,,142.08,percent of total billed charges,80% of total billed charges,46.77,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,177.6,80,,142.08,percent of total billed charges,80% of total billed charges,137.06,61.74,,109.648,percent of total billed charges,61.74% of total billed charges,43.54,102,,,Fee Schedule,102% of GA Medicaid Rate,46.31,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,42.69,199.8,
Blood test to measure level of prealbumin,5000456,CDM,301,RC,84134,HCPCS,Outpatient,,,223,167.25,,173.94,78,,139.152,percent of total billed charges,78% of total billed charges,18.34,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.59,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.59,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,200.7,90,,160.56,percent of total billed charges,90% of total billed charges,19.26,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,150.02,67.275,,120.016,percent of total billed charges,67.275% of total billed charges,178.4,80,,142.72,percent of total billed charges,80% of total billed charges,14.74,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,178.4,80,,142.72,percent of total billed charges,80% of total billed charges,137.68,61.74,,110.144,percent of total billed charges,61.74% of total billed charges,18.71,102,,,Fee Schedule,102% of GA Medicaid Rate,14.59,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.59,200.7,
ACE,5001937,CDM,301,RC,82164,HCPCS,Outpatient,,,223,167.25,,173.94,78,,139.152,percent of total billed charges,78% of total billed charges,18.35,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,200.7,90,,160.56,percent of total billed charges,90% of total billed charges,19.27,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,150.02,67.275,,120.016,percent of total billed charges,67.275% of total billed charges,178.4,80,,142.72,percent of total billed charges,80% of total billed charges,14.75,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,178.4,80,,142.72,percent of total billed charges,80% of total billed charges,137.68,61.74,,110.144,percent of total billed charges,61.74% of total billed charges,18.72,102,,,Fee Schedule,102% of GA Medicaid Rate,14.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.6,200.7,
"US OB GREATER/= 14 WKS,EACH ADD'L GESTAT",7300011,CDM,402,RC,76810,HCPCS,Outpatient,,,223,167.25,,173.94,78,,139.152,percent of total billed charges,78% of total billed charges,140.49,63,,112.392,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,84.74,38,,67.792,percent of total billed charges,38% of total billed charges,84.74,38,,67.792,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,200.7,90,,160.56,percent of total billed charges,90% of total billed charges,78.05,35,,62.44,percent of total billed charges,35% of total billed charges,150.02,67.275,,120.016,percent of total billed charges,67.275% of total billed charges,178.4,80,,142.72,percent of total billed charges,80% of total billed charges,85.59,38.38,,68.472,percent of total billed charges,38.38% of total billed charges,178.4,80,,142.72,percent of total billed charges,80% of total billed charges,137.68,61.74,,110.144,percent of total billed charges,61.74% of total billed charges,227.46,102,,181.968,percent of total billed charges,102% of total billed charges,84.74,38,,67.792,percent of total billed charges,38% of total billed charges,78.05,227.46,
ST EVALUATION SPEECH/COGNITION,9000116,CDM,440,RC,92522,HCPCS,Outpatient,,,223,167.25,,173.94,78,,139.152,percent of total billed charges,78% of total billed charges,140.49,63,,112.392,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,84.74,38,,67.792,percent of total billed charges,38% of total billed charges,84.74,38,,67.792,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,200.7,90,,160.56,percent of total billed charges,90% of total billed charges,78.05,35,,62.44,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,178.4,80,,142.72,percent of total billed charges,80% of total billed charges,85.59,38.38,,68.472,percent of total billed charges,38.38% of total billed charges,178.4,80,,142.72,percent of total billed charges,80% of total billed charges,137.68,61.74,,110.144,percent of total billed charges,61.74% of total billed charges,227.46,102,,181.968,percent of total billed charges,102% of total billed charges,84.74,38,,67.792,percent of total billed charges,38% of total billed charges,78.05,227.46,
GRASPING FORCEP,3004283,CDM,270,RC,,,Outpatient,,,223.6,167.7,,174.41,78,,139.528,percent of total billed charges,78% of total billed charges,140.87,63,,112.696,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,84.97,38,,67.976,percent of total billed charges,38% of total billed charges,84.97,38,,67.976,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,201.24,90,,160.992,percent of total billed charges,90% of total billed charges,78.26,35,,62.608,percent of total billed charges,35% of total billed charges,150.43,67.275,,120.344,percent of total billed charges,67.275% of total billed charges,178.88,80,,143.104,percent of total billed charges,80% of total billed charges,85.82,38.38,,68.656,percent of total billed charges,38.38% of total billed charges,178.88,80,,143.104,percent of total billed charges,80% of total billed charges,138.05,61.74,,110.44,percent of total billed charges,61.74% of total billed charges,228.07,102,,182.456,percent of total billed charges,102% of total billed charges,84.97,38,,67.976,percent of total billed charges,38% of total billed charges,78.26,228.07,
SURGICEL 4X8,3001773,CDM,270,RC,,,Outpatient,,,224.16,168.12,,174.84,78,,139.872,percent of total billed charges,78% of total billed charges,141.22,63,,112.976,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,85.18,38,,68.144,percent of total billed charges,38% of total billed charges,85.18,38,,68.144,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,201.74,90,,161.392,percent of total billed charges,90% of total billed charges,78.46,35,,62.768,percent of total billed charges,35% of total billed charges,150.8,67.275,,120.64,percent of total billed charges,67.275% of total billed charges,179.33,80,,143.464,percent of total billed charges,80% of total billed charges,86.03,38.38,,68.824,percent of total billed charges,38.38% of total billed charges,179.33,80,,143.464,percent of total billed charges,80% of total billed charges,138.4,61.74,,110.72,percent of total billed charges,61.74% of total billed charges,228.64,102,,182.912,percent of total billed charges,102% of total billed charges,85.18,38,,68.144,percent of total billed charges,38% of total billed charges,78.46,228.64,
ALK PHOSPHATASE ISOENZYMES,5000754,CDM,301,RC,84080,HCPCS,Outpatient,,,225,168.75,,175.5,78,,140.4,percent of total billed charges,78% of total billed charges,18.59,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.78,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.78,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,202.5,90,,162,percent of total billed charges,90% of total billed charges,19.52,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,151.37,67.275,,121.096,percent of total billed charges,67.275% of total billed charges,180,80,,144,percent of total billed charges,80% of total billed charges,14.93,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,180,80,,144,percent of total billed charges,80% of total billed charges,138.92,61.74,,111.136,percent of total billed charges,61.74% of total billed charges,18.96,102,,,Fee Schedule,102% of GA Medicaid Rate,14.78,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.78,202.5,
.PHOS ALK ISOENZYME,5001420,CDM,301,RC,84080,HCPCS,Outpatient,,,225,168.75,,175.5,78,,140.4,percent of total billed charges,78% of total billed charges,18.59,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,14.78,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.78,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,202.5,90,,162,percent of total billed charges,90% of total billed charges,19.52,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,151.37,67.275,,121.096,percent of total billed charges,67.275% of total billed charges,180,80,,144,percent of total billed charges,80% of total billed charges,14.93,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,180,80,,144,percent of total billed charges,80% of total billed charges,138.92,61.74,,111.136,percent of total billed charges,61.74% of total billed charges,18.96,102,,,Fee Schedule,102% of GA Medicaid Rate,14.78,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,14.78,202.5,
.METHYLENETETRAHYDROFOLATE REDUCTASE,5001666,CDM,301,RC,83891,HCPCS,Outpatient,,,226,169.5,,176.28,78,,141.024,percent of total billed charges,78% of total billed charges,142.38,63,,113.904,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,85.88,38,,68.704,percent of total billed charges,38% of total billed charges,85.88,38,,68.704,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,203.4,90,,162.72,percent of total billed charges,90% of total billed charges,79.1,35,,63.28,percent of total billed charges,35% of total billed charges,152.04,67.275,,121.632,percent of total billed charges,67.275% of total billed charges,180.8,80,,144.64,percent of total billed charges,80% of total billed charges,86.74,38.38,,69.392,percent of total billed charges,38.38% of total billed charges,180.8,80,,144.64,percent of total billed charges,80% of total billed charges,139.53,61.74,,111.624,percent of total billed charges,61.74% of total billed charges,230.52,102,,184.416,percent of total billed charges,102% of total billed charges,85.88,38,,68.704,percent of total billed charges,38% of total billed charges,79.1,230.52,
AIRWAY EXCHANGE CATH 14 FR,3001014,CDM,270,RC,,,Outpatient,,,226.92,170.19,,177,78,,141.6,percent of total billed charges,78% of total billed charges,142.96,63,,114.368,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,86.23,38,,68.984,percent of total billed charges,38% of total billed charges,86.23,38,,68.984,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,204.23,90,,163.384,percent of total billed charges,90% of total billed charges,79.42,35,,63.536,percent of total billed charges,35% of total billed charges,152.66,67.275,,122.128,percent of total billed charges,67.275% of total billed charges,181.54,80,,145.232,percent of total billed charges,80% of total billed charges,87.09,38.38,,69.672,percent of total billed charges,38.38% of total billed charges,181.54,80,,145.232,percent of total billed charges,80% of total billed charges,140.1,61.74,,112.08,percent of total billed charges,61.74% of total billed charges,231.46,102,,185.168,percent of total billed charges,102% of total billed charges,86.23,38,,68.984,percent of total billed charges,38% of total billed charges,79.42,231.46,
COLLAR PHILADELPHIA TRACH,3003564,CDM,270,RC,,,Outpatient,,,228,171,,177.84,78,,142.272,percent of total billed charges,78% of total billed charges,143.64,63,,114.912,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,86.64,38,,69.312,percent of total billed charges,38% of total billed charges,86.64,38,,69.312,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,205.2,90,,164.16,percent of total billed charges,90% of total billed charges,79.8,35,,63.84,percent of total billed charges,35% of total billed charges,153.39,67.275,,122.712,percent of total billed charges,67.275% of total billed charges,182.4,80,,145.92,percent of total billed charges,80% of total billed charges,87.51,38.38,,70.008,percent of total billed charges,38.38% of total billed charges,182.4,80,,145.92,percent of total billed charges,80% of total billed charges,140.77,61.74,,112.616,percent of total billed charges,61.74% of total billed charges,232.56,102,,186.048,percent of total billed charges,102% of total billed charges,86.64,38,,69.312,percent of total billed charges,38% of total billed charges,79.8,232.56,
"KAPPA LIGHT CHAINS, FREE",5002009,CDM,301,RC,83883,HCPCS,Outpatient,,,228,171,,177.84,78,,142.272,percent of total billed charges,78% of total billed charges,17.1,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,205.2,90,,164.16,percent of total billed charges,90% of total billed charges,17.96,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,153.39,67.275,,122.712,percent of total billed charges,67.275% of total billed charges,182.4,80,,145.92,percent of total billed charges,80% of total billed charges,13.74,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,182.4,80,,145.92,percent of total billed charges,80% of total billed charges,140.77,61.74,,112.616,percent of total billed charges,61.74% of total billed charges,17.44,102,,,Fee Schedule,102% of GA Medicaid Rate,13.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.6,205.2,
"LAMBDA LIGHT CHAIN, FREE",5003908,CDM,301,RC,83883,HCPCS,Outpatient,,,228,171,,177.84,78,,142.272,percent of total billed charges,78% of total billed charges,17.1,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,205.2,90,,164.16,percent of total billed charges,90% of total billed charges,17.96,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,153.39,67.275,,122.712,percent of total billed charges,67.275% of total billed charges,182.4,80,,145.92,percent of total billed charges,80% of total billed charges,13.74,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,182.4,80,,145.92,percent of total billed charges,80% of total billed charges,140.77,61.74,,112.616,percent of total billed charges,61.74% of total billed charges,17.44,102,,,Fee Schedule,102% of GA Medicaid Rate,13.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.6,205.2,
ASPERGILLUS NIGER,5001941,CDM,302,RC,86606,HCPCS,Outpatient,,,230,172.5,,179.4,78,,143.52,percent of total billed charges,78% of total billed charges,18.93,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,15.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,207,90,,165.6,percent of total billed charges,90% of total billed charges,19.88,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,154.73,67.275,,123.784,percent of total billed charges,67.275% of total billed charges,184,80,,147.2,percent of total billed charges,80% of total billed charges,15.2,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,184,80,,147.2,percent of total billed charges,80% of total billed charges,142,61.74,,113.6,percent of total billed charges,61.74% of total billed charges,19.31,102,,,Fee Schedule,102% of GA Medicaid Rate,15.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.05,207,
VIP VASOACTIVE INTESTINAL PEPTIDE,5001997,CDM,301,RC,84586,HCPCS,Outpatient,,,231,173.25,,180.18,78,,144.144,percent of total billed charges,78% of total billed charges,44.43,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,35.33,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,35.33,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,207.9,90,,166.32,percent of total billed charges,90% of total billed charges,46.65,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,155.41,67.275,,124.328,percent of total billed charges,67.275% of total billed charges,184.8,80,,147.84,percent of total billed charges,80% of total billed charges,35.68,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,184.8,80,,147.84,percent of total billed charges,80% of total billed charges,142.62,61.74,,114.096,percent of total billed charges,61.74% of total billed charges,45.32,102,,,Fee Schedule,102% of GA Medicaid Rate,35.33,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,35.33,207.9,
AIRVO A/S CIRCUIT KIT,3000014,CDM,270,RC,,,Outpatient,,,232,174,,180.96,78,,144.768,percent of total billed charges,78% of total billed charges,146.16,63,,116.928,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,88.16,38,,70.528,percent of total billed charges,38% of total billed charges,88.16,38,,70.528,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,208.8,90,,167.04,percent of total billed charges,90% of total billed charges,81.2,35,,64.96,percent of total billed charges,35% of total billed charges,156.08,67.275,,124.864,percent of total billed charges,67.275% of total billed charges,185.6,80,,148.48,percent of total billed charges,80% of total billed charges,89.04,38.38,,71.232,percent of total billed charges,38.38% of total billed charges,185.6,80,,148.48,percent of total billed charges,80% of total billed charges,143.24,61.74,,114.592,percent of total billed charges,61.74% of total billed charges,236.64,102,,189.312,percent of total billed charges,102% of total billed charges,88.16,38,,70.528,percent of total billed charges,38% of total billed charges,81.2,236.64,
Chemical test of the blood to measure presence or concentration of a substance in the blood,5000192,CDM,301,RC,83516,HCPCS,Outpatient,,,232,174,,180.96,78,,144.768,percent of total billed charges,78% of total billed charges,13.45,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,11.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,208.8,90,,167.04,percent of total billed charges,90% of total billed charges,14.12,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,156.08,67.275,,124.864,percent of total billed charges,67.275% of total billed charges,185.6,80,,148.48,percent of total billed charges,80% of total billed charges,11.65,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,185.6,80,,148.48,percent of total billed charges,80% of total billed charges,143.24,61.74,,114.592,percent of total billed charges,61.74% of total billed charges,13.72,102,,,Fee Schedule,102% of GA Medicaid Rate,11.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.53,208.8,
Chemical test of the blood to measure presence or concentration of a substance in the blood,5000258,CDM,301,RC,83516,HCPCS,Outpatient,,,232,174,,180.96,78,,144.768,percent of total billed charges,78% of total billed charges,13.45,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,11.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,208.8,90,,167.04,percent of total billed charges,90% of total billed charges,14.12,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,156.08,67.275,,124.864,percent of total billed charges,67.275% of total billed charges,185.6,80,,148.48,percent of total billed charges,80% of total billed charges,11.65,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,185.6,80,,148.48,percent of total billed charges,80% of total billed charges,143.24,61.74,,114.592,percent of total billed charges,61.74% of total billed charges,13.72,102,,,Fee Schedule,102% of GA Medicaid Rate,11.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,11.53,208.8,
.EPSTEIN BARR NA,5001815,CDM,302,RC,86664,HCPCS,Outpatient,,,232,174,,180.96,78,,144.768,percent of total billed charges,78% of total billed charges,19.24,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,15.29,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.29,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,208.8,90,,167.04,percent of total billed charges,90% of total billed charges,20.2,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,156.08,67.275,,124.864,percent of total billed charges,67.275% of total billed charges,185.6,80,,148.48,percent of total billed charges,80% of total billed charges,15.44,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,185.6,80,,148.48,percent of total billed charges,80% of total billed charges,143.24,61.74,,114.592,percent of total billed charges,61.74% of total billed charges,19.62,102,,,Fee Schedule,102% of GA Medicaid Rate,15.29,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.29,208.8,
INCENTIVE SPIROMETRY 1ST TREATMENT,8094642,CDM,460,RC,94640,HCPCS,Outpatient,,,234,175.5,,182.52,78,,146.016,percent of total billed charges,78% of total billed charges,147.42,63,,117.936,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,88.92,38,,71.136,percent of total billed charges,38% of total billed charges,88.92,38,,71.136,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,210.6,90,,168.48,percent of total billed charges,90% of total billed charges,81.9,35,,65.52,percent of total billed charges,35% of total billed charges,157.42,67.275,,125.936,percent of total billed charges,67.275% of total billed charges,187.2,80,,149.76,percent of total billed charges,80% of total billed charges,89.81,38.38,,71.848,percent of total billed charges,38.38% of total billed charges,187.2,80,,149.76,percent of total billed charges,80% of total billed charges,144.47,61.74,,115.576,percent of total billed charges,61.74% of total billed charges,238.68,102,,190.944,percent of total billed charges,102% of total billed charges,88.92,38,,71.136,percent of total billed charges,38% of total billed charges,81.9,238.68,
DRAINAGE PLEURX SPECIAL,3001170,CDM,270,RC,,,Outpatient,,,236,177,,184.08,78,,147.264,percent of total billed charges,78% of total billed charges,148.68,63,,118.944,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,89.68,38,,71.744,percent of total billed charges,38% of total billed charges,89.68,38,,71.744,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,212.4,90,,169.92,percent of total billed charges,90% of total billed charges,82.6,35,,66.08,percent of total billed charges,35% of total billed charges,158.77,67.275,,127.016,percent of total billed charges,67.275% of total billed charges,188.8,80,,151.04,percent of total billed charges,80% of total billed charges,90.58,38.38,,72.464,percent of total billed charges,38.38% of total billed charges,188.8,80,,151.04,percent of total billed charges,80% of total billed charges,145.71,61.74,,116.568,percent of total billed charges,61.74% of total billed charges,240.72,102,,192.576,percent of total billed charges,102% of total billed charges,89.68,38,,71.744,percent of total billed charges,38% of total billed charges,82.6,240.72,
"LYME, CSF",5001432,CDM,306,RC,87476,HCPCS,Outpatient,,,236,177,,184.08,78,,147.264,percent of total billed charges,78% of total billed charges,24.67,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,212.4,90,,169.92,percent of total billed charges,90% of total billed charges,25.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,158.77,67.275,,127.016,percent of total billed charges,67.275% of total billed charges,188.8,80,,151.04,percent of total billed charges,80% of total billed charges,35.44,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,188.8,80,,151.04,percent of total billed charges,80% of total billed charges,145.71,61.74,,116.568,percent of total billed charges,61.74% of total billed charges,25.16,102,,,Fee Schedule,102% of GA Medicaid Rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,24.67,212.4,
TREATMENT OF BURNS,1001182,CDM,450,RC,,,Outpatient,,,239,179.25,,186.42,78,,149.136,percent of total billed charges,78% of total billed charges,150.57,63,,120.456,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,90.82,38,,72.656,percent of total billed charges,38% of total billed charges,90.82,38,,72.656,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,215.1,90,,172.08,percent of total billed charges,90% of total billed charges,83.65,35,,66.92,percent of total billed charges,35% of total billed charges,160.79,67.275,,128.632,percent of total billed charges,67.275% of total billed charges,191.2,80,,152.96,percent of total billed charges,80% of total billed charges,91.73,38.38,,73.384,percent of total billed charges,38.38% of total billed charges,191.2,80,,152.96,percent of total billed charges,80% of total billed charges,147.56,61.74,,118.048,percent of total billed charges,61.74% of total billed charges,243.78,102,,195.024,percent of total billed charges,102% of total billed charges,90.82,38,,72.656,percent of total billed charges,38% of total billed charges,83.65,243.78,
ACHR BLOCKING ANTIBODY,5001646,CDM,301,RC,83519,HCPCS,Outpatient,,,239,179.25,,186.42,78,,149.136,percent of total billed charges,78% of total billed charges,16.99,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,215.1,90,,172.08,percent of total billed charges,90% of total billed charges,17.84,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,160.79,67.275,,128.632,percent of total billed charges,67.275% of total billed charges,191.2,80,,152.96,percent of total billed charges,80% of total billed charges,18.58,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,191.2,80,,152.96,percent of total billed charges,80% of total billed charges,147.56,61.74,,118.048,percent of total billed charges,61.74% of total billed charges,17.33,102,,,Fee Schedule,102% of GA Medicaid Rate,18.4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.99,215.1,
ACETYLCHOLINE BINDING AB,5001647,CDM,301,RC,84238,HCPCS,Outpatient,,,239,179.25,,186.42,78,,149.136,percent of total billed charges,78% of total billed charges,45.98,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,36.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,36.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,215.1,90,,172.08,percent of total billed charges,90% of total billed charges,48.28,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,160.79,67.275,,128.632,percent of total billed charges,67.275% of total billed charges,191.2,80,,152.96,percent of total billed charges,80% of total billed charges,36.94,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,191.2,80,,152.96,percent of total billed charges,80% of total billed charges,147.56,61.74,,118.048,percent of total billed charges,61.74% of total billed charges,46.9,102,,,Fee Schedule,102% of GA Medicaid Rate,36.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,36.57,215.1,
MYCOBACTERIUM TB PCR,5002084,CDM,306,RC,87556,HCPCS,Outpatient,,,239,179.25,,186.42,78,,149.136,percent of total billed charges,78% of total billed charges,150.57,63,,120.456,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,41.68,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,41.68,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,215.1,90,,172.08,percent of total billed charges,90% of total billed charges,83.65,35,,66.92,percent of total billed charges,35% of total billed charges,160.79,67.275,,128.632,percent of total billed charges,67.275% of total billed charges,191.2,80,,152.96,percent of total billed charges,80% of total billed charges,42.1,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,191.2,80,,152.96,percent of total billed charges,80% of total billed charges,147.56,61.74,,118.048,percent of total billed charges,61.74% of total billed charges,243.78,102,,195.024,percent of total billed charges,102% of total billed charges,41.68,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,41.68,243.78,
AMBULATING AFO BOOT - MEDIUM,3004504,CDM,270,RC,,,Outpatient,,,239.96,179.97,,187.17,78,,149.736,percent of total billed charges,78% of total billed charges,151.17,63,,120.936,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,91.18,38,,72.944,percent of total billed charges,38% of total billed charges,91.18,38,,72.944,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,215.96,90,,172.768,percent of total billed charges,90% of total billed charges,83.99,35,,67.192,percent of total billed charges,35% of total billed charges,161.43,67.275,,129.144,percent of total billed charges,67.275% of total billed charges,191.97,80,,153.576,percent of total billed charges,80% of total billed charges,92.1,38.38,,73.68,percent of total billed charges,38.38% of total billed charges,191.97,80,,153.576,percent of total billed charges,80% of total billed charges,148.15,61.74,,118.52,percent of total billed charges,61.74% of total billed charges,244.76,102,,195.808,percent of total billed charges,102% of total billed charges,91.18,38,,72.944,percent of total billed charges,38% of total billed charges,83.99,244.76,
AMBULATING AFO BOOT- LARGE,3004505,CDM,270,RC,,,Outpatient,,,239.96,179.97,,187.17,78,,149.736,percent of total billed charges,78% of total billed charges,151.17,63,,120.936,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,91.18,38,,72.944,percent of total billed charges,38% of total billed charges,91.18,38,,72.944,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,215.96,90,,172.768,percent of total billed charges,90% of total billed charges,83.99,35,,67.192,percent of total billed charges,35% of total billed charges,161.43,67.275,,129.144,percent of total billed charges,67.275% of total billed charges,191.97,80,,153.576,percent of total billed charges,80% of total billed charges,92.1,38.38,,73.68,percent of total billed charges,38.38% of total billed charges,191.97,80,,153.576,percent of total billed charges,80% of total billed charges,148.15,61.74,,118.52,percent of total billed charges,61.74% of total billed charges,244.76,102,,195.808,percent of total billed charges,102% of total billed charges,91.18,38,,72.944,percent of total billed charges,38% of total billed charges,83.99,244.76,
AMBULATING AFO BOOT -  XL,3004506,CDM,270,RC,,,Outpatient,,,239.96,179.97,,187.17,78,,149.736,percent of total billed charges,78% of total billed charges,151.17,63,,120.936,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,91.18,38,,72.944,percent of total billed charges,38% of total billed charges,91.18,38,,72.944,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,215.96,90,,172.768,percent of total billed charges,90% of total billed charges,83.99,35,,67.192,percent of total billed charges,35% of total billed charges,161.43,67.275,,129.144,percent of total billed charges,67.275% of total billed charges,191.97,80,,153.576,percent of total billed charges,80% of total billed charges,92.1,38.38,,73.68,percent of total billed charges,38.38% of total billed charges,191.97,80,,153.576,percent of total billed charges,80% of total billed charges,148.15,61.74,,118.52,percent of total billed charges,61.74% of total billed charges,244.76,102,,195.808,percent of total billed charges,102% of total billed charges,91.18,38,,72.944,percent of total billed charges,38% of total billed charges,83.99,244.76,
"ZYVOX: 600 MG, TABS, 20 EA, BOTTLE",1002639,CDM,259,RC,,,Outpatient,,,241,180.75,,187.98,78,,150.384,percent of total billed charges,78% of total billed charges,151.83,63,,121.464,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,91.58,38,,73.264,percent of total billed charges,38% of total billed charges,91.58,38,,73.264,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,216.9,90,,173.52,percent of total billed charges,90% of total billed charges,84.35,35,,67.48,percent of total billed charges,35% of total billed charges,162.13,67.275,,129.704,percent of total billed charges,67.275% of total billed charges,192.8,80,,154.24,percent of total billed charges,80% of total billed charges,92.5,38.38,,74,percent of total billed charges,38.38% of total billed charges,192.8,80,,154.24,percent of total billed charges,80% of total billed charges,148.79,61.74,,119.032,percent of total billed charges,61.74% of total billed charges,245.82,102,,196.656,percent of total billed charges,102% of total billed charges,91.58,38,,73.264,percent of total billed charges,38% of total billed charges,84.35,245.82,
"HEP C RNA,QUAL PCR",5001779,CDM,306,RC,87521,HCPCS,Outpatient,,,241,180.75,,187.98,78,,150.384,percent of total billed charges,78% of total billed charges,24.67,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,216.9,90,,173.52,percent of total billed charges,90% of total billed charges,25.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,162.13,67.275,,129.704,percent of total billed charges,67.275% of total billed charges,192.8,80,,154.24,percent of total billed charges,80% of total billed charges,35.44,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,192.8,80,,154.24,percent of total billed charges,80% of total billed charges,148.79,61.74,,119.032,percent of total billed charges,61.74% of total billed charges,25.16,102,,,Fee Schedule,102% of GA Medicaid Rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,24.67,216.9,
MASTOIDS COMPLETE,7000120,CDM,320,RC,70130,HCPCS,Outpatient,,,241,180.75,,187.98,78,,150.384,percent of total billed charges,78% of total billed charges,151.83,63,,121.464,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,91.58,38,,73.264,percent of total billed charges,38% of total billed charges,91.58,38,,73.264,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,216.9,90,,173.52,percent of total billed charges,90% of total billed charges,84.35,35,,67.48,percent of total billed charges,35% of total billed charges,162.13,67.275,,129.704,percent of total billed charges,67.275% of total billed charges,192.8,80,,154.24,percent of total billed charges,80% of total billed charges,92.5,38.38,,74,percent of total billed charges,38.38% of total billed charges,192.8,80,,154.24,percent of total billed charges,80% of total billed charges,148.79,61.74,,119.032,percent of total billed charges,61.74% of total billed charges,245.82,102,,196.656,percent of total billed charges,102% of total billed charges,91.58,38,,73.264,percent of total billed charges,38% of total billed charges,84.35,245.82,
ORBITS-RT,7000130,CDM,320,RC,70200,HCPCS,Outpatient,,,241,180.75,,187.98,78,,150.384,percent of total billed charges,78% of total billed charges,151.83,63,,121.464,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,91.58,38,,73.264,percent of total billed charges,38% of total billed charges,91.58,38,,73.264,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,216.9,90,,173.52,percent of total billed charges,90% of total billed charges,84.35,35,,67.48,percent of total billed charges,35% of total billed charges,162.13,67.275,,129.704,percent of total billed charges,67.275% of total billed charges,192.8,80,,154.24,percent of total billed charges,80% of total billed charges,92.5,38.38,,74,percent of total billed charges,38.38% of total billed charges,192.8,80,,154.24,percent of total billed charges,80% of total billed charges,148.79,61.74,,119.032,percent of total billed charges,61.74% of total billed charges,245.82,102,,196.656,percent of total billed charges,102% of total billed charges,91.58,38,,73.264,percent of total billed charges,38% of total billed charges,84.35,245.82,
SKULL LESS THAN 4 VIEWS,7000146,CDM,320,RC,70250,HCPCS,Outpatient,,,241,180.75,,187.98,78,,150.384,percent of total billed charges,78% of total billed charges,151.83,63,,121.464,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,91.58,38,,73.264,percent of total billed charges,38% of total billed charges,91.58,38,,73.264,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,216.9,90,,173.52,percent of total billed charges,90% of total billed charges,84.35,35,,67.48,percent of total billed charges,35% of total billed charges,162.13,67.275,,129.704,percent of total billed charges,67.275% of total billed charges,192.8,80,,154.24,percent of total billed charges,80% of total billed charges,92.5,38.38,,74,percent of total billed charges,38.38% of total billed charges,192.8,80,,154.24,percent of total billed charges,80% of total billed charges,148.79,61.74,,119.032,percent of total billed charges,61.74% of total billed charges,245.82,102,,196.656,percent of total billed charges,102% of total billed charges,91.58,38,,73.264,percent of total billed charges,38% of total billed charges,84.35,245.82,
SCAPULA COMPLETE-RT,7000325,CDM,320,RC,73010,HCPCS,Outpatient,,,241,180.75,,187.98,78,,150.384,percent of total billed charges,78% of total billed charges,151.83,63,,121.464,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,91.58,38,,73.264,percent of total billed charges,38% of total billed charges,91.58,38,,73.264,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,216.9,90,,173.52,percent of total billed charges,90% of total billed charges,84.35,35,,67.48,percent of total billed charges,35% of total billed charges,162.13,67.275,,129.704,percent of total billed charges,67.275% of total billed charges,192.8,80,,154.24,percent of total billed charges,80% of total billed charges,92.5,38.38,,74,percent of total billed charges,38.38% of total billed charges,192.8,80,,154.24,percent of total billed charges,80% of total billed charges,148.79,61.74,,119.032,percent of total billed charges,61.74% of total billed charges,245.82,102,,196.656,percent of total billed charges,102% of total billed charges,91.58,38,,73.264,percent of total billed charges,38% of total billed charges,84.35,245.82,
ABDOMEN FLAT AND UPRIGHT 2 VIEWS,7000510,CDM,320,RC,74019,HCPCS,Outpatient,,,241,180.75,,187.98,78,,150.384,percent of total billed charges,78% of total billed charges,151.83,63,,121.464,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,91.58,38,,73.264,percent of total billed charges,38% of total billed charges,91.58,38,,73.264,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,216.9,90,,173.52,percent of total billed charges,90% of total billed charges,84.35,35,,67.48,percent of total billed charges,35% of total billed charges,162.13,67.275,,129.704,percent of total billed charges,67.275% of total billed charges,192.8,80,,154.24,percent of total billed charges,80% of total billed charges,92.5,38.38,,74,percent of total billed charges,38.38% of total billed charges,192.8,80,,154.24,percent of total billed charges,80% of total billed charges,148.79,61.74,,119.032,percent of total billed charges,61.74% of total billed charges,245.82,102,,196.656,percent of total billed charges,102% of total billed charges,91.58,38,,73.264,percent of total billed charges,38% of total billed charges,84.35,245.82,
PELVIS COMPLETE,7000520,CDM,320,RC,72190,HCPCS,Outpatient,,,241,180.75,,187.98,78,,150.384,percent of total billed charges,78% of total billed charges,151.83,63,,121.464,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,91.58,38,,73.264,percent of total billed charges,38% of total billed charges,91.58,38,,73.264,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,216.9,90,,173.52,percent of total billed charges,90% of total billed charges,84.35,35,,67.48,percent of total billed charges,35% of total billed charges,162.13,67.275,,129.704,percent of total billed charges,67.275% of total billed charges,192.8,80,,154.24,percent of total billed charges,80% of total billed charges,92.5,38.38,,74,percent of total billed charges,38.38% of total billed charges,192.8,80,,154.24,percent of total billed charges,80% of total billed charges,148.79,61.74,,119.032,percent of total billed charges,61.74% of total billed charges,245.82,102,,196.656,percent of total billed charges,102% of total billed charges,91.58,38,,73.264,percent of total billed charges,38% of total billed charges,84.35,245.82,
Radiologic examination of the knee with 3 views,7000704,CDM,320,RC,73562,HCPCS,Outpatient,,,241,180.75,,187.98,78,,150.384,percent of total billed charges,78% of total billed charges,151.83,63,,121.464,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,91.58,38,,73.264,percent of total billed charges,38% of total billed charges,91.58,38,,73.264,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,216.9,90,,173.52,percent of total billed charges,90% of total billed charges,84.35,35,,67.48,percent of total billed charges,35% of total billed charges,162.13,67.275,,129.704,percent of total billed charges,67.275% of total billed charges,192.8,80,,154.24,percent of total billed charges,80% of total billed charges,92.5,38.38,,74,percent of total billed charges,38.38% of total billed charges,192.8,80,,154.24,percent of total billed charges,80% of total billed charges,148.79,61.74,,119.032,percent of total billed charges,61.74% of total billed charges,245.82,102,,196.656,percent of total billed charges,102% of total billed charges,91.58,38,,73.264,percent of total billed charges,38% of total billed charges,84.35,245.82,
Radiologic examination of the knee with 3 views,7000714,CDM,320,RC,73562,HCPCS,Outpatient,,,241,180.75,,187.98,78,,150.384,percent of total billed charges,78% of total billed charges,151.83,63,,121.464,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,91.58,38,,73.264,percent of total billed charges,38% of total billed charges,91.58,38,,73.264,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,216.9,90,,173.52,percent of total billed charges,90% of total billed charges,84.35,35,,67.48,percent of total billed charges,35% of total billed charges,162.13,67.275,,129.704,percent of total billed charges,67.275% of total billed charges,192.8,80,,154.24,percent of total billed charges,80% of total billed charges,92.5,38.38,,74,percent of total billed charges,38.38% of total billed charges,192.8,80,,154.24,percent of total billed charges,80% of total billed charges,148.79,61.74,,119.032,percent of total billed charges,61.74% of total billed charges,245.82,102,,196.656,percent of total billed charges,102% of total billed charges,91.58,38,,73.264,percent of total billed charges,38% of total billed charges,84.35,245.82,
BONE AGE STUDY,7000749,CDM,320,RC,77072,HCPCS,Outpatient,,,241,180.75,,187.98,78,,150.384,percent of total billed charges,78% of total billed charges,151.83,63,,121.464,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,91.58,38,,73.264,percent of total billed charges,38% of total billed charges,91.58,38,,73.264,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,216.9,90,,173.52,percent of total billed charges,90% of total billed charges,84.35,35,,67.48,percent of total billed charges,35% of total billed charges,162.13,67.275,,129.704,percent of total billed charges,67.275% of total billed charges,192.8,80,,154.24,percent of total billed charges,80% of total billed charges,92.5,38.38,,74,percent of total billed charges,38.38% of total billed charges,192.8,80,,154.24,percent of total billed charges,80% of total billed charges,148.79,61.74,,119.032,percent of total billed charges,61.74% of total billed charges,245.82,102,,196.656,percent of total billed charges,102% of total billed charges,91.58,38,,73.264,percent of total billed charges,38% of total billed charges,84.35,245.82,
ORBITS-LT,7300131,CDM,320,RC,70200,HCPCS,Outpatient,,,241,180.75,,187.98,78,,150.384,percent of total billed charges,78% of total billed charges,151.83,63,,121.464,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,91.58,38,,73.264,percent of total billed charges,38% of total billed charges,91.58,38,,73.264,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,216.9,90,,173.52,percent of total billed charges,90% of total billed charges,84.35,35,,67.48,percent of total billed charges,35% of total billed charges,162.13,67.275,,129.704,percent of total billed charges,67.275% of total billed charges,192.8,80,,154.24,percent of total billed charges,80% of total billed charges,92.5,38.38,,74,percent of total billed charges,38.38% of total billed charges,192.8,80,,154.24,percent of total billed charges,80% of total billed charges,148.79,61.74,,119.032,percent of total billed charges,61.74% of total billed charges,245.82,102,,196.656,percent of total billed charges,102% of total billed charges,91.58,38,,73.264,percent of total billed charges,38% of total billed charges,84.35,245.82,
SCAPULA COMPLETE-LT,7300326,CDM,320,RC,73010,HCPCS,Outpatient,,,241,180.75,,187.98,78,,150.384,percent of total billed charges,78% of total billed charges,151.83,63,,121.464,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,91.58,38,,73.264,percent of total billed charges,38% of total billed charges,91.58,38,,73.264,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,216.9,90,,173.52,percent of total billed charges,90% of total billed charges,84.35,35,,67.48,percent of total billed charges,35% of total billed charges,162.13,67.275,,129.704,percent of total billed charges,67.275% of total billed charges,192.8,80,,154.24,percent of total billed charges,80% of total billed charges,92.5,38.38,,74,percent of total billed charges,38.38% of total billed charges,192.8,80,,154.24,percent of total billed charges,80% of total billed charges,148.79,61.74,,119.032,percent of total billed charges,61.74% of total billed charges,245.82,102,,196.656,percent of total billed charges,102% of total billed charges,91.58,38,,73.264,percent of total billed charges,38% of total billed charges,84.35,245.82,
"CONTINUOUS INHALAT W/ AERO,MED,FIRST HR",8000005,CDM,410,RC,94644,HCPCS,Outpatient,,,245,183.75,,191.1,78,,152.88,percent of total billed charges,78% of total billed charges,154.35,63,,123.48,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,93.1,38,,74.48,percent of total billed charges,38% of total billed charges,93.1,38,,74.48,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,220.5,90,,176.4,percent of total billed charges,90% of total billed charges,85.75,35,,68.6,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,196,80,,156.8,percent of total billed charges,80% of total billed charges,94.03,38.38,,75.224,percent of total billed charges,38.38% of total billed charges,196,80,,156.8,percent of total billed charges,80% of total billed charges,151.26,61.74,,121.008,percent of total billed charges,61.74% of total billed charges,249.9,102,,199.92,percent of total billed charges,102% of total billed charges,93.1,38,,74.48,percent of total billed charges,38% of total billed charges,85.75,249.9,
TRANSTRACHAEL AIRWAY CATHS EMERGENCY 7.5,3000010,CDM,270,RC,,,Outpatient,,,245.4,184.05,,191.41,78,,153.128,percent of total billed charges,78% of total billed charges,154.6,63,,123.68,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,93.25,38,,74.6,percent of total billed charges,38% of total billed charges,93.25,38,,74.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,220.86,90,,176.688,percent of total billed charges,90% of total billed charges,85.89,35,,68.712,percent of total billed charges,35% of total billed charges,165.09,67.275,,132.072,percent of total billed charges,67.275% of total billed charges,196.32,80,,157.056,percent of total billed charges,80% of total billed charges,94.18,38.38,,75.344,percent of total billed charges,38.38% of total billed charges,196.32,80,,157.056,percent of total billed charges,80% of total billed charges,151.51,61.74,,121.208,percent of total billed charges,61.74% of total billed charges,250.31,102,,200.248,percent of total billed charges,102% of total billed charges,93.25,38,,74.6,percent of total billed charges,38% of total billed charges,85.89,250.31,
BETA 2 MICROGLOBULIN,5001863,CDM,301,RC,82232,HCPCS,Outpatient,,,246,184.5,,191.88,78,,153.504,percent of total billed charges,78% of total billed charges,20.35,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,221.4,90,,177.12,percent of total billed charges,90% of total billed charges,21.37,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,165.5,67.275,,132.4,percent of total billed charges,67.275% of total billed charges,196.8,80,,157.44,percent of total billed charges,80% of total billed charges,16.34,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,196.8,80,,157.44,percent of total billed charges,80% of total billed charges,151.88,61.74,,121.504,percent of total billed charges,61.74% of total billed charges,20.76,102,,,Fee Schedule,102% of GA Medicaid Rate,16.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.18,221.4,
INCENTIVE SPIROMETRY TREATMENT EA  ADDL,8094643,CDM,460,RC,94640,HCPCS,Outpatient,,,246,184.5,,191.88,78,,153.504,percent of total billed charges,78% of total billed charges,154.98,63,,123.984,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,93.48,38,,74.784,percent of total billed charges,38% of total billed charges,93.48,38,,74.784,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,221.4,90,,177.12,percent of total billed charges,90% of total billed charges,86.1,35,,68.88,percent of total billed charges,35% of total billed charges,165.5,67.275,,132.4,percent of total billed charges,67.275% of total billed charges,196.8,80,,157.44,percent of total billed charges,80% of total billed charges,94.41,38.38,,75.528,percent of total billed charges,38.38% of total billed charges,196.8,80,,157.44,percent of total billed charges,80% of total billed charges,151.88,61.74,,121.504,percent of total billed charges,61.74% of total billed charges,250.92,102,,200.736,percent of total billed charges,102% of total billed charges,93.48,38,,74.784,percent of total billed charges,38% of total billed charges,86.1,250.92,
TRACHEOSTOMY DISP 6LPC,3004167,CDM,270,RC,,,Outpatient,,,247,185.25,,192.66,78,,154.128,percent of total billed charges,78% of total billed charges,155.61,63,,124.488,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,93.86,38,,75.088,percent of total billed charges,38% of total billed charges,93.86,38,,75.088,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,222.3,90,,177.84,percent of total billed charges,90% of total billed charges,86.45,35,,69.16,percent of total billed charges,35% of total billed charges,166.17,67.275,,132.936,percent of total billed charges,67.275% of total billed charges,197.6,80,,158.08,percent of total billed charges,80% of total billed charges,94.8,38.38,,75.84,percent of total billed charges,38.38% of total billed charges,197.6,80,,158.08,percent of total billed charges,80% of total billed charges,152.5,61.74,,122,percent of total billed charges,61.74% of total billed charges,251.94,102,,201.552,percent of total billed charges,102% of total billed charges,93.86,38,,75.088,percent of total billed charges,38% of total billed charges,86.45,251.94,
TRACHEOSTOMY DISP 8LPC,3004168,CDM,270,RC,,,Outpatient,,,247,185.25,,192.66,78,,154.128,percent of total billed charges,78% of total billed charges,155.61,63,,124.488,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,93.86,38,,75.088,percent of total billed charges,38% of total billed charges,93.86,38,,75.088,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,222.3,90,,177.84,percent of total billed charges,90% of total billed charges,86.45,35,,69.16,percent of total billed charges,35% of total billed charges,166.17,67.275,,132.936,percent of total billed charges,67.275% of total billed charges,197.6,80,,158.08,percent of total billed charges,80% of total billed charges,94.8,38.38,,75.84,percent of total billed charges,38.38% of total billed charges,197.6,80,,158.08,percent of total billed charges,80% of total billed charges,152.5,61.74,,122,percent of total billed charges,61.74% of total billed charges,251.94,102,,201.552,percent of total billed charges,102% of total billed charges,93.86,38,,75.088,percent of total billed charges,38% of total billed charges,86.45,251.94,
TRACHEOSTOMY DISP 4LPC,3004170,CDM,270,RC,,,Outpatient,,,247,185.25,,192.66,78,,154.128,percent of total billed charges,78% of total billed charges,155.61,63,,124.488,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,93.86,38,,75.088,percent of total billed charges,38% of total billed charges,93.86,38,,75.088,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,222.3,90,,177.84,percent of total billed charges,90% of total billed charges,86.45,35,,69.16,percent of total billed charges,35% of total billed charges,166.17,67.275,,132.936,percent of total billed charges,67.275% of total billed charges,197.6,80,,158.08,percent of total billed charges,80% of total billed charges,94.8,38.38,,75.84,percent of total billed charges,38.38% of total billed charges,197.6,80,,158.08,percent of total billed charges,80% of total billed charges,152.5,61.74,,122,percent of total billed charges,61.74% of total billed charges,251.94,102,,201.552,percent of total billed charges,102% of total billed charges,93.86,38,,75.088,percent of total billed charges,38% of total billed charges,86.45,251.94,
COXSACKIE A AB,5000503,CDM,302,RC,86658,HCPCS,Outpatient,,,248,186,,193.44,78,,154.752,percent of total billed charges,78% of total billed charges,16.38,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.03,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.03,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,223.2,90,,178.56,percent of total billed charges,90% of total billed charges,17.2,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,166.84,67.275,,133.472,percent of total billed charges,67.275% of total billed charges,198.4,80,,158.72,percent of total billed charges,80% of total billed charges,13.16,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,198.4,80,,158.72,percent of total billed charges,80% of total billed charges,153.12,61.74,,122.496,percent of total billed charges,61.74% of total billed charges,16.71,102,,,Fee Schedule,102% of GA Medicaid Rate,13.03,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.03,223.2,
THYROGLOBULIN PANEL,5001399,CDM,300,RC,84432,HCPCS,Outpatient,,,249,186.75,,194.22,78,,155.376,percent of total billed charges,78% of total billed charges,20.2,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.06,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.06,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,224.1,90,,179.28,percent of total billed charges,90% of total billed charges,21.21,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,167.51,67.275,,134.008,percent of total billed charges,67.275% of total billed charges,199.2,80,,159.36,percent of total billed charges,80% of total billed charges,16.22,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,199.2,80,,159.36,percent of total billed charges,80% of total billed charges,153.73,61.74,,122.984,percent of total billed charges,61.74% of total billed charges,20.6,102,,,Fee Schedule,102% of GA Medicaid Rate,16.06,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.06,224.1,
TELEMETRY,6000413,CDM,731,RC,93226,HCPCS,Outpatient,,,249,186.75,,194.22,78,,155.376,percent of total billed charges,78% of total billed charges,156.87,63,,125.496,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,94.62,38,,75.696,percent of total billed charges,38% of total billed charges,94.62,38,,75.696,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,224.1,90,,179.28,percent of total billed charges,90% of total billed charges,87.15,35,,69.72,percent of total billed charges,35% of total billed charges,167.51,67.275,,134.008,percent of total billed charges,67.275% of total billed charges,199.2,80,,159.36,percent of total billed charges,80% of total billed charges,95.57,38.38,,76.456,percent of total billed charges,38.38% of total billed charges,199.2,80,,159.36,percent of total billed charges,80% of total billed charges,153.73,61.74,,122.984,percent of total billed charges,61.74% of total billed charges,253.98,102,,203.184,percent of total billed charges,102% of total billed charges,94.62,38,,75.696,percent of total billed charges,38% of total billed charges,87.15,253.98,
BB ADMIN WHOLE BLOOD,5200002,CDM,399,RC,,,Outpatient,,,250,187.5,,195,78,,156,percent of total billed charges,78% of total billed charges,157.5,63,,126,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,95,38,,76,percent of total billed charges,38% of total billed charges,95,38,,76,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,225,90,,180,percent of total billed charges,90% of total billed charges,87.5,35,,70,percent of total billed charges,35% of total billed charges,168.19,67.275,,134.552,percent of total billed charges,67.275% of total billed charges,200,80,,160,percent of total billed charges,80% of total billed charges,95.95,38.38,,76.76,percent of total billed charges,38.38% of total billed charges,200,80,,160,percent of total billed charges,80% of total billed charges,154.35,61.74,,123.48,percent of total billed charges,61.74% of total billed charges,255,102,,204,percent of total billed charges,102% of total billed charges,95,38,,76,percent of total billed charges,38% of total billed charges,87.5,255,
BETA-HCG QUANT,5000327,CDM,301,RC,84702,HCPCS,Outpatient,,,251,188.25,,195.78,78,,156.624,percent of total billed charges,78% of total billed charges,8.07,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,15.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,15.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,225.9,90,,180.72,percent of total billed charges,90% of total billed charges,8.47,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,168.86,67.275,,135.088,percent of total billed charges,67.275% of total billed charges,200.8,80,,160.64,percent of total billed charges,80% of total billed charges,15.2,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,200.8,80,,160.64,percent of total billed charges,80% of total billed charges,154.97,61.74,,123.976,percent of total billed charges,61.74% of total billed charges,8.23,102,,,Fee Schedule,102% of GA Medicaid Rate,15.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,8.07,225.9,
METHYLMALONIC ACID,5001772,CDM,301,RC,83921,HCPCS,Outpatient,,,251,188.25,,195.78,78,,156.624,percent of total billed charges,78% of total billed charges,20.7,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,21.21,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,21.21,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,225.9,90,,180.72,percent of total billed charges,90% of total billed charges,21.74,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,168.86,67.275,,135.088,percent of total billed charges,67.275% of total billed charges,200.8,80,,160.64,percent of total billed charges,80% of total billed charges,21.42,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,200.8,80,,160.64,percent of total billed charges,80% of total billed charges,154.97,61.74,,123.976,percent of total billed charges,61.74% of total billed charges,21.11,102,,,Fee Schedule,102% of GA Medicaid Rate,21.21,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.7,225.9,
IGE QUANTITATIVE,5001847,CDM,301,RC,82785,HCPCS,Outpatient,,,251,188.25,,195.78,78,,156.624,percent of total billed charges,78% of total billed charges,20.71,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.46,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.46,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,225.9,90,,180.72,percent of total billed charges,90% of total billed charges,21.75,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,168.86,67.275,,135.088,percent of total billed charges,67.275% of total billed charges,200.8,80,,160.64,percent of total billed charges,80% of total billed charges,16.62,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,200.8,80,,160.64,percent of total billed charges,80% of total billed charges,154.97,61.74,,123.976,percent of total billed charges,61.74% of total billed charges,21.12,102,,,Fee Schedule,102% of GA Medicaid Rate,16.46,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.46,225.9,
ASSAY OF IGE,5082785,CDM,301,RC,82785,HCPCS,Outpatient,,,251,188.25,,195.78,78,,156.624,percent of total billed charges,78% of total billed charges,20.71,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.46,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.46,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,225.9,90,,180.72,percent of total billed charges,90% of total billed charges,21.75,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,168.86,67.275,,135.088,percent of total billed charges,67.275% of total billed charges,200.8,80,,160.64,percent of total billed charges,80% of total billed charges,16.62,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,200.8,80,,160.64,percent of total billed charges,80% of total billed charges,154.97,61.74,,123.976,percent of total billed charges,61.74% of total billed charges,21.12,102,,,Fee Schedule,102% of GA Medicaid Rate,16.46,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.46,225.9,
ACTH,5001827,CDM,301,RC,82024,HCPCS,Outpatient,,,253,189.75,,197.34,78,,157.872,percent of total billed charges,78% of total billed charges,48.57,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,38.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,38.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,227.7,90,,182.16,percent of total billed charges,90% of total billed charges,51,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,170.21,67.275,,136.168,percent of total billed charges,67.275% of total billed charges,202.4,80,,161.92,percent of total billed charges,80% of total billed charges,39.01,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,202.4,80,,161.92,percent of total billed charges,80% of total billed charges,156.2,61.74,,124.96,percent of total billed charges,61.74% of total billed charges,49.54,102,,,Fee Schedule,102% of GA Medicaid Rate,38.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,38.62,227.7,
CORTISOL FREE SERUM,5001678,CDM,301,RC,82530,HCPCS,Outpatient,,,255,191.25,,198.9,78,,159.12,percent of total billed charges,78% of total billed charges,21.02,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.71,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.71,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,229.5,90,,183.6,percent of total billed charges,90% of total billed charges,22.07,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,171.55,67.275,,137.24,percent of total billed charges,67.275% of total billed charges,204,80,,163.2,percent of total billed charges,80% of total billed charges,16.88,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,204,80,,163.2,percent of total billed charges,80% of total billed charges,157.44,61.74,,125.952,percent of total billed charges,61.74% of total billed charges,21.44,102,,,Fee Schedule,102% of GA Medicaid Rate,16.71,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.71,229.5,
DRILL BIT 2.5 x 125MM GOLD,3000605,CDM,270,RC,,,Outpatient,,,257.96,193.47,,201.21,78,,160.968,percent of total billed charges,78% of total billed charges,162.51,63,,130.008,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,98.02,38,,78.416,percent of total billed charges,38% of total billed charges,98.02,38,,78.416,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,232.16,90,,185.728,percent of total billed charges,90% of total billed charges,90.29,35,,72.232,percent of total billed charges,35% of total billed charges,173.54,67.275,,138.832,percent of total billed charges,67.275% of total billed charges,206.37,80,,165.096,percent of total billed charges,80% of total billed charges,99.01,38.38,,79.208,percent of total billed charges,38.38% of total billed charges,206.37,80,,165.096,percent of total billed charges,80% of total billed charges,159.26,61.74,,127.408,percent of total billed charges,61.74% of total billed charges,263.12,102,,210.496,percent of total billed charges,102% of total billed charges,98.02,38,,78.416,percent of total billed charges,38% of total billed charges,90.29,263.12,
DRILL BIT 3.5 x 125MM,3001019,CDM,270,RC,,,Outpatient,,,257.96,193.47,,201.21,78,,160.968,percent of total billed charges,78% of total billed charges,162.51,63,,130.008,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,98.02,38,,78.416,percent of total billed charges,38% of total billed charges,98.02,38,,78.416,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,232.16,90,,185.728,percent of total billed charges,90% of total billed charges,90.29,35,,72.232,percent of total billed charges,35% of total billed charges,173.54,67.275,,138.832,percent of total billed charges,67.275% of total billed charges,206.37,80,,165.096,percent of total billed charges,80% of total billed charges,99.01,38.38,,79.208,percent of total billed charges,38.38% of total billed charges,206.37,80,,165.096,percent of total billed charges,80% of total billed charges,159.26,61.74,,127.408,percent of total billed charges,61.74% of total billed charges,263.12,102,,210.496,percent of total billed charges,102% of total billed charges,98.02,38,,78.416,percent of total billed charges,38% of total billed charges,90.29,263.12,
T3 FREE,5001398,CDM,301,RC,84481,HCPCS,Outpatient,,,258,193.5,,201.24,78,,160.992,percent of total billed charges,78% of total billed charges,21.3,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.94,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.94,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,232.2,90,,185.76,percent of total billed charges,90% of total billed charges,22.37,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,173.57,67.275,,138.856,percent of total billed charges,67.275% of total billed charges,206.4,80,,165.12,percent of total billed charges,80% of total billed charges,17.11,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,206.4,80,,165.12,percent of total billed charges,80% of total billed charges,159.29,61.74,,127.432,percent of total billed charges,61.74% of total billed charges,21.73,102,,,Fee Schedule,102% of GA Medicaid Rate,16.94,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.94,232.2,
HIP W/ PELVIS 1 VIEW RIGHT,7000535,CDM,320,RC,73501,HCPCS,Outpatient,,,258,193.5,,201.24,78,,160.992,percent of total billed charges,78% of total billed charges,162.54,63,,130.032,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,98.04,38,,78.432,percent of total billed charges,38% of total billed charges,98.04,38,,78.432,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,232.2,90,,185.76,percent of total billed charges,90% of total billed charges,90.3,35,,72.24,percent of total billed charges,35% of total billed charges,173.57,67.275,,138.856,percent of total billed charges,67.275% of total billed charges,206.4,80,,165.12,percent of total billed charges,80% of total billed charges,99.02,38.38,,79.216,percent of total billed charges,38.38% of total billed charges,206.4,80,,165.12,percent of total billed charges,80% of total billed charges,159.29,61.74,,127.432,percent of total billed charges,61.74% of total billed charges,263.16,102,,210.528,percent of total billed charges,102% of total billed charges,98.04,38,,78.432,percent of total billed charges,38% of total billed charges,90.3,263.16,
HIP W/ PELVIS 1 VIEW LEFT,7000536,CDM,320,RC,73501,HCPCS,Outpatient,,,258,193.5,,201.24,78,,160.992,percent of total billed charges,78% of total billed charges,162.54,63,,130.032,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,98.04,38,,78.432,percent of total billed charges,38% of total billed charges,98.04,38,,78.432,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,232.2,90,,185.76,percent of total billed charges,90% of total billed charges,90.3,35,,72.24,percent of total billed charges,35% of total billed charges,173.57,67.275,,138.856,percent of total billed charges,67.275% of total billed charges,206.4,80,,165.12,percent of total billed charges,80% of total billed charges,99.02,38.38,,79.216,percent of total billed charges,38.38% of total billed charges,206.4,80,,165.12,percent of total billed charges,80% of total billed charges,159.29,61.74,,127.432,percent of total billed charges,61.74% of total billed charges,263.16,102,,210.528,percent of total billed charges,102% of total billed charges,98.04,38,,78.432,percent of total billed charges,38% of total billed charges,90.3,263.16,
Radiologic examination of the ankle with 2 views,7400944,CDM,320,RC,73600,HCPCS,Outpatient,,,258,193.5,,201.24,78,,160.992,percent of total billed charges,78% of total billed charges,162.54,63,,130.032,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,98.04,38,,78.432,percent of total billed charges,38% of total billed charges,98.04,38,,78.432,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,232.2,90,,185.76,percent of total billed charges,90% of total billed charges,90.3,35,,72.24,percent of total billed charges,35% of total billed charges,173.57,67.275,,138.856,percent of total billed charges,67.275% of total billed charges,206.4,80,,165.12,percent of total billed charges,80% of total billed charges,99.02,38.38,,79.216,percent of total billed charges,38.38% of total billed charges,206.4,80,,165.12,percent of total billed charges,80% of total billed charges,159.29,61.74,,127.432,percent of total billed charges,61.74% of total billed charges,263.16,102,,210.528,percent of total billed charges,102% of total billed charges,98.04,38,,78.432,percent of total billed charges,38% of total billed charges,90.3,263.16,
3 or more views,7400945,CDM,320,RC,73100,HCPCS,Outpatient,,,258,193.5,,201.24,78,,160.992,percent of total billed charges,78% of total billed charges,162.54,63,,130.032,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,98.04,38,,78.432,percent of total billed charges,38% of total billed charges,98.04,38,,78.432,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,232.2,90,,185.76,percent of total billed charges,90% of total billed charges,90.3,35,,72.24,percent of total billed charges,35% of total billed charges,173.57,67.275,,138.856,percent of total billed charges,67.275% of total billed charges,206.4,80,,165.12,percent of total billed charges,80% of total billed charges,99.02,38.38,,79.216,percent of total billed charges,38.38% of total billed charges,206.4,80,,165.12,percent of total billed charges,80% of total billed charges,159.29,61.74,,127.432,percent of total billed charges,61.74% of total billed charges,263.16,102,,210.528,percent of total billed charges,102% of total billed charges,98.04,38,,78.432,percent of total billed charges,38% of total billed charges,90.3,263.16,
LACTOFERRIN QUAL STOOL,5001684,CDM,301,RC,83630,HCPCS,Outpatient,,,259,194.25,,202.02,78,,161.616,percent of total billed charges,78% of total billed charges,13.45,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,19.7,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,19.7,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,233.1,90,,186.48,percent of total billed charges,90% of total billed charges,14.12,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,174.24,67.275,,139.392,percent of total billed charges,67.275% of total billed charges,207.2,80,,165.76,percent of total billed charges,80% of total billed charges,19.9,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,207.2,80,,165.76,percent of total billed charges,80% of total billed charges,159.91,61.74,,127.928,percent of total billed charges,61.74% of total billed charges,13.72,102,,,Fee Schedule,102% of GA Medicaid Rate,19.7,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.45,233.1,
.DRG SCN EACH CLASS,5000195,CDM,301,RC,80101,HCPCS,Outpatient,,,260,195,,202.8,78,,162.24,percent of total billed charges,78% of total billed charges,163.8,63,,131.04,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,98.8,38,,79.04,percent of total billed charges,38% of total billed charges,98.8,38,,79.04,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,234,90,,187.2,percent of total billed charges,90% of total billed charges,91,35,,72.8,percent of total billed charges,35% of total billed charges,174.92,67.275,,139.936,percent of total billed charges,67.275% of total billed charges,208,80,,166.4,percent of total billed charges,80% of total billed charges,99.79,38.38,,79.832,percent of total billed charges,38.38% of total billed charges,208,80,,166.4,percent of total billed charges,80% of total billed charges,160.52,61.74,,128.416,percent of total billed charges,61.74% of total billed charges,265.2,102,,212.16,percent of total billed charges,102% of total billed charges,98.8,38,,79.04,percent of total billed charges,38% of total billed charges,91,265.2,
Obstetric blood test panel,5001428,CDM,301,RC,80055,HCPCS,Outpatient,,,260,195,,202.8,78,,162.24,percent of total billed charges,78% of total billed charges,28.08,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,47.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,47.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,234,90,,187.2,percent of total billed charges,90% of total billed charges,29.48,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,174.92,67.275,,139.936,percent of total billed charges,67.275% of total billed charges,208,80,,166.4,percent of total billed charges,80% of total billed charges,48.29,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,208,80,,166.4,percent of total billed charges,80% of total billed charges,160.52,61.74,,128.416,percent of total billed charges,61.74% of total billed charges,28.64,102,,,Fee Schedule,102% of GA Medicaid Rate,47.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,28.08,234,
Acute hepatitis panel,5001735,CDM,301,RC,80074,HCPCS,Outpatient,,,261,195.75,,203.58,78,,162.864,percent of total billed charges,78% of total billed charges,59.89,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,47.63,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,47.63,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,234.9,90,,187.92,percent of total billed charges,90% of total billed charges,62.88,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,175.59,67.275,,140.472,percent of total billed charges,67.275% of total billed charges,208.8,80,,167.04,percent of total billed charges,80% of total billed charges,48.11,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,208.8,80,,167.04,percent of total billed charges,80% of total billed charges,161.14,61.74,,128.912,percent of total billed charges,61.74% of total billed charges,61.09,102,,,Fee Schedule,102% of GA Medicaid Rate,47.63,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,47.63,234.9,
Test is used to measure the amount of the drug in the blood to determine whether the concentration has reached a therapeutic level and is below the to,5001959,CDM,301,RC,80197,HCPCS,Outpatient,,,261,195.75,,203.58,78,,162.864,percent of total billed charges,78% of total billed charges,17.25,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.73,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.73,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,234.9,90,,187.92,percent of total billed charges,90% of total billed charges,18.11,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,175.59,67.275,,140.472,percent of total billed charges,67.275% of total billed charges,208.8,80,,167.04,percent of total billed charges,80% of total billed charges,13.87,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,208.8,80,,167.04,percent of total billed charges,80% of total billed charges,161.14,61.74,,128.912,percent of total billed charges,61.74% of total billed charges,17.6,102,,,Fee Schedule,102% of GA Medicaid Rate,13.73,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.73,234.9,
ST ASSESMENT OF APHASIA,9000120,CDM,440,RC,96105,HCPCS,Outpatient,,,262,196.5,,204.36,78,,163.488,percent of total billed charges,78% of total billed charges,165.06,63,,132.048,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,99.56,38,,79.648,percent of total billed charges,38% of total billed charges,99.56,38,,79.648,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,235.8,90,,188.64,percent of total billed charges,90% of total billed charges,91.7,35,,73.36,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,209.6,80,,167.68,percent of total billed charges,80% of total billed charges,100.56,38.38,,80.448,percent of total billed charges,38.38% of total billed charges,209.6,80,,167.68,percent of total billed charges,80% of total billed charges,161.76,61.74,,129.408,percent of total billed charges,61.74% of total billed charges,267.24,102,,213.792,percent of total billed charges,102% of total billed charges,99.56,38,,79.648,percent of total billed charges,38% of total billed charges,91.7,267.24,
ASNIS GUIDE WIRE  2.0,3005062,CDM,270,RC,,,Outpatient,,,264,198,,205.92,78,,164.736,percent of total billed charges,78% of total billed charges,166.32,63,,133.056,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,100.32,38,,80.256,percent of total billed charges,38% of total billed charges,100.32,38,,80.256,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,237.6,90,,190.08,percent of total billed charges,90% of total billed charges,92.4,35,,73.92,percent of total billed charges,35% of total billed charges,177.61,67.275,,142.088,percent of total billed charges,67.275% of total billed charges,211.2,80,,168.96,percent of total billed charges,80% of total billed charges,101.32,38.38,,81.056,percent of total billed charges,38.38% of total billed charges,211.2,80,,168.96,percent of total billed charges,80% of total billed charges,162.99,61.74,,130.392,percent of total billed charges,61.74% of total billed charges,269.28,102,,215.424,percent of total billed charges,102% of total billed charges,100.32,38,,80.256,percent of total billed charges,38% of total billed charges,92.4,269.28,
OBSERVATION FIRST HR,2000003,CDM,762,RC,,,Outpatient,,,265,198.75,,206.7,78,,165.36,percent of total billed charges,78% of total billed charges,166.95,63,,133.56,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,100.7,38,,80.56,percent of total billed charges,38% of total billed charges,100.7,38,,80.56,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,238.5,90,,190.8,percent of total billed charges,90% of total billed charges,92.75,35,,74.2,percent of total billed charges,35% of total billed charges,1802.97,67.275,,1442.376,percent of total billed charges,67.275% of total billed charges,212,80,,169.6,percent of total billed charges,80% of total billed charges,101.71,38.38,,81.368,percent of total billed charges,38.38% of total billed charges,212,80,,169.6,percent of total billed charges,80% of total billed charges,163.61,61.74,,130.888,percent of total billed charges,61.74% of total billed charges,270.3,102,,216.24,percent of total billed charges,102% of total billed charges,100.7,38,,80.56,percent of total billed charges,38% of total billed charges,92.75,1802.97,
PNEUMOTHORAX ASPIRATION SET - ER,3005082,CDM,270,RC,,,Outpatient,,,265.28,198.96,,206.92,78,,165.536,percent of total billed charges,78% of total billed charges,167.13,63,,133.704,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,100.81,38,,80.648,percent of total billed charges,38% of total billed charges,100.81,38,,80.648,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,238.75,90,,191,percent of total billed charges,90% of total billed charges,92.85,35,,74.28,percent of total billed charges,35% of total billed charges,178.47,67.275,,142.776,percent of total billed charges,67.275% of total billed charges,212.22,80,,169.776,percent of total billed charges,80% of total billed charges,101.81,38.38,,81.448,percent of total billed charges,38.38% of total billed charges,212.22,80,,169.776,percent of total billed charges,80% of total billed charges,163.78,61.74,,131.024,percent of total billed charges,61.74% of total billed charges,270.59,102,,216.472,percent of total billed charges,102% of total billed charges,100.81,38,,80.648,percent of total billed charges,38% of total billed charges,92.85,270.59,
ENDOPATH XCEL TROCAR SLEEVE 5MM,3004083,CDM,270,RC,,,Outpatient,,,265.64,199.23,,207.2,78,,165.76,percent of total billed charges,78% of total billed charges,167.35,63,,133.88,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,100.94,38,,80.752,percent of total billed charges,38% of total billed charges,100.94,38,,80.752,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,239.08,90,,191.264,percent of total billed charges,90% of total billed charges,92.97,35,,74.376,percent of total billed charges,35% of total billed charges,178.71,67.275,,142.968,percent of total billed charges,67.275% of total billed charges,212.51,80,,170.008,percent of total billed charges,80% of total billed charges,101.95,38.38,,81.56,percent of total billed charges,38.38% of total billed charges,212.51,80,,170.008,percent of total billed charges,80% of total billed charges,164.01,61.74,,131.208,percent of total billed charges,61.74% of total billed charges,270.95,102,,216.76,percent of total billed charges,102% of total billed charges,100.94,38,,80.752,percent of total billed charges,38% of total billed charges,92.97,270.95,
ALDOSTERONE,5001819,CDM,301,RC,82088,HCPCS,Outpatient,,,266,199.5,,207.48,78,,165.984,percent of total billed charges,78% of total billed charges,51.25,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,40.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,40.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,239.4,90,,191.52,percent of total billed charges,90% of total billed charges,53.81,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,178.95,67.275,,143.16,percent of total billed charges,67.275% of total billed charges,212.8,80,,170.24,percent of total billed charges,80% of total billed charges,41.16,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,212.8,80,,170.24,percent of total billed charges,80% of total billed charges,164.23,61.74,,131.384,percent of total billed charges,61.74% of total billed charges,52.28,102,,,Fee Schedule,102% of GA Medicaid Rate,40.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,40.75,239.4,
ALDOSTERONE 24 HR URINE,5002080,CDM,301,RC,82088,HCPCS,Outpatient,,,266,199.5,,207.48,78,,165.984,percent of total billed charges,78% of total billed charges,51.25,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,40.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,40.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,239.4,90,,191.52,percent of total billed charges,90% of total billed charges,53.81,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,178.95,67.275,,143.16,percent of total billed charges,67.275% of total billed charges,212.8,80,,170.24,percent of total billed charges,80% of total billed charges,41.16,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,212.8,80,,170.24,percent of total billed charges,80% of total billed charges,164.23,61.74,,131.384,percent of total billed charges,61.74% of total billed charges,52.28,102,,,Fee Schedule,102% of GA Medicaid Rate,40.75,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,40.75,239.4,
ARTERIAL CATH CUTDOWN,1001134,CDM,450,RC,36625,HCPCS,Outpatient,,,267,200.25,,208.26,78,,166.608,percent of total billed charges,78% of total billed charges,168.21,63,,134.568,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,101.46,38,,81.168,percent of total billed charges,38% of total billed charges,101.46,38,,81.168,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,240.3,90,,192.24,percent of total billed charges,90% of total billed charges,93.45,35,,74.76,percent of total billed charges,35% of total billed charges,179.62,67.275,,143.696,percent of total billed charges,67.275% of total billed charges,213.6,80,,170.88,percent of total billed charges,80% of total billed charges,102.47,38.38,,81.976,percent of total billed charges,38.38% of total billed charges,213.6,80,,170.88,percent of total billed charges,80% of total billed charges,164.85,61.74,,131.88,percent of total billed charges,61.74% of total billed charges,272.34,102,,217.872,percent of total billed charges,102% of total billed charges,101.46,38,,81.168,percent of total billed charges,38% of total billed charges,93.45,272.34,
General health panel,5000500,CDM,301,RC,80050,HCPCS,Outpatient,,,267,200.25,,208.26,78,,166.608,percent of total billed charges,78% of total billed charges,168.21,63,,134.568,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,101.46,38,,81.168,percent of total billed charges,38% of total billed charges,101.46,38,,81.168,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,240.3,90,,192.24,percent of total billed charges,90% of total billed charges,93.45,35,,74.76,percent of total billed charges,35% of total billed charges,179.62,67.275,,143.696,percent of total billed charges,67.275% of total billed charges,213.6,80,,170.88,percent of total billed charges,80% of total billed charges,102.47,38.38,,81.976,percent of total billed charges,38.38% of total billed charges,213.6,80,,170.88,percent of total billed charges,80% of total billed charges,164.85,61.74,,131.88,percent of total billed charges,61.74% of total billed charges,272.34,102,,217.872,percent of total billed charges,102% of total billed charges,101.46,38,,81.168,percent of total billed charges,38% of total billed charges,93.45,272.34,
FLEX LITE HINGED KNEE WALKING BRACE - MD,3005095,CDM,270,RC,,,Outpatient,,,267.32,200.49,,208.51,78,,166.808,percent of total billed charges,78% of total billed charges,168.41,63,,134.728,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,101.58,38,,81.264,percent of total billed charges,38% of total billed charges,101.58,38,,81.264,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,240.59,90,,192.472,percent of total billed charges,90% of total billed charges,93.56,35,,74.848,percent of total billed charges,35% of total billed charges,179.84,67.275,,143.872,percent of total billed charges,67.275% of total billed charges,213.86,80,,171.088,percent of total billed charges,80% of total billed charges,102.6,38.38,,82.08,percent of total billed charges,38.38% of total billed charges,213.86,80,,171.088,percent of total billed charges,80% of total billed charges,165.04,61.74,,132.032,percent of total billed charges,61.74% of total billed charges,272.67,102,,218.136,percent of total billed charges,102% of total billed charges,101.58,38,,81.264,percent of total billed charges,38% of total billed charges,93.56,272.67,
US ARTER DUP RLE/LTD,7300026,CDM,921,RC,93926,HCPCS,Outpatient,,,268,201,,209.04,78,,167.232,percent of total billed charges,78% of total billed charges,168.84,63,,135.072,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,101.84,38,,81.472,percent of total billed charges,38% of total billed charges,101.84,38,,81.472,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,241.2,90,,192.96,percent of total billed charges,90% of total billed charges,93.8,35,,75.04,percent of total billed charges,35% of total billed charges,180.3,67.275,,144.24,percent of total billed charges,67.275% of total billed charges,214.4,80,,171.52,percent of total billed charges,80% of total billed charges,102.86,38.38,,82.288,percent of total billed charges,38.38% of total billed charges,214.4,80,,171.52,percent of total billed charges,80% of total billed charges,165.46,61.74,,132.368,percent of total billed charges,61.74% of total billed charges,273.36,102,,218.688,percent of total billed charges,102% of total billed charges,101.84,38,,81.472,percent of total billed charges,38% of total billed charges,93.8,273.36,
US ARTER DUP LUE/LTD,7300035,CDM,921,RC,93931,HCPCS,Outpatient,,,268,201,,209.04,78,,167.232,percent of total billed charges,78% of total billed charges,168.84,63,,135.072,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,101.84,38,,81.472,percent of total billed charges,38% of total billed charges,101.84,38,,81.472,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,241.2,90,,192.96,percent of total billed charges,90% of total billed charges,93.8,35,,75.04,percent of total billed charges,35% of total billed charges,180.3,67.275,,144.24,percent of total billed charges,67.275% of total billed charges,214.4,80,,171.52,percent of total billed charges,80% of total billed charges,102.86,38.38,,82.288,percent of total billed charges,38.38% of total billed charges,214.4,80,,171.52,percent of total billed charges,80% of total billed charges,165.46,61.74,,132.368,percent of total billed charges,61.74% of total billed charges,273.36,102,,218.688,percent of total billed charges,102% of total billed charges,101.84,38,,81.472,percent of total billed charges,38% of total billed charges,93.8,273.36,
US ARTER DUP RUE/LTD,7300036,CDM,921,RC,93931,HCPCS,Outpatient,,,268,201,,209.04,78,,167.232,percent of total billed charges,78% of total billed charges,168.84,63,,135.072,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,101.84,38,,81.472,percent of total billed charges,38% of total billed charges,101.84,38,,81.472,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,241.2,90,,192.96,percent of total billed charges,90% of total billed charges,93.8,35,,75.04,percent of total billed charges,35% of total billed charges,180.3,67.275,,144.24,percent of total billed charges,67.275% of total billed charges,214.4,80,,171.52,percent of total billed charges,80% of total billed charges,102.86,38.38,,82.288,percent of total billed charges,38.38% of total billed charges,214.4,80,,171.52,percent of total billed charges,80% of total billed charges,165.46,61.74,,132.368,percent of total billed charges,61.74% of total billed charges,273.36,102,,218.688,percent of total billed charges,102% of total billed charges,101.84,38,,81.472,percent of total billed charges,38% of total billed charges,93.8,273.36,
US ARTER DUP UPPER EXT BILAT LIMITED,7300038,CDM,921,RC,93931,HCPCS,Outpatient,,,268,201,,209.04,78,,167.232,percent of total billed charges,78% of total billed charges,168.84,63,,135.072,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,101.84,38,,81.472,percent of total billed charges,38% of total billed charges,101.84,38,,81.472,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,241.2,90,,192.96,percent of total billed charges,90% of total billed charges,93.8,35,,75.04,percent of total billed charges,35% of total billed charges,180.3,67.275,,144.24,percent of total billed charges,67.275% of total billed charges,214.4,80,,171.52,percent of total billed charges,80% of total billed charges,102.86,38.38,,82.288,percent of total billed charges,38.38% of total billed charges,214.4,80,,171.52,percent of total billed charges,80% of total billed charges,165.46,61.74,,132.368,percent of total billed charges,61.74% of total billed charges,273.36,102,,218.688,percent of total billed charges,102% of total billed charges,101.84,38,,81.472,percent of total billed charges,38% of total billed charges,93.8,273.36,
MANGANESE,5001920,CDM,301,RC,83785,HCPCS,Outpatient,,,269,201.75,,209.82,78,,167.856,percent of total billed charges,78% of total billed charges,30.92,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,26.65,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,26.65,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,242.1,90,,193.68,percent of total billed charges,90% of total billed charges,32.47,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,180.97,67.275,,144.776,percent of total billed charges,67.275% of total billed charges,215.2,80,,172.16,percent of total billed charges,80% of total billed charges,26.92,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,215.2,80,,172.16,percent of total billed charges,80% of total billed charges,166.08,61.74,,132.864,percent of total billed charges,61.74% of total billed charges,31.54,102,,,Fee Schedule,102% of GA Medicaid Rate,26.65,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,26.65,242.1,
HIV 1 DNA QUAL PCR,5002032,CDM,306,RC,87535,HCPCS,Outpatient,,,270,202.5,,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,24.67,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,243,90,,194.4,percent of total billed charges,90% of total billed charges,25.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,181.64,67.275,,145.312,percent of total billed charges,67.275% of total billed charges,216,80,,172.8,percent of total billed charges,80% of total billed charges,35.44,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,216,80,,172.8,percent of total billed charges,80% of total billed charges,166.7,61.74,,133.36,percent of total billed charges,61.74% of total billed charges,25.16,102,,,Fee Schedule,102% of GA Medicaid Rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,24.67,243,
Limited ultrasound of the pelvis,7300932,CDM,402,RC,76857,HCPCS,Outpatient,,,270,202.5,,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,102.6,38,,82.08,percent of total billed charges,38% of total billed charges,102.6,38,,82.08,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,243,90,,194.4,percent of total billed charges,90% of total billed charges,94.5,35,,75.6,percent of total billed charges,35% of total billed charges,181.64,67.275,,145.312,percent of total billed charges,67.275% of total billed charges,216,80,,172.8,percent of total billed charges,80% of total billed charges,103.63,38.38,,82.904,percent of total billed charges,38.38% of total billed charges,216,80,,172.8,percent of total billed charges,80% of total billed charges,166.7,61.74,,133.36,percent of total billed charges,61.74% of total billed charges,275.4,102,,220.32,percent of total billed charges,102% of total billed charges,102.6,38,,82.08,percent of total billed charges,38% of total billed charges,94.5,275.4,
US UNLISTED PROCEDURE,7300950,CDM,402,RC,76999,HCPCS,Outpatient,,,270,202.5,,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,102.6,38,,82.08,percent of total billed charges,38% of total billed charges,102.6,38,,82.08,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,243,90,,194.4,percent of total billed charges,90% of total billed charges,94.5,35,,75.6,percent of total billed charges,35% of total billed charges,181.64,67.275,,145.312,percent of total billed charges,67.275% of total billed charges,216,80,,172.8,percent of total billed charges,80% of total billed charges,103.63,38.38,,82.904,percent of total billed charges,38.38% of total billed charges,216,80,,172.8,percent of total billed charges,80% of total billed charges,166.7,61.74,,133.36,percent of total billed charges,61.74% of total billed charges,275.4,102,,220.32,percent of total billed charges,102% of total billed charges,102.6,38,,82.08,percent of total billed charges,38% of total billed charges,94.5,275.4,
Ultrasound of bladder to measure urine capacity,7300972,CDM,402,RC,51798,HCPCS,Outpatient,,,270,202.5,,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,102.6,38,,82.08,percent of total billed charges,38% of total billed charges,102.6,38,,82.08,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,243,90,,194.4,percent of total billed charges,90% of total billed charges,94.5,35,,75.6,percent of total billed charges,35% of total billed charges,181.64,67.275,,145.312,percent of total billed charges,67.275% of total billed charges,216,80,,172.8,percent of total billed charges,80% of total billed charges,103.63,38.38,,82.904,percent of total billed charges,38.38% of total billed charges,216,80,,172.8,percent of total billed charges,80% of total billed charges,166.7,61.74,,133.36,percent of total billed charges,61.74% of total billed charges,275.4,102,,220.32,percent of total billed charges,102% of total billed charges,102.6,38,,82.08,percent of total billed charges,38% of total billed charges,94.5,275.4,
TRILUMEN CV 20 CM NEW,3004180,CDM,270,RC,,,Outpatient,,,271.92,203.94,,212.1,78,,169.68,percent of total billed charges,78% of total billed charges,171.31,63,,137.048,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,103.33,38,,82.664,percent of total billed charges,38% of total billed charges,103.33,38,,82.664,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,244.73,90,,195.784,percent of total billed charges,90% of total billed charges,95.17,35,,76.136,percent of total billed charges,35% of total billed charges,182.93,67.275,,146.344,percent of total billed charges,67.275% of total billed charges,217.54,80,,174.032,percent of total billed charges,80% of total billed charges,104.36,38.38,,83.488,percent of total billed charges,38.38% of total billed charges,217.54,80,,174.032,percent of total billed charges,80% of total billed charges,167.88,61.74,,134.304,percent of total billed charges,61.74% of total billed charges,277.36,102,,221.888,percent of total billed charges,102% of total billed charges,103.33,38,,82.664,percent of total billed charges,38% of total billed charges,95.17,277.36,
FROZEN SECTION,5001206,CDM,312,RC,88331,HCPCS,Outpatient,,,272,204,,212.16,78,,169.728,percent of total billed charges,78% of total billed charges,74.76,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,78.5,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,182.99,67.275,,146.392,percent of total billed charges,67.275% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,104.39,38.38,,83.512,percent of total billed charges,38.38% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,167.93,61.74,,134.344,percent of total billed charges,61.74% of total billed charges,76.26,102,,,Fee Schedule,102% of GA Medicaid Rate,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,74.76,244.8,
BB ARC CROSSMATCH,5200013,CDM,300,RC,86922,HCPCS,Outpatient,,,272,204,,212.16,78,,169.728,percent of total billed charges,78% of total billed charges,171.36,63,,137.088,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,95.2,35,,76.16,percent of total billed charges,35% of total billed charges,182.99,67.275,,146.392,percent of total billed charges,67.275% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,104.39,38.38,,83.512,percent of total billed charges,38.38% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,167.93,61.74,,134.344,percent of total billed charges,61.74% of total billed charges,277.44,102,,221.952,percent of total billed charges,102% of total billed charges,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,95.2,277.44,
BB AB ELUTION,5200014,CDM,300,RC,86860,HCPCS,Outpatient,,,272,204,,212.16,78,,169.728,percent of total billed charges,78% of total billed charges,6.12,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,6.43,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,182.99,67.275,,146.392,percent of total billed charges,67.275% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,104.39,38.38,,83.512,percent of total billed charges,38.38% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,167.93,61.74,,134.344,percent of total billed charges,61.74% of total billed charges,6.24,102,,,Fee Schedule,102% of GA Medicaid Rate,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,6.12,244.8,
BB SEPARATION BY DENSITY GRAD,5200017,CDM,300,RC,86972,HCPCS,Outpatient,,,272,204,,212.16,78,,169.728,percent of total billed charges,78% of total billed charges,171.36,63,,137.088,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,95.2,35,,76.16,percent of total billed charges,35% of total billed charges,182.99,67.275,,146.392,percent of total billed charges,67.275% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,104.39,38.38,,83.512,percent of total billed charges,38.38% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,167.93,61.74,,134.344,percent of total billed charges,61.74% of total billed charges,277.44,102,,221.952,percent of total billed charges,102% of total billed charges,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,95.2,277.44,
"BB AB ID, EA CELL",5200022,CDM,300,RC,86885,HCPCS,Outpatient,,,272,204,,212.16,78,,169.728,percent of total billed charges,78% of total billed charges,7.19,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.72,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.72,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,7.55,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,182.99,67.275,,146.392,percent of total billed charges,67.275% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,5.78,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,167.93,61.74,,134.344,percent of total billed charges,61.74% of total billed charges,7.33,102,,,Fee Schedule,102% of GA Medicaid Rate,5.72,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.72,244.8,
".ABID, SELECTED REAGENT CELL",5200034,CDM,300,RC,86885,HCPCS,Outpatient,,,272,204,,212.16,78,,169.728,percent of total billed charges,78% of total billed charges,7.19,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,5.72,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.72,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,7.55,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,182.99,67.275,,146.392,percent of total billed charges,67.275% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,5.78,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,167.93,61.74,,134.344,percent of total billed charges,61.74% of total billed charges,7.33,102,,,Fee Schedule,102% of GA Medicaid Rate,5.72,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,5.72,244.8,
BB CROSSMATCH,5200440,CDM,300,RC,86923,HCPCS,Outpatient,,,272,204,,212.16,78,,169.728,percent of total billed charges,78% of total billed charges,171.36,63,,137.088,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,95.2,35,,76.16,percent of total billed charges,35% of total billed charges,182.99,67.275,,146.392,percent of total billed charges,67.275% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,104.39,38.38,,83.512,percent of total billed charges,38.38% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,167.93,61.74,,134.344,percent of total billed charges,61.74% of total billed charges,277.44,102,,221.952,percent of total billed charges,102% of total billed charges,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,95.2,277.44,
MANDIBLE COMP RT,7000115,CDM,320,RC,70110,HCPCS,Outpatient,,,272,204,,212.16,78,,169.728,percent of total billed charges,78% of total billed charges,171.36,63,,137.088,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,95.2,35,,76.16,percent of total billed charges,35% of total billed charges,182.99,67.275,,146.392,percent of total billed charges,67.275% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,104.39,38.38,,83.512,percent of total billed charges,38.38% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,167.93,61.74,,134.344,percent of total billed charges,61.74% of total billed charges,277.44,102,,221.952,percent of total billed charges,102% of total billed charges,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,95.2,277.44,
MANDIBLE PARTIAL LT MINIMUM 3 VIEWS,7000117,CDM,320,RC,70110,HCPCS,Outpatient,,,272,204,,212.16,78,,169.728,percent of total billed charges,78% of total billed charges,171.36,63,,137.088,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,95.2,35,,76.16,percent of total billed charges,35% of total billed charges,182.99,67.275,,146.392,percent of total billed charges,67.275% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,104.39,38.38,,83.512,percent of total billed charges,38.38% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,167.93,61.74,,134.344,percent of total billed charges,61.74% of total billed charges,277.44,102,,221.952,percent of total billed charges,102% of total billed charges,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,95.2,277.44,
MANDIBLE PARTIAL RT MINIMUM 3 VIEWS,7000118,CDM,320,RC,70110,HCPCS,Outpatient,,,272,204,,212.16,78,,169.728,percent of total billed charges,78% of total billed charges,171.36,63,,137.088,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,95.2,35,,76.16,percent of total billed charges,35% of total billed charges,182.99,67.275,,146.392,percent of total billed charges,67.275% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,104.39,38.38,,83.512,percent of total billed charges,38.38% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,167.93,61.74,,134.344,percent of total billed charges,61.74% of total billed charges,277.44,102,,221.952,percent of total billed charges,102% of total billed charges,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,95.2,277.44,
RIBS UNI 2 VIEWS-RT,7000215,CDM,320,RC,71100,HCPCS,Outpatient,,,272,204,,212.16,78,,169.728,percent of total billed charges,78% of total billed charges,171.36,63,,137.088,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,95.2,35,,76.16,percent of total billed charges,35% of total billed charges,182.99,67.275,,146.392,percent of total billed charges,67.275% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,104.39,38.38,,83.512,percent of total billed charges,38.38% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,167.93,61.74,,134.344,percent of total billed charges,61.74% of total billed charges,277.44,102,,221.952,percent of total billed charges,102% of total billed charges,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,95.2,277.44,
X-ray of the lower spine 2-3 views,7000422,CDM,320,RC,72100,HCPCS,Outpatient,,,272,204,,212.16,78,,169.728,percent of total billed charges,78% of total billed charges,171.36,63,,137.088,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,95.2,35,,76.16,percent of total billed charges,35% of total billed charges,182.99,67.275,,146.392,percent of total billed charges,67.275% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,104.39,38.38,,83.512,percent of total billed charges,38.38% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,167.93,61.74,,134.344,percent of total billed charges,61.74% of total billed charges,277.44,102,,221.952,percent of total billed charges,102% of total billed charges,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,95.2,277.44,
Serial radiologic examination of the abdomen,7000503,CDM,320,RC,74022,HCPCS,Outpatient,,,272,204,,212.16,78,,169.728,percent of total billed charges,78% of total billed charges,171.36,63,,137.088,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,95.2,35,,76.16,percent of total billed charges,35% of total billed charges,182.99,67.275,,146.392,percent of total billed charges,67.275% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,104.39,38.38,,83.512,percent of total billed charges,38.38% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,167.93,61.74,,134.344,percent of total billed charges,61.74% of total billed charges,277.44,102,,221.952,percent of total billed charges,102% of total billed charges,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,95.2,277.44,
MANDIBLE COMP LT,7300116,CDM,320,RC,70110,HCPCS,Outpatient,,,272,204,,212.16,78,,169.728,percent of total billed charges,78% of total billed charges,171.36,63,,137.088,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,95.2,35,,76.16,percent of total billed charges,35% of total billed charges,182.99,67.275,,146.392,percent of total billed charges,67.275% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,104.39,38.38,,83.512,percent of total billed charges,38.38% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,167.93,61.74,,134.344,percent of total billed charges,61.74% of total billed charges,277.44,102,,221.952,percent of total billed charges,102% of total billed charges,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,95.2,277.44,
RIBS UNI 2 VIEWS-LT,7300217,CDM,320,RC,71100,HCPCS,Outpatient,,,272,204,,212.16,78,,169.728,percent of total billed charges,78% of total billed charges,171.36,63,,137.088,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,95.2,35,,76.16,percent of total billed charges,35% of total billed charges,182.99,67.275,,146.392,percent of total billed charges,67.275% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,104.39,38.38,,83.512,percent of total billed charges,38.38% of total billed charges,217.6,80,,174.08,percent of total billed charges,80% of total billed charges,167.93,61.74,,134.344,percent of total billed charges,61.74% of total billed charges,277.44,102,,221.952,percent of total billed charges,102% of total billed charges,103.36,38,,82.688,percent of total billed charges,38% of total billed charges,95.2,277.44,
BARTONELLA DNA BY PCR,5002062,CDM,306,RC,87471,HCPCS,Outpatient,,,273,204.75,,212.94,78,,170.352,percent of total billed charges,78% of total billed charges,24.67,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,245.7,90,,196.56,percent of total billed charges,90% of total billed charges,25.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,183.66,67.275,,146.928,percent of total billed charges,67.275% of total billed charges,218.4,80,,174.72,percent of total billed charges,80% of total billed charges,35.44,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,218.4,80,,174.72,percent of total billed charges,80% of total billed charges,168.55,61.74,,134.84,percent of total billed charges,61.74% of total billed charges,25.16,102,,,Fee Schedule,102% of GA Medicaid Rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,24.67,245.7,
ER MD CRITICARE EA ADDL 30,1200106,CDM,981,RC,99292,HCPCS,Outpatient,,,275,206.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,120.42,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,120.42,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,120.42,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,120.42,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,120.42,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,85.63,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,126.7,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,152.81,61.74,,122.248,percent of total billed charges,61.74% of total billed charges,81.55,102,,,Fee Schedule,102% of GA Medicaid Rate,120.42,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,81.55,152.81,
ST EVALUATION SPEECH FLUENCY,9000122,CDM,440,RC,92521,HCPCS,Outpatient,,,275,206.25,,214.5,78,,171.6,percent of total billed charges,78% of total billed charges,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,104.5,38,,83.6,percent of total billed charges,38% of total billed charges,104.5,38,,83.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,247.5,90,,198,percent of total billed charges,90% of total billed charges,96.25,35,,77,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,220,80,,176,percent of total billed charges,80% of total billed charges,105.55,38.38,,84.44,percent of total billed charges,38.38% of total billed charges,220,80,,176,percent of total billed charges,80% of total billed charges,169.79,61.74,,135.832,percent of total billed charges,61.74% of total billed charges,280.5,102,,224.4,percent of total billed charges,102% of total billed charges,104.5,38,,83.6,percent of total billed charges,38% of total billed charges,96.25,280.5,
TRILUMEN CV 16 CM SUPER,3004179,CDM,270,RC,,,Outpatient,,,275.8,206.85,,215.12,78,,172.096,percent of total billed charges,78% of total billed charges,173.75,63,,139,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,104.8,38,,83.84,percent of total billed charges,38% of total billed charges,104.8,38,,83.84,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,248.22,90,,198.576,percent of total billed charges,90% of total billed charges,96.53,35,,77.224,percent of total billed charges,35% of total billed charges,185.54,67.275,,148.432,percent of total billed charges,67.275% of total billed charges,220.64,80,,176.512,percent of total billed charges,80% of total billed charges,105.85,38.38,,84.68,percent of total billed charges,38.38% of total billed charges,220.64,80,,176.512,percent of total billed charges,80% of total billed charges,170.28,61.74,,136.224,percent of total billed charges,61.74% of total billed charges,281.32,102,,225.056,percent of total billed charges,102% of total billed charges,104.8,38,,83.84,percent of total billed charges,38% of total billed charges,96.53,281.32,
ENDO LEVEL 1 EA ADDL 15 M,400145,CDM,360,RC,,,Outpatient,,,277,207.75,,216.06,78,,172.848,percent of total billed charges,78% of total billed charges,174.51,63,,139.608,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,105.26,38,,84.208,percent of total billed charges,38% of total billed charges,105.26,38,,84.208,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,96.95,35,,77.56,percent of total billed charges,35% of total billed charges,186.35,67.275,,149.08,percent of total billed charges,67.275% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,106.31,38.38,,85.048,percent of total billed charges,38.38% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,171.02,61.74,,136.816,percent of total billed charges,61.74% of total billed charges,282.54,102,,226.032,percent of total billed charges,102% of total billed charges,105.26,38,,84.208,percent of total billed charges,38% of total billed charges,96.95,282.54,
Blood test to diagnose mononucleosis,5001986,CDM,302,RC,86665,HCPCS,Outpatient,,,277,207.75,,216.06,78,,172.848,percent of total billed charges,78% of total billed charges,22.82,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.14,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.14,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,23.96,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,186.35,67.275,,149.08,percent of total billed charges,67.275% of total billed charges,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,18.32,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,221.6,80,,177.28,percent of total billed charges,80% of total billed charges,171.02,61.74,,136.816,percent of total billed charges,61.74% of total billed charges,23.28,102,,,Fee Schedule,102% of GA Medicaid Rate,18.14,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.14,249.3,
S PNEUM IgG AB (6 SERO),5001503,CDM,302,RC,,,Outpatient,,,278,208.5,,216.84,78,,173.472,percent of total billed charges,78% of total billed charges,175.14,63,,140.112,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,105.64,38,,84.512,percent of total billed charges,38% of total billed charges,105.64,38,,84.512,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,250.2,90,,200.16,percent of total billed charges,90% of total billed charges,97.3,35,,77.84,percent of total billed charges,35% of total billed charges,187.02,67.275,,149.616,percent of total billed charges,67.275% of total billed charges,222.4,80,,177.92,percent of total billed charges,80% of total billed charges,106.7,38.38,,85.36,percent of total billed charges,38.38% of total billed charges,222.4,80,,177.92,percent of total billed charges,80% of total billed charges,171.64,61.74,,137.312,percent of total billed charges,61.74% of total billed charges,283.56,102,,226.848,percent of total billed charges,102% of total billed charges,105.64,38,,84.512,percent of total billed charges,38% of total billed charges,97.3,283.56,
D-DIMER,5001415,CDM,305,RC,85379,HCPCS,Outpatient,,,280,210,,218.4,78,,174.72,percent of total billed charges,78% of total billed charges,12.8,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,10.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,252,90,,201.6,percent of total billed charges,90% of total billed charges,13.44,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,188.37,67.275,,150.696,percent of total billed charges,67.275% of total billed charges,224,80,,179.2,percent of total billed charges,80% of total billed charges,10.28,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,224,80,,179.2,percent of total billed charges,80% of total billed charges,172.87,61.74,,138.296,percent of total billed charges,61.74% of total billed charges,13.06,102,,,Fee Schedule,102% of GA Medicaid Rate,10.18,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,10.18,252,
PSA (prostate specific antigen) measurement,5001788,CDM,301,RC,84154,HCPCS,Outpatient,,,280,210,,218.4,78,,174.72,percent of total billed charges,78% of total billed charges,23.13,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,252,90,,201.6,percent of total billed charges,90% of total billed charges,24.29,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,188.37,67.275,,150.696,percent of total billed charges,67.275% of total billed charges,224,80,,179.2,percent of total billed charges,80% of total billed charges,18.57,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,224,80,,179.2,percent of total billed charges,80% of total billed charges,172.87,61.74,,138.296,percent of total billed charges,61.74% of total billed charges,23.59,102,,,Fee Schedule,102% of GA Medicaid Rate,18.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.39,252,
"MTHFR, DNA MUTATION ANALYSIS",5017911,CDM,300,RC,81291,HCPCS,Outpatient,,,280,210,,218.4,78,,174.72,percent of total billed charges,78% of total billed charges,40,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,65.34,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,65.34,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,252,90,,201.6,percent of total billed charges,90% of total billed charges,42,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,188.37,67.275,,150.696,percent of total billed charges,67.275% of total billed charges,224,80,,179.2,percent of total billed charges,80% of total billed charges,65.99,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,224,80,,179.2,percent of total billed charges,80% of total billed charges,172.87,61.74,,138.296,percent of total billed charges,61.74% of total billed charges,40.8,102,,,Fee Schedule,102% of GA Medicaid Rate,65.34,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,40,252,
I&D PILONIDAL CYST SIMPLE,1001164,CDM,450,RC,,,Outpatient,,,281,210.75,,219.18,78,,175.344,percent of total billed charges,78% of total billed charges,177.03,63,,141.624,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,106.78,38,,85.424,percent of total billed charges,38% of total billed charges,106.78,38,,85.424,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,252.9,90,,202.32,percent of total billed charges,90% of total billed charges,98.35,35,,78.68,percent of total billed charges,35% of total billed charges,189.04,67.275,,151.232,percent of total billed charges,67.275% of total billed charges,224.8,80,,179.84,percent of total billed charges,80% of total billed charges,107.85,38.38,,86.28,percent of total billed charges,38.38% of total billed charges,224.8,80,,179.84,percent of total billed charges,80% of total billed charges,173.49,61.74,,138.792,percent of total billed charges,61.74% of total billed charges,286.62,102,,229.296,percent of total billed charges,102% of total billed charges,106.78,38,,85.424,percent of total billed charges,38% of total billed charges,98.35,286.62,
VENOUS CUTDOWN,1001144,CDM,450,RC,,,Outpatient,,,283,212.25,,220.74,78,,176.592,percent of total billed charges,78% of total billed charges,178.29,63,,142.632,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,107.54,38,,86.032,percent of total billed charges,38% of total billed charges,107.54,38,,86.032,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,254.7,90,,203.76,percent of total billed charges,90% of total billed charges,99.05,35,,79.24,percent of total billed charges,35% of total billed charges,190.39,67.275,,152.312,percent of total billed charges,67.275% of total billed charges,226.4,80,,181.12,percent of total billed charges,80% of total billed charges,108.62,38.38,,86.896,percent of total billed charges,38.38% of total billed charges,226.4,80,,181.12,percent of total billed charges,80% of total billed charges,174.72,61.74,,139.776,percent of total billed charges,61.74% of total billed charges,288.66,102,,230.928,percent of total billed charges,102% of total billed charges,107.54,38,,86.032,percent of total billed charges,38% of total billed charges,99.05,288.66,
NOSEBLEED ANTERIOR PACKS,1001214,CDM,450,RC,,,Outpatient,,,284,213,,221.52,78,,177.216,percent of total billed charges,78% of total billed charges,178.92,63,,143.136,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,107.92,38,,86.336,percent of total billed charges,38% of total billed charges,107.92,38,,86.336,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,255.6,90,,204.48,percent of total billed charges,90% of total billed charges,99.4,35,,79.52,percent of total billed charges,35% of total billed charges,191.06,67.275,,152.848,percent of total billed charges,67.275% of total billed charges,227.2,80,,181.76,percent of total billed charges,80% of total billed charges,109,38.38,,87.2,percent of total billed charges,38.38% of total billed charges,227.2,80,,181.76,percent of total billed charges,80% of total billed charges,175.34,61.74,,140.272,percent of total billed charges,61.74% of total billed charges,289.68,102,,231.744,percent of total billed charges,102% of total billed charges,107.92,38,,86.336,percent of total billed charges,38% of total billed charges,99.4,289.68,
LONG ARM SPLINT,1200185,CDM,981,RC,29105,HCPCS,Outpatient,,,285,213.75,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.85,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,47.85,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,47.85,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,47.85,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,47.85,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,88.47,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,49.32,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,172.44,61.74,,137.952,percent of total billed charges,61.74% of total billed charges,84.26,102,,,Fee Schedule,102% of GA Medicaid Rate,47.85,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,47.85,172.44,
"BACK STRAPPING, THORAX",1200188,CDM,981,RC,29200,HCPCS,Outpatient,,,285,213.75,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.79,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,20.79,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.79,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.79,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,20.79,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,50.4,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.63,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,172.44,61.74,,137.952,percent of total billed charges,61.74% of total billed charges,48,102,,,Fee Schedule,102% of GA Medicaid Rate,20.79,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.79,172.44,
LONG LEG SPLINT,1200190,CDM,981,RC,29505,HCPCS,Outpatient,,,285,213.75,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,57.04,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,57.04,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,57.04,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,57.04,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,57.04,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,88.68,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,58.04,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,172.44,61.74,,137.952,percent of total billed charges,61.74% of total billed charges,84.46,102,,,Fee Schedule,102% of GA Medicaid Rate,57.04,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,57.04,172.44,
SHORT LEG SPLINT,1200191,CDM,981,RC,29515,HCPCS,Outpatient,,,285,213.75,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,54.42,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,54.42,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,54.42,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,54.42,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,54.42,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,75.56,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,56.15,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,172.44,61.74,,137.952,percent of total billed charges,61.74% of total billed charges,71.96,102,,,Fee Schedule,102% of GA Medicaid Rate,54.42,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,54.42,172.44,
KNEE SUPPORT BRACE - WEB - M/L,3001111,CDM,270,RC,,,Outpatient,,,285.72,214.29,,222.86,78,,178.288,percent of total billed charges,78% of total billed charges,180,63,,144,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,108.57,38,,86.856,percent of total billed charges,38% of total billed charges,108.57,38,,86.856,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,257.15,90,,205.72,percent of total billed charges,90% of total billed charges,100,35,,80,percent of total billed charges,35% of total billed charges,192.22,67.275,,153.776,percent of total billed charges,67.275% of total billed charges,228.58,80,,182.864,percent of total billed charges,80% of total billed charges,109.66,38.38,,87.728,percent of total billed charges,38.38% of total billed charges,228.58,80,,182.864,percent of total billed charges,80% of total billed charges,176.4,61.74,,141.12,percent of total billed charges,61.74% of total billed charges,291.43,102,,233.144,percent of total billed charges,102% of total billed charges,108.57,38,,86.856,percent of total billed charges,38% of total billed charges,100,291.43,
STERNOCLAVICULAR JOINTS 3,7000230,CDM,320,RC,71130,HCPCS,Outpatient,,,286,214.5,,223.08,78,,178.464,percent of total billed charges,78% of total billed charges,180.18,63,,144.144,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,100.1,35,,80.08,percent of total billed charges,35% of total billed charges,192.41,67.275,,153.928,percent of total billed charges,67.275% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,109.77,38.38,,87.816,percent of total billed charges,38.38% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,176.58,61.74,,141.264,percent of total billed charges,61.74% of total billed charges,291.72,102,,233.376,percent of total billed charges,102% of total billed charges,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,100.1,291.72,
Radiologic examination of the shoulder,7000310,CDM,320,RC,73030,HCPCS,Outpatient,,,286,214.5,,223.08,78,,178.464,percent of total billed charges,78% of total billed charges,180.18,63,,144.144,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,100.1,35,,80.08,percent of total billed charges,35% of total billed charges,192.41,67.275,,153.928,percent of total billed charges,67.275% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,109.77,38.38,,87.816,percent of total billed charges,38.38% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,176.58,61.74,,141.264,percent of total billed charges,61.74% of total billed charges,291.72,102,,233.376,percent of total billed charges,102% of total billed charges,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,100.1,291.72,
Radiologic examination of the collar bone,7000320,CDM,320,RC,73000,HCPCS,Outpatient,,,286,214.5,,223.08,78,,178.464,percent of total billed charges,78% of total billed charges,180.18,63,,144.144,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,100.1,35,,80.08,percent of total billed charges,35% of total billed charges,192.41,67.275,,153.928,percent of total billed charges,67.275% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,109.77,38.38,,87.816,percent of total billed charges,38.38% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,176.58,61.74,,141.264,percent of total billed charges,61.74% of total billed charges,291.72,102,,233.376,percent of total billed charges,102% of total billed charges,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,100.1,291.72,
"Radiologic examination of the neck/spine, 2-3 views",7000409,CDM,320,RC,72040,HCPCS,Outpatient,,,286,214.5,,223.08,78,,178.464,percent of total billed charges,78% of total billed charges,180.18,63,,144.144,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,100.1,35,,80.08,percent of total billed charges,35% of total billed charges,192.41,67.275,,153.928,percent of total billed charges,67.275% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,109.77,38.38,,87.816,percent of total billed charges,38.38% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,176.58,61.74,,141.264,percent of total billed charges,61.74% of total billed charges,291.72,102,,233.376,percent of total billed charges,102% of total billed charges,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,100.1,291.72,
SPINE THORACIC COMPLETE,7000415,CDM,320,RC,72074,HCPCS,Outpatient,,,286,214.5,,223.08,78,,178.464,percent of total billed charges,78% of total billed charges,180.18,63,,144.144,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,100.1,35,,80.08,percent of total billed charges,35% of total billed charges,192.41,67.275,,153.928,percent of total billed charges,67.275% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,109.77,38.38,,87.816,percent of total billed charges,38.38% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,176.58,61.74,,141.264,percent of total billed charges,61.74% of total billed charges,291.72,102,,233.376,percent of total billed charges,102% of total billed charges,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,100.1,291.72,
HIP W/ PELVIS BILATERAL 2 VIEWS,7000542,CDM,320,RC,73521,HCPCS,Outpatient,,,286,214.5,,223.08,78,,178.464,percent of total billed charges,78% of total billed charges,180.18,63,,144.144,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,100.1,35,,80.08,percent of total billed charges,35% of total billed charges,192.41,67.275,,153.928,percent of total billed charges,67.275% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,109.77,38.38,,87.816,percent of total billed charges,38.38% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,176.58,61.74,,141.264,percent of total billed charges,61.74% of total billed charges,291.72,102,,233.376,percent of total billed charges,102% of total billed charges,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,100.1,291.72,
"Radiologic examination, elbow; 3 or more views",7000710,CDM,320,RC,73080,HCPCS,Outpatient,,,286,214.5,,223.08,78,,178.464,percent of total billed charges,78% of total billed charges,180.18,63,,144.144,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,100.1,35,,80.08,percent of total billed charges,35% of total billed charges,192.41,67.275,,153.928,percent of total billed charges,67.275% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,109.77,38.38,,87.816,percent of total billed charges,38.38% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,176.58,61.74,,141.264,percent of total billed charges,61.74% of total billed charges,291.72,102,,233.376,percent of total billed charges,102% of total billed charges,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,100.1,291.72,
"Radiologic examination, elbow; 3 or more views",7000716,CDM,320,RC,73080,HCPCS,Outpatient,,,286,214.5,,223.08,78,,178.464,percent of total billed charges,78% of total billed charges,180.18,63,,144.144,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,100.1,35,,80.08,percent of total billed charges,35% of total billed charges,192.41,67.275,,153.928,percent of total billed charges,67.275% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,109.77,38.38,,87.816,percent of total billed charges,38.38% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,176.58,61.74,,141.264,percent of total billed charges,61.74% of total billed charges,291.72,102,,233.376,percent of total billed charges,102% of total billed charges,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,100.1,291.72,
Up to 3 views,7000720,CDM,320,RC,73110,HCPCS,Outpatient,,,286,214.5,,223.08,78,,178.464,percent of total billed charges,78% of total billed charges,180.18,63,,144.144,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,100.1,35,,80.08,percent of total billed charges,35% of total billed charges,192.41,67.275,,153.928,percent of total billed charges,67.275% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,109.77,38.38,,87.816,percent of total billed charges,38.38% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,176.58,61.74,,141.264,percent of total billed charges,61.74% of total billed charges,291.72,102,,233.376,percent of total billed charges,102% of total billed charges,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,100.1,291.72,
Up to 3 views,7000722,CDM,320,RC,73110,HCPCS,Outpatient,,,286,214.5,,223.08,78,,178.464,percent of total billed charges,78% of total billed charges,180.18,63,,144.144,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,100.1,35,,80.08,percent of total billed charges,35% of total billed charges,192.41,67.275,,153.928,percent of total billed charges,67.275% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,109.77,38.38,,87.816,percent of total billed charges,38.38% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,176.58,61.74,,141.264,percent of total billed charges,61.74% of total billed charges,291.72,102,,233.376,percent of total billed charges,102% of total billed charges,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,100.1,291.72,
Radiologic examination of the foot with 3 or more views,7000750,CDM,320,RC,73630,HCPCS,Outpatient,,,286,214.5,,223.08,78,,178.464,percent of total billed charges,78% of total billed charges,180.18,63,,144.144,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,100.1,35,,80.08,percent of total billed charges,35% of total billed charges,192.41,67.275,,153.928,percent of total billed charges,67.275% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,109.77,38.38,,87.816,percent of total billed charges,38.38% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,176.58,61.74,,141.264,percent of total billed charges,61.74% of total billed charges,291.72,102,,233.376,percent of total billed charges,102% of total billed charges,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,100.1,291.72,
Radiologic examination of the foot with 3 or more views,7000752,CDM,320,RC,73630,HCPCS,Outpatient,,,286,214.5,,223.08,78,,178.464,percent of total billed charges,78% of total billed charges,180.18,63,,144.144,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,100.1,35,,80.08,percent of total billed charges,35% of total billed charges,192.41,67.275,,153.928,percent of total billed charges,67.275% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,109.77,38.38,,87.816,percent of total billed charges,38.38% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,176.58,61.74,,141.264,percent of total billed charges,61.74% of total billed charges,291.72,102,,233.376,percent of total billed charges,102% of total billed charges,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,100.1,291.72,
Radiologic examination of the heel,7000755,CDM,320,RC,73650,HCPCS,Outpatient,,,286,214.5,,223.08,78,,178.464,percent of total billed charges,78% of total billed charges,180.18,63,,144.144,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,100.1,35,,80.08,percent of total billed charges,35% of total billed charges,192.41,67.275,,153.928,percent of total billed charges,67.275% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,109.77,38.38,,87.816,percent of total billed charges,38.38% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,176.58,61.74,,141.264,percent of total billed charges,61.74% of total billed charges,291.72,102,,233.376,percent of total billed charges,102% of total billed charges,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,100.1,291.72,
Radiologic examination of the heel,7000756,CDM,320,RC,73650,HCPCS,Outpatient,,,286,214.5,,223.08,78,,178.464,percent of total billed charges,78% of total billed charges,180.18,63,,144.144,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,100.1,35,,80.08,percent of total billed charges,35% of total billed charges,192.41,67.275,,153.928,percent of total billed charges,67.275% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,109.77,38.38,,87.816,percent of total billed charges,38.38% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,176.58,61.74,,141.264,percent of total billed charges,61.74% of total billed charges,291.72,102,,233.376,percent of total billed charges,102% of total billed charges,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,100.1,291.72,
Radiologic examination of the shoulder,7300311,CDM,320,RC,73030,HCPCS,Outpatient,,,286,214.5,,223.08,78,,178.464,percent of total billed charges,78% of total billed charges,180.18,63,,144.144,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,100.1,35,,80.08,percent of total billed charges,35% of total billed charges,192.41,67.275,,153.928,percent of total billed charges,67.275% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,109.77,38.38,,87.816,percent of total billed charges,38.38% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,176.58,61.74,,141.264,percent of total billed charges,61.74% of total billed charges,291.72,102,,233.376,percent of total billed charges,102% of total billed charges,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,100.1,291.72,
Radiologic examination of the collar bone,7300321,CDM,320,RC,73000,HCPCS,Outpatient,,,286,214.5,,223.08,78,,178.464,percent of total billed charges,78% of total billed charges,180.18,63,,144.144,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,100.1,35,,80.08,percent of total billed charges,35% of total billed charges,192.41,67.275,,153.928,percent of total billed charges,67.275% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,109.77,38.38,,87.816,percent of total billed charges,38.38% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,176.58,61.74,,141.264,percent of total billed charges,61.74% of total billed charges,291.72,102,,233.376,percent of total billed charges,102% of total billed charges,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,100.1,291.72,
X-ray of the hand with 2 views,7400947,CDM,320,RC,73120,HCPCS,Outpatient,,,286,214.5,,223.08,78,,178.464,percent of total billed charges,78% of total billed charges,180.18,63,,144.144,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,100.1,35,,80.08,percent of total billed charges,35% of total billed charges,192.41,67.275,,153.928,percent of total billed charges,67.275% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,109.77,38.38,,87.816,percent of total billed charges,38.38% of total billed charges,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,176.58,61.74,,141.264,percent of total billed charges,61.74% of total billed charges,291.72,102,,233.376,percent of total billed charges,102% of total billed charges,108.68,38,,86.944,percent of total billed charges,38% of total billed charges,100.1,291.72,
"URINARY CATH, FOLEY, COMPL",1200238,CDM,981,RC,51703,HCPCS,Outpatient,,,287,215.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,85,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,85,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,85,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,85,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,85,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,159.73,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,89.39,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,173.65,61.74,,138.92,percent of total billed charges,61.74% of total billed charges,152.12,102,,,Fee Schedule,102% of GA Medicaid Rate,85,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,85,173.65,
"PEAK FLOW, EACH",8000009,CDM,410,RC,94150,HCPCS,Outpatient,,,287,215.25,,223.86,78,,179.088,percent of total billed charges,78% of total billed charges,180.81,63,,144.648,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,109.06,38,,87.248,percent of total billed charges,38% of total billed charges,109.06,38,,87.248,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,258.3,90,,206.64,percent of total billed charges,90% of total billed charges,100.45,35,,80.36,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,229.6,80,,183.68,percent of total billed charges,80% of total billed charges,110.15,38.38,,88.12,percent of total billed charges,38.38% of total billed charges,229.6,80,,183.68,percent of total billed charges,80% of total billed charges,177.19,61.74,,141.752,percent of total billed charges,61.74% of total billed charges,292.74,102,,234.192,percent of total billed charges,102% of total billed charges,109.06,38,,87.248,percent of total billed charges,38% of total billed charges,100.45,292.74,
Test to determine how well oxygen moves from the lungs to the blood stream,8000062,CDM,460,RC,94010,HCPCS,Outpatient,,,287,215.25,,223.86,78,,179.088,percent of total billed charges,78% of total billed charges,180.81,63,,144.648,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,109.06,38,,87.248,percent of total billed charges,38% of total billed charges,109.06,38,,87.248,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,258.3,90,,206.64,percent of total billed charges,90% of total billed charges,100.45,35,,80.36,percent of total billed charges,35% of total billed charges,193.08,67.275,,154.464,percent of total billed charges,67.275% of total billed charges,229.6,80,,183.68,percent of total billed charges,80% of total billed charges,110.15,38.38,,88.12,percent of total billed charges,38.38% of total billed charges,229.6,80,,183.68,percent of total billed charges,80% of total billed charges,177.19,61.74,,141.752,percent of total billed charges,61.74% of total billed charges,292.74,102,,234.192,percent of total billed charges,102% of total billed charges,109.06,38,,87.248,percent of total billed charges,38% of total billed charges,100.45,292.74,
SPUTUM INDUCE W/O INHALNT,8000088,CDM,410,RC,94799,HCPCS,Outpatient,,,287,215.25,,223.86,78,,179.088,percent of total billed charges,78% of total billed charges,180.81,63,,144.648,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,109.06,38,,87.248,percent of total billed charges,38% of total billed charges,109.06,38,,87.248,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,258.3,90,,206.64,percent of total billed charges,90% of total billed charges,100.45,35,,80.36,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,229.6,80,,183.68,percent of total billed charges,80% of total billed charges,110.15,38.38,,88.12,percent of total billed charges,38.38% of total billed charges,229.6,80,,183.68,percent of total billed charges,80% of total billed charges,177.19,61.74,,141.752,percent of total billed charges,61.74% of total billed charges,292.74,102,,234.192,percent of total billed charges,102% of total billed charges,109.06,38,,87.248,percent of total billed charges,38% of total billed charges,100.45,292.74,
EMG THREE EXTREM W OR W/O PARASPINALS,9600012,CDM,922,RC,95863,HCPCS,Outpatient,,,287,215.25,,223.86,78,,179.088,percent of total billed charges,78% of total billed charges,180.81,63,,144.648,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,109.06,38,,87.248,percent of total billed charges,38% of total billed charges,109.06,38,,87.248,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,258.3,90,,206.64,percent of total billed charges,90% of total billed charges,100.45,35,,80.36,percent of total billed charges,35% of total billed charges,193.08,67.275,,154.464,percent of total billed charges,67.275% of total billed charges,229.6,80,,183.68,percent of total billed charges,80% of total billed charges,110.15,38.38,,88.12,percent of total billed charges,38.38% of total billed charges,229.6,80,,183.68,percent of total billed charges,80% of total billed charges,177.19,61.74,,141.752,percent of total billed charges,61.74% of total billed charges,292.74,102,,234.192,percent of total billed charges,102% of total billed charges,109.06,38,,87.248,percent of total billed charges,38% of total billed charges,100.45,292.74,
EMG FOUR EXTREM W OR W/O PARASPINALS,9600013,CDM,922,RC,95864,HCPCS,Outpatient,,,287,215.25,,223.86,78,,179.088,percent of total billed charges,78% of total billed charges,180.81,63,,144.648,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,109.06,38,,87.248,percent of total billed charges,38% of total billed charges,109.06,38,,87.248,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,258.3,90,,206.64,percent of total billed charges,90% of total billed charges,100.45,35,,80.36,percent of total billed charges,35% of total billed charges,193.08,67.275,,154.464,percent of total billed charges,67.275% of total billed charges,229.6,80,,183.68,percent of total billed charges,80% of total billed charges,110.15,38.38,,88.12,percent of total billed charges,38.38% of total billed charges,229.6,80,,183.68,percent of total billed charges,80% of total billed charges,177.19,61.74,,141.752,percent of total billed charges,61.74% of total billed charges,292.74,102,,234.192,percent of total billed charges,102% of total billed charges,109.06,38,,87.248,percent of total billed charges,38% of total billed charges,100.45,292.74,
EMG CRANIAL NERVE UNILATERAL,9600014,CDM,922,RC,95867,HCPCS,Outpatient,,,287,215.25,,223.86,78,,179.088,percent of total billed charges,78% of total billed charges,180.81,63,,144.648,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,109.06,38,,87.248,percent of total billed charges,38% of total billed charges,109.06,38,,87.248,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,258.3,90,,206.64,percent of total billed charges,90% of total billed charges,100.45,35,,80.36,percent of total billed charges,35% of total billed charges,193.08,67.275,,154.464,percent of total billed charges,67.275% of total billed charges,229.6,80,,183.68,percent of total billed charges,80% of total billed charges,110.15,38.38,,88.12,percent of total billed charges,38.38% of total billed charges,229.6,80,,183.68,percent of total billed charges,80% of total billed charges,177.19,61.74,,141.752,percent of total billed charges,61.74% of total billed charges,292.74,102,,234.192,percent of total billed charges,102% of total billed charges,109.06,38,,87.248,percent of total billed charges,38% of total billed charges,100.45,292.74,
EMG THORACIC PARASPINALS,9600015,CDM,922,RC,95869,HCPCS,Outpatient,,,287,215.25,,223.86,78,,179.088,percent of total billed charges,78% of total billed charges,180.81,63,,144.648,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,109.06,38,,87.248,percent of total billed charges,38% of total billed charges,109.06,38,,87.248,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,258.3,90,,206.64,percent of total billed charges,90% of total billed charges,100.45,35,,80.36,percent of total billed charges,35% of total billed charges,193.08,67.275,,154.464,percent of total billed charges,67.275% of total billed charges,229.6,80,,183.68,percent of total billed charges,80% of total billed charges,110.15,38.38,,88.12,percent of total billed charges,38.38% of total billed charges,229.6,80,,183.68,percent of total billed charges,80% of total billed charges,177.19,61.74,,141.752,percent of total billed charges,61.74% of total billed charges,292.74,102,,234.192,percent of total billed charges,102% of total billed charges,109.06,38,,87.248,percent of total billed charges,38% of total billed charges,100.45,292.74,
EMG NEUROMUSCULAR JUNCTION TESTING,9600022,CDM,922,RC,95937,HCPCS,Outpatient,,,287,215.25,,223.86,78,,179.088,percent of total billed charges,78% of total billed charges,180.81,63,,144.648,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,109.06,38,,87.248,percent of total billed charges,38% of total billed charges,109.06,38,,87.248,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,258.3,90,,206.64,percent of total billed charges,90% of total billed charges,100.45,35,,80.36,percent of total billed charges,35% of total billed charges,193.08,67.275,,154.464,percent of total billed charges,67.275% of total billed charges,229.6,80,,183.68,percent of total billed charges,80% of total billed charges,110.15,38.38,,88.12,percent of total billed charges,38.38% of total billed charges,229.6,80,,183.68,percent of total billed charges,80% of total billed charges,177.19,61.74,,141.752,percent of total billed charges,61.74% of total billed charges,292.74,102,,234.192,percent of total billed charges,102% of total billed charges,109.06,38,,87.248,percent of total billed charges,38% of total billed charges,100.45,292.74,
EMG CRANIAL NERVE BILATERAL,9600027,CDM,922,RC,95868,HCPCS,Outpatient,,,287,215.25,,223.86,78,,179.088,percent of total billed charges,78% of total billed charges,180.81,63,,144.648,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,109.06,38,,87.248,percent of total billed charges,38% of total billed charges,109.06,38,,87.248,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,258.3,90,,206.64,percent of total billed charges,90% of total billed charges,100.45,35,,80.36,percent of total billed charges,35% of total billed charges,193.08,67.275,,154.464,percent of total billed charges,67.275% of total billed charges,229.6,80,,183.68,percent of total billed charges,80% of total billed charges,110.15,38.38,,88.12,percent of total billed charges,38.38% of total billed charges,229.6,80,,183.68,percent of total billed charges,80% of total billed charges,177.19,61.74,,141.752,percent of total billed charges,61.74% of total billed charges,292.74,102,,234.192,percent of total billed charges,102% of total billed charges,109.06,38,,87.248,percent of total billed charges,38% of total billed charges,100.45,292.74,
NERVE CONDUCTION STUDIES; 1-2 STUDIES,9600040,CDM,922,RC,95907,HCPCS,Outpatient,,,287,215.25,,223.86,78,,179.088,percent of total billed charges,78% of total billed charges,180.81,63,,144.648,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,109.06,38,,87.248,percent of total billed charges,38% of total billed charges,109.06,38,,87.248,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,258.3,90,,206.64,percent of total billed charges,90% of total billed charges,100.45,35,,80.36,percent of total billed charges,35% of total billed charges,193.08,67.275,,154.464,percent of total billed charges,67.275% of total billed charges,229.6,80,,183.68,percent of total billed charges,80% of total billed charges,110.15,38.38,,88.12,percent of total billed charges,38.38% of total billed charges,229.6,80,,183.68,percent of total billed charges,80% of total billed charges,177.19,61.74,,141.752,percent of total billed charges,61.74% of total billed charges,292.74,102,,234.192,percent of total billed charges,102% of total billed charges,109.06,38,,87.248,percent of total billed charges,38% of total billed charges,100.45,292.74,
"FLUOROSCOPY,> 1 HOUR",7000811,CDM,320,RC,76001,HCPCS,Outpatient,,,289,216.75,,225.42,78,,180.336,percent of total billed charges,78% of total billed charges,182.07,63,,145.656,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,109.82,38,,87.856,percent of total billed charges,38% of total billed charges,109.82,38,,87.856,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,260.1,90,,208.08,percent of total billed charges,90% of total billed charges,101.15,35,,80.92,percent of total billed charges,35% of total billed charges,194.42,67.275,,155.536,percent of total billed charges,67.275% of total billed charges,231.2,80,,184.96,percent of total billed charges,80% of total billed charges,110.92,38.38,,88.736,percent of total billed charges,38.38% of total billed charges,231.2,80,,184.96,percent of total billed charges,80% of total billed charges,178.43,61.74,,142.744,percent of total billed charges,61.74% of total billed charges,294.78,102,,235.824,percent of total billed charges,102% of total billed charges,109.82,38,,87.856,percent of total billed charges,38% of total billed charges,101.15,294.78,
CARCINOEMBRYONIC ANTIGEN,5001410,CDM,301,RC,82378,HCPCS,Outpatient,,,290,217.5,,226.2,78,,180.96,percent of total billed charges,78% of total billed charges,23.86,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,18.96,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.96,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,261,90,,208.8,percent of total billed charges,90% of total billed charges,25.05,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,195.1,67.275,,156.08,percent of total billed charges,67.275% of total billed charges,232,80,,185.6,percent of total billed charges,80% of total billed charges,19.15,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,232,80,,185.6,percent of total billed charges,80% of total billed charges,179.05,61.74,,143.24,percent of total billed charges,61.74% of total billed charges,24.34,102,,,Fee Schedule,102% of GA Medicaid Rate,18.96,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,18.96,261,
TRANSTRACHAEL AIRWAY CATHS EMERGENCY 5.0,3000008,CDM,270,RC,,,Outpatient,,,290.76,218.07,,226.79,78,,181.432,percent of total billed charges,78% of total billed charges,183.18,63,,146.544,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,110.49,38,,88.392,percent of total billed charges,38% of total billed charges,110.49,38,,88.392,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,261.68,90,,209.344,percent of total billed charges,90% of total billed charges,101.77,35,,81.416,percent of total billed charges,35% of total billed charges,195.61,67.275,,156.488,percent of total billed charges,67.275% of total billed charges,232.61,80,,186.088,percent of total billed charges,80% of total billed charges,111.59,38.38,,89.272,percent of total billed charges,38.38% of total billed charges,232.61,80,,186.088,percent of total billed charges,80% of total billed charges,179.52,61.74,,143.616,percent of total billed charges,61.74% of total billed charges,296.58,102,,237.264,percent of total billed charges,102% of total billed charges,110.49,38,,88.392,percent of total billed charges,38% of total billed charges,101.77,296.58,
Urine test,5002106,CDM,311,RC,88112,HCPCS,Outpatient,,,292,219,,227.76,78,,182.208,percent of total billed charges,78% of total billed charges,106.19,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,110.96,38,,88.768,percent of total billed charges,38% of total billed charges,110.96,38,,88.768,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,262.8,90,,210.24,percent of total billed charges,90% of total billed charges,111.5,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,196.44,67.275,,157.152,percent of total billed charges,67.275% of total billed charges,233.6,80,,186.88,percent of total billed charges,80% of total billed charges,112.07,38.38,,89.656,percent of total billed charges,38.38% of total billed charges,233.6,80,,186.88,percent of total billed charges,80% of total billed charges,180.28,61.74,,144.224,percent of total billed charges,61.74% of total billed charges,108.31,102,,,Fee Schedule,102% of GA Medicaid Rate,110.96,38,,88.768,percent of total billed charges,38% of total billed charges,106.19,262.8,
Radiologic examination of the toe(s),7000765,CDM,320,RC,73660,HCPCS,Outpatient,,,292,219,,227.76,78,,182.208,percent of total billed charges,78% of total billed charges,183.96,63,,147.168,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,110.96,38,,88.768,percent of total billed charges,38% of total billed charges,110.96,38,,88.768,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,262.8,90,,210.24,percent of total billed charges,90% of total billed charges,102.2,35,,81.76,percent of total billed charges,35% of total billed charges,196.44,67.275,,157.152,percent of total billed charges,67.275% of total billed charges,233.6,80,,186.88,percent of total billed charges,80% of total billed charges,112.07,38.38,,89.656,percent of total billed charges,38.38% of total billed charges,233.6,80,,186.88,percent of total billed charges,80% of total billed charges,180.28,61.74,,144.224,percent of total billed charges,61.74% of total billed charges,297.84,102,,238.272,percent of total billed charges,102% of total billed charges,110.96,38,,88.768,percent of total billed charges,38% of total billed charges,102.2,297.84,
Radiologic examination of the toe(s),7000766,CDM,320,RC,73660,HCPCS,Outpatient,,,292,219,,227.76,78,,182.208,percent of total billed charges,78% of total billed charges,183.96,63,,147.168,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,110.96,38,,88.768,percent of total billed charges,38% of total billed charges,110.96,38,,88.768,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,262.8,90,,210.24,percent of total billed charges,90% of total billed charges,102.2,35,,81.76,percent of total billed charges,35% of total billed charges,196.44,67.275,,157.152,percent of total billed charges,67.275% of total billed charges,233.6,80,,186.88,percent of total billed charges,80% of total billed charges,112.07,38.38,,89.656,percent of total billed charges,38.38% of total billed charges,233.6,80,,186.88,percent of total billed charges,80% of total billed charges,180.28,61.74,,144.224,percent of total billed charges,61.74% of total billed charges,297.84,102,,238.272,percent of total billed charges,102% of total billed charges,110.96,38,,88.768,percent of total billed charges,38% of total billed charges,102.2,297.84,
CAST LOWER EXTREMITY,1001084,CDM,450,RC,,,Outpatient,,,298,223.5,,232.44,78,,185.952,percent of total billed charges,78% of total billed charges,187.74,63,,150.192,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,113.24,38,,90.592,percent of total billed charges,38% of total billed charges,113.24,38,,90.592,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,268.2,90,,214.56,percent of total billed charges,90% of total billed charges,104.3,35,,83.44,percent of total billed charges,35% of total billed charges,200.48,67.275,,160.384,percent of total billed charges,67.275% of total billed charges,238.4,80,,190.72,percent of total billed charges,80% of total billed charges,114.37,38.38,,91.496,percent of total billed charges,38.38% of total billed charges,238.4,80,,190.72,percent of total billed charges,80% of total billed charges,183.99,61.74,,147.192,percent of total billed charges,61.74% of total billed charges,303.96,102,,243.168,percent of total billed charges,102% of total billed charges,113.24,38,,90.592,percent of total billed charges,38% of total billed charges,104.3,303.96,
SCREW CORTICAL 24MM X 2.7MM,3000504,CDM,270,RC,,,Outpatient,,,300,225,,234,78,,187.2,percent of total billed charges,78% of total billed charges,189,63,,151.2,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,114,38,,91.2,percent of total billed charges,38% of total billed charges,114,38,,91.2,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,270,90,,216,percent of total billed charges,90% of total billed charges,105,35,,84,percent of total billed charges,35% of total billed charges,201.83,67.275,,161.464,percent of total billed charges,67.275% of total billed charges,240,80,,192,percent of total billed charges,80% of total billed charges,115.14,38.38,,92.112,percent of total billed charges,38.38% of total billed charges,240,80,,192,percent of total billed charges,80% of total billed charges,185.22,61.74,,148.176,percent of total billed charges,61.74% of total billed charges,306,102,,244.8,percent of total billed charges,102% of total billed charges,114,38,,91.2,percent of total billed charges,38% of total billed charges,105,306,
SCREW CORTICAL 18MM X 2.7MM,3001521,CDM,270,RC,,,Outpatient,,,300,225,,234,78,,187.2,percent of total billed charges,78% of total billed charges,189,63,,151.2,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,114,38,,91.2,percent of total billed charges,38% of total billed charges,114,38,,91.2,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,270,90,,216,percent of total billed charges,90% of total billed charges,105,35,,84,percent of total billed charges,35% of total billed charges,201.83,67.275,,161.464,percent of total billed charges,67.275% of total billed charges,240,80,,192,percent of total billed charges,80% of total billed charges,115.14,38.38,,92.112,percent of total billed charges,38.38% of total billed charges,240,80,,192,percent of total billed charges,80% of total billed charges,185.22,61.74,,148.176,percent of total billed charges,61.74% of total billed charges,306,102,,244.8,percent of total billed charges,102% of total billed charges,114,38,,91.2,percent of total billed charges,38% of total billed charges,105,306,
CONSIGN - SCREW CORTICAL 18 X 2.7,3009004,CDM,270,RC,,,Outpatient,,,300,225,,234,78,,187.2,percent of total billed charges,78% of total billed charges,189,63,,151.2,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,114,38,,91.2,percent of total billed charges,38% of total billed charges,114,38,,91.2,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,270,90,,216,percent of total billed charges,90% of total billed charges,105,35,,84,percent of total billed charges,35% of total billed charges,201.83,67.275,,161.464,percent of total billed charges,67.275% of total billed charges,240,80,,192,percent of total billed charges,80% of total billed charges,115.14,38.38,,92.112,percent of total billed charges,38.38% of total billed charges,240,80,,192,percent of total billed charges,80% of total billed charges,185.22,61.74,,148.176,percent of total billed charges,61.74% of total billed charges,306,102,,244.8,percent of total billed charges,102% of total billed charges,114,38,,91.2,percent of total billed charges,38% of total billed charges,105,306,
CONSIGN - SCREW CORTICAL 20 X 2.7,3009005,CDM,270,RC,,,Outpatient,,,300,225,,234,78,,187.2,percent of total billed charges,78% of total billed charges,189,63,,151.2,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,114,38,,91.2,percent of total billed charges,38% of total billed charges,114,38,,91.2,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,270,90,,216,percent of total billed charges,90% of total billed charges,105,35,,84,percent of total billed charges,35% of total billed charges,201.83,67.275,,161.464,percent of total billed charges,67.275% of total billed charges,240,80,,192,percent of total billed charges,80% of total billed charges,115.14,38.38,,92.112,percent of total billed charges,38.38% of total billed charges,240,80,,192,percent of total billed charges,80% of total billed charges,185.22,61.74,,148.176,percent of total billed charges,61.74% of total billed charges,306,102,,244.8,percent of total billed charges,102% of total billed charges,114,38,,91.2,percent of total billed charges,38% of total billed charges,105,306,
"CALPROTECTIN, STOOL",5002067,CDM,301,RC,83993,HCPCS,Outpatient,,,300,225,,234,78,,187.2,percent of total billed charges,78% of total billed charges,24.68,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,19.63,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,19.63,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,270,90,,216,percent of total billed charges,90% of total billed charges,25.91,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,201.83,67.275,,161.464,percent of total billed charges,67.275% of total billed charges,240,80,,192,percent of total billed charges,80% of total billed charges,19.83,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,240,80,,192,percent of total billed charges,80% of total billed charges,185.22,61.74,,148.176,percent of total billed charges,61.74% of total billed charges,25.17,102,,,Fee Schedule,102% of GA Medicaid Rate,19.63,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,19.63,270,
EXTUBATION OF AIRWAY,8094799,CDM,410,RC,94799,HCPCS,Outpatient,,,300,225,,234,78,,187.2,percent of total billed charges,78% of total billed charges,189,63,,151.2,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,114,38,,91.2,percent of total billed charges,38% of total billed charges,114,38,,91.2,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,270,90,,216,percent of total billed charges,90% of total billed charges,105,35,,84,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,240,80,,192,percent of total billed charges,80% of total billed charges,115.14,38.38,,92.112,percent of total billed charges,38.38% of total billed charges,240,80,,192,percent of total billed charges,80% of total billed charges,185.22,61.74,,148.176,percent of total billed charges,61.74% of total billed charges,306,102,,244.8,percent of total billed charges,102% of total billed charges,114,38,,91.2,percent of total billed charges,38% of total billed charges,105,306,
ST COGNITIVE NON MCR PATIENT,9000128,CDM,440,RC,97127,HCPCS,Outpatient,,,300,225,,234,78,,187.2,percent of total billed charges,78% of total billed charges,189,63,,151.2,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,114,38,,91.2,percent of total billed charges,38% of total billed charges,114,38,,91.2,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,270,90,,216,percent of total billed charges,90% of total billed charges,105,35,,84,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,240,80,,192,percent of total billed charges,80% of total billed charges,115.14,38.38,,92.112,percent of total billed charges,38.38% of total billed charges,240,80,,192,percent of total billed charges,80% of total billed charges,185.22,61.74,,148.176,percent of total billed charges,61.74% of total billed charges,306,102,,244.8,percent of total billed charges,102% of total billed charges,114,38,,91.2,percent of total billed charges,38% of total billed charges,105,306,
ST COGNITIVE MCR PATIENT,9000130,CDM,440,RC,G0515,HCPCS,Outpatient,,,300,225,,234,78,,187.2,percent of total billed charges,78% of total billed charges,189,63,,151.2,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,114,38,,91.2,percent of total billed charges,38% of total billed charges,114,38,,91.2,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,270,90,,216,percent of total billed charges,90% of total billed charges,105,35,,84,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,240,80,,192,percent of total billed charges,80% of total billed charges,115.14,38.38,,92.112,percent of total billed charges,38.38% of total billed charges,240,80,,192,percent of total billed charges,80% of total billed charges,185.22,61.74,,148.176,percent of total billed charges,61.74% of total billed charges,306,102,,244.8,percent of total billed charges,102% of total billed charges,114,38,,91.2,percent of total billed charges,38% of total billed charges,105,306,
CLIP APPLIER ER320,3004056,CDM,270,RC,,,Outpatient,,,301.32,225.99,,235.03,78,,188.024,percent of total billed charges,78% of total billed charges,189.83,63,,151.864,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,114.5,38,,91.6,percent of total billed charges,38% of total billed charges,114.5,38,,91.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,271.19,90,,216.952,percent of total billed charges,90% of total billed charges,105.46,35,,84.368,percent of total billed charges,35% of total billed charges,202.71,67.275,,162.168,percent of total billed charges,67.275% of total billed charges,241.06,80,,192.848,percent of total billed charges,80% of total billed charges,115.65,38.38,,92.52,percent of total billed charges,38.38% of total billed charges,241.06,80,,192.848,percent of total billed charges,80% of total billed charges,186.03,61.74,,148.824,percent of total billed charges,61.74% of total billed charges,307.35,102,,245.88,percent of total billed charges,102% of total billed charges,114.5,38,,91.6,percent of total billed charges,38% of total billed charges,105.46,307.35,
HOLE POST 3 MALE,3006010,CDM,270,RC,,,Outpatient,,,303,227.25,,236.34,78,,189.072,percent of total billed charges,78% of total billed charges,190.89,63,,152.712,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,115.14,38,,92.112,percent of total billed charges,38% of total billed charges,115.14,38,,92.112,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,106.05,35,,84.84,percent of total billed charges,35% of total billed charges,203.84,67.275,,163.072,percent of total billed charges,67.275% of total billed charges,242.4,80,,193.92,percent of total billed charges,80% of total billed charges,116.29,38.38,,93.032,percent of total billed charges,38.38% of total billed charges,242.4,80,,193.92,percent of total billed charges,80% of total billed charges,187.07,61.74,,149.656,percent of total billed charges,61.74% of total billed charges,309.06,102,,247.248,percent of total billed charges,102% of total billed charges,115.14,38,,92.112,percent of total billed charges,38% of total billed charges,106.05,309.06,
LEUKEMIA LYMPHOMA PROFILE,5001908,CDM,300,RC,88185,HCPCS,Outpatient,,,304,228,,237.12,78,,189.696,percent of total billed charges,78% of total billed charges,22.67,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,115.52,38,,92.416,percent of total billed charges,38% of total billed charges,115.52,38,,92.416,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,273.6,90,,218.88,percent of total billed charges,90% of total billed charges,23.8,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,204.52,67.275,,163.616,percent of total billed charges,67.275% of total billed charges,243.2,80,,194.56,percent of total billed charges,80% of total billed charges,116.68,38.38,,93.344,percent of total billed charges,38.38% of total billed charges,243.2,80,,194.56,percent of total billed charges,80% of total billed charges,187.69,61.74,,150.152,percent of total billed charges,61.74% of total billed charges,23.12,102,,,Fee Schedule,102% of GA Medicaid Rate,115.52,38,,92.416,percent of total billed charges,38% of total billed charges,22.67,273.6,
PATH FLOW CYTO EA ADD'L,5003135,CDM,319,RC,88185,HCPCS,Outpatient,,,304,228,,237.12,78,,189.696,percent of total billed charges,78% of total billed charges,22.67,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,115.52,38,,92.416,percent of total billed charges,38% of total billed charges,115.52,38,,92.416,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,273.6,90,,218.88,percent of total billed charges,90% of total billed charges,23.8,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,204.52,67.275,,163.616,percent of total billed charges,67.275% of total billed charges,243.2,80,,194.56,percent of total billed charges,80% of total billed charges,116.68,38.38,,93.344,percent of total billed charges,38.38% of total billed charges,243.2,80,,194.56,percent of total billed charges,80% of total billed charges,187.69,61.74,,150.152,percent of total billed charges,61.74% of total billed charges,23.12,102,,,Fee Schedule,102% of GA Medicaid Rate,115.52,38,,92.416,percent of total billed charges,38% of total billed charges,22.67,273.6,
"SMALL BOWEL SERIES, THIN",7000625,CDM,320,RC,74250,HCPCS,Outpatient,,,305,228.75,,237.9,78,,190.32,percent of total billed charges,78% of total billed charges,192.15,63,,153.72,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,115.9,38,,92.72,percent of total billed charges,38% of total billed charges,115.9,38,,92.72,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,274.5,90,,219.6,percent of total billed charges,90% of total billed charges,106.75,35,,85.4,percent of total billed charges,35% of total billed charges,205.19,67.275,,164.152,percent of total billed charges,67.275% of total billed charges,244,80,,195.2,percent of total billed charges,80% of total billed charges,117.06,38.38,,93.648,percent of total billed charges,38.38% of total billed charges,244,80,,195.2,percent of total billed charges,80% of total billed charges,188.31,61.74,,150.648,percent of total billed charges,61.74% of total billed charges,311.1,102,,248.88,percent of total billed charges,102% of total billed charges,115.9,38,,92.72,percent of total billed charges,38% of total billed charges,106.75,311.1,
SWALLOW FUNCTION CINERADIOGRAPHY,7000636,CDM,320,RC,74230,HCPCS,Outpatient,,,305,228.75,,237.9,78,,190.32,percent of total billed charges,78% of total billed charges,192.15,63,,153.72,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,115.9,38,,92.72,percent of total billed charges,38% of total billed charges,115.9,38,,92.72,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,274.5,90,,219.6,percent of total billed charges,90% of total billed charges,106.75,35,,85.4,percent of total billed charges,35% of total billed charges,205.19,67.275,,164.152,percent of total billed charges,67.275% of total billed charges,244,80,,195.2,percent of total billed charges,80% of total billed charges,117.06,38.38,,93.648,percent of total billed charges,38.38% of total billed charges,244,80,,195.2,percent of total billed charges,80% of total billed charges,188.31,61.74,,150.648,percent of total billed charges,61.74% of total billed charges,311.1,102,,248.88,percent of total billed charges,102% of total billed charges,115.9,38,,92.72,percent of total billed charges,38% of total billed charges,106.75,311.1,
PROLENE MESH,3004011,CDM,270,RC,,,Outpatient,,,305.2,228.9,,238.06,78,,190.448,percent of total billed charges,78% of total billed charges,192.28,63,,153.824,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,115.98,38,,92.784,percent of total billed charges,38% of total billed charges,115.98,38,,92.784,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,274.68,90,,219.744,percent of total billed charges,90% of total billed charges,106.82,35,,85.456,percent of total billed charges,35% of total billed charges,205.32,67.275,,164.256,percent of total billed charges,67.275% of total billed charges,244.16,80,,195.328,percent of total billed charges,80% of total billed charges,117.14,38.38,,93.712,percent of total billed charges,38.38% of total billed charges,244.16,80,,195.328,percent of total billed charges,80% of total billed charges,188.43,61.74,,150.744,percent of total billed charges,61.74% of total billed charges,311.3,102,,249.04,percent of total billed charges,102% of total billed charges,115.98,38,,92.784,percent of total billed charges,38% of total billed charges,106.82,311.3,
"US OB LESS THAN 14 WKS,EACH ADD'L GESTAT",7300018,CDM,402,RC,76802,HCPCS,Outpatient,,,306,229.5,,238.68,78,,190.944,percent of total billed charges,78% of total billed charges,192.78,63,,154.224,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,116.28,38,,93.024,percent of total billed charges,38% of total billed charges,116.28,38,,93.024,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,275.4,90,,220.32,percent of total billed charges,90% of total billed charges,107.1,35,,85.68,percent of total billed charges,35% of total billed charges,205.86,67.275,,164.688,percent of total billed charges,67.275% of total billed charges,244.8,80,,195.84,percent of total billed charges,80% of total billed charges,117.44,38.38,,93.952,percent of total billed charges,38.38% of total billed charges,244.8,80,,195.84,percent of total billed charges,80% of total billed charges,188.92,61.74,,151.136,percent of total billed charges,61.74% of total billed charges,312.12,102,,249.696,percent of total billed charges,102% of total billed charges,116.28,38,,93.024,percent of total billed charges,38% of total billed charges,107.1,312.12,
Blood test used to diagnose heart failure,5001993,CDM,301,RC,83880,HCPCS,Outpatient,,,307,230.25,,239.46,78,,191.568,percent of total billed charges,78% of total billed charges,42.69,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,39.26,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,39.26,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,276.3,90,,221.04,percent of total billed charges,90% of total billed charges,44.82,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,206.53,67.275,,165.224,percent of total billed charges,67.275% of total billed charges,245.6,80,,196.48,percent of total billed charges,80% of total billed charges,39.65,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,245.6,80,,196.48,percent of total billed charges,80% of total billed charges,189.54,61.74,,151.632,percent of total billed charges,61.74% of total billed charges,43.54,102,,,Fee Schedule,102% of GA Medicaid Rate,39.26,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,39.26,276.3,
LINEAR STAPLER 60MM,3001823,CDM,270,RC,,,Outpatient,,,308.64,231.48,,240.74,78,,192.592,percent of total billed charges,78% of total billed charges,194.44,63,,155.552,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,117.28,38,,93.824,percent of total billed charges,38% of total billed charges,117.28,38,,93.824,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,277.78,90,,222.224,percent of total billed charges,90% of total billed charges,108.02,35,,86.416,percent of total billed charges,35% of total billed charges,207.64,67.275,,166.112,percent of total billed charges,67.275% of total billed charges,246.91,80,,197.528,percent of total billed charges,80% of total billed charges,118.46,38.38,,94.768,percent of total billed charges,38.38% of total billed charges,246.91,80,,197.528,percent of total billed charges,80% of total billed charges,190.55,61.74,,152.44,percent of total billed charges,61.74% of total billed charges,314.81,102,,251.848,percent of total billed charges,102% of total billed charges,117.28,38,,93.824,percent of total billed charges,38% of total billed charges,108.02,314.81,
"CHROMIUM, SERUM",5001676,CDM,301,RC,82495,HCPCS,Outpatient,,,309,231.75,,241.02,78,,192.816,percent of total billed charges,78% of total billed charges,25.51,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,20.28,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.28,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,26.79,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,207.88,67.275,,166.304,percent of total billed charges,67.275% of total billed charges,247.2,80,,197.76,percent of total billed charges,80% of total billed charges,20.48,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,247.2,80,,197.76,percent of total billed charges,80% of total billed charges,190.78,61.74,,152.624,percent of total billed charges,61.74% of total billed charges,26.02,102,,,Fee Schedule,102% of GA Medicaid Rate,20.28,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.28,278.1,
CHROMIUM 24 HR URINE,5002090,CDM,301,RC,82495,HCPCS,Outpatient,,,309,231.75,,241.02,78,,192.816,percent of total billed charges,78% of total billed charges,25.51,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,20.28,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.28,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,26.79,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,207.88,67.275,,166.304,percent of total billed charges,67.275% of total billed charges,247.2,80,,197.76,percent of total billed charges,80% of total billed charges,20.48,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,247.2,80,,197.76,percent of total billed charges,80% of total billed charges,190.78,61.74,,152.624,percent of total billed charges,61.74% of total billed charges,26.02,102,,,Fee Schedule,102% of GA Medicaid Rate,20.28,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.28,278.1,
NOSEBLEED POSTERIOR PACKS,1001216,CDM,450,RC,,,Outpatient,,,311,233.25,,242.58,78,,194.064,percent of total billed charges,78% of total billed charges,195.93,63,,156.744,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,118.18,38,,94.544,percent of total billed charges,38% of total billed charges,118.18,38,,94.544,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,279.9,90,,223.92,percent of total billed charges,90% of total billed charges,108.85,35,,87.08,percent of total billed charges,35% of total billed charges,209.23,67.275,,167.384,percent of total billed charges,67.275% of total billed charges,248.8,80,,199.04,percent of total billed charges,80% of total billed charges,119.36,38.38,,95.488,percent of total billed charges,38.38% of total billed charges,248.8,80,,199.04,percent of total billed charges,80% of total billed charges,192.01,61.74,,153.608,percent of total billed charges,61.74% of total billed charges,317.22,102,,253.776,percent of total billed charges,102% of total billed charges,118.18,38,,94.544,percent of total billed charges,38% of total billed charges,108.85,317.22,
PROGESTERONE,5001721,CDM,301,RC,84144,HCPCS,Outpatient,,,311,233.25,,242.58,78,,194.064,percent of total billed charges,78% of total billed charges,25.61,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,20.86,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.86,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,279.9,90,,223.92,percent of total billed charges,90% of total billed charges,26.89,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,209.23,67.275,,167.384,percent of total billed charges,67.275% of total billed charges,248.8,80,,199.04,percent of total billed charges,80% of total billed charges,21.07,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,248.8,80,,199.04,percent of total billed charges,80% of total billed charges,192.01,61.74,,153.608,percent of total billed charges,61.74% of total billed charges,26.12,102,,,Fee Schedule,102% of GA Medicaid Rate,20.86,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.86,279.9,
Radiologic examination of the knee with 4 or more views,7000701,CDM,320,RC,73564,HCPCS,Outpatient,,,314,235.5,,244.92,78,,195.936,percent of total billed charges,78% of total billed charges,197.82,63,,158.256,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,119.32,38,,95.456,percent of total billed charges,38% of total billed charges,119.32,38,,95.456,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,282.6,90,,226.08,percent of total billed charges,90% of total billed charges,109.9,35,,87.92,percent of total billed charges,35% of total billed charges,211.24,67.275,,168.992,percent of total billed charges,67.275% of total billed charges,251.2,80,,200.96,percent of total billed charges,80% of total billed charges,120.51,38.38,,96.408,percent of total billed charges,38.38% of total billed charges,251.2,80,,200.96,percent of total billed charges,80% of total billed charges,193.86,61.74,,155.088,percent of total billed charges,61.74% of total billed charges,320.28,102,,256.224,percent of total billed charges,102% of total billed charges,119.32,38,,95.456,percent of total billed charges,38% of total billed charges,109.9,320.28,
Radiologic examination of the knee with 4 or more views,7000715,CDM,320,RC,73564,HCPCS,Outpatient,,,314,235.5,,244.92,78,,195.936,percent of total billed charges,78% of total billed charges,197.82,63,,158.256,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,119.32,38,,95.456,percent of total billed charges,38% of total billed charges,119.32,38,,95.456,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,282.6,90,,226.08,percent of total billed charges,90% of total billed charges,109.9,35,,87.92,percent of total billed charges,35% of total billed charges,211.24,67.275,,168.992,percent of total billed charges,67.275% of total billed charges,251.2,80,,200.96,percent of total billed charges,80% of total billed charges,120.51,38.38,,96.408,percent of total billed charges,38.38% of total billed charges,251.2,80,,200.96,percent of total billed charges,80% of total billed charges,193.86,61.74,,155.088,percent of total billed charges,61.74% of total billed charges,320.28,102,,256.224,percent of total billed charges,102% of total billed charges,119.32,38,,95.456,percent of total billed charges,38% of total billed charges,109.9,320.28,
Radiologic examination of the knee with 3 views,7000840,CDM,320,RC,73562,HCPCS,Outpatient,,,314,235.5,,244.92,78,,195.936,percent of total billed charges,78% of total billed charges,197.82,63,,158.256,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,119.32,38,,95.456,percent of total billed charges,38% of total billed charges,119.32,38,,95.456,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,282.6,90,,226.08,percent of total billed charges,90% of total billed charges,109.9,35,,87.92,percent of total billed charges,35% of total billed charges,211.24,67.275,,168.992,percent of total billed charges,67.275% of total billed charges,251.2,80,,200.96,percent of total billed charges,80% of total billed charges,120.51,38.38,,96.408,percent of total billed charges,38.38% of total billed charges,251.2,80,,200.96,percent of total billed charges,80% of total billed charges,193.86,61.74,,155.088,percent of total billed charges,61.74% of total billed charges,320.28,102,,256.224,percent of total billed charges,102% of total billed charges,119.32,38,,95.456,percent of total billed charges,38% of total billed charges,109.9,320.28,
Radiologic examination of the knee with 3 views,7000841,CDM,320,RC,73562,HCPCS,Outpatient,,,314,235.5,,244.92,78,,195.936,percent of total billed charges,78% of total billed charges,197.82,63,,158.256,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,119.32,38,,95.456,percent of total billed charges,38% of total billed charges,119.32,38,,95.456,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,282.6,90,,226.08,percent of total billed charges,90% of total billed charges,109.9,35,,87.92,percent of total billed charges,35% of total billed charges,211.24,67.275,,168.992,percent of total billed charges,67.275% of total billed charges,251.2,80,,200.96,percent of total billed charges,80% of total billed charges,120.51,38.38,,96.408,percent of total billed charges,38.38% of total billed charges,251.2,80,,200.96,percent of total billed charges,80% of total billed charges,193.86,61.74,,155.088,percent of total billed charges,61.74% of total billed charges,320.28,102,,256.224,percent of total billed charges,102% of total billed charges,119.32,38,,95.456,percent of total billed charges,38% of total billed charges,109.9,320.28,
CATH BILARY BALLOON 5FR CV5001,3000214,CDM,270,RC,,,Outpatient,,,316,237,,246.48,78,,197.184,percent of total billed charges,78% of total billed charges,199.08,63,,159.264,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,120.08,38,,96.064,percent of total billed charges,38% of total billed charges,120.08,38,,96.064,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,110.6,35,,88.48,percent of total billed charges,35% of total billed charges,212.59,67.275,,170.072,percent of total billed charges,67.275% of total billed charges,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,121.28,38.38,,97.024,percent of total billed charges,38.38% of total billed charges,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,195.1,61.74,,156.08,percent of total billed charges,61.74% of total billed charges,322.32,102,,257.856,percent of total billed charges,102% of total billed charges,120.08,38,,96.064,percent of total billed charges,38% of total billed charges,110.6,322.32,
"New patient office of other outpatient visit, typically 45 min",1001024,CDM,510,RC,99204,HCPCS,Outpatient,,,317,237.75,,247.26,78,,197.808,percent of total billed charges,78% of total billed charges,199.71,63,,159.768,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,120.46,38,,96.368,percent of total billed charges,38% of total billed charges,120.46,38,,96.368,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,285.3,90,,228.24,percent of total billed charges,90% of total billed charges,110.95,35,,88.76,percent of total billed charges,35% of total billed charges,133.52,67.275,,106.816,percent of total billed charges,67.275% of total billed charges,253.6,80,,202.88,percent of total billed charges,80% of total billed charges,121.66,38.38,,97.328,percent of total billed charges,38.38% of total billed charges,253.6,80,,202.88,percent of total billed charges,80% of total billed charges,195.72,61.74,,156.576,percent of total billed charges,61.74% of total billed charges,323.34,102,,258.672,percent of total billed charges,102% of total billed charges,120.46,38,,96.368,percent of total billed charges,38% of total billed charges,110.95,323.34,
CANDIDA ANTIBODY,5000143,CDM,302,RC,86628,HCPCS,Outpatient,,,318,238.5,,248.04,78,,198.432,percent of total billed charges,78% of total billed charges,15.1,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,12.01,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.01,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,286.2,90,,228.96,percent of total billed charges,90% of total billed charges,15.86,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,213.93,67.275,,171.144,percent of total billed charges,67.275% of total billed charges,254.4,80,,203.52,percent of total billed charges,80% of total billed charges,12.13,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,254.4,80,,203.52,percent of total billed charges,80% of total billed charges,196.33,61.74,,157.064,percent of total billed charges,61.74% of total billed charges,15.4,102,,,Fee Schedule,102% of GA Medicaid Rate,12.01,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,12.01,286.2,
Blood test to monitor for cancer,5001931,CDM,302,RC,86304,HCPCS,Outpatient,,,318,238.5,,248.04,78,,198.432,percent of total billed charges,78% of total billed charges,26.16,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,20.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,286.2,90,,228.96,percent of total billed charges,90% of total billed charges,27.47,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,213.93,67.275,,171.144,percent of total billed charges,67.275% of total billed charges,254.4,80,,203.52,percent of total billed charges,80% of total billed charges,21.02,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,254.4,80,,203.52,percent of total billed charges,80% of total billed charges,196.33,61.74,,157.064,percent of total billed charges,61.74% of total billed charges,26.68,102,,,Fee Schedule,102% of GA Medicaid Rate,20.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,20.81,286.2,
"US GUIDANCE, NEEDLE PLACEMENT",7300990,CDM,402,RC,76942,HCPCS,Outpatient,,,318,238.5,,248.04,78,,198.432,percent of total billed charges,78% of total billed charges,200.34,63,,160.272,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,120.84,38,,96.672,percent of total billed charges,38% of total billed charges,120.84,38,,96.672,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,286.2,90,,228.96,percent of total billed charges,90% of total billed charges,111.3,35,,89.04,percent of total billed charges,35% of total billed charges,213.93,67.275,,171.144,percent of total billed charges,67.275% of total billed charges,254.4,80,,203.52,percent of total billed charges,80% of total billed charges,122.05,38.38,,97.64,percent of total billed charges,38.38% of total billed charges,254.4,80,,203.52,percent of total billed charges,80% of total billed charges,196.33,61.74,,157.064,percent of total billed charges,61.74% of total billed charges,324.36,102,,259.488,percent of total billed charges,102% of total billed charges,120.84,38,,96.672,percent of total billed charges,38% of total billed charges,111.3,324.36,
CHOLANGIOGRAM CATHETER 23 CM,3004061,CDM,270,RC,,,Outpatient,,,321,240.75,,250.38,78,,200.304,percent of total billed charges,78% of total billed charges,202.23,63,,161.784,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,121.98,38,,97.584,percent of total billed charges,38% of total billed charges,121.98,38,,97.584,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,288.9,90,,231.12,percent of total billed charges,90% of total billed charges,112.35,35,,89.88,percent of total billed charges,35% of total billed charges,215.95,67.275,,172.76,percent of total billed charges,67.275% of total billed charges,256.8,80,,205.44,percent of total billed charges,80% of total billed charges,123.2,38.38,,98.56,percent of total billed charges,38.38% of total billed charges,256.8,80,,205.44,percent of total billed charges,80% of total billed charges,198.19,61.74,,158.552,percent of total billed charges,61.74% of total billed charges,327.42,102,,261.936,percent of total billed charges,102% of total billed charges,121.98,38,,97.584,percent of total billed charges,38% of total billed charges,112.35,327.42,
CT BIOPSY CHEST TUBE,3007050,CDM,270,RC,,,Outpatient,,,321,240.75,,250.38,78,,200.304,percent of total billed charges,78% of total billed charges,202.23,63,,161.784,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,121.98,38,,97.584,percent of total billed charges,38% of total billed charges,121.98,38,,97.584,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,288.9,90,,231.12,percent of total billed charges,90% of total billed charges,112.35,35,,89.88,percent of total billed charges,35% of total billed charges,215.95,67.275,,172.76,percent of total billed charges,67.275% of total billed charges,256.8,80,,205.44,percent of total billed charges,80% of total billed charges,123.2,38.38,,98.56,percent of total billed charges,38.38% of total billed charges,256.8,80,,205.44,percent of total billed charges,80% of total billed charges,198.19,61.74,,158.552,percent of total billed charges,61.74% of total billed charges,327.42,102,,261.936,percent of total billed charges,102% of total billed charges,121.98,38,,97.584,percent of total billed charges,38% of total billed charges,112.35,327.42,
VITAMIN B-1,5002008,CDM,301,RC,84425,HCPCS,Outpatient,,,323,242.25,,251.94,78,,201.552,percent of total billed charges,78% of total billed charges,26.7,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,21.23,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,21.23,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,290.7,90,,232.56,percent of total billed charges,90% of total billed charges,28.04,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,217.3,67.275,,173.84,percent of total billed charges,67.275% of total billed charges,258.4,80,,206.72,percent of total billed charges,80% of total billed charges,21.44,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,258.4,80,,206.72,percent of total billed charges,80% of total billed charges,199.42,61.74,,159.536,percent of total billed charges,61.74% of total billed charges,27.23,102,,,Fee Schedule,102% of GA Medicaid Rate,21.23,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,21.23,290.7,
US ARTER DUP LWR EXT BILAT LIMITED,7300037,CDM,921,RC,93926,HCPCS,Outpatient,,,323,242.25,,251.94,78,,201.552,percent of total billed charges,78% of total billed charges,203.49,63,,162.792,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,122.74,38,,98.192,percent of total billed charges,38% of total billed charges,122.74,38,,98.192,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,290.7,90,,232.56,percent of total billed charges,90% of total billed charges,113.05,35,,90.44,percent of total billed charges,35% of total billed charges,217.3,67.275,,173.84,percent of total billed charges,67.275% of total billed charges,258.4,80,,206.72,percent of total billed charges,80% of total billed charges,123.97,38.38,,99.176,percent of total billed charges,38.38% of total billed charges,258.4,80,,206.72,percent of total billed charges,80% of total billed charges,199.42,61.74,,159.536,percent of total billed charges,61.74% of total billed charges,329.46,102,,263.568,percent of total billed charges,102% of total billed charges,122.74,38,,98.192,percent of total billed charges,38% of total billed charges,113.05,329.46,
INSULIN-LIKE GROWTH FACTOR IGFI,5001841,CDM,301,RC,84305,HCPCS,Outpatient,,,325,243.75,,253.5,78,,202.8,percent of total billed charges,78% of total billed charges,26.73,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,21.26,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,21.26,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,292.5,90,,234,percent of total billed charges,90% of total billed charges,28.07,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,218.64,67.275,,174.912,percent of total billed charges,67.275% of total billed charges,260,80,,208,percent of total billed charges,80% of total billed charges,21.47,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,260,80,,208,percent of total billed charges,80% of total billed charges,200.66,61.74,,160.528,percent of total billed charges,61.74% of total billed charges,27.26,102,,,Fee Schedule,102% of GA Medicaid Rate,21.26,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,21.26,292.5,
"CMV DNA, QUAL PCR",5002060,CDM,306,RC,87496,HCPCS,Outpatient,,,326,244.5,,254.28,78,,203.424,percent of total billed charges,78% of total billed charges,24.67,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,293.4,90,,234.72,percent of total billed charges,90% of total billed charges,25.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,219.32,67.275,,175.456,percent of total billed charges,67.275% of total billed charges,260.8,80,,208.64,percent of total billed charges,80% of total billed charges,35.44,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,260.8,80,,208.64,percent of total billed charges,80% of total billed charges,201.27,61.74,,161.016,percent of total billed charges,61.74% of total billed charges,25.16,102,,,Fee Schedule,102% of GA Medicaid Rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,24.67,293.4,
SIMPLE REPAIR WOUND,1001188,CDM,450,RC,,,Outpatient,,,328,246,,255.84,78,,204.672,percent of total billed charges,78% of total billed charges,206.64,63,,165.312,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,124.64,38,,99.712,percent of total billed charges,38% of total billed charges,124.64,38,,99.712,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,295.2,90,,236.16,percent of total billed charges,90% of total billed charges,114.8,35,,91.84,percent of total billed charges,35% of total billed charges,220.66,67.275,,176.528,percent of total billed charges,67.275% of total billed charges,262.4,80,,209.92,percent of total billed charges,80% of total billed charges,125.89,38.38,,100.712,percent of total billed charges,38.38% of total billed charges,262.4,80,,209.92,percent of total billed charges,80% of total billed charges,202.51,61.74,,162.008,percent of total billed charges,61.74% of total billed charges,334.56,102,,267.648,percent of total billed charges,102% of total billed charges,124.64,38,,99.712,percent of total billed charges,38% of total billed charges,114.8,334.56,
OXYGEN USE/DAY,8000052,CDM,270,RC,,,Outpatient,,,328,246,,255.84,78,,204.672,percent of total billed charges,78% of total billed charges,206.64,63,,165.312,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,124.64,38,,99.712,percent of total billed charges,38% of total billed charges,124.64,38,,99.712,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,295.2,90,,236.16,percent of total billed charges,90% of total billed charges,114.8,35,,91.84,percent of total billed charges,35% of total billed charges,220.66,67.275,,176.528,percent of total billed charges,67.275% of total billed charges,262.4,80,,209.92,percent of total billed charges,80% of total billed charges,125.89,38.38,,100.712,percent of total billed charges,38.38% of total billed charges,262.4,80,,209.92,percent of total billed charges,80% of total billed charges,202.51,61.74,,162.008,percent of total billed charges,61.74% of total billed charges,334.56,102,,267.648,percent of total billed charges,102% of total billed charges,124.64,38,,99.712,percent of total billed charges,38% of total billed charges,114.8,334.56,
AIRWAY EXCHANGE CATH 11 FR,3001013,CDM,270,RC,,,Outpatient,,,332.52,249.39,,259.37,78,,207.496,percent of total billed charges,78% of total billed charges,209.49,63,,167.592,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,126.36,38,,101.088,percent of total billed charges,38% of total billed charges,126.36,38,,101.088,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,299.27,90,,239.416,percent of total billed charges,90% of total billed charges,116.38,35,,93.104,percent of total billed charges,35% of total billed charges,223.7,67.275,,178.96,percent of total billed charges,67.275% of total billed charges,266.02,80,,212.816,percent of total billed charges,80% of total billed charges,127.62,38.38,,102.096,percent of total billed charges,38.38% of total billed charges,266.02,80,,212.816,percent of total billed charges,80% of total billed charges,205.3,61.74,,164.24,percent of total billed charges,61.74% of total billed charges,339.17,102,,271.336,percent of total billed charges,102% of total billed charges,126.36,38,,101.088,percent of total billed charges,38% of total billed charges,116.38,339.17,
PNEUMOTHORAX SET W/O GUIDEWIRE,3005081,CDM,270,RC,,,Outpatient,,,335.56,251.67,,261.74,78,,209.392,percent of total billed charges,78% of total billed charges,211.4,63,,169.12,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,127.51,38,,102.008,percent of total billed charges,38% of total billed charges,127.51,38,,102.008,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,302,90,,241.6,percent of total billed charges,90% of total billed charges,117.45,35,,93.96,percent of total billed charges,35% of total billed charges,225.75,67.275,,180.6,percent of total billed charges,67.275% of total billed charges,268.45,80,,214.76,percent of total billed charges,80% of total billed charges,128.79,38.38,,103.032,percent of total billed charges,38.38% of total billed charges,268.45,80,,214.76,percent of total billed charges,80% of total billed charges,207.17,61.74,,165.736,percent of total billed charges,61.74% of total billed charges,342.27,102,,273.816,percent of total billed charges,102% of total billed charges,127.51,38,,102.008,percent of total billed charges,38% of total billed charges,117.45,342.27,
ENDOTRAC HOOK BLADE,3005031,CDM,270,RC,,,Outpatient,,,336,252,,262.08,78,,209.664,percent of total billed charges,78% of total billed charges,211.68,63,,169.344,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,127.68,38,,102.144,percent of total billed charges,38% of total billed charges,127.68,38,,102.144,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,302.4,90,,241.92,percent of total billed charges,90% of total billed charges,117.6,35,,94.08,percent of total billed charges,35% of total billed charges,226.04,67.275,,180.832,percent of total billed charges,67.275% of total billed charges,268.8,80,,215.04,percent of total billed charges,80% of total billed charges,128.96,38.38,,103.168,percent of total billed charges,38.38% of total billed charges,268.8,80,,215.04,percent of total billed charges,80% of total billed charges,207.45,61.74,,165.96,percent of total billed charges,61.74% of total billed charges,342.72,102,,274.176,percent of total billed charges,102% of total billed charges,127.68,38,,102.144,percent of total billed charges,38% of total billed charges,117.6,342.72,
Blood test to monitor vitamin D levels,5002102,CDM,301,RC,82306,HCPCS,Outpatient,,,336,252,,262.08,78,,209.664,percent of total billed charges,78% of total billed charges,37.22,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,29.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,29.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,302.4,90,,241.92,percent of total billed charges,90% of total billed charges,39.08,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,226.04,67.275,,180.832,percent of total billed charges,67.275% of total billed charges,268.8,80,,215.04,percent of total billed charges,80% of total billed charges,29.9,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,268.8,80,,215.04,percent of total billed charges,80% of total billed charges,207.45,61.74,,165.96,percent of total billed charges,61.74% of total billed charges,37.96,102,,,Fee Schedule,102% of GA Medicaid Rate,29.6,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,29.6,302.4,
BARTHOLIN GLAND ABSCESS,1200147,CDM,981,RC,56420,HCPCS,Outpatient,,,338,253.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,122.99,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,122.99,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,122.99,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,122.99,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,122.99,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,100.04,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,128.5,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,204.51,61.74,,163.608,percent of total billed charges,61.74% of total billed charges,95.28,102,,,Fee Schedule,102% of GA Medicaid Rate,122.99,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,95.28,204.51,
SEXUAL ASSAULT EXAM,1200206,CDM,981,RC,58999,HCPCS,Outpatient,,,338,253.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,204.51,61.74,,163.608,percent of total billed charges,61.74% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,204.51,204.51,
"HIV 2 RNA/DNA QUAL, PCR",5002033,CDM,306,RC,87538,HCPCS,Outpatient,,,338,253.5,,263.64,78,,210.912,percent of total billed charges,78% of total billed charges,212.94,63,,170.352,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,304.2,90,,243.36,percent of total billed charges,90% of total billed charges,118.3,35,,94.64,percent of total billed charges,35% of total billed charges,227.39,67.275,,181.912,percent of total billed charges,67.275% of total billed charges,270.4,80,,216.32,percent of total billed charges,80% of total billed charges,35.44,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,270.4,80,,216.32,percent of total billed charges,80% of total billed charges,208.68,61.74,,166.944,percent of total billed charges,61.74% of total billed charges,344.76,102,,275.808,percent of total billed charges,102% of total billed charges,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,35.09,344.76,
Test to determine if wheezing is present,8000063,CDM,460,RC,94060,HCPCS,Outpatient,,,338,253.5,,263.64,78,,210.912,percent of total billed charges,78% of total billed charges,212.94,63,,170.352,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,128.44,38,,102.752,percent of total billed charges,38% of total billed charges,128.44,38,,102.752,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,304.2,90,,243.36,percent of total billed charges,90% of total billed charges,118.3,35,,94.64,percent of total billed charges,35% of total billed charges,227.39,67.275,,181.912,percent of total billed charges,67.275% of total billed charges,270.4,80,,216.32,percent of total billed charges,80% of total billed charges,129.72,38.38,,103.776,percent of total billed charges,38.38% of total billed charges,270.4,80,,216.32,percent of total billed charges,80% of total billed charges,208.68,61.74,,166.944,percent of total billed charges,61.74% of total billed charges,344.76,102,,275.808,percent of total billed charges,102% of total billed charges,128.44,38,,102.752,percent of total billed charges,38% of total billed charges,118.3,344.76,
IMMUNOFIXATION SERUM,5002003,CDM,302,RC,86334,HCPCS,Outpatient,,,340,255,,265.2,78,,212.16,percent of total billed charges,78% of total billed charges,28.09,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,22.34,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,22.34,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,306,90,,244.8,percent of total billed charges,90% of total billed charges,29.49,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,228.74,67.275,,182.992,percent of total billed charges,67.275% of total billed charges,272,80,,217.6,percent of total billed charges,80% of total billed charges,22.56,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,272,80,,217.6,percent of total billed charges,80% of total billed charges,209.92,61.74,,167.936,percent of total billed charges,61.74% of total billed charges,28.65,102,,,Fee Schedule,102% of GA Medicaid Rate,22.34,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,22.34,306,
ESOPHAGEAL DILATOR,3000414,CDM,270,RC,,,Outpatient,,,345,258.75,,269.1,78,,215.28,percent of total billed charges,78% of total billed charges,217.35,63,,173.88,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,131.1,38,,104.88,percent of total billed charges,38% of total billed charges,131.1,38,,104.88,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,310.5,90,,248.4,percent of total billed charges,90% of total billed charges,120.75,35,,96.6,percent of total billed charges,35% of total billed charges,232.1,67.275,,185.68,percent of total billed charges,67.275% of total billed charges,276,80,,220.8,percent of total billed charges,80% of total billed charges,132.41,38.38,,105.928,percent of total billed charges,38.38% of total billed charges,276,80,,220.8,percent of total billed charges,80% of total billed charges,213,61.74,,170.4,percent of total billed charges,61.74% of total billed charges,351.9,102,,281.52,percent of total billed charges,102% of total billed charges,131.1,38,,104.88,percent of total billed charges,38% of total billed charges,120.75,351.9,
DNA ANALYSIS OR CELL CYCL,5003709,CDM,311,RC,88182,HCPCS,Outpatient,,,345,258.75,,269.1,78,,215.28,percent of total billed charges,78% of total billed charges,66.96,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,131.1,38,,104.88,percent of total billed charges,38% of total billed charges,131.1,38,,104.88,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,310.5,90,,248.4,percent of total billed charges,90% of total billed charges,70.31,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,232.1,67.275,,185.68,percent of total billed charges,67.275% of total billed charges,276,80,,220.8,percent of total billed charges,80% of total billed charges,132.41,38.38,,105.928,percent of total billed charges,38.38% of total billed charges,276,80,,220.8,percent of total billed charges,80% of total billed charges,213,61.74,,170.4,percent of total billed charges,61.74% of total billed charges,68.3,102,,,Fee Schedule,102% of GA Medicaid Rate,131.1,38,,104.88,percent of total billed charges,38% of total billed charges,66.96,310.5,
DRILL BIT 2.5,3000028,CDM,270,RC,,,Outpatient,,,346,259.5,,269.88,78,,215.904,percent of total billed charges,78% of total billed charges,217.98,63,,174.384,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,131.48,38,,105.184,percent of total billed charges,38% of total billed charges,131.48,38,,105.184,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,311.4,90,,249.12,percent of total billed charges,90% of total billed charges,121.1,35,,96.88,percent of total billed charges,35% of total billed charges,232.77,67.275,,186.216,percent of total billed charges,67.275% of total billed charges,276.8,80,,221.44,percent of total billed charges,80% of total billed charges,132.79,38.38,,106.232,percent of total billed charges,38.38% of total billed charges,276.8,80,,221.44,percent of total billed charges,80% of total billed charges,213.62,61.74,,170.896,percent of total billed charges,61.74% of total billed charges,352.92,102,,282.336,percent of total billed charges,102% of total billed charges,131.48,38,,105.184,percent of total billed charges,38% of total billed charges,121.1,352.92,
SQUARE NUT,3006002,CDM,270,RC,,,Outpatient,,,348,261,,271.44,78,,217.152,percent of total billed charges,78% of total billed charges,219.24,63,,175.392,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,132.24,38,,105.792,percent of total billed charges,38% of total billed charges,132.24,38,,105.792,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,313.2,90,,250.56,percent of total billed charges,90% of total billed charges,121.8,35,,97.44,percent of total billed charges,35% of total billed charges,234.12,67.275,,187.296,percent of total billed charges,67.275% of total billed charges,278.4,80,,222.72,percent of total billed charges,80% of total billed charges,133.56,38.38,,106.848,percent of total billed charges,38.38% of total billed charges,278.4,80,,222.72,percent of total billed charges,80% of total billed charges,214.86,61.74,,171.888,percent of total billed charges,61.74% of total billed charges,354.96,102,,283.968,percent of total billed charges,102% of total billed charges,132.24,38,,105.792,percent of total billed charges,38% of total billed charges,121.8,354.96,
Echo with doppler,7300940,CDM,480,RC,93320,HCPCS,Outpatient,,,348,261,,271.44,78,,217.152,percent of total billed charges,78% of total billed charges,219.24,63,,175.392,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,132.24,38,,105.792,percent of total billed charges,38% of total billed charges,132.24,38,,105.792,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,313.2,90,,250.56,percent of total billed charges,90% of total billed charges,121.8,35,,97.44,percent of total billed charges,35% of total billed charges,234.12,67.275,,187.296,percent of total billed charges,67.275% of total billed charges,278.4,80,,222.72,percent of total billed charges,80% of total billed charges,133.56,38.38,,106.848,percent of total billed charges,38.38% of total billed charges,278.4,80,,222.72,percent of total billed charges,80% of total billed charges,214.86,61.74,,171.888,percent of total billed charges,61.74% of total billed charges,354.96,102,,283.968,percent of total billed charges,102% of total billed charges,132.24,38,,105.792,percent of total billed charges,38% of total billed charges,121.8,354.96,
TELESCOPING TROM LEG BRACE,3006045,CDM,270,RC,,,Outpatient,,,349.14,261.86,,272.33,78,,217.864,percent of total billed charges,78% of total billed charges,219.96,63,,175.968,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,132.67,38,,106.136,percent of total billed charges,38% of total billed charges,132.67,38,,106.136,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,314.23,90,,251.384,percent of total billed charges,90% of total billed charges,122.2,35,,97.76,percent of total billed charges,35% of total billed charges,234.88,67.275,,187.904,percent of total billed charges,67.275% of total billed charges,279.31,80,,223.448,percent of total billed charges,80% of total billed charges,134,38.38,,107.2,percent of total billed charges,38.38% of total billed charges,279.31,80,,223.448,percent of total billed charges,80% of total billed charges,215.56,61.74,,172.448,percent of total billed charges,61.74% of total billed charges,356.12,102,,284.896,percent of total billed charges,102% of total billed charges,132.67,38,,106.136,percent of total billed charges,38% of total billed charges,122.2,356.12,
TB AG RESPONSE T CELL SUSP,5086481,CDM,300,RC,86481,HCPCS,Outpatient,,,350,262.5,,273,78,,218.4,percent of total billed charges,78% of total billed charges,69.78,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,100,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,100,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,315,90,,252,percent of total billed charges,90% of total billed charges,73.27,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,235.46,67.275,,188.368,percent of total billed charges,67.275% of total billed charges,280,80,,224,percent of total billed charges,80% of total billed charges,101,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,280,80,,224,percent of total billed charges,80% of total billed charges,216.09,61.74,,172.872,percent of total billed charges,61.74% of total billed charges,71.18,102,,,Fee Schedule,102% of GA Medicaid Rate,100,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,69.78,315,
VARIAX 2.0MM DRILL BIT,3004019,CDM,270,RC,,,Outpatient,,,352,264,,274.56,78,,219.648,percent of total billed charges,78% of total billed charges,221.76,63,,177.408,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,133.76,38,,107.008,percent of total billed charges,38% of total billed charges,133.76,38,,107.008,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,316.8,90,,253.44,percent of total billed charges,90% of total billed charges,123.2,35,,98.56,percent of total billed charges,35% of total billed charges,236.81,67.275,,189.448,percent of total billed charges,67.275% of total billed charges,281.6,80,,225.28,percent of total billed charges,80% of total billed charges,135.1,38.38,,108.08,percent of total billed charges,38.38% of total billed charges,281.6,80,,225.28,percent of total billed charges,80% of total billed charges,217.32,61.74,,173.856,percent of total billed charges,61.74% of total billed charges,359.04,102,,287.232,percent of total billed charges,102% of total billed charges,133.76,38,,107.008,percent of total billed charges,38% of total billed charges,123.2,359.04,
CLOSED DISLOC WITH MANIP,1001080,CDM,450,RC,,,Outpatient,,,353,264.75,,275.34,78,,220.272,percent of total billed charges,78% of total billed charges,222.39,63,,177.912,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,134.14,38,,107.312,percent of total billed charges,38% of total billed charges,134.14,38,,107.312,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,317.7,90,,254.16,percent of total billed charges,90% of total billed charges,123.55,35,,98.84,percent of total billed charges,35% of total billed charges,237.48,67.275,,189.984,percent of total billed charges,67.275% of total billed charges,282.4,80,,225.92,percent of total billed charges,80% of total billed charges,135.48,38.38,,108.384,percent of total billed charges,38.38% of total billed charges,282.4,80,,225.92,percent of total billed charges,80% of total billed charges,217.94,61.74,,174.352,percent of total billed charges,61.74% of total billed charges,360.06,102,,288.048,percent of total billed charges,102% of total billed charges,134.14,38,,107.312,percent of total billed charges,38% of total billed charges,123.55,360.06,
"Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities",1200113,CDM,981,RC,12001,HCPCS,Outpatient,,,355,266.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,50.78,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,50.78,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,50.78,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,50.78,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,50.78,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,109.07,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,53.91,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,214.79,61.74,,171.832,percent of total billed charges,61.74% of total billed charges,103.88,102,,,Fee Schedule,102% of GA Medicaid Rate,50.78,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,50.78,214.79,
SUTURING SIMPLE 2.6 TO 7.5 CM,1200114,CDM,981,RC,12002,HCPCS,Outpatient,,,355,266.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.52,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,66.52,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,66.52,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,66.52,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,66.52,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,120.02,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,70.69,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,214.79,61.74,,171.832,percent of total billed charges,61.74% of total billed charges,114.3,102,,,Fee Schedule,102% of GA Medicaid Rate,66.52,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,66.52,214.79,
SUTURING SIMPLE 7.6 TO 12.5 CM,1200115,CDM,981,RC,12004,HCPCS,Outpatient,,,355,266.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,82.58,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,82.58,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,82.58,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,82.58,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,82.58,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,143.12,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,87.48,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,214.79,61.74,,171.832,percent of total billed charges,61.74% of total billed charges,136.3,102,,,Fee Schedule,102% of GA Medicaid Rate,82.58,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,82.58,214.79,
"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes",1200125,CDM,981,RC,12011,HCPCS,Outpatient,,,355,266.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,62.31,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,62.31,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,62.31,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,62.31,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,62.31,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,116.07,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.3,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,214.79,61.74,,171.832,percent of total billed charges,61.74% of total billed charges,110.54,102,,,Fee Schedule,102% of GA Medicaid Rate,62.31,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,62.31,214.79,
SIMPLE REPAIR 2.6 CM TO 5.0 CM,1200126,CDM,981,RC,12013,HCPCS,Outpatient,,,355,266.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.7,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,66.7,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,66.7,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,66.7,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,66.7,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,131.62,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,70.76,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,214.79,61.74,,171.832,percent of total billed charges,61.74% of total billed charges,125.35,102,,,Fee Schedule,102% of GA Medicaid Rate,66.7,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,66.7,214.79,
SIMPLE REPAIR 5.1 TO 7.5 CM,1200127,CDM,981,RC,12014,HCPCS,Outpatient,,,355,266.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,85.07,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,85.07,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,85.07,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,85.07,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,85.07,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,155.99,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,90.96,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,214.79,61.74,,171.832,percent of total billed charges,61.74% of total billed charges,148.56,102,,,Fee Schedule,102% of GA Medicaid Rate,85.07,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,85.07,214.79,
SIMPLE REPAIR 7.6 TO 12.5 CM,1200128,CDM,981,RC,12015,HCPCS,Outpatient,,,355,266.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,107.3,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,107.3,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,107.3,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,107.3,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,107.3,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,197.18,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,114.79,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,214.79,61.74,,171.832,percent of total billed charges,61.74% of total billed charges,187.79,102,,,Fee Schedule,102% of GA Medicaid Rate,107.3,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,107.3,214.79,
Incision and drainage of abscess; simple or single and complex or multiple,1200135,CDM,981,RC,10060,HCPCS,Outpatient,,,355,266.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,114.08,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,114.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,114.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,114.08,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,114.08,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,70.06,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,116.32,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,214.79,61.74,,171.832,percent of total billed charges,61.74% of total billed charges,66.72,102,,,Fee Schedule,102% of GA Medicaid Rate,114.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,66.72,214.79,
Incision and drainage of abscess; simple or single and complex or multiple,1200137,CDM,981,RC,10060,HCPCS,Outpatient,,,355,266.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,114.08,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,114.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,114.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,114.08,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,114.08,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,70.06,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,116.32,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,214.79,61.74,,171.832,percent of total billed charges,61.74% of total billed charges,66.72,102,,,Fee Schedule,102% of GA Medicaid Rate,114.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,66.72,214.79,
Separation and removal of the entire nail plate or a portion of nail plate,1200141,CDM,981,RC,11730,HCPCS,Outpatient,,,355,266.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,59.97,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,59.97,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,59.97,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,59.97,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,59.97,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,59.34,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,62,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,214.79,61.74,,171.832,percent of total billed charges,61.74% of total billed charges,56.51,102,,,Fee Schedule,102% of GA Medicaid Rate,59.97,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,56.51,214.79,
1ST DEGREE INIT/LOCAL,1200181,CDM,981,RC,16000,HCPCS,Outpatient,,,355,266.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,51.54,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,51.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,51.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,51.54,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,51.54,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,53.51,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,52.94,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,214.79,61.74,,171.832,percent of total billed charges,61.74% of total billed charges,50.96,102,,,Fee Schedule,102% of GA Medicaid Rate,51.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,50.96,214.79,
"SMALL, DRESS/DEBRID BURN INIT/SUBSEQ",1200182,CDM,981,RC,16020,HCPCS,Outpatient,,,355,266.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,60.56,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,60.56,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,60.56,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,60.56,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,60.56,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,51.26,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,61.65,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,214.79,61.74,,171.832,percent of total billed charges,61.74% of total billed charges,48.82,102,,,Fee Schedule,102% of GA Medicaid Rate,60.56,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,48.82,214.79,
"MED, DRESS/DEBRID BURN INIT/SUBSEQ",1200183,CDM,981,RC,16025,HCPCS,Outpatient,,,355,266.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,122.08,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,122.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,122.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,122.08,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,122.08,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,100.51,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,128.28,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,214.79,61.74,,171.832,percent of total billed charges,61.74% of total billed charges,95.72,102,,,Fee Schedule,102% of GA Medicaid Rate,122.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,95.72,214.79,
SUTURING SIMPLE OVER 30 CM,1200223,CDM,981,RC,12007,HCPCS,Outpatient,,,355,266.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,164,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,164,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,164,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,164,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,164,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,254.31,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,175.42,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,214.79,61.74,,171.832,percent of total billed charges,61.74% of total billed charges,242.2,102,,,Fee Schedule,102% of GA Medicaid Rate,164,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,164,254.31,
SIMPLE REPAIR OVER 30 CM,1200229,CDM,981,RC,12018,HCPCS,Outpatient,,,355,266.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,197.81,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,197.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,197.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,197.81,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,197.81,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,387.73,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,211.49,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,214.79,61.74,,171.832,percent of total billed charges,61.74% of total billed charges,369.27,102,,,Fee Schedule,102% of GA Medicaid Rate,197.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,197.81,387.73,
"Debridement (for example, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps)",9000014,CDM,420,RC,97597,HCPCS,Outpatient,,,355,266.25,,276.9,78,,221.52,percent of total billed charges,78% of total billed charges,223.65,63,,178.92,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,134.9,38,,107.92,percent of total billed charges,38% of total billed charges,134.9,38,,107.92,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,319.5,90,,255.6,percent of total billed charges,90% of total billed charges,124.25,35,,99.4,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,284,80,,227.2,percent of total billed charges,80% of total billed charges,136.25,38.38,,109,percent of total billed charges,38.38% of total billed charges,284,80,,227.2,percent of total billed charges,80% of total billed charges,219.18,61.74,,175.344,percent of total billed charges,61.74% of total billed charges,362.1,102,,289.68,percent of total billed charges,102% of total billed charges,134.9,38,,107.92,percent of total billed charges,38% of total billed charges,124.25,362.1,
PT DEBRIDEMENT/REMV'L DEVITALIZED TISSUE,9000034,CDM,420,RC,97602,HCPCS,Outpatient,,,355,266.25,,276.9,78,,221.52,percent of total billed charges,78% of total billed charges,223.65,63,,178.92,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,134.9,38,,107.92,percent of total billed charges,38% of total billed charges,134.9,38,,107.92,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,319.5,90,,255.6,percent of total billed charges,90% of total billed charges,124.25,35,,99.4,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,284,80,,227.2,percent of total billed charges,80% of total billed charges,136.25,38.38,,109,percent of total billed charges,38.38% of total billed charges,284,80,,227.2,percent of total billed charges,80% of total billed charges,219.18,61.74,,175.344,percent of total billed charges,61.74% of total billed charges,362.1,102,,289.68,percent of total billed charges,102% of total billed charges,134.9,38,,107.92,percent of total billed charges,38% of total billed charges,124.25,362.1,
PT WOUND VAC/CARE <= 50 SQ CM (DME),9000610,CDM,420,RC,97605,HCPCS,Outpatient,,,355,266.25,,276.9,78,,221.52,percent of total billed charges,78% of total billed charges,223.65,63,,178.92,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,134.9,38,,107.92,percent of total billed charges,38% of total billed charges,134.9,38,,107.92,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,319.5,90,,255.6,percent of total billed charges,90% of total billed charges,124.25,35,,99.4,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,284,80,,227.2,percent of total billed charges,80% of total billed charges,136.25,38.38,,109,percent of total billed charges,38.38% of total billed charges,284,80,,227.2,percent of total billed charges,80% of total billed charges,219.18,61.74,,175.344,percent of total billed charges,61.74% of total billed charges,362.1,102,,289.68,percent of total billed charges,102% of total billed charges,134.9,38,,107.92,percent of total billed charges,38% of total billed charges,124.25,362.1,
PNEUMOTHORAX SET ER,3005008,CDM,270,RC,,,Outpatient,,,356.13,267.1,,277.78,78,,222.224,percent of total billed charges,78% of total billed charges,224.36,63,,179.488,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,135.33,38,,108.264,percent of total billed charges,38% of total billed charges,135.33,38,,108.264,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,320.52,90,,256.416,percent of total billed charges,90% of total billed charges,124.65,35,,99.72,percent of total billed charges,35% of total billed charges,239.59,67.275,,191.672,percent of total billed charges,67.275% of total billed charges,284.9,80,,227.92,percent of total billed charges,80% of total billed charges,136.68,38.38,,109.344,percent of total billed charges,38.38% of total billed charges,284.9,80,,227.92,percent of total billed charges,80% of total billed charges,219.87,61.74,,175.896,percent of total billed charges,61.74% of total billed charges,363.25,102,,290.6,percent of total billed charges,102% of total billed charges,135.33,38,,108.264,percent of total billed charges,38% of total billed charges,124.65,363.25,
ENDO POUCH RETRIEVER BAG,3004062,CDM,272,RC,,,Outpatient,,,358,268.5,,279.24,78,,223.392,percent of total billed charges,78% of total billed charges,225.54,63,,180.432,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,136.04,38,,108.832,percent of total billed charges,38% of total billed charges,136.04,38,,108.832,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,322.2,90,,257.76,percent of total billed charges,90% of total billed charges,125.3,35,,100.24,percent of total billed charges,35% of total billed charges,240.84,67.275,,192.672,percent of total billed charges,67.275% of total billed charges,286.4,80,,229.12,percent of total billed charges,80% of total billed charges,137.4,38.38,,109.92,percent of total billed charges,38.38% of total billed charges,286.4,80,,229.12,percent of total billed charges,80% of total billed charges,221.03,61.74,,176.824,percent of total billed charges,61.74% of total billed charges,365.16,102,,292.128,percent of total billed charges,102% of total billed charges,136.04,38,,108.832,percent of total billed charges,38% of total billed charges,125.3,365.16,
DILATOR SET for FEEDING TUBE,3005019,CDM,270,RC,,,Outpatient,,,360,270,,280.8,78,,224.64,percent of total billed charges,78% of total billed charges,226.8,63,,181.44,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,136.8,38,,109.44,percent of total billed charges,38% of total billed charges,136.8,38,,109.44,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,324,90,,259.2,percent of total billed charges,90% of total billed charges,126,35,,100.8,percent of total billed charges,35% of total billed charges,242.19,67.275,,193.752,percent of total billed charges,67.275% of total billed charges,288,80,,230.4,percent of total billed charges,80% of total billed charges,138.17,38.38,,110.536,percent of total billed charges,38.38% of total billed charges,288,80,,230.4,percent of total billed charges,80% of total billed charges,222.26,61.74,,177.808,percent of total billed charges,61.74% of total billed charges,367.2,102,,293.76,percent of total billed charges,102% of total billed charges,136.8,38,,109.44,percent of total billed charges,38% of total billed charges,126,367.2,
ENDO LEVEL 2 EA ADDL 15 M,400155,CDM,360,RC,,,Outpatient,,,361,270.75,,281.58,78,,225.264,percent of total billed charges,78% of total billed charges,227.43,63,,181.944,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,137.18,38,,109.744,percent of total billed charges,38% of total billed charges,137.18,38,,109.744,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,324.9,90,,259.92,percent of total billed charges,90% of total billed charges,126.35,35,,101.08,percent of total billed charges,35% of total billed charges,242.86,67.275,,194.288,percent of total billed charges,67.275% of total billed charges,288.8,80,,231.04,percent of total billed charges,80% of total billed charges,138.55,38.38,,110.84,percent of total billed charges,38.38% of total billed charges,288.8,80,,231.04,percent of total billed charges,80% of total billed charges,222.88,61.74,,178.304,percent of total billed charges,61.74% of total billed charges,368.22,102,,294.576,percent of total billed charges,102% of total billed charges,137.18,38,,109.744,percent of total billed charges,38% of total billed charges,126.35,368.22,
"Radiologic examination, foot; 2 views",7400943,CDM,320,RC,73620,HCPCS,Outpatient,,,361,270.75,,281.58,78,,225.264,percent of total billed charges,78% of total billed charges,227.43,63,,181.944,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,137.18,38,,109.744,percent of total billed charges,38% of total billed charges,137.18,38,,109.744,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,324.9,90,,259.92,percent of total billed charges,90% of total billed charges,126.35,35,,101.08,percent of total billed charges,35% of total billed charges,242.86,67.275,,194.288,percent of total billed charges,67.275% of total billed charges,288.8,80,,231.04,percent of total billed charges,80% of total billed charges,138.55,38.38,,110.84,percent of total billed charges,38.38% of total billed charges,288.8,80,,231.04,percent of total billed charges,80% of total billed charges,222.88,61.74,,178.304,percent of total billed charges,61.74% of total billed charges,368.22,102,,294.576,percent of total billed charges,102% of total billed charges,137.18,38,,109.744,percent of total billed charges,38% of total billed charges,126.35,368.22,
FROVA BOUGIE,3001804,CDM,270,RC,,,Outpatient,,,361.12,270.84,,281.67,78,,225.336,percent of total billed charges,78% of total billed charges,227.51,63,,182.008,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,137.23,38,,109.784,percent of total billed charges,38% of total billed charges,137.23,38,,109.784,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,325.01,90,,260.008,percent of total billed charges,90% of total billed charges,126.39,35,,101.112,percent of total billed charges,35% of total billed charges,242.94,67.275,,194.352,percent of total billed charges,67.275% of total billed charges,288.9,80,,231.12,percent of total billed charges,80% of total billed charges,138.6,38.38,,110.88,percent of total billed charges,38.38% of total billed charges,288.9,80,,231.12,percent of total billed charges,80% of total billed charges,222.96,61.74,,178.368,percent of total billed charges,61.74% of total billed charges,368.34,102,,294.672,percent of total billed charges,102% of total billed charges,137.23,38,,109.784,percent of total billed charges,38% of total billed charges,126.39,368.34,
RESPIRATORY PATHOGEN PANEL(PCR),5002061,CDM,306,RC,87798,HCPCS,Outpatient,,,362,271.5,,282.36,78,,225.888,percent of total billed charges,78% of total billed charges,24.67,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,325.8,90,,260.64,percent of total billed charges,90% of total billed charges,25.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,243.54,67.275,,194.832,percent of total billed charges,67.275% of total billed charges,289.6,80,,231.68,percent of total billed charges,80% of total billed charges,35.44,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,289.6,80,,231.68,percent of total billed charges,80% of total billed charges,223.5,61.74,,178.8,percent of total billed charges,61.74% of total billed charges,25.16,102,,,Fee Schedule,102% of GA Medicaid Rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,24.67,325.8,
Ultrasound of back wall of the abdomen with limited areas viewed,7300973,CDM,402,RC,76775,HCPCS,Outpatient,,,363,272.25,,283.14,78,,226.512,percent of total billed charges,78% of total billed charges,228.69,63,,182.952,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,137.94,38,,110.352,percent of total billed charges,38% of total billed charges,137.94,38,,110.352,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,326.7,90,,261.36,percent of total billed charges,90% of total billed charges,127.05,35,,101.64,percent of total billed charges,35% of total billed charges,244.21,67.275,,195.368,percent of total billed charges,67.275% of total billed charges,290.4,80,,232.32,percent of total billed charges,80% of total billed charges,139.32,38.38,,111.456,percent of total billed charges,38.38% of total billed charges,290.4,80,,232.32,percent of total billed charges,80% of total billed charges,224.12,61.74,,179.296,percent of total billed charges,61.74% of total billed charges,370.26,102,,296.208,percent of total billed charges,102% of total billed charges,137.94,38,,110.352,percent of total billed charges,38% of total billed charges,127.05,370.26,
PLASMINOGEN ACTIVITY,5000457,CDM,305,RC,85420,HCPCS,Outpatient,,,368,276,,287.04,78,,229.632,percent of total billed charges,78% of total billed charges,8.22,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,331.2,90,,264.96,percent of total billed charges,90% of total billed charges,8.63,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,247.57,67.275,,198.056,percent of total billed charges,67.275% of total billed charges,294.4,80,,235.52,percent of total billed charges,80% of total billed charges,6.6,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,294.4,80,,235.52,percent of total billed charges,80% of total billed charges,227.2,61.74,,181.76,percent of total billed charges,61.74% of total billed charges,8.38,102,,,Fee Schedule,102% of GA Medicaid Rate,6.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.53,331.2,
HIV RNA QUAL TMA,5002081,CDM,306,RC,87535,HCPCS,Outpatient,,,369,276.75,,287.82,78,,230.256,percent of total billed charges,78% of total billed charges,24.67,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,332.1,90,,265.68,percent of total billed charges,90% of total billed charges,25.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,248.24,67.275,,198.592,percent of total billed charges,67.275% of total billed charges,295.2,80,,236.16,percent of total billed charges,80% of total billed charges,35.44,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,295.2,80,,236.16,percent of total billed charges,80% of total billed charges,227.82,61.74,,182.256,percent of total billed charges,61.74% of total billed charges,25.16,102,,,Fee Schedule,102% of GA Medicaid Rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,24.67,332.1,
ENTEROVIRUS PCR,5002034,CDM,306,RC,87498,HCPCS,Outpatient,,,370,277.5,,288.6,78,,230.88,percent of total billed charges,78% of total billed charges,24.67,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,333,90,,266.4,percent of total billed charges,90% of total billed charges,25.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,248.92,67.275,,199.136,percent of total billed charges,67.275% of total billed charges,296,80,,236.8,percent of total billed charges,80% of total billed charges,35.44,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,296,80,,236.8,percent of total billed charges,80% of total billed charges,228.44,61.74,,182.752,percent of total billed charges,61.74% of total billed charges,25.16,102,,,Fee Schedule,102% of GA Medicaid Rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,24.67,333,
MASK COMFORT FULL LARGE VISION,3000278,CDM,270,RC,,,Outpatient,,,370.8,278.1,,289.22,78,,231.376,percent of total billed charges,78% of total billed charges,233.6,63,,186.88,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,140.9,38,,112.72,percent of total billed charges,38% of total billed charges,140.9,38,,112.72,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,333.72,90,,266.976,percent of total billed charges,90% of total billed charges,129.78,35,,103.824,percent of total billed charges,35% of total billed charges,249.46,67.275,,199.568,percent of total billed charges,67.275% of total billed charges,296.64,80,,237.312,percent of total billed charges,80% of total billed charges,142.31,38.38,,113.848,percent of total billed charges,38.38% of total billed charges,296.64,80,,237.312,percent of total billed charges,80% of total billed charges,228.93,61.74,,183.144,percent of total billed charges,61.74% of total billed charges,378.22,102,,302.576,percent of total billed charges,102% of total billed charges,140.9,38,,112.72,percent of total billed charges,38% of total billed charges,129.78,378.22,
DRILL BIT 1.5MM,3001828,CDM,270,RC,,,Outpatient,,,372,279,,290.16,78,,232.128,percent of total billed charges,78% of total billed charges,234.36,63,,187.488,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,141.36,38,,113.088,percent of total billed charges,38% of total billed charges,141.36,38,,113.088,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,334.8,90,,267.84,percent of total billed charges,90% of total billed charges,130.2,35,,104.16,percent of total billed charges,35% of total billed charges,250.26,67.275,,200.208,percent of total billed charges,67.275% of total billed charges,297.6,80,,238.08,percent of total billed charges,80% of total billed charges,142.77,38.38,,114.216,percent of total billed charges,38.38% of total billed charges,297.6,80,,238.08,percent of total billed charges,80% of total billed charges,229.67,61.74,,183.736,percent of total billed charges,61.74% of total billed charges,379.44,102,,303.552,percent of total billed charges,102% of total billed charges,141.36,38,,113.088,percent of total billed charges,38% of total billed charges,130.2,379.44,
ENDOTRACHEAL INTUBATION,1001050,CDM,450,RC,31500,HCPCS,Outpatient,,,375,281.25,,292.5,78,,234,percent of total billed charges,78% of total billed charges,236.25,63,,189,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,142.5,38,,114,percent of total billed charges,38% of total billed charges,142.5,38,,114,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,337.5,90,,270,percent of total billed charges,90% of total billed charges,131.25,35,,105,percent of total billed charges,35% of total billed charges,252.28,67.275,,201.824,percent of total billed charges,67.275% of total billed charges,300,80,,240,percent of total billed charges,80% of total billed charges,143.93,38.38,,115.144,percent of total billed charges,38.38% of total billed charges,300,80,,240,percent of total billed charges,80% of total billed charges,231.53,61.74,,185.224,percent of total billed charges,61.74% of total billed charges,382.5,102,,306,percent of total billed charges,102% of total billed charges,142.5,38,,114,percent of total billed charges,38% of total billed charges,131.25,382.5,
ENDOTRACHEAL INTUBATION,1200192,CDM,981,RC,31500,HCPCS,Outpatient,,,375,281.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,159.32,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,159.32,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,159.32,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,159.32,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,159.32,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,111.83,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,168.23,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,226.89,61.74,,181.512,percent of total billed charges,61.74% of total billed charges,106.5,102,,,Fee Schedule,102% of GA Medicaid Rate,159.32,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,106.5,226.89,
ENCOMPASS LASER GUIDE PIN,3003108,CDM,270,RC,,,Outpatient,,,375,281.25,,292.5,78,,234,percent of total billed charges,78% of total billed charges,236.25,63,,189,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,142.5,38,,114,percent of total billed charges,38% of total billed charges,142.5,38,,114,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,337.5,90,,270,percent of total billed charges,90% of total billed charges,131.25,35,,105,percent of total billed charges,35% of total billed charges,252.28,67.275,,201.824,percent of total billed charges,67.275% of total billed charges,300,80,,240,percent of total billed charges,80% of total billed charges,143.93,38.38,,115.144,percent of total billed charges,38.38% of total billed charges,300,80,,240,percent of total billed charges,80% of total billed charges,231.53,61.74,,185.224,percent of total billed charges,61.74% of total billed charges,382.5,102,,306,percent of total billed charges,102% of total billed charges,142.5,38,,114,percent of total billed charges,38% of total billed charges,131.25,382.5,
Mammography of both breasts-2 or more views,7601000,CDM,403,RC,77067,HCPCS,Outpatient,,,375,281.25,,292.5,78,,234,percent of total billed charges,78% of total billed charges,236.25,63,,189,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,142.5,38,,114,percent of total billed charges,38% of total billed charges,142.5,38,,114,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,337.5,90,,270,percent of total billed charges,90% of total billed charges,131.25,35,,105,percent of total billed charges,35% of total billed charges,252.28,67.275,,201.824,percent of total billed charges,67.275% of total billed charges,300,80,,240,percent of total billed charges,80% of total billed charges,143.93,38.38,,115.144,percent of total billed charges,38.38% of total billed charges,300,80,,240,percent of total billed charges,80% of total billed charges,231.53,61.74,,185.224,percent of total billed charges,61.74% of total billed charges,382.5,102,,306,percent of total billed charges,102% of total billed charges,142.5,38,,114,percent of total billed charges,38% of total billed charges,131.25,382.5,
ENDOTRACHEAL INTUBATION,8000038,CDM,460,RC,31500,HCPCS,Outpatient,,,375,281.25,,292.5,78,,234,percent of total billed charges,78% of total billed charges,236.25,63,,189,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,142.5,38,,114,percent of total billed charges,38% of total billed charges,142.5,38,,114,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,337.5,90,,270,percent of total billed charges,90% of total billed charges,131.25,35,,105,percent of total billed charges,35% of total billed charges,252.28,67.275,,201.824,percent of total billed charges,67.275% of total billed charges,300,80,,240,percent of total billed charges,80% of total billed charges,143.93,38.38,,115.144,percent of total billed charges,38.38% of total billed charges,300,80,,240,percent of total billed charges,80% of total billed charges,231.53,61.74,,185.224,percent of total billed charges,61.74% of total billed charges,382.5,102,,306,percent of total billed charges,102% of total billed charges,142.5,38,,114,percent of total billed charges,38% of total billed charges,131.25,382.5,
TRACH CARE,8000039,CDM,460,RC,31502,HCPCS,Outpatient,,,375,281.25,,292.5,78,,234,percent of total billed charges,78% of total billed charges,236.25,63,,189,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,142.5,38,,114,percent of total billed charges,38% of total billed charges,142.5,38,,114,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,337.5,90,,270,percent of total billed charges,90% of total billed charges,131.25,35,,105,percent of total billed charges,35% of total billed charges,252.28,67.275,,201.824,percent of total billed charges,67.275% of total billed charges,300,80,,240,percent of total billed charges,80% of total billed charges,143.93,38.38,,115.144,percent of total billed charges,38.38% of total billed charges,300,80,,240,percent of total billed charges,80% of total billed charges,231.53,61.74,,185.224,percent of total billed charges,61.74% of total billed charges,382.5,102,,306,percent of total billed charges,102% of total billed charges,142.5,38,,114,percent of total billed charges,38% of total billed charges,131.25,382.5,
ST COGNITIVE EVALUATION,9000121,CDM,440,RC,96125,HCPCS,Outpatient,,,375,281.25,,292.5,78,,234,percent of total billed charges,78% of total billed charges,236.25,63,,189,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,142.5,38,,114,percent of total billed charges,38% of total billed charges,142.5,38,,114,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,337.5,90,,270,percent of total billed charges,90% of total billed charges,131.25,35,,105,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,300,80,,240,percent of total billed charges,80% of total billed charges,143.93,38.38,,115.144,percent of total billed charges,38.38% of total billed charges,300,80,,240,percent of total billed charges,80% of total billed charges,231.53,61.74,,185.224,percent of total billed charges,61.74% of total billed charges,382.5,102,,306,percent of total billed charges,102% of total billed charges,142.5,38,,114,percent of total billed charges,38% of total billed charges,131.25,382.5,
FLEX KNEE ORTHOTIC - MD,3001113,CDM,270,RC,,,Outpatient,,,378.12,283.59,,294.93,78,,235.944,percent of total billed charges,78% of total billed charges,238.22,63,,190.576,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,143.69,38,,114.952,percent of total billed charges,38% of total billed charges,143.69,38,,114.952,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,340.31,90,,272.248,percent of total billed charges,90% of total billed charges,132.34,35,,105.872,percent of total billed charges,35% of total billed charges,254.38,67.275,,203.504,percent of total billed charges,67.275% of total billed charges,302.5,80,,242,percent of total billed charges,80% of total billed charges,145.12,38.38,,116.096,percent of total billed charges,38.38% of total billed charges,302.5,80,,242,percent of total billed charges,80% of total billed charges,233.45,61.74,,186.76,percent of total billed charges,61.74% of total billed charges,385.68,102,,308.544,percent of total billed charges,102% of total billed charges,143.69,38,,114.952,percent of total billed charges,38% of total billed charges,132.34,385.68,
Limited ultrasound of the breast,7300934,CDM,402,RC,76642,HCPCS,Outpatient,,,379,284.25,,295.62,78,,236.496,percent of total billed charges,78% of total billed charges,238.77,63,,191.016,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,144.02,38,,115.216,percent of total billed charges,38% of total billed charges,144.02,38,,115.216,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,341.1,90,,272.88,percent of total billed charges,90% of total billed charges,132.65,35,,106.12,percent of total billed charges,35% of total billed charges,254.97,67.275,,203.976,percent of total billed charges,67.275% of total billed charges,303.2,80,,242.56,percent of total billed charges,80% of total billed charges,145.46,38.38,,116.368,percent of total billed charges,38.38% of total billed charges,303.2,80,,242.56,percent of total billed charges,80% of total billed charges,233.99,61.74,,187.192,percent of total billed charges,61.74% of total billed charges,386.58,102,,309.264,percent of total billed charges,102% of total billed charges,144.02,38,,115.216,percent of total billed charges,38% of total billed charges,132.65,386.58,
Limited ultrasound of the breast,7300936,CDM,402,RC,76642,HCPCS,Outpatient,,,379,284.25,,295.62,78,,236.496,percent of total billed charges,78% of total billed charges,238.77,63,,191.016,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,144.02,38,,115.216,percent of total billed charges,38% of total billed charges,144.02,38,,115.216,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,341.1,90,,272.88,percent of total billed charges,90% of total billed charges,132.65,35,,106.12,percent of total billed charges,35% of total billed charges,254.97,67.275,,203.976,percent of total billed charges,67.275% of total billed charges,303.2,80,,242.56,percent of total billed charges,80% of total billed charges,145.46,38.38,,116.368,percent of total billed charges,38.38% of total billed charges,303.2,80,,242.56,percent of total billed charges,80% of total billed charges,233.99,61.74,,187.192,percent of total billed charges,61.74% of total billed charges,386.58,102,,309.264,percent of total billed charges,102% of total billed charges,144.02,38,,115.216,percent of total billed charges,38% of total billed charges,132.65,386.58,
BB FFP EA UNIT,5200005,CDM,390,RC,P9017,HCPCS,Outpatient,,,380,285,,296.4,78,,237.12,percent of total billed charges,78% of total billed charges,239.4,63,,191.52,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,144.4,38,,115.52,percent of total billed charges,38% of total billed charges,144.4,38,,115.52,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,342,90,,273.6,percent of total billed charges,90% of total billed charges,133,35,,106.4,percent of total billed charges,35% of total billed charges,255.65,67.275,,204.52,percent of total billed charges,67.275% of total billed charges,304,80,,243.2,percent of total billed charges,80% of total billed charges,145.84,38.38,,116.672,percent of total billed charges,38.38% of total billed charges,304,80,,243.2,percent of total billed charges,80% of total billed charges,234.61,61.74,,187.688,percent of total billed charges,61.74% of total billed charges,387.6,102,,310.08,percent of total billed charges,102% of total billed charges,144.4,38,,115.52,percent of total billed charges,38% of total billed charges,133,387.6,
DHEA,5001713,CDM,301,RC,82626,HCPCS,Outpatient,,,385,288.75,,300.3,78,,240.24,percent of total billed charges,78% of total billed charges,31.78,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,25.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,25.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,346.5,90,,277.2,percent of total billed charges,90% of total billed charges,33.37,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,259.01,67.275,,207.208,percent of total billed charges,67.275% of total billed charges,308,80,,246.4,percent of total billed charges,80% of total billed charges,25.52,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,308,80,,246.4,percent of total billed charges,80% of total billed charges,237.7,61.74,,190.16,percent of total billed charges,61.74% of total billed charges,32.42,102,,,Fee Schedule,102% of GA Medicaid Rate,25.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,25.27,346.5,
CUTTER 55MM,3004278,CDM,270,RC,,,Outpatient,,,385.84,289.38,,300.96,78,,240.768,percent of total billed charges,78% of total billed charges,243.08,63,,194.464,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,146.62,38,,117.296,percent of total billed charges,38% of total billed charges,146.62,38,,117.296,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,347.26,90,,277.808,percent of total billed charges,90% of total billed charges,135.04,35,,108.032,percent of total billed charges,35% of total billed charges,259.57,67.275,,207.656,percent of total billed charges,67.275% of total billed charges,308.67,80,,246.936,percent of total billed charges,80% of total billed charges,148.09,38.38,,118.472,percent of total billed charges,38.38% of total billed charges,308.67,80,,246.936,percent of total billed charges,80% of total billed charges,238.22,61.74,,190.576,percent of total billed charges,61.74% of total billed charges,393.56,102,,314.848,percent of total billed charges,102% of total billed charges,146.62,38,,117.296,percent of total billed charges,38% of total billed charges,135.04,393.56,
BB RBC LEUK REDU,5200009,CDM,390,RC,P9016,HCPCS,Outpatient,,,387,290.25,,301.86,78,,241.488,percent of total billed charges,78% of total billed charges,243.81,63,,195.048,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,147.06,38,,117.648,percent of total billed charges,38% of total billed charges,147.06,38,,117.648,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,348.3,90,,278.64,percent of total billed charges,90% of total billed charges,135.45,35,,108.36,percent of total billed charges,35% of total billed charges,260.35,67.275,,208.28,percent of total billed charges,67.275% of total billed charges,309.6,80,,247.68,percent of total billed charges,80% of total billed charges,148.53,38.38,,118.824,percent of total billed charges,38.38% of total billed charges,309.6,80,,247.68,percent of total billed charges,80% of total billed charges,238.93,61.74,,191.144,percent of total billed charges,61.74% of total billed charges,394.74,102,,315.792,percent of total billed charges,102% of total billed charges,147.06,38,,117.648,percent of total billed charges,38% of total billed charges,135.45,394.74,
Blood test to determine cause of inappropriate blood clot formation,5000909,CDM,302,RC,86147,HCPCS,Outpatient,,,388,291,,302.64,78,,242.112,percent of total billed charges,78% of total billed charges,31.99,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,25.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,25.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,349.2,90,,279.36,percent of total billed charges,90% of total billed charges,33.59,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,261.03,67.275,,208.824,percent of total billed charges,67.275% of total billed charges,310.4,80,,248.32,percent of total billed charges,80% of total billed charges,25.7,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,310.4,80,,248.32,percent of total billed charges,80% of total billed charges,239.55,61.74,,191.64,percent of total billed charges,61.74% of total billed charges,32.63,102,,,Fee Schedule,102% of GA Medicaid Rate,25.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,25.45,349.2,
Blood test to determine cause of inappropriate blood clot formation,5000911,CDM,302,RC,86147,HCPCS,Outpatient,,,388,291,,302.64,78,,242.112,percent of total billed charges,78% of total billed charges,31.99,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,25.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,25.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,349.2,90,,279.36,percent of total billed charges,90% of total billed charges,33.59,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,261.03,67.275,,208.824,percent of total billed charges,67.275% of total billed charges,310.4,80,,248.32,percent of total billed charges,80% of total billed charges,25.7,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,310.4,80,,248.32,percent of total billed charges,80% of total billed charges,239.55,61.74,,191.64,percent of total billed charges,61.74% of total billed charges,32.63,102,,,Fee Schedule,102% of GA Medicaid Rate,25.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,25.45,349.2,
Blood test to determine cause of inappropriate blood clot formation,5000912,CDM,302,RC,86147,HCPCS,Outpatient,,,388,291,,302.64,78,,242.112,percent of total billed charges,78% of total billed charges,31.99,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,25.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,25.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,349.2,90,,279.36,percent of total billed charges,90% of total billed charges,33.59,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,261.03,67.275,,208.824,percent of total billed charges,67.275% of total billed charges,310.4,80,,248.32,percent of total billed charges,80% of total billed charges,25.7,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,310.4,80,,248.32,percent of total billed charges,80% of total billed charges,239.55,61.74,,191.64,percent of total billed charges,61.74% of total billed charges,32.63,102,,,Fee Schedule,102% of GA Medicaid Rate,25.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,25.45,349.2,
Blood test to determine cause of inappropriate blood clot formation,5000913,CDM,302,RC,86147,HCPCS,Outpatient,,,388,291,,302.64,78,,242.112,percent of total billed charges,78% of total billed charges,31.99,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,25.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,25.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,349.2,90,,279.36,percent of total billed charges,90% of total billed charges,33.59,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,261.03,67.275,,208.824,percent of total billed charges,67.275% of total billed charges,310.4,80,,248.32,percent of total billed charges,80% of total billed charges,25.7,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,310.4,80,,248.32,percent of total billed charges,80% of total billed charges,239.55,61.74,,191.64,percent of total billed charges,61.74% of total billed charges,32.63,102,,,Fee Schedule,102% of GA Medicaid Rate,25.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,25.45,349.2,
Blood test to determine cause of inappropriate blood clot formation,5001972,CDM,302,RC,86147,HCPCS,Outpatient,,,388,291,,302.64,78,,242.112,percent of total billed charges,78% of total billed charges,31.99,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,25.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,25.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,349.2,90,,279.36,percent of total billed charges,90% of total billed charges,33.59,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,261.03,67.275,,208.824,percent of total billed charges,67.275% of total billed charges,310.4,80,,248.32,percent of total billed charges,80% of total billed charges,25.7,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,310.4,80,,248.32,percent of total billed charges,80% of total billed charges,239.55,61.74,,191.64,percent of total billed charges,61.74% of total billed charges,32.63,102,,,Fee Schedule,102% of GA Medicaid Rate,25.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,25.45,349.2,
EXC/BI/REMOVAL FB COMPL,1001186,CDM,450,RC,,,Outpatient,,,391,293.25,,304.98,78,,243.984,percent of total billed charges,78% of total billed charges,246.33,63,,197.064,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,148.58,38,,118.864,percent of total billed charges,38% of total billed charges,148.58,38,,118.864,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,351.9,90,,281.52,percent of total billed charges,90% of total billed charges,136.85,35,,109.48,percent of total billed charges,35% of total billed charges,263.05,67.275,,210.44,percent of total billed charges,67.275% of total billed charges,312.8,80,,250.24,percent of total billed charges,80% of total billed charges,150.07,38.38,,120.056,percent of total billed charges,38.38% of total billed charges,312.8,80,,250.24,percent of total billed charges,80% of total billed charges,241.4,61.74,,193.12,percent of total billed charges,61.74% of total billed charges,398.82,102,,319.056,percent of total billed charges,102% of total billed charges,148.58,38,,118.864,percent of total billed charges,38% of total billed charges,136.85,398.82,
"UPDRAFT INITIAL, RESP THERAPIST",8000007,CDM,410,RC,94640,HCPCS,Outpatient,,,392,294,,305.76,78,,244.608,percent of total billed charges,78% of total billed charges,246.96,63,,197.568,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,148.96,38,,119.168,percent of total billed charges,38% of total billed charges,148.96,38,,119.168,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,352.8,90,,282.24,percent of total billed charges,90% of total billed charges,137.2,35,,109.76,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,313.6,80,,250.88,percent of total billed charges,80% of total billed charges,150.45,38.38,,120.36,percent of total billed charges,38.38% of total billed charges,313.6,80,,250.88,percent of total billed charges,80% of total billed charges,242.02,61.74,,193.616,percent of total billed charges,61.74% of total billed charges,399.84,102,,319.872,percent of total billed charges,102% of total billed charges,148.96,38,,119.168,percent of total billed charges,38% of total billed charges,137.2,399.84,
IPPB TREATMENT INIT,8000041,CDM,410,RC,94640,HCPCS,Outpatient,,,392,294,,305.76,78,,244.608,percent of total billed charges,78% of total billed charges,246.96,63,,197.568,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,148.96,38,,119.168,percent of total billed charges,38% of total billed charges,148.96,38,,119.168,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,352.8,90,,282.24,percent of total billed charges,90% of total billed charges,137.2,35,,109.76,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,313.6,80,,250.88,percent of total billed charges,80% of total billed charges,150.45,38.38,,120.36,percent of total billed charges,38.38% of total billed charges,313.6,80,,250.88,percent of total billed charges,80% of total billed charges,242.02,61.74,,193.616,percent of total billed charges,61.74% of total billed charges,399.84,102,,319.872,percent of total billed charges,102% of total billed charges,148.96,38,,119.168,percent of total billed charges,38% of total billed charges,137.2,399.84,
BI-LEVEL W/O RATE,8000058,CDM,410,RC,94660,HCPCS,Outpatient,,,392,294,,305.76,78,,244.608,percent of total billed charges,78% of total billed charges,246.96,63,,197.568,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,148.96,38,,119.168,percent of total billed charges,38% of total billed charges,148.96,38,,119.168,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,352.8,90,,282.24,percent of total billed charges,90% of total billed charges,137.2,35,,109.76,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,313.6,80,,250.88,percent of total billed charges,80% of total billed charges,150.45,38.38,,120.36,percent of total billed charges,38.38% of total billed charges,313.6,80,,250.88,percent of total billed charges,80% of total billed charges,242.02,61.74,,193.616,percent of total billed charges,61.74% of total billed charges,399.84,102,,319.872,percent of total billed charges,102% of total billed charges,148.96,38,,119.168,percent of total billed charges,38% of total billed charges,137.2,399.84,
CONTINUOUS + AIRWAY(CPAP)(BIPAP) DAILY,8000059,CDM,410,RC,94660,HCPCS,Outpatient,,,392,294,,305.76,78,,244.608,percent of total billed charges,78% of total billed charges,246.96,63,,197.568,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,148.96,38,,119.168,percent of total billed charges,38% of total billed charges,148.96,38,,119.168,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,352.8,90,,282.24,percent of total billed charges,90% of total billed charges,137.2,35,,109.76,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,313.6,80,,250.88,percent of total billed charges,80% of total billed charges,150.45,38.38,,120.36,percent of total billed charges,38.38% of total billed charges,313.6,80,,250.88,percent of total billed charges,80% of total billed charges,242.02,61.74,,193.616,percent of total billed charges,61.74% of total billed charges,399.84,102,,319.872,percent of total billed charges,102% of total billed charges,148.96,38,,119.168,percent of total billed charges,38% of total billed charges,137.2,399.84,
"NASOTRACHEAL ASPIRATION, SEPARATE PROCED",8000070,CDM,410,RC,31720,HCPCS,Outpatient,,,392,294,,305.76,78,,244.608,percent of total billed charges,78% of total billed charges,246.96,63,,197.568,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,148.96,38,,119.168,percent of total billed charges,38% of total billed charges,148.96,38,,119.168,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,352.8,90,,282.24,percent of total billed charges,90% of total billed charges,137.2,35,,109.76,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,313.6,80,,250.88,percent of total billed charges,80% of total billed charges,150.45,38.38,,120.36,percent of total billed charges,38.38% of total billed charges,313.6,80,,250.88,percent of total billed charges,80% of total billed charges,242.02,61.74,,193.616,percent of total billed charges,61.74% of total billed charges,399.84,102,,319.872,percent of total billed charges,102% of total billed charges,148.96,38,,119.168,percent of total billed charges,38% of total billed charges,137.2,399.84,
"SPUTUM INDUCTION INITIAL, EACH DAY",8000089,CDM,410,RC,94640,HCPCS,Outpatient,,,392,294,,305.76,78,,244.608,percent of total billed charges,78% of total billed charges,246.96,63,,197.568,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,148.96,38,,119.168,percent of total billed charges,38% of total billed charges,148.96,38,,119.168,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,352.8,90,,282.24,percent of total billed charges,90% of total billed charges,137.2,35,,109.76,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,313.6,80,,250.88,percent of total billed charges,80% of total billed charges,150.45,38.38,,120.36,percent of total billed charges,38.38% of total billed charges,313.6,80,,250.88,percent of total billed charges,80% of total billed charges,242.02,61.74,,193.616,percent of total billed charges,61.74% of total billed charges,399.84,102,,319.872,percent of total billed charges,102% of total billed charges,148.96,38,,119.168,percent of total billed charges,38% of total billed charges,137.2,399.84,
"DEMONSTRATION / EVAL BY RESP, EACH DAY",8000100,CDM,410,RC,94664,HCPCS,Outpatient,,,392,294,,305.76,78,,244.608,percent of total billed charges,78% of total billed charges,246.96,63,,197.568,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,148.96,38,,119.168,percent of total billed charges,38% of total billed charges,148.96,38,,119.168,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,352.8,90,,282.24,percent of total billed charges,90% of total billed charges,137.2,35,,109.76,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,313.6,80,,250.88,percent of total billed charges,80% of total billed charges,150.45,38.38,,120.36,percent of total billed charges,38.38% of total billed charges,313.6,80,,250.88,percent of total billed charges,80% of total billed charges,242.02,61.74,,193.616,percent of total billed charges,61.74% of total billed charges,399.84,102,,319.872,percent of total billed charges,102% of total billed charges,148.96,38,,119.168,percent of total billed charges,38% of total billed charges,137.2,399.84,
MDI THERAPY FIRST TREATMENT,8094640,CDM,410,RC,94640,HCPCS,Outpatient,,,392,294,,305.76,78,,244.608,percent of total billed charges,78% of total billed charges,246.96,63,,197.568,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,148.96,38,,119.168,percent of total billed charges,38% of total billed charges,148.96,38,,119.168,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,352.8,90,,282.24,percent of total billed charges,90% of total billed charges,137.2,35,,109.76,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,313.6,80,,250.88,percent of total billed charges,80% of total billed charges,150.45,38.38,,120.36,percent of total billed charges,38.38% of total billed charges,313.6,80,,250.88,percent of total billed charges,80% of total billed charges,242.02,61.74,,193.616,percent of total billed charges,61.74% of total billed charges,399.84,102,,319.872,percent of total billed charges,102% of total billed charges,148.96,38,,119.168,percent of total billed charges,38% of total billed charges,137.2,399.84,
"TESTOSTERONE, TOTAL",5001728,CDM,300,RC,84403,HCPCS,Outpatient,,,393,294.75,,306.54,78,,245.232,percent of total billed charges,78% of total billed charges,32.47,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,25.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,25.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,353.7,90,,282.96,percent of total billed charges,90% of total billed charges,34.09,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,264.39,67.275,,211.512,percent of total billed charges,67.275% of total billed charges,314.4,80,,251.52,percent of total billed charges,80% of total billed charges,26.07,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,314.4,80,,251.52,percent of total billed charges,80% of total billed charges,242.64,61.74,,194.112,percent of total billed charges,61.74% of total billed charges,33.12,102,,,Fee Schedule,102% of GA Medicaid Rate,25.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,25.81,353.7,
DRILL BIT 2.0MM,3001527,CDM,270,RC,,,Outpatient,,,394,295.5,,307.32,78,,245.856,percent of total billed charges,78% of total billed charges,248.22,63,,198.576,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,149.72,38,,119.776,percent of total billed charges,38% of total billed charges,149.72,38,,119.776,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,354.6,90,,283.68,percent of total billed charges,90% of total billed charges,137.9,35,,110.32,percent of total billed charges,35% of total billed charges,265.06,67.275,,212.048,percent of total billed charges,67.275% of total billed charges,315.2,80,,252.16,percent of total billed charges,80% of total billed charges,151.22,38.38,,120.976,percent of total billed charges,38.38% of total billed charges,315.2,80,,252.16,percent of total billed charges,80% of total billed charges,243.26,61.74,,194.608,percent of total billed charges,61.74% of total billed charges,401.88,102,,321.504,percent of total billed charges,102% of total billed charges,149.72,38,,119.776,percent of total billed charges,38% of total billed charges,137.9,401.88,
AMINOACID ANALYSIS,5002087,CDM,301,RC,82139,HCPCS,Outpatient,,,398,298.5,,310.44,78,,248.352,percent of total billed charges,78% of total billed charges,21.21,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,358.2,90,,286.56,percent of total billed charges,90% of total billed charges,22.27,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,267.75,67.275,,214.2,percent of total billed charges,67.275% of total billed charges,318.4,80,,254.72,percent of total billed charges,80% of total billed charges,17.04,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,318.4,80,,254.72,percent of total billed charges,80% of total billed charges,245.73,61.74,,196.584,percent of total billed charges,61.74% of total billed charges,21.63,102,,,Fee Schedule,102% of GA Medicaid Rate,16.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.87,358.2,
LYMPHOCYTE SUBSET PANEL 5,5002100,CDM,302,RC,86361,HCPCS,Outpatient,,,398,298.5,,310.44,78,,248.352,percent of total billed charges,78% of total billed charges,32.82,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,26.78,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,26.78,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,358.2,90,,286.56,percent of total billed charges,90% of total billed charges,34.46,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,267.75,67.275,,214.2,percent of total billed charges,67.275% of total billed charges,318.4,80,,254.72,percent of total billed charges,80% of total billed charges,27.05,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,318.4,80,,254.72,percent of total billed charges,80% of total billed charges,245.73,61.74,,196.584,percent of total billed charges,61.74% of total billed charges,33.48,102,,,Fee Schedule,102% of GA Medicaid Rate,26.78,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,26.78,358.2,
AMINO ACID ANALYSIS,5003729,CDM,301,RC,82139,HCPCS,Outpatient,,,398,298.5,,310.44,78,,248.352,percent of total billed charges,78% of total billed charges,21.21,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,358.2,90,,286.56,percent of total billed charges,90% of total billed charges,22.27,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,267.75,67.275,,214.2,percent of total billed charges,67.275% of total billed charges,318.4,80,,254.72,percent of total billed charges,80% of total billed charges,17.04,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,318.4,80,,254.72,percent of total billed charges,80% of total billed charges,245.73,61.74,,196.584,percent of total billed charges,61.74% of total billed charges,21.63,102,,,Fee Schedule,102% of GA Medicaid Rate,16.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.87,358.2,
EYE FOREIGN BODY DETECTION,7000112,CDM,320,RC,70030,HCPCS,Outpatient,,,400,300,,312,78,,249.6,percent of total billed charges,78% of total billed charges,252,63,,201.6,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,152,38,,121.6,percent of total billed charges,38% of total billed charges,152,38,,121.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,360,90,,288,percent of total billed charges,90% of total billed charges,140,35,,112,percent of total billed charges,35% of total billed charges,269.1,67.275,,215.28,percent of total billed charges,67.275% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,153.52,38.38,,122.816,percent of total billed charges,38.38% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,246.96,61.74,,197.568,percent of total billed charges,61.74% of total billed charges,408,102,,326.4,percent of total billed charges,102% of total billed charges,152,38,,121.6,percent of total billed charges,38% of total billed charges,140,408,
NASAL BONES COMPLETE,7000125,CDM,320,RC,70160,HCPCS,Outpatient,,,400,300,,312,78,,249.6,percent of total billed charges,78% of total billed charges,252,63,,201.6,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,152,38,,121.6,percent of total billed charges,38% of total billed charges,152,38,,121.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,360,90,,288,percent of total billed charges,90% of total billed charges,140,35,,112,percent of total billed charges,35% of total billed charges,269.1,67.275,,215.28,percent of total billed charges,67.275% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,153.52,38.38,,122.816,percent of total billed charges,38.38% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,246.96,61.74,,197.568,percent of total billed charges,61.74% of total billed charges,408,102,,326.4,percent of total billed charges,102% of total billed charges,152,38,,121.6,percent of total billed charges,38% of total billed charges,140,408,
"2 views, front and back",7000210,CDM,320,RC,71046,HCPCS,Outpatient,,,400,300,,312,78,,249.6,percent of total billed charges,78% of total billed charges,252,63,,201.6,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,152,38,,121.6,percent of total billed charges,38% of total billed charges,152,38,,121.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,360,90,,288,percent of total billed charges,90% of total billed charges,140,35,,112,percent of total billed charges,35% of total billed charges,269.1,67.275,,215.28,percent of total billed charges,67.275% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,153.52,38.38,,122.816,percent of total billed charges,38.38% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,246.96,61.74,,197.568,percent of total billed charges,61.74% of total billed charges,408,102,,326.4,percent of total billed charges,102% of total billed charges,152,38,,121.6,percent of total billed charges,38% of total billed charges,140,408,
"X-ray of lower and sacral spine, minimum of 4 views",7000420,CDM,320,RC,72110,HCPCS,Outpatient,,,400,300,,312,78,,249.6,percent of total billed charges,78% of total billed charges,252,63,,201.6,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,152,38,,121.6,percent of total billed charges,38% of total billed charges,152,38,,121.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,360,90,,288,percent of total billed charges,90% of total billed charges,140,35,,112,percent of total billed charges,35% of total billed charges,269.1,67.275,,215.28,percent of total billed charges,67.275% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,153.52,38.38,,122.816,percent of total billed charges,38.38% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,246.96,61.74,,197.568,percent of total billed charges,61.74% of total billed charges,408,102,,326.4,percent of total billed charges,102% of total billed charges,152,38,,121.6,percent of total billed charges,38% of total billed charges,140,408,
SPINE 1 VIEW,7000421,CDM,320,RC,72020,HCPCS,Outpatient,,,400,300,,312,78,,249.6,percent of total billed charges,78% of total billed charges,252,63,,201.6,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,152,38,,121.6,percent of total billed charges,38% of total billed charges,152,38,,121.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,360,90,,288,percent of total billed charges,90% of total billed charges,140,35,,112,percent of total billed charges,35% of total billed charges,269.1,67.275,,215.28,percent of total billed charges,67.275% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,153.52,38.38,,122.816,percent of total billed charges,38.38% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,246.96,61.74,,197.568,percent of total billed charges,61.74% of total billed charges,408,102,,326.4,percent of total billed charges,102% of total billed charges,152,38,,121.6,percent of total billed charges,38% of total billed charges,140,408,
SACRUM 2 VIEWS,7000425,CDM,320,RC,72220,HCPCS,Outpatient,,,400,300,,312,78,,249.6,percent of total billed charges,78% of total billed charges,252,63,,201.6,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,152,38,,121.6,percent of total billed charges,38% of total billed charges,152,38,,121.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,360,90,,288,percent of total billed charges,90% of total billed charges,140,35,,112,percent of total billed charges,35% of total billed charges,269.1,67.275,,215.28,percent of total billed charges,67.275% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,153.52,38.38,,122.816,percent of total billed charges,38.38% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,246.96,61.74,,197.568,percent of total billed charges,61.74% of total billed charges,408,102,,326.4,percent of total billed charges,102% of total billed charges,152,38,,121.6,percent of total billed charges,38% of total billed charges,140,408,
COCCYX 2 VIEWS,7000430,CDM,320,RC,72220,HCPCS,Outpatient,,,400,300,,312,78,,249.6,percent of total billed charges,78% of total billed charges,252,63,,201.6,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,152,38,,121.6,percent of total billed charges,38% of total billed charges,152,38,,121.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,360,90,,288,percent of total billed charges,90% of total billed charges,140,35,,112,percent of total billed charges,35% of total billed charges,269.1,67.275,,215.28,percent of total billed charges,67.275% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,153.52,38.38,,122.816,percent of total billed charges,38.38% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,246.96,61.74,,197.568,percent of total billed charges,61.74% of total billed charges,408,102,,326.4,percent of total billed charges,102% of total billed charges,152,38,,121.6,percent of total billed charges,38% of total billed charges,140,408,
Radiologic examination of the pelvis,7000515,CDM,320,RC,72170,HCPCS,Outpatient,,,400,300,,312,78,,249.6,percent of total billed charges,78% of total billed charges,252,63,,201.6,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,152,38,,121.6,percent of total billed charges,38% of total billed charges,152,38,,121.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,360,90,,288,percent of total billed charges,90% of total billed charges,140,35,,112,percent of total billed charges,35% of total billed charges,269.1,67.275,,215.28,percent of total billed charges,67.275% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,153.52,38.38,,122.816,percent of total billed charges,38.38% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,246.96,61.74,,197.568,percent of total billed charges,61.74% of total billed charges,408,102,,326.4,percent of total billed charges,102% of total billed charges,152,38,,121.6,percent of total billed charges,38% of total billed charges,140,408,
SACROILIAC JOINTS MIN 3,7000530,CDM,320,RC,72202,HCPCS,Outpatient,,,400,300,,312,78,,249.6,percent of total billed charges,78% of total billed charges,252,63,,201.6,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,152,38,,121.6,percent of total billed charges,38% of total billed charges,152,38,,121.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,360,90,,288,percent of total billed charges,90% of total billed charges,140,35,,112,percent of total billed charges,35% of total billed charges,269.1,67.275,,215.28,percent of total billed charges,67.275% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,153.52,38.38,,122.816,percent of total billed charges,38.38% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,246.96,61.74,,197.568,percent of total billed charges,61.74% of total billed charges,408,102,,326.4,percent of total billed charges,102% of total billed charges,152,38,,121.6,percent of total billed charges,38% of total billed charges,140,408,
ARM (HUMERUS) 2V-RT,7000725,CDM,320,RC,73060,HCPCS,Outpatient,,,400,300,,312,78,,249.6,percent of total billed charges,78% of total billed charges,252,63,,201.6,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,152,38,,121.6,percent of total billed charges,38% of total billed charges,152,38,,121.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,360,90,,288,percent of total billed charges,90% of total billed charges,140,35,,112,percent of total billed charges,35% of total billed charges,269.1,67.275,,215.28,percent of total billed charges,67.275% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,153.52,38.38,,122.816,percent of total billed charges,38.38% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,246.96,61.74,,197.568,percent of total billed charges,61.74% of total billed charges,408,102,,326.4,percent of total billed charges,102% of total billed charges,152,38,,121.6,percent of total billed charges,38% of total billed charges,140,408,
ARM (HUMERUS) 2V-LT,7000727,CDM,320,RC,73060,HCPCS,Outpatient,,,400,300,,312,78,,249.6,percent of total billed charges,78% of total billed charges,252,63,,201.6,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,152,38,,121.6,percent of total billed charges,38% of total billed charges,152,38,,121.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,360,90,,288,percent of total billed charges,90% of total billed charges,140,35,,112,percent of total billed charges,35% of total billed charges,269.1,67.275,,215.28,percent of total billed charges,67.275% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,153.52,38.38,,122.816,percent of total billed charges,38.38% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,246.96,61.74,,197.568,percent of total billed charges,61.74% of total billed charges,408,102,,326.4,percent of total billed charges,102% of total billed charges,152,38,,121.6,percent of total billed charges,38% of total billed charges,140,408,
Radiologic examination of the finger(s),7000760,CDM,320,RC,73140,HCPCS,Outpatient,,,400,300,,312,78,,249.6,percent of total billed charges,78% of total billed charges,252,63,,201.6,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,152,38,,121.6,percent of total billed charges,38% of total billed charges,152,38,,121.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,360,90,,288,percent of total billed charges,90% of total billed charges,140,35,,112,percent of total billed charges,35% of total billed charges,269.1,67.275,,215.28,percent of total billed charges,67.275% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,153.52,38.38,,122.816,percent of total billed charges,38.38% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,246.96,61.74,,197.568,percent of total billed charges,61.74% of total billed charges,408,102,,326.4,percent of total billed charges,102% of total billed charges,152,38,,121.6,percent of total billed charges,38% of total billed charges,140,408,
Radiologic examination of the finger(s),7000763,CDM,320,RC,73140,HCPCS,Outpatient,,,400,300,,312,78,,249.6,percent of total billed charges,78% of total billed charges,252,63,,201.6,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,152,38,,121.6,percent of total billed charges,38% of total billed charges,152,38,,121.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,360,90,,288,percent of total billed charges,90% of total billed charges,140,35,,112,percent of total billed charges,35% of total billed charges,269.1,67.275,,215.28,percent of total billed charges,67.275% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,153.52,38.38,,122.816,percent of total billed charges,38.38% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,246.96,61.74,,197.568,percent of total billed charges,61.74% of total billed charges,408,102,,326.4,percent of total billed charges,102% of total billed charges,152,38,,121.6,percent of total billed charges,38% of total billed charges,140,408,
US SPINE 1V LAT,7000980,CDM,320,RC,72020,HCPCS,Outpatient,,,400,300,,312,78,,249.6,percent of total billed charges,78% of total billed charges,252,63,,201.6,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,152,38,,121.6,percent of total billed charges,38% of total billed charges,152,38,,121.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,360,90,,288,percent of total billed charges,90% of total billed charges,140,35,,112,percent of total billed charges,35% of total billed charges,269.1,67.275,,215.28,percent of total billed charges,67.275% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,153.52,38.38,,122.816,percent of total billed charges,38.38% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,246.96,61.74,,197.568,percent of total billed charges,61.74% of total billed charges,408,102,,326.4,percent of total billed charges,102% of total billed charges,152,38,,121.6,percent of total billed charges,38% of total billed charges,140,408,
"Diagnostic ultrasound of an extremity excluding the bone, joints or vessels",7300022,CDM,402,RC,76882,HCPCS,Outpatient,,,400,300,,312,78,,249.6,percent of total billed charges,78% of total billed charges,252,63,,201.6,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,152,38,,121.6,percent of total billed charges,38% of total billed charges,152,38,,121.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,360,90,,288,percent of total billed charges,90% of total billed charges,140,35,,112,percent of total billed charges,35% of total billed charges,269.1,67.275,,215.28,percent of total billed charges,67.275% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,153.52,38.38,,122.816,percent of total billed charges,38.38% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,246.96,61.74,,197.568,percent of total billed charges,61.74% of total billed charges,408,102,,326.4,percent of total billed charges,102% of total billed charges,152,38,,121.6,percent of total billed charges,38% of total billed charges,140,408,
"Diagnostic ultrasound of an extremity excluding the bone, joints or vessels",7300023,CDM,402,RC,76882,HCPCS,Outpatient,,,400,300,,312,78,,249.6,percent of total billed charges,78% of total billed charges,252,63,,201.6,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,152,38,,121.6,percent of total billed charges,38% of total billed charges,152,38,,121.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,360,90,,288,percent of total billed charges,90% of total billed charges,140,35,,112,percent of total billed charges,35% of total billed charges,269.1,67.275,,215.28,percent of total billed charges,67.275% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,153.52,38.38,,122.816,percent of total billed charges,38.38% of total billed charges,320,80,,256,percent of total billed charges,80% of total billed charges,246.96,61.74,,197.568,percent of total billed charges,61.74% of total billed charges,408,102,,326.4,percent of total billed charges,102% of total billed charges,152,38,,121.6,percent of total billed charges,38% of total billed charges,140,408,
"INFUSION HYDRATION, 31 MIN TO 1 HR",1001270,CDM,450,RC,96360,HCPCS,Outpatient,,,402,301.5,,313.56,78,,250.848,percent of total billed charges,78% of total billed charges,253.26,63,,202.608,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,152.76,38,,122.208,percent of total billed charges,38% of total billed charges,152.76,38,,122.208,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,361.8,90,,289.44,percent of total billed charges,90% of total billed charges,140.7,35,,112.56,percent of total billed charges,35% of total billed charges,270.45,67.275,,216.36,percent of total billed charges,67.275% of total billed charges,321.6,80,,257.28,percent of total billed charges,80% of total billed charges,154.29,38.38,,123.432,percent of total billed charges,38.38% of total billed charges,321.6,80,,257.28,percent of total billed charges,80% of total billed charges,248.19,61.74,,198.552,percent of total billed charges,61.74% of total billed charges,410.04,102,,328.032,percent of total billed charges,102% of total billed charges,152.76,38,,122.208,percent of total billed charges,38% of total billed charges,140.7,410.04,
US CHEST BIL INCLUDING MEDIASTINUM,7300931,CDM,402,RC,76604,HCPCS,Outpatient,,,403,302.25,,314.34,78,,251.472,percent of total billed charges,78% of total billed charges,253.89,63,,203.112,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,153.14,38,,122.512,percent of total billed charges,38% of total billed charges,153.14,38,,122.512,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,362.7,90,,290.16,percent of total billed charges,90% of total billed charges,141.05,35,,112.84,percent of total billed charges,35% of total billed charges,271.12,67.275,,216.896,percent of total billed charges,67.275% of total billed charges,322.4,80,,257.92,percent of total billed charges,80% of total billed charges,154.67,38.38,,123.736,percent of total billed charges,38.38% of total billed charges,322.4,80,,257.92,percent of total billed charges,80% of total billed charges,248.81,61.74,,199.048,percent of total billed charges,61.74% of total billed charges,411.06,102,,328.848,percent of total billed charges,102% of total billed charges,153.14,38,,122.512,percent of total billed charges,38% of total billed charges,141.05,411.06,
Ultrasound of the pelvis through vagina,7300937,CDM,402,RC,76830,HCPCS,Outpatient,,,403,302.25,,314.34,78,,251.472,percent of total billed charges,78% of total billed charges,253.89,63,,203.112,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,153.14,38,,122.512,percent of total billed charges,38% of total billed charges,153.14,38,,122.512,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,362.7,90,,290.16,percent of total billed charges,90% of total billed charges,141.05,35,,112.84,percent of total billed charges,35% of total billed charges,271.12,67.275,,216.896,percent of total billed charges,67.275% of total billed charges,322.4,80,,257.92,percent of total billed charges,80% of total billed charges,154.67,38.38,,123.736,percent of total billed charges,38.38% of total billed charges,322.4,80,,257.92,percent of total billed charges,80% of total billed charges,248.81,61.74,,199.048,percent of total billed charges,61.74% of total billed charges,411.06,102,,328.848,percent of total billed charges,102% of total billed charges,153.14,38,,122.512,percent of total billed charges,38% of total billed charges,141.05,411.06,
US CHEST LEFT INCLUDING MEDIASTINUM,7300938,CDM,402,RC,76604,HCPCS,Outpatient,,,403,302.25,,314.34,78,,251.472,percent of total billed charges,78% of total billed charges,253.89,63,,203.112,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,153.14,38,,122.512,percent of total billed charges,38% of total billed charges,153.14,38,,122.512,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,362.7,90,,290.16,percent of total billed charges,90% of total billed charges,141.05,35,,112.84,percent of total billed charges,35% of total billed charges,271.12,67.275,,216.896,percent of total billed charges,67.275% of total billed charges,322.4,80,,257.92,percent of total billed charges,80% of total billed charges,154.67,38.38,,123.736,percent of total billed charges,38.38% of total billed charges,322.4,80,,257.92,percent of total billed charges,80% of total billed charges,248.81,61.74,,199.048,percent of total billed charges,61.74% of total billed charges,411.06,102,,328.848,percent of total billed charges,102% of total billed charges,153.14,38,,122.512,percent of total billed charges,38% of total billed charges,141.05,411.06,
US CHEST RIGHT INCLUDING MEDIASTINUM,7300939,CDM,402,RC,76604,HCPCS,Outpatient,,,403,302.25,,314.34,78,,251.472,percent of total billed charges,78% of total billed charges,253.89,63,,203.112,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,153.14,38,,122.512,percent of total billed charges,38% of total billed charges,153.14,38,,122.512,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,362.7,90,,290.16,percent of total billed charges,90% of total billed charges,141.05,35,,112.84,percent of total billed charges,35% of total billed charges,271.12,67.275,,216.896,percent of total billed charges,67.275% of total billed charges,322.4,80,,257.92,percent of total billed charges,80% of total billed charges,154.67,38.38,,123.736,percent of total billed charges,38.38% of total billed charges,322.4,80,,257.92,percent of total billed charges,80% of total billed charges,248.81,61.74,,199.048,percent of total billed charges,61.74% of total billed charges,411.06,102,,328.848,percent of total billed charges,102% of total billed charges,153.14,38,,122.512,percent of total billed charges,38% of total billed charges,141.05,411.06,
DRILL BIT 2.0 x 125MM 700346,3002006,CDM,270,RC,,,Outpatient,,,407.4,305.55,,317.77,78,,254.216,percent of total billed charges,78% of total billed charges,256.66,63,,205.328,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,154.81,38,,123.848,percent of total billed charges,38% of total billed charges,154.81,38,,123.848,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,366.66,90,,293.328,percent of total billed charges,90% of total billed charges,142.59,35,,114.072,percent of total billed charges,35% of total billed charges,274.08,67.275,,219.264,percent of total billed charges,67.275% of total billed charges,325.92,80,,260.736,percent of total billed charges,80% of total billed charges,156.36,38.38,,125.088,percent of total billed charges,38.38% of total billed charges,325.92,80,,260.736,percent of total billed charges,80% of total billed charges,251.53,61.74,,201.224,percent of total billed charges,61.74% of total billed charges,415.55,102,,332.44,percent of total billed charges,102% of total billed charges,154.81,38,,123.848,percent of total billed charges,38% of total billed charges,142.59,415.55,
IO 45MM NEEDLE & STABILIZER,3002011,CDM,270,RC,,,Outpatient,,,407.4,305.55,,317.77,78,,254.216,percent of total billed charges,78% of total billed charges,256.66,63,,205.328,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,154.81,38,,123.848,percent of total billed charges,38% of total billed charges,154.81,38,,123.848,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,366.66,90,,293.328,percent of total billed charges,90% of total billed charges,142.59,35,,114.072,percent of total billed charges,35% of total billed charges,274.08,67.275,,219.264,percent of total billed charges,67.275% of total billed charges,325.92,80,,260.736,percent of total billed charges,80% of total billed charges,156.36,38.38,,125.088,percent of total billed charges,38.38% of total billed charges,325.92,80,,260.736,percent of total billed charges,80% of total billed charges,251.53,61.74,,201.224,percent of total billed charges,61.74% of total billed charges,415.55,102,,332.44,percent of total billed charges,102% of total billed charges,154.81,38,,123.848,percent of total billed charges,38% of total billed charges,142.59,415.55,
IO 25MM NEEDLE & STABILIZER,3002012,CDM,270,RC,,,Outpatient,,,407.4,305.55,,317.77,78,,254.216,percent of total billed charges,78% of total billed charges,256.66,63,,205.328,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,154.81,38,,123.848,percent of total billed charges,38% of total billed charges,154.81,38,,123.848,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,366.66,90,,293.328,percent of total billed charges,90% of total billed charges,142.59,35,,114.072,percent of total billed charges,35% of total billed charges,274.08,67.275,,219.264,percent of total billed charges,67.275% of total billed charges,325.92,80,,260.736,percent of total billed charges,80% of total billed charges,156.36,38.38,,125.088,percent of total billed charges,38.38% of total billed charges,325.92,80,,260.736,percent of total billed charges,80% of total billed charges,251.53,61.74,,201.224,percent of total billed charges,61.74% of total billed charges,415.55,102,,332.44,percent of total billed charges,102% of total billed charges,154.81,38,,123.848,percent of total billed charges,38% of total billed charges,142.59,415.55,
IO 15MM NEEDLE & STABILIZER,3002013,CDM,270,RC,,,Outpatient,,,407.4,305.55,,317.77,78,,254.216,percent of total billed charges,78% of total billed charges,256.66,63,,205.328,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,154.81,38,,123.848,percent of total billed charges,38% of total billed charges,154.81,38,,123.848,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,366.66,90,,293.328,percent of total billed charges,90% of total billed charges,142.59,35,,114.072,percent of total billed charges,35% of total billed charges,274.08,67.275,,219.264,percent of total billed charges,67.275% of total billed charges,325.92,80,,260.736,percent of total billed charges,80% of total billed charges,156.36,38.38,,125.088,percent of total billed charges,38.38% of total billed charges,325.92,80,,260.736,percent of total billed charges,80% of total billed charges,251.53,61.74,,201.224,percent of total billed charges,61.74% of total billed charges,415.55,102,,332.44,percent of total billed charges,102% of total billed charges,154.81,38,,123.848,percent of total billed charges,38% of total billed charges,142.59,415.55,
DRILL BIT 2.7 x 125MM 700348,3004276,CDM,270,RC,,,Outpatient,,,407.4,305.55,,317.77,78,,254.216,percent of total billed charges,78% of total billed charges,256.66,63,,205.328,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,154.81,38,,123.848,percent of total billed charges,38% of total billed charges,154.81,38,,123.848,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,366.66,90,,293.328,percent of total billed charges,90% of total billed charges,142.59,35,,114.072,percent of total billed charges,35% of total billed charges,274.08,67.275,,219.264,percent of total billed charges,67.275% of total billed charges,325.92,80,,260.736,percent of total billed charges,80% of total billed charges,156.36,38.38,,125.088,percent of total billed charges,38.38% of total billed charges,325.92,80,,260.736,percent of total billed charges,80% of total billed charges,251.53,61.74,,201.224,percent of total billed charges,61.74% of total billed charges,415.55,102,,332.44,percent of total billed charges,102% of total billed charges,154.81,38,,123.848,percent of total billed charges,38% of total billed charges,142.59,415.55,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",1001274,CDM,450,RC,96365,HCPCS,Outpatient,,,409,306.75,,319.02,78,,255.216,percent of total billed charges,78% of total billed charges,257.67,63,,206.136,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,155.42,38,,124.336,percent of total billed charges,38% of total billed charges,155.42,38,,124.336,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,368.1,90,,294.48,percent of total billed charges,90% of total billed charges,143.15,35,,114.52,percent of total billed charges,35% of total billed charges,275.15,67.275,,220.12,percent of total billed charges,67.275% of total billed charges,327.2,80,,261.76,percent of total billed charges,80% of total billed charges,156.97,38.38,,125.576,percent of total billed charges,38.38% of total billed charges,327.2,80,,261.76,percent of total billed charges,80% of total billed charges,252.52,61.74,,202.016,percent of total billed charges,61.74% of total billed charges,417.18,102,,333.744,percent of total billed charges,102% of total billed charges,155.42,38,,124.336,percent of total billed charges,38% of total billed charges,143.15,417.18,
CALCITONIN,5001452,CDM,301,RC,82308,HCPCS,Outpatient,,,409,306.75,,319.02,78,,255.216,percent of total billed charges,78% of total billed charges,33.67,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,26.79,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,26.79,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,368.1,90,,294.48,percent of total billed charges,90% of total billed charges,35.35,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,275.15,67.275,,220.12,percent of total billed charges,67.275% of total billed charges,327.2,80,,261.76,percent of total billed charges,80% of total billed charges,27.06,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,327.2,80,,261.76,percent of total billed charges,80% of total billed charges,252.52,61.74,,202.016,percent of total billed charges,61.74% of total billed charges,34.34,102,,,Fee Schedule,102% of GA Medicaid Rate,26.79,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,26.79,368.1,
PATH LEVEL III,5002012,CDM,312,RC,88304,HCPCS,Outpatient,,,409,306.75,,319.02,78,,255.216,percent of total billed charges,78% of total billed charges,30.18,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,155.42,38,,124.336,percent of total billed charges,38% of total billed charges,155.42,38,,124.336,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,368.1,90,,294.48,percent of total billed charges,90% of total billed charges,31.69,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,275.15,67.275,,220.12,percent of total billed charges,67.275% of total billed charges,327.2,80,,261.76,percent of total billed charges,80% of total billed charges,156.97,38.38,,125.576,percent of total billed charges,38.38% of total billed charges,327.2,80,,261.76,percent of total billed charges,80% of total billed charges,252.52,61.74,,202.016,percent of total billed charges,61.74% of total billed charges,30.78,102,,,Fee Schedule,102% of GA Medicaid Rate,155.42,38,,124.336,percent of total billed charges,38% of total billed charges,30.18,368.1,
PATH BIOPSY TISSUE PROCESSING,5003200,CDM,312,RC,88304,HCPCS,Outpatient,,,409,306.75,,319.02,78,,255.216,percent of total billed charges,78% of total billed charges,30.18,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,155.42,38,,124.336,percent of total billed charges,38% of total billed charges,155.42,38,,124.336,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,368.1,90,,294.48,percent of total billed charges,90% of total billed charges,31.69,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,275.15,67.275,,220.12,percent of total billed charges,67.275% of total billed charges,327.2,80,,261.76,percent of total billed charges,80% of total billed charges,156.97,38.38,,125.576,percent of total billed charges,38.38% of total billed charges,327.2,80,,261.76,percent of total billed charges,80% of total billed charges,252.52,61.74,,202.016,percent of total billed charges,61.74% of total billed charges,30.78,102,,,Fee Schedule,102% of GA Medicaid Rate,155.42,38,,124.336,percent of total billed charges,38% of total billed charges,30.18,368.1,
BK VIRUS PLASMA DNA QUANT PCR,5009169,CDM,301,RC,82308,HCPCS,Outpatient,,,409,306.75,,319.02,78,,255.216,percent of total billed charges,78% of total billed charges,33.67,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,26.79,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,26.79,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,368.1,90,,294.48,percent of total billed charges,90% of total billed charges,35.35,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,275.15,67.275,,220.12,percent of total billed charges,67.275% of total billed charges,327.2,80,,261.76,percent of total billed charges,80% of total billed charges,27.06,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,327.2,80,,261.76,percent of total billed charges,80% of total billed charges,252.52,61.74,,202.016,percent of total billed charges,61.74% of total billed charges,34.34,102,,,Fee Schedule,102% of GA Medicaid Rate,26.79,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,26.79,368.1,
"PTH, INTACT",5001865,CDM,301,RC,83970,HCPCS,Outpatient,,,410,307.5,,319.8,78,,255.84,percent of total billed charges,78% of total billed charges,51.9,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,41.28,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,41.28,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,369,90,,295.2,percent of total billed charges,90% of total billed charges,54.5,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,275.83,67.275,,220.664,percent of total billed charges,67.275% of total billed charges,328,80,,262.4,percent of total billed charges,80% of total billed charges,41.69,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,328,80,,262.4,percent of total billed charges,80% of total billed charges,253.13,61.74,,202.504,percent of total billed charges,61.74% of total billed charges,52.94,102,,,Fee Schedule,102% of GA Medicaid Rate,41.28,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,41.28,369,
PTH INTACT AND CALCIUM,5001866,CDM,301,RC,83970,HCPCS,Outpatient,,,410,307.5,,319.8,78,,255.84,percent of total billed charges,78% of total billed charges,51.9,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,41.28,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,41.28,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,369,90,,295.2,percent of total billed charges,90% of total billed charges,54.5,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,275.83,67.275,,220.664,percent of total billed charges,67.275% of total billed charges,328,80,,262.4,percent of total billed charges,80% of total billed charges,41.69,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,328,80,,262.4,percent of total billed charges,80% of total billed charges,253.13,61.74,,202.504,percent of total billed charges,61.74% of total billed charges,52.94,102,,,Fee Schedule,102% of GA Medicaid Rate,41.28,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,41.28,369,
PARATHYROID HORMONE-MID,5001867,CDM,301,RC,83970,HCPCS,Outpatient,,,410,307.5,,319.8,78,,255.84,percent of total billed charges,78% of total billed charges,51.9,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,41.28,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,41.28,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,369,90,,295.2,percent of total billed charges,90% of total billed charges,54.5,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,275.83,67.275,,220.664,percent of total billed charges,67.275% of total billed charges,328,80,,262.4,percent of total billed charges,80% of total billed charges,41.69,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,328,80,,262.4,percent of total billed charges,80% of total billed charges,253.13,61.74,,202.504,percent of total billed charges,61.74% of total billed charges,52.94,102,,,Fee Schedule,102% of GA Medicaid Rate,41.28,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,41.28,369,
PARATHYROID HORMONE C TER,5001868,CDM,301,RC,83970,HCPCS,Outpatient,,,410,307.5,,319.8,78,,255.84,percent of total billed charges,78% of total billed charges,51.9,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,41.28,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,41.28,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,369,90,,295.2,percent of total billed charges,90% of total billed charges,54.5,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,275.83,67.275,,220.664,percent of total billed charges,67.275% of total billed charges,328,80,,262.4,percent of total billed charges,80% of total billed charges,41.69,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,328,80,,262.4,percent of total billed charges,80% of total billed charges,253.13,61.74,,202.504,percent of total billed charges,61.74% of total billed charges,52.94,102,,,Fee Schedule,102% of GA Medicaid Rate,41.28,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,41.28,369,
"Diagnostic mammography, including computer-aided detection (cad) when performed; unilateral",7601055,CDM,401,RC,77065,HCPCS,Outpatient,,,410,307.5,,319.8,78,,255.84,percent of total billed charges,78% of total billed charges,258.3,63,,206.64,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,155.8,38,,124.64,percent of total billed charges,38% of total billed charges,155.8,38,,124.64,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,369,90,,295.2,percent of total billed charges,90% of total billed charges,143.5,35,,114.8,percent of total billed charges,35% of total billed charges,275.83,67.275,,220.664,percent of total billed charges,67.275% of total billed charges,328,80,,262.4,percent of total billed charges,80% of total billed charges,157.36,38.38,,125.888,percent of total billed charges,38.38% of total billed charges,328,80,,262.4,percent of total billed charges,80% of total billed charges,253.13,61.74,,202.504,percent of total billed charges,61.74% of total billed charges,418.2,102,,334.56,percent of total billed charges,102% of total billed charges,155.8,38,,124.64,percent of total billed charges,38% of total billed charges,143.5,418.2,
"Diagnostic mammography, including computer-aided detection (cad) when performed; unilateral",7601065,CDM,401,RC,77065,HCPCS,Outpatient,,,410,307.5,,319.8,78,,255.84,percent of total billed charges,78% of total billed charges,258.3,63,,206.64,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,155.8,38,,124.64,percent of total billed charges,38% of total billed charges,155.8,38,,124.64,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,369,90,,295.2,percent of total billed charges,90% of total billed charges,143.5,35,,114.8,percent of total billed charges,35% of total billed charges,275.83,67.275,,220.664,percent of total billed charges,67.275% of total billed charges,328,80,,262.4,percent of total billed charges,80% of total billed charges,157.36,38.38,,125.888,percent of total billed charges,38.38% of total billed charges,328,80,,262.4,percent of total billed charges,80% of total billed charges,253.13,61.74,,202.504,percent of total billed charges,61.74% of total billed charges,418.2,102,,334.56,percent of total billed charges,102% of total billed charges,155.8,38,,124.64,percent of total billed charges,38% of total billed charges,143.5,418.2,
URINARY CATH SIMPLE,1001100,CDM,450,RC,51702,HCPCS,Outpatient,,,412,309,,321.36,78,,257.088,percent of total billed charges,78% of total billed charges,259.56,63,,207.648,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,156.56,38,,125.248,percent of total billed charges,38% of total billed charges,156.56,38,,125.248,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,370.8,90,,296.64,percent of total billed charges,90% of total billed charges,144.2,35,,115.36,percent of total billed charges,35% of total billed charges,277.17,67.275,,221.736,percent of total billed charges,67.275% of total billed charges,329.6,80,,263.68,percent of total billed charges,80% of total billed charges,158.13,38.38,,126.504,percent of total billed charges,38.38% of total billed charges,329.6,80,,263.68,percent of total billed charges,80% of total billed charges,254.37,61.74,,203.496,percent of total billed charges,61.74% of total billed charges,420.24,102,,336.192,percent of total billed charges,102% of total billed charges,156.56,38,,125.248,percent of total billed charges,38% of total billed charges,144.2,420.24,
Ultrasound of abdomen with all areas scanned,7300929,CDM,402,RC,76700,HCPCS,Outpatient,,,413,309.75,,322.14,78,,257.712,percent of total billed charges,78% of total billed charges,260.19,63,,208.152,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,156.94,38,,125.552,percent of total billed charges,38% of total billed charges,156.94,38,,125.552,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,371.7,90,,297.36,percent of total billed charges,90% of total billed charges,144.55,35,,115.64,percent of total billed charges,35% of total billed charges,277.85,67.275,,222.28,percent of total billed charges,67.275% of total billed charges,330.4,80,,264.32,percent of total billed charges,80% of total billed charges,158.51,38.38,,126.808,percent of total billed charges,38.38% of total billed charges,330.4,80,,264.32,percent of total billed charges,80% of total billed charges,254.99,61.74,,203.992,percent of total billed charges,61.74% of total billed charges,421.26,102,,337.008,percent of total billed charges,102% of total billed charges,156.94,38,,125.552,percent of total billed charges,38% of total billed charges,144.55,421.26,
"New patient office of other outpatient visit, typically 60 min",1001025,CDM,510,RC,99205,HCPCS,Outpatient,,,414,310.5,,322.92,78,,258.336,percent of total billed charges,78% of total billed charges,260.82,63,,208.656,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,157.32,38,,125.856,percent of total billed charges,38% of total billed charges,157.32,38,,125.856,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,372.6,90,,298.08,percent of total billed charges,90% of total billed charges,144.9,35,,115.92,percent of total billed charges,35% of total billed charges,133.52,67.275,,106.816,percent of total billed charges,67.275% of total billed charges,331.2,80,,264.96,percent of total billed charges,80% of total billed charges,158.89,38.38,,127.112,percent of total billed charges,38.38% of total billed charges,331.2,80,,264.96,percent of total billed charges,80% of total billed charges,255.6,61.74,,204.48,percent of total billed charges,61.74% of total billed charges,422.28,102,,337.824,percent of total billed charges,102% of total billed charges,157.32,38,,125.856,percent of total billed charges,38% of total billed charges,133.52,422.28,
TR45W  RELOAD,3005032,CDM,270,RC,,,Outpatient,,,418.05,313.54,,326.08,78,,260.864,percent of total billed charges,78% of total billed charges,263.37,63,,210.696,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,158.86,38,,127.088,percent of total billed charges,38% of total billed charges,158.86,38,,127.088,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,376.25,90,,301,percent of total billed charges,90% of total billed charges,146.32,35,,117.056,percent of total billed charges,35% of total billed charges,281.24,67.275,,224.992,percent of total billed charges,67.275% of total billed charges,334.44,80,,267.552,percent of total billed charges,80% of total billed charges,160.45,38.38,,128.36,percent of total billed charges,38.38% of total billed charges,334.44,80,,267.552,percent of total billed charges,80% of total billed charges,258.1,61.74,,206.48,percent of total billed charges,61.74% of total billed charges,426.41,102,,341.128,percent of total billed charges,102% of total billed charges,158.86,38,,127.088,percent of total billed charges,38% of total billed charges,146.32,426.41,
6R45B  RELOAD,3005039,CDM,270,RC,,,Outpatient,,,418.05,313.54,,326.08,78,,260.864,percent of total billed charges,78% of total billed charges,263.37,63,,210.696,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,158.86,38,,127.088,percent of total billed charges,38% of total billed charges,158.86,38,,127.088,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,376.25,90,,301,percent of total billed charges,90% of total billed charges,146.32,35,,117.056,percent of total billed charges,35% of total billed charges,281.24,67.275,,224.992,percent of total billed charges,67.275% of total billed charges,334.44,80,,267.552,percent of total billed charges,80% of total billed charges,160.45,38.38,,128.36,percent of total billed charges,38.38% of total billed charges,334.44,80,,267.552,percent of total billed charges,80% of total billed charges,258.1,61.74,,206.48,percent of total billed charges,61.74% of total billed charges,426.41,102,,341.128,percent of total billed charges,102% of total billed charges,158.86,38,,127.088,percent of total billed charges,38% of total billed charges,146.32,426.41,
"VIROPTIC: 1 %, SOLN, 7.500 ML, BOTTLE",1002597,CDM,259,RC,,,Outpatient,,,419.8,314.85,,327.44,78,,261.952,percent of total billed charges,78% of total billed charges,264.47,63,,211.576,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,159.52,38,,127.616,percent of total billed charges,38% of total billed charges,159.52,38,,127.616,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,377.82,90,,302.256,percent of total billed charges,90% of total billed charges,146.93,35,,117.544,percent of total billed charges,35% of total billed charges,282.42,67.275,,225.936,percent of total billed charges,67.275% of total billed charges,335.84,80,,268.672,percent of total billed charges,80% of total billed charges,161.12,38.38,,128.896,percent of total billed charges,38.38% of total billed charges,335.84,80,,268.672,percent of total billed charges,80% of total billed charges,259.18,61.74,,207.344,percent of total billed charges,61.74% of total billed charges,428.2,102,,342.56,percent of total billed charges,102% of total billed charges,159.52,38,,127.616,percent of total billed charges,38% of total billed charges,146.93,428.2,
ROTH NET RETRIEVAL,3005006,CDM,270,RC,,,Outpatient,,,420,315,,327.6,78,,262.08,percent of total billed charges,78% of total billed charges,264.6,63,,211.68,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,159.6,38,,127.68,percent of total billed charges,38% of total billed charges,159.6,38,,127.68,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,378,90,,302.4,percent of total billed charges,90% of total billed charges,147,35,,117.6,percent of total billed charges,35% of total billed charges,282.56,67.275,,226.048,percent of total billed charges,67.275% of total billed charges,336,80,,268.8,percent of total billed charges,80% of total billed charges,161.2,38.38,,128.96,percent of total billed charges,38.38% of total billed charges,336,80,,268.8,percent of total billed charges,80% of total billed charges,259.31,61.74,,207.448,percent of total billed charges,61.74% of total billed charges,428.4,102,,342.72,percent of total billed charges,102% of total billed charges,159.6,38,,127.68,percent of total billed charges,38% of total billed charges,147,428.4,
CT - RECONSTRUCTION,7400950,CDM,350,RC,76376,HCPCS,Outpatient,,,420,315,,327.6,78,,262.08,percent of total billed charges,78% of total billed charges,264.6,63,,211.68,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,159.6,38,,127.68,percent of total billed charges,38% of total billed charges,159.6,38,,127.68,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,378,90,,302.4,percent of total billed charges,90% of total billed charges,147,35,,117.6,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,336,80,,268.8,percent of total billed charges,80% of total billed charges,161.2,38.38,,128.96,percent of total billed charges,38.38% of total billed charges,336,80,,268.8,percent of total billed charges,80% of total billed charges,259.31,61.74,,207.448,percent of total billed charges,61.74% of total billed charges,428.4,102,,342.72,percent of total billed charges,102% of total billed charges,159.6,38,,127.68,percent of total billed charges,38% of total billed charges,147,428.4,
CT RECONSTRUCTION W/O POST PROCESSING,7400951,CDM,350,RC,76376,HCPCS,Outpatient,,,420,315,,327.6,78,,262.08,percent of total billed charges,78% of total billed charges,264.6,63,,211.68,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,159.6,38,,127.68,percent of total billed charges,38% of total billed charges,159.6,38,,127.68,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,378,90,,302.4,percent of total billed charges,90% of total billed charges,147,35,,117.6,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,336,80,,268.8,percent of total billed charges,80% of total billed charges,161.2,38.38,,128.96,percent of total billed charges,38.38% of total billed charges,336,80,,268.8,percent of total billed charges,80% of total billed charges,259.31,61.74,,207.448,percent of total billed charges,61.74% of total billed charges,428.4,102,,342.72,percent of total billed charges,102% of total billed charges,159.6,38,,127.68,percent of total billed charges,38% of total billed charges,147,428.4,
CT RECONSTRUCTION WITH POST PROCESSING,7400952,CDM,350,RC,76377,HCPCS,Outpatient,,,420,315,,327.6,78,,262.08,percent of total billed charges,78% of total billed charges,264.6,63,,211.68,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,159.6,38,,127.68,percent of total billed charges,38% of total billed charges,159.6,38,,127.68,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,378,90,,302.4,percent of total billed charges,90% of total billed charges,147,35,,117.6,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,336,80,,268.8,percent of total billed charges,80% of total billed charges,161.2,38.38,,128.96,percent of total billed charges,38.38% of total billed charges,336,80,,268.8,percent of total billed charges,80% of total billed charges,259.31,61.74,,207.448,percent of total billed charges,61.74% of total billed charges,428.4,102,,342.72,percent of total billed charges,102% of total billed charges,159.6,38,,127.68,percent of total billed charges,38% of total billed charges,147,428.4,
TENS DEVICE,9590101,CDM,420,RC,,,Outpatient,,,420,315,,327.6,78,,262.08,percent of total billed charges,78% of total billed charges,264.6,63,,211.68,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,159.6,38,,127.68,percent of total billed charges,38% of total billed charges,159.6,38,,127.68,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,378,90,,302.4,percent of total billed charges,90% of total billed charges,147,35,,117.6,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,336,80,,268.8,percent of total billed charges,80% of total billed charges,161.2,38.38,,128.96,percent of total billed charges,38.38% of total billed charges,336,80,,268.8,percent of total billed charges,80% of total billed charges,259.31,61.74,,207.448,percent of total billed charges,61.74% of total billed charges,428.4,102,,342.72,percent of total billed charges,102% of total billed charges,159.6,38,,127.68,percent of total billed charges,38% of total billed charges,145.93,428.4,
NARCOLEPSY PANEL,5000700,CDM,302,RC,86817,HCPCS,Outpatient,,,421,315.75,,328.38,78,,262.704,percent of total billed charges,78% of total billed charges,80.96,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,106.14,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,106.14,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,378.9,90,,303.12,percent of total billed charges,90% of total billed charges,85.01,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,283.23,67.275,,226.584,percent of total billed charges,67.275% of total billed charges,336.8,80,,269.44,percent of total billed charges,80% of total billed charges,107.2,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,336.8,80,,269.44,percent of total billed charges,80% of total billed charges,259.93,61.74,,207.944,percent of total billed charges,61.74% of total billed charges,82.58,102,,,Fee Schedule,102% of GA Medicaid Rate,106.14,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,80.96,378.9,
PATH PEROXIDASE STAIN,5003701,CDM,312,RC,84233,HCPCS,Outpatient,,,422,316.5,,329.16,78,,263.328,percent of total billed charges,78% of total billed charges,80.99,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,87.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,87.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,379.8,90,,303.84,percent of total billed charges,90% of total billed charges,85.04,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,283.9,67.275,,227.12,percent of total billed charges,67.275% of total billed charges,337.6,80,,270.08,percent of total billed charges,80% of total billed charges,88.76,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,337.6,80,,270.08,percent of total billed charges,80% of total billed charges,260.54,61.74,,208.432,percent of total billed charges,61.74% of total billed charges,82.61,102,,,Fee Schedule,102% of GA Medicaid Rate,87.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,80.99,379.8,
PATH ERA,5003710,CDM,301,RC,84233,HCPCS,Outpatient,,,422,316.5,,329.16,78,,263.328,percent of total billed charges,78% of total billed charges,80.99,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,87.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,87.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,379.8,90,,303.84,percent of total billed charges,90% of total billed charges,85.04,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,283.9,67.275,,227.12,percent of total billed charges,67.275% of total billed charges,337.6,80,,270.08,percent of total billed charges,80% of total billed charges,88.76,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,337.6,80,,270.08,percent of total billed charges,80% of total billed charges,260.54,61.74,,208.432,percent of total billed charges,61.74% of total billed charges,82.61,102,,,Fee Schedule,102% of GA Medicaid Rate,87.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,80.99,379.8,
URINARY CATH COMPLEX,1001102,CDM,450,RC,,,Outpatient,,,423,317.25,,329.94,78,,263.952,percent of total billed charges,78% of total billed charges,266.49,63,,213.192,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,160.74,38,,128.592,percent of total billed charges,38% of total billed charges,160.74,38,,128.592,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,380.7,90,,304.56,percent of total billed charges,90% of total billed charges,148.05,35,,118.44,percent of total billed charges,35% of total billed charges,284.57,67.275,,227.656,percent of total billed charges,67.275% of total billed charges,338.4,80,,270.72,percent of total billed charges,80% of total billed charges,162.35,38.38,,129.88,percent of total billed charges,38.38% of total billed charges,338.4,80,,270.72,percent of total billed charges,80% of total billed charges,261.16,61.74,,208.928,percent of total billed charges,61.74% of total billed charges,431.46,102,,345.168,percent of total billed charges,102% of total billed charges,160.74,38,,128.592,percent of total billed charges,38% of total billed charges,148.05,431.46,
PATH PRA,5003711,CDM,301,RC,84234,HCPCS,Outpatient,,,425,318.75,,331.5,78,,265.2,percent of total billed charges,78% of total billed charges,81.58,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,64.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,64.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,382.5,90,,306,percent of total billed charges,90% of total billed charges,85.66,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,285.92,67.275,,228.736,percent of total billed charges,67.275% of total billed charges,340,80,,272,percent of total billed charges,80% of total billed charges,65.53,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,340,80,,272,percent of total billed charges,80% of total billed charges,262.4,61.74,,209.92,percent of total billed charges,61.74% of total billed charges,83.21,102,,,Fee Schedule,102% of GA Medicaid Rate,64.88,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,64.88,382.5,
US LMTD DUPLEX ART/VEN ABD PELV SCROT,7300013,CDM,921,RC,93976,HCPCS,Outpatient,,,425,318.75,,331.5,78,,265.2,percent of total billed charges,78% of total billed charges,267.75,63,,214.2,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,161.5,38,,129.2,percent of total billed charges,38% of total billed charges,161.5,38,,129.2,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,382.5,90,,306,percent of total billed charges,90% of total billed charges,148.75,35,,119,percent of total billed charges,35% of total billed charges,285.92,67.275,,228.736,percent of total billed charges,67.275% of total billed charges,340,80,,272,percent of total billed charges,80% of total billed charges,163.12,38.38,,130.496,percent of total billed charges,38.38% of total billed charges,340,80,,272,percent of total billed charges,80% of total billed charges,262.4,61.74,,209.92,percent of total billed charges,61.74% of total billed charges,433.5,102,,346.8,percent of total billed charges,102% of total billed charges,161.5,38,,129.2,percent of total billed charges,38% of total billed charges,148.75,433.5,
Blood test to measure a type of estrogen in the blood,5001726,CDM,301,RC,82670,HCPCS,Outpatient,,,426,319.5,,332.28,78,,265.824,percent of total billed charges,78% of total billed charges,35.14,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,27.94,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,27.94,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,383.4,90,,306.72,percent of total billed charges,90% of total billed charges,36.9,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,286.59,67.275,,229.272,percent of total billed charges,67.275% of total billed charges,340.8,80,,272.64,percent of total billed charges,80% of total billed charges,28.22,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,340.8,80,,272.64,percent of total billed charges,80% of total billed charges,263.01,61.74,,210.408,percent of total billed charges,61.74% of total billed charges,35.84,102,,,Fee Schedule,102% of GA Medicaid Rate,27.94,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,27.94,383.4,
MULTI INSTRUMENT SYSEM STRAIGHT GRIP,3001174,CDM,270,RC,,,Outpatient,,,426.03,319.52,,332.3,78,,265.84,percent of total billed charges,78% of total billed charges,268.4,63,,214.72,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,161.89,38,,129.512,percent of total billed charges,38% of total billed charges,161.89,38,,129.512,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,383.43,90,,306.744,percent of total billed charges,90% of total billed charges,149.11,35,,119.288,percent of total billed charges,35% of total billed charges,286.61,67.275,,229.288,percent of total billed charges,67.275% of total billed charges,340.82,80,,272.656,percent of total billed charges,80% of total billed charges,163.51,38.38,,130.808,percent of total billed charges,38.38% of total billed charges,340.82,80,,272.656,percent of total billed charges,80% of total billed charges,263.03,61.74,,210.424,percent of total billed charges,61.74% of total billed charges,434.55,102,,347.64,percent of total billed charges,102% of total billed charges,161.89,38,,129.512,percent of total billed charges,38% of total billed charges,149.11,434.55,
CRICOTHYROTOMY CATHETER SET,3000102,CDM,270,RC,,,Outpatient,,,427.47,320.6,,333.43,78,,266.744,percent of total billed charges,78% of total billed charges,269.31,63,,215.448,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,162.44,38,,129.952,percent of total billed charges,38% of total billed charges,162.44,38,,129.952,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,384.72,90,,307.776,percent of total billed charges,90% of total billed charges,149.61,35,,119.688,percent of total billed charges,35% of total billed charges,287.58,67.275,,230.064,percent of total billed charges,67.275% of total billed charges,341.98,80,,273.584,percent of total billed charges,80% of total billed charges,164.06,38.38,,131.248,percent of total billed charges,38.38% of total billed charges,341.98,80,,273.584,percent of total billed charges,80% of total billed charges,263.92,61.74,,211.136,percent of total billed charges,61.74% of total billed charges,436.02,102,,348.816,percent of total billed charges,102% of total billed charges,162.44,38,,129.952,percent of total billed charges,38% of total billed charges,149.61,436.02,
VIT B6  PYRIDOXINE,5001797,CDM,301,RC,84207,HCPCS,Outpatient,,,428,321,,333.84,78,,267.072,percent of total billed charges,78% of total billed charges,35.33,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,28.1,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,28.1,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,385.2,90,,308.16,percent of total billed charges,90% of total billed charges,37.1,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,287.94,67.275,,230.352,percent of total billed charges,67.275% of total billed charges,342.4,80,,273.92,percent of total billed charges,80% of total billed charges,28.38,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,342.4,80,,273.92,percent of total billed charges,80% of total billed charges,264.25,61.74,,211.4,percent of total billed charges,61.74% of total billed charges,36.04,102,,,Fee Schedule,102% of GA Medicaid Rate,28.1,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,28.1,385.2,
CONSIGN - DRILL BIT 2.0MM X 100MM,3009053,CDM,270,RC,,,Outpatient,,,432,324,,336.96,78,,269.568,percent of total billed charges,78% of total billed charges,272.16,63,,217.728,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,164.16,38,,131.328,percent of total billed charges,38% of total billed charges,164.16,38,,131.328,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,388.8,90,,311.04,percent of total billed charges,90% of total billed charges,151.2,35,,120.96,percent of total billed charges,35% of total billed charges,290.63,67.275,,232.504,percent of total billed charges,67.275% of total billed charges,345.6,80,,276.48,percent of total billed charges,80% of total billed charges,165.8,38.38,,132.64,percent of total billed charges,38.38% of total billed charges,345.6,80,,276.48,percent of total billed charges,80% of total billed charges,266.72,61.74,,213.376,percent of total billed charges,61.74% of total billed charges,440.64,102,,352.512,percent of total billed charges,102% of total billed charges,164.16,38,,131.328,percent of total billed charges,38% of total billed charges,151.2,440.64,
CONSIGN - DRILL BIT 2.7MM X 100MM,3009054,CDM,270,RC,,,Outpatient,,,435,326.25,,339.3,78,,271.44,percent of total billed charges,78% of total billed charges,274.05,63,,219.24,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,165.3,38,,132.24,percent of total billed charges,38% of total billed charges,165.3,38,,132.24,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,391.5,90,,313.2,percent of total billed charges,90% of total billed charges,152.25,35,,121.8,percent of total billed charges,35% of total billed charges,292.65,67.275,,234.12,percent of total billed charges,67.275% of total billed charges,348,80,,278.4,percent of total billed charges,80% of total billed charges,166.95,38.38,,133.56,percent of total billed charges,38.38% of total billed charges,348,80,,278.4,percent of total billed charges,80% of total billed charges,268.57,61.74,,214.856,percent of total billed charges,61.74% of total billed charges,443.7,102,,354.96,percent of total billed charges,102% of total billed charges,165.3,38,,132.24,percent of total billed charges,38% of total billed charges,152.25,443.7,
BIT DRILL 2.7 MM,3006026,CDM,270,RC,,,Outpatient,,,444,333,,346.32,78,,277.056,percent of total billed charges,78% of total billed charges,279.72,63,,223.776,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,168.72,38,,134.976,percent of total billed charges,38% of total billed charges,168.72,38,,134.976,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,399.6,90,,319.68,percent of total billed charges,90% of total billed charges,155.4,35,,124.32,percent of total billed charges,35% of total billed charges,298.7,67.275,,238.96,percent of total billed charges,67.275% of total billed charges,355.2,80,,284.16,percent of total billed charges,80% of total billed charges,170.41,38.38,,136.328,percent of total billed charges,38.38% of total billed charges,355.2,80,,284.16,percent of total billed charges,80% of total billed charges,274.13,61.74,,219.304,percent of total billed charges,61.74% of total billed charges,452.88,102,,362.304,percent of total billed charges,102% of total billed charges,168.72,38,,134.976,percent of total billed charges,38% of total billed charges,155.4,452.88,
HLA - B27,5001824,CDM,302,RC,86812,HCPCS,Outpatient,,,444,333,,346.32,78,,277.056,percent of total billed charges,78% of total billed charges,32.45,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,25.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,25.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,399.6,90,,319.68,percent of total billed charges,90% of total billed charges,34.07,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,298.7,67.275,,238.96,percent of total billed charges,67.275% of total billed charges,355.2,80,,284.16,percent of total billed charges,80% of total billed charges,26.07,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,355.2,80,,284.16,percent of total billed charges,80% of total billed charges,274.13,61.74,,219.304,percent of total billed charges,61.74% of total billed charges,33.1,102,,,Fee Schedule,102% of GA Medicaid Rate,25.81,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,25.81,399.6,
US ARTER DUP LLE/LTD,7300025,CDM,921,RC,93926,HCPCS,Outpatient,,,447,335.25,,348.66,78,,278.928,percent of total billed charges,78% of total billed charges,281.61,63,,225.288,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,169.86,38,,135.888,percent of total billed charges,38% of total billed charges,169.86,38,,135.888,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,402.3,90,,321.84,percent of total billed charges,90% of total billed charges,156.45,35,,125.16,percent of total billed charges,35% of total billed charges,300.72,67.275,,240.576,percent of total billed charges,67.275% of total billed charges,357.6,80,,286.08,percent of total billed charges,80% of total billed charges,171.56,38.38,,137.248,percent of total billed charges,38.38% of total billed charges,357.6,80,,286.08,percent of total billed charges,80% of total billed charges,275.98,61.74,,220.784,percent of total billed charges,61.74% of total billed charges,455.94,102,,364.752,percent of total billed charges,102% of total billed charges,169.86,38,,135.888,percent of total billed charges,38% of total billed charges,156.45,455.94,
Test of tissues for diagnosis of abnormalities,5002013,CDM,312,RC,88305,HCPCS,Outpatient,,,449,336.75,,350.22,78,,280.176,percent of total billed charges,78% of total billed charges,65.88,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,170.62,38,,136.496,percent of total billed charges,38% of total billed charges,170.62,38,,136.496,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,404.1,90,,323.28,percent of total billed charges,90% of total billed charges,69.17,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,302.06,67.275,,241.648,percent of total billed charges,67.275% of total billed charges,359.2,80,,287.36,percent of total billed charges,80% of total billed charges,172.33,38.38,,137.864,percent of total billed charges,38.38% of total billed charges,359.2,80,,287.36,percent of total billed charges,80% of total billed charges,277.21,61.74,,221.768,percent of total billed charges,61.74% of total billed charges,67.2,102,,,Fee Schedule,102% of GA Medicaid Rate,170.62,38,,136.496,percent of total billed charges,38% of total billed charges,65.88,404.1,
Test of tissues for diagnosis of abnormalities,5002107,CDM,310,RC,88305,HCPCS,Outpatient,,,449,336.75,,350.22,78,,280.176,percent of total billed charges,78% of total billed charges,65.88,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,170.62,38,,136.496,percent of total billed charges,38% of total billed charges,170.62,38,,136.496,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,404.1,90,,323.28,percent of total billed charges,90% of total billed charges,69.17,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,302.06,67.275,,241.648,percent of total billed charges,67.275% of total billed charges,359.2,80,,287.36,percent of total billed charges,80% of total billed charges,172.33,38.38,,137.864,percent of total billed charges,38.38% of total billed charges,359.2,80,,287.36,percent of total billed charges,80% of total billed charges,277.21,61.74,,221.768,percent of total billed charges,61.74% of total billed charges,67.2,102,,,Fee Schedule,102% of GA Medicaid Rate,170.62,38,,136.496,percent of total billed charges,38% of total billed charges,65.88,404.1,
ER VISIT LEVEL 1,1001011,CDM,450,RC,99281,HCPCS,Outpatient,,,450,337.5,,351,78,,280.8,percent of total billed charges,78% of total billed charges,50,100,,,Case rate,Pays based on per visit,131,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,171,38,,136.8,percent of total billed charges,38% of total billed charges,171,38,,136.8,percent of total billed charges,38% of total billed charges,131,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,405,90,,324,percent of total billed charges,90% of total billed charges,157.5,35,,126,percent of total billed charges,35% of total billed charges,796.95,67.275,,637.56,percent of total billed charges,67.275% of total billed charges,360,80,,288,percent of total billed charges,80% of total billed charges,172.71,38.38,,138.168,percent of total billed charges,38.38% of total billed charges,360,80,,288,percent of total billed charges,80% of total billed charges,277.83,61.74,,222.264,percent of total billed charges,61.74% of total billed charges,459,102,,367.2,percent of total billed charges,102% of total billed charges,171,38,,136.8,percent of total billed charges,38% of total billed charges,50,796.95,
ER E&M L1 SELF LTD/MINOR,1200101,CDM,981,RC,99281,HCPCS,Outpatient,,,450,337.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13.37,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,13.37,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.37,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.37,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,13.37,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,18.14,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.77,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,250.05,61.74,,200.04,percent of total billed charges,61.74% of total billed charges,17.28,102,,,Fee Schedule,102% of GA Medicaid Rate,13.37,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.37,250.05,
US EXT NON-VAS-RT,7300012,CDM,402,RC,76881,HCPCS,Outpatient,,,450,337.5,,351,78,,280.8,percent of total billed charges,78% of total billed charges,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,171,38,,136.8,percent of total billed charges,38% of total billed charges,171,38,,136.8,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,405,90,,324,percent of total billed charges,90% of total billed charges,157.5,35,,126,percent of total billed charges,35% of total billed charges,302.74,67.275,,242.192,percent of total billed charges,67.275% of total billed charges,360,80,,288,percent of total billed charges,80% of total billed charges,172.71,38.38,,138.168,percent of total billed charges,38.38% of total billed charges,360,80,,288,percent of total billed charges,80% of total billed charges,277.83,61.74,,222.264,percent of total billed charges,61.74% of total billed charges,459,102,,367.2,percent of total billed charges,102% of total billed charges,171,38,,136.8,percent of total billed charges,38% of total billed charges,157.5,459,
US EXT NON-VAS-LT,7300015,CDM,402,RC,76881,HCPCS,Outpatient,,,450,337.5,,351,78,,280.8,percent of total billed charges,78% of total billed charges,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,171,38,,136.8,percent of total billed charges,38% of total billed charges,171,38,,136.8,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,405,90,,324,percent of total billed charges,90% of total billed charges,157.5,35,,126,percent of total billed charges,35% of total billed charges,302.74,67.275,,242.192,percent of total billed charges,67.275% of total billed charges,360,80,,288,percent of total billed charges,80% of total billed charges,172.71,38.38,,138.168,percent of total billed charges,38.38% of total billed charges,360,80,,288,percent of total billed charges,80% of total billed charges,277.83,61.74,,222.264,percent of total billed charges,61.74% of total billed charges,459,102,,367.2,percent of total billed charges,102% of total billed charges,171,38,,136.8,percent of total billed charges,38% of total billed charges,157.5,459,
"Diagnostic ultrasound of an extremity excluding the bone, joints or vessels",7300021,CDM,402,RC,76882,HCPCS,Outpatient,,,450,337.5,,351,78,,280.8,percent of total billed charges,78% of total billed charges,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,171,38,,136.8,percent of total billed charges,38% of total billed charges,171,38,,136.8,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,405,90,,324,percent of total billed charges,90% of total billed charges,157.5,35,,126,percent of total billed charges,35% of total billed charges,302.74,67.275,,242.192,percent of total billed charges,67.275% of total billed charges,360,80,,288,percent of total billed charges,80% of total billed charges,172.71,38.38,,138.168,percent of total billed charges,38.38% of total billed charges,360,80,,288,percent of total billed charges,80% of total billed charges,277.83,61.74,,222.264,percent of total billed charges,61.74% of total billed charges,459,102,,367.2,percent of total billed charges,102% of total billed charges,171,38,,136.8,percent of total billed charges,38% of total billed charges,157.5,459,
"Diagnostic mammography, including computer-aided detection (cad) when performed; bilateral",7601050,CDM,401,RC,77066,HCPCS,Outpatient,,,450,337.5,,351,78,,280.8,percent of total billed charges,78% of total billed charges,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,171,38,,136.8,percent of total billed charges,38% of total billed charges,171,38,,136.8,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,405,90,,324,percent of total billed charges,90% of total billed charges,157.5,35,,126,percent of total billed charges,35% of total billed charges,302.74,67.275,,242.192,percent of total billed charges,67.275% of total billed charges,360,80,,288,percent of total billed charges,80% of total billed charges,172.71,38.38,,138.168,percent of total billed charges,38.38% of total billed charges,360,80,,288,percent of total billed charges,80% of total billed charges,277.83,61.74,,222.264,percent of total billed charges,61.74% of total billed charges,459,102,,367.2,percent of total billed charges,102% of total billed charges,171,38,,136.8,percent of total billed charges,38% of total billed charges,157.5,459,
NASAL BONE,1200148,CDM,981,RC,21310,HCPCS,Outpatient,,,452,339,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,73.67,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,273.48,61.74,,218.784,percent of total billed charges,61.74% of total billed charges,70.16,102,,,Fee Schedule,102% of GA Medicaid Rate,,,,,Other,Not Separately reimbursable,70.16,273.48,
CLAVICLE W/O MANIPULATION,1200150,CDM,981,RC,23500,HCPCS,Outpatient,,,452,339,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,254.59,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,254.59,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,254.59,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,254.59,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,254.59,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,158.04,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,258.1,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,273.48,61.74,,218.784,percent of total billed charges,61.74% of total billed charges,150.51,102,,,Fee Schedule,102% of GA Medicaid Rate,254.59,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,150.51,273.48,
"METACARPAL, EACH",1200151,CDM,981,RC,26600,HCPCS,Outpatient,,,452,339,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,318.11,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,318.11,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,318.11,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,318.11,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,318.11,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,196.86,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,324.24,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,273.48,61.74,,218.784,percent of total billed charges,61.74% of total billed charges,187.49,102,,,Fee Schedule,102% of GA Medicaid Rate,318.11,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,187.49,324.24,
"PROXIMAL MIDDLE PHALANX, EACH",1200152,CDM,981,RC,26720,HCPCS,Outpatient,,,452,339,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,210.09,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,210.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,210.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,210.09,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,210.09,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,121.54,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,213.38,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,273.48,61.74,,218.784,percent of total billed charges,61.74% of total billed charges,115.75,102,,,Fee Schedule,102% of GA Medicaid Rate,210.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,115.75,273.48,
"DISTAL PHALANX, EACH",1200153,CDM,981,RC,26750,HCPCS,Outpatient,,,452,339,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,211.36,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,211.36,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,211.36,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,211.36,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,211.36,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,124.88,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,213.94,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,273.48,61.74,,218.784,percent of total billed charges,61.74% of total billed charges,118.93,102,,,Fee Schedule,102% of GA Medicaid Rate,211.36,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,118.93,273.48,
"COCCYX FX, CLOSED",1200154,CDM,981,RC,27200,HCPCS,Outpatient,,,452,339,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,208.93,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,208.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,208.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,208.93,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,208.93,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,135.46,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,214.73,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,273.48,61.74,,218.784,percent of total billed charges,61.74% of total billed charges,129.01,102,,,Fee Schedule,102% of GA Medicaid Rate,208.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,129.01,273.48,
"METATARSAL, EACH",1200155,CDM,981,RC,28470,HCPCS,Outpatient,,,452,339,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,224.71,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,224.71,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,224.71,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,224.71,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,224.71,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,201.59,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,230.01,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,273.48,61.74,,218.784,percent of total billed charges,61.74% of total billed charges,191.99,102,,,Fee Schedule,102% of GA Medicaid Rate,224.71,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,191.99,273.48,
GREAT TOE,1200156,CDM,981,RC,28490,HCPCS,Outpatient,,,452,339,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,136.77,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,136.77,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,136.77,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,136.77,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,136.77,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,91.27,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,138.32,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,273.48,61.74,,218.784,percent of total billed charges,61.74% of total billed charges,86.92,102,,,Fee Schedule,102% of GA Medicaid Rate,136.77,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,86.92,273.48,
"FRACTURE-OTHER TOES, EACH",1200157,CDM,981,RC,28510,HCPCS,Outpatient,,,452,339,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,131.47,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,131.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,131.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,131.47,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,131.47,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,86.58,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,131.49,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,273.48,61.74,,218.784,percent of total billed charges,61.74% of total billed charges,82.46,102,,,Fee Schedule,102% of GA Medicaid Rate,131.47,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,82.46,273.48,
REDUCE SHOULDER,1200158,CDM,981,RC,23650,HCPCS,Outpatient,,,452,339,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,336.33,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,336.33,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,336.33,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,336.33,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,336.33,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,235.62,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,342.51,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,273.48,61.74,,218.784,percent of total billed charges,61.74% of total billed charges,224.4,102,,,Fee Schedule,102% of GA Medicaid Rate,336.33,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,224.4,342.51,
REDUCE ELBOW,1200159,CDM,981,RC,24600,HCPCS,Outpatient,,,452,339,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,385.74,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,385.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,385.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,385.74,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,385.74,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,326.11,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,395.72,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,273.48,61.74,,218.784,percent of total billed charges,61.74% of total billed charges,310.58,102,,,Fee Schedule,102% of GA Medicaid Rate,385.74,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,273.48,395.72,
REDUCE PATELLA,1200160,CDM,981,RC,27560,HCPCS,Outpatient,,,452,339,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,383.46,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,383.46,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,383.46,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,383.46,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,383.46,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,289.3,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,389.04,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,273.48,61.74,,218.784,percent of total billed charges,61.74% of total billed charges,275.52,102,,,Fee Schedule,102% of GA Medicaid Rate,383.46,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,273.48,389.04,
"REDUCE FINGER OR TOE, IP JOINT",1200161,CDM,981,RC,28660,HCPCS,Outpatient,,,452,339,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,103.21,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,103.21,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,103.21,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,103.21,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,103.21,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,119.72,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,106.99,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,273.48,61.74,,218.784,percent of total billed charges,61.74% of total billed charges,114.02,102,,,Fee Schedule,102% of GA Medicaid Rate,103.21,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,103.21,273.48,
PATH FLOW CYTO 1ST MARKER,5003134,CDM,319,RC,88184,HCPCS,Outpatient,,,453,339.75,,353.34,78,,282.672,percent of total billed charges,78% of total billed charges,46.1,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,172.14,38,,137.712,percent of total billed charges,38% of total billed charges,172.14,38,,137.712,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,407.7,90,,326.16,percent of total billed charges,90% of total billed charges,48.41,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,304.76,67.275,,243.808,percent of total billed charges,67.275% of total billed charges,362.4,80,,289.92,percent of total billed charges,80% of total billed charges,173.86,38.38,,139.088,percent of total billed charges,38.38% of total billed charges,362.4,80,,289.92,percent of total billed charges,80% of total billed charges,279.68,61.74,,223.744,percent of total billed charges,61.74% of total billed charges,47.02,102,,,Fee Schedule,102% of GA Medicaid Rate,172.14,38,,137.712,percent of total billed charges,38% of total billed charges,46.1,407.7,
BB RBC AG OTHER THAN ABD OR D,5200010,CDM,300,RC,86905,HCPCS,Outpatient,,,453,339.75,,353.34,78,,282.672,percent of total billed charges,78% of total billed charges,4.81,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,3.83,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.83,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,407.7,90,,326.16,percent of total billed charges,90% of total billed charges,5.05,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,304.76,67.275,,243.808,percent of total billed charges,67.275% of total billed charges,362.4,80,,289.92,percent of total billed charges,80% of total billed charges,3.87,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,362.4,80,,289.92,percent of total billed charges,80% of total billed charges,279.68,61.74,,223.744,percent of total billed charges,61.74% of total billed charges,4.91,102,,,Fee Schedule,102% of GA Medicaid Rate,3.83,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.83,407.7,
BB ARC AB ID PANEL,5200012,CDM,300,RC,86870,HCPCS,Outpatient,,,453,339.75,,353.34,78,,282.672,percent of total billed charges,78% of total billed charges,6.12,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,172.14,38,,137.712,percent of total billed charges,38% of total billed charges,172.14,38,,137.712,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,407.7,90,,326.16,percent of total billed charges,90% of total billed charges,6.43,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,304.76,67.275,,243.808,percent of total billed charges,67.275% of total billed charges,362.4,80,,289.92,percent of total billed charges,80% of total billed charges,173.86,38.38,,139.088,percent of total billed charges,38.38% of total billed charges,362.4,80,,289.92,percent of total billed charges,80% of total billed charges,279.68,61.74,,223.744,percent of total billed charges,61.74% of total billed charges,6.24,102,,,Fee Schedule,102% of GA Medicaid Rate,172.14,38,,137.712,percent of total billed charges,38% of total billed charges,6.12,407.7,
BB AUTOLOGOUS UNIT COL\PROC\,5200018,CDM,300,RC,86890,HCPCS,Outpatient,,,453,339.75,,353.34,78,,282.672,percent of total billed charges,78% of total billed charges,285.39,63,,228.312,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,172.14,38,,137.712,percent of total billed charges,38% of total billed charges,172.14,38,,137.712,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,407.7,90,,326.16,percent of total billed charges,90% of total billed charges,158.55,35,,126.84,percent of total billed charges,35% of total billed charges,304.76,67.275,,243.808,percent of total billed charges,67.275% of total billed charges,362.4,80,,289.92,percent of total billed charges,80% of total billed charges,173.86,38.38,,139.088,percent of total billed charges,38.38% of total billed charges,362.4,80,,289.92,percent of total billed charges,80% of total billed charges,279.68,61.74,,223.744,percent of total billed charges,61.74% of total billed charges,462.06,102,,369.648,percent of total billed charges,102% of total billed charges,172.14,38,,137.712,percent of total billed charges,38% of total billed charges,158.55,462.06,
BB RBC PRETREAT/ENZYME,5200024,CDM,300,RC,86971,HCPCS,Outpatient,,,453,339.75,,353.34,78,,282.672,percent of total billed charges,78% of total billed charges,285.39,63,,228.312,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,172.14,38,,137.712,percent of total billed charges,38% of total billed charges,172.14,38,,137.712,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,407.7,90,,326.16,percent of total billed charges,90% of total billed charges,158.55,35,,126.84,percent of total billed charges,35% of total billed charges,304.76,67.275,,243.808,percent of total billed charges,67.275% of total billed charges,362.4,80,,289.92,percent of total billed charges,80% of total billed charges,173.86,38.38,,139.088,percent of total billed charges,38.38% of total billed charges,362.4,80,,289.92,percent of total billed charges,80% of total billed charges,279.68,61.74,,223.744,percent of total billed charges,61.74% of total billed charges,462.06,102,,369.648,percent of total billed charges,102% of total billed charges,172.14,38,,137.712,percent of total billed charges,38% of total billed charges,158.55,462.06,
BB AG TYPE COMMON UNIT,5200027,CDM,300,RC,86902,HCPCS,Outpatient,,,453,339.75,,353.34,78,,282.672,percent of total billed charges,78% of total billed charges,4.3,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,6.35,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,6.35,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,407.7,90,,326.16,percent of total billed charges,90% of total billed charges,4.52,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,304.76,67.275,,243.808,percent of total billed charges,67.275% of total billed charges,362.4,80,,289.92,percent of total billed charges,80% of total billed charges,6.41,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,362.4,80,,289.92,percent of total billed charges,80% of total billed charges,279.68,61.74,,223.744,percent of total billed charges,61.74% of total billed charges,4.39,102,,,Fee Schedule,102% of GA Medicaid Rate,6.35,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,4.3,407.7,
.BB AG TYPE HIGH INCIDENT UNI,5200028,CDM,300,RC,86905,HCPCS,Outpatient,,,453,339.75,,353.34,78,,282.672,percent of total billed charges,78% of total billed charges,4.81,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,3.83,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.83,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,407.7,90,,326.16,percent of total billed charges,90% of total billed charges,5.05,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,304.76,67.275,,243.808,percent of total billed charges,67.275% of total billed charges,362.4,80,,289.92,percent of total billed charges,80% of total billed charges,3.87,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,362.4,80,,289.92,percent of total billed charges,80% of total billed charges,279.68,61.74,,223.744,percent of total billed charges,61.74% of total billed charges,4.91,102,,,Fee Schedule,102% of GA Medicaid Rate,3.83,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,3.83,407.7,
ATW35 RELOAD WHITE,3004238,CDM,270,RC,,,Outpatient,,,453.76,340.32,,353.93,78,,283.144,percent of total billed charges,78% of total billed charges,285.87,63,,228.696,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,172.43,38,,137.944,percent of total billed charges,38% of total billed charges,172.43,38,,137.944,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,408.38,90,,326.704,percent of total billed charges,90% of total billed charges,158.82,35,,127.056,percent of total billed charges,35% of total billed charges,305.27,67.275,,244.216,percent of total billed charges,67.275% of total billed charges,363.01,80,,290.408,percent of total billed charges,80% of total billed charges,174.15,38.38,,139.32,percent of total billed charges,38.38% of total billed charges,363.01,80,,290.408,percent of total billed charges,80% of total billed charges,280.15,61.74,,224.12,percent of total billed charges,61.74% of total billed charges,462.84,102,,370.272,percent of total billed charges,102% of total billed charges,172.43,38,,137.944,percent of total billed charges,38% of total billed charges,158.82,462.84,
ATW35 RELOAD BLUE,3004239,CDM,270,RC,,,Outpatient,,,453.76,340.32,,353.93,78,,283.144,percent of total billed charges,78% of total billed charges,285.87,63,,228.696,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,172.43,38,,137.944,percent of total billed charges,38% of total billed charges,172.43,38,,137.944,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,408.38,90,,326.704,percent of total billed charges,90% of total billed charges,158.82,35,,127.056,percent of total billed charges,35% of total billed charges,305.27,67.275,,244.216,percent of total billed charges,67.275% of total billed charges,363.01,80,,290.408,percent of total billed charges,80% of total billed charges,174.15,38.38,,139.32,percent of total billed charges,38.38% of total billed charges,363.01,80,,290.408,percent of total billed charges,80% of total billed charges,280.15,61.74,,224.12,percent of total billed charges,61.74% of total billed charges,462.84,102,,370.272,percent of total billed charges,102% of total billed charges,172.43,38,,137.944,percent of total billed charges,38% of total billed charges,158.82,462.84,
"CMV DNA, QUANTATATIVE PCR",5002059,CDM,306,RC,87497,HCPCS,Outpatient,,,454,340.5,,354.12,78,,283.296,percent of total billed charges,78% of total billed charges,53.87,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,42.84,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,42.84,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,408.6,90,,326.88,percent of total billed charges,90% of total billed charges,56.56,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,305.43,67.275,,244.344,percent of total billed charges,67.275% of total billed charges,363.2,80,,290.56,percent of total billed charges,80% of total billed charges,43.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,363.2,80,,290.56,percent of total billed charges,80% of total billed charges,280.3,61.74,,224.24,percent of total billed charges,61.74% of total billed charges,54.95,102,,,Fee Schedule,102% of GA Medicaid Rate,42.84,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,42.84,408.6,
FACIAL BONES COMPLETE,7000110,CDM,320,RC,70150,HCPCS,Outpatient,,,454,340.5,,354.12,78,,283.296,percent of total billed charges,78% of total billed charges,286.02,63,,228.816,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,172.52,38,,138.016,percent of total billed charges,38% of total billed charges,172.52,38,,138.016,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,408.6,90,,326.88,percent of total billed charges,90% of total billed charges,158.9,35,,127.12,percent of total billed charges,35% of total billed charges,305.43,67.275,,244.344,percent of total billed charges,67.275% of total billed charges,363.2,80,,290.56,percent of total billed charges,80% of total billed charges,174.25,38.38,,139.4,percent of total billed charges,38.38% of total billed charges,363.2,80,,290.56,percent of total billed charges,80% of total billed charges,280.3,61.74,,224.24,percent of total billed charges,61.74% of total billed charges,463.08,102,,370.464,percent of total billed charges,102% of total billed charges,172.52,38,,138.016,percent of total billed charges,38% of total billed charges,158.9,463.08,
Radiologic examination of one side of the chest/ribs,7000216,CDM,320,RC,71101,HCPCS,Outpatient,,,454,340.5,,354.12,78,,283.296,percent of total billed charges,78% of total billed charges,286.02,63,,228.816,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,172.52,38,,138.016,percent of total billed charges,38% of total billed charges,172.52,38,,138.016,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,408.6,90,,326.88,percent of total billed charges,90% of total billed charges,158.9,35,,127.12,percent of total billed charges,35% of total billed charges,305.43,67.275,,244.344,percent of total billed charges,67.275% of total billed charges,363.2,80,,290.56,percent of total billed charges,80% of total billed charges,174.25,38.38,,139.4,percent of total billed charges,38.38% of total billed charges,363.2,80,,290.56,percent of total billed charges,80% of total billed charges,280.3,61.74,,224.24,percent of total billed charges,61.74% of total billed charges,463.08,102,,370.464,percent of total billed charges,102% of total billed charges,172.52,38,,138.016,percent of total billed charges,38% of total billed charges,158.9,463.08,
RIBS BILATERAL 3 VIEWS,7000220,CDM,320,RC,71110,HCPCS,Outpatient,,,454,340.5,,354.12,78,,283.296,percent of total billed charges,78% of total billed charges,286.02,63,,228.816,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,172.52,38,,138.016,percent of total billed charges,38% of total billed charges,172.52,38,,138.016,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,408.6,90,,326.88,percent of total billed charges,90% of total billed charges,158.9,35,,127.12,percent of total billed charges,35% of total billed charges,305.43,67.275,,244.344,percent of total billed charges,67.275% of total billed charges,363.2,80,,290.56,percent of total billed charges,80% of total billed charges,174.25,38.38,,139.4,percent of total billed charges,38.38% of total billed charges,363.2,80,,290.56,percent of total billed charges,80% of total billed charges,280.3,61.74,,224.24,percent of total billed charges,61.74% of total billed charges,463.08,102,,370.464,percent of total billed charges,102% of total billed charges,172.52,38,,138.016,percent of total billed charges,38% of total billed charges,158.9,463.08,
"Radiologic examination of the neck/spine, 4-5 views",7000410,CDM,320,RC,72050,HCPCS,Outpatient,,,454,340.5,,354.12,78,,283.296,percent of total billed charges,78% of total billed charges,286.02,63,,228.816,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,172.52,38,,138.016,percent of total billed charges,38% of total billed charges,172.52,38,,138.016,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,408.6,90,,326.88,percent of total billed charges,90% of total billed charges,158.9,35,,127.12,percent of total billed charges,35% of total billed charges,305.43,67.275,,244.344,percent of total billed charges,67.275% of total billed charges,363.2,80,,290.56,percent of total billed charges,80% of total billed charges,174.25,38.38,,139.4,percent of total billed charges,38.38% of total billed charges,363.2,80,,290.56,percent of total billed charges,80% of total billed charges,280.3,61.74,,224.24,percent of total billed charges,61.74% of total billed charges,463.08,102,,370.464,percent of total billed charges,102% of total billed charges,172.52,38,,138.016,percent of total billed charges,38% of total billed charges,158.9,463.08,
SPINE C W/OBL & BENDING,7000411,CDM,320,RC,72052,HCPCS,Outpatient,,,454,340.5,,354.12,78,,283.296,percent of total billed charges,78% of total billed charges,286.02,63,,228.816,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,172.52,38,,138.016,percent of total billed charges,38% of total billed charges,172.52,38,,138.016,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,408.6,90,,326.88,percent of total billed charges,90% of total billed charges,158.9,35,,127.12,percent of total billed charges,35% of total billed charges,305.43,67.275,,244.344,percent of total billed charges,67.275% of total billed charges,363.2,80,,290.56,percent of total billed charges,80% of total billed charges,174.25,38.38,,139.4,percent of total billed charges,38.38% of total billed charges,363.2,80,,290.56,percent of total billed charges,80% of total billed charges,280.3,61.74,,224.24,percent of total billed charges,61.74% of total billed charges,463.08,102,,370.464,percent of total billed charges,102% of total billed charges,172.52,38,,138.016,percent of total billed charges,38% of total billed charges,158.9,463.08,
Radiologic examination of one side of the chest/ribs,7300218,CDM,320,RC,71101,HCPCS,Outpatient,,,454,340.5,,354.12,78,,283.296,percent of total billed charges,78% of total billed charges,286.02,63,,228.816,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,172.52,38,,138.016,percent of total billed charges,38% of total billed charges,172.52,38,,138.016,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,408.6,90,,326.88,percent of total billed charges,90% of total billed charges,158.9,35,,127.12,percent of total billed charges,35% of total billed charges,305.43,67.275,,244.344,percent of total billed charges,67.275% of total billed charges,363.2,80,,290.56,percent of total billed charges,80% of total billed charges,174.25,38.38,,139.4,percent of total billed charges,38.38% of total billed charges,363.2,80,,290.56,percent of total billed charges,80% of total billed charges,280.3,61.74,,224.24,percent of total billed charges,61.74% of total billed charges,463.08,102,,370.464,percent of total billed charges,102% of total billed charges,172.52,38,,138.016,percent of total billed charges,38% of total billed charges,158.9,463.08,
"MYCOBACTERIUM AVIUM DNA, PCR",5002083,CDM,306,RC,87561,HCPCS,Outpatient,,,455,341.25,,354.9,78,,283.92,percent of total billed charges,78% of total billed charges,286.65,63,,229.32,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,409.5,90,,327.6,percent of total billed charges,90% of total billed charges,159.25,35,,127.4,percent of total billed charges,35% of total billed charges,306.1,67.275,,244.88,percent of total billed charges,67.275% of total billed charges,364,80,,291.2,percent of total billed charges,80% of total billed charges,35.44,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,364,80,,291.2,percent of total billed charges,80% of total billed charges,280.92,61.74,,224.736,percent of total billed charges,61.74% of total billed charges,464.1,102,,371.28,percent of total billed charges,102% of total billed charges,35.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,35.09,464.1,
LIGAMAX 5MM CLIP APPLIER,3004063,CDM,270,RC,,,Outpatient,,,460.98,345.74,,359.56,78,,287.648,percent of total billed charges,78% of total billed charges,290.42,63,,232.336,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,175.17,38,,140.136,percent of total billed charges,38% of total billed charges,175.17,38,,140.136,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,414.88,90,,331.904,percent of total billed charges,90% of total billed charges,161.34,35,,129.072,percent of total billed charges,35% of total billed charges,310.12,67.275,,248.096,percent of total billed charges,67.275% of total billed charges,368.78,80,,295.024,percent of total billed charges,80% of total billed charges,176.92,38.38,,141.536,percent of total billed charges,38.38% of total billed charges,368.78,80,,295.024,percent of total billed charges,80% of total billed charges,284.61,61.74,,227.688,percent of total billed charges,61.74% of total billed charges,470.2,102,,376.16,percent of total billed charges,102% of total billed charges,175.17,38,,140.136,percent of total billed charges,38% of total billed charges,161.34,470.2,
ENDO LEVEL 3 EA ADDL 15 M,400165,CDM,360,RC,,,Outpatient,,,464,348,,361.92,78,,289.536,percent of total billed charges,78% of total billed charges,292.32,63,,233.856,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,176.32,38,,141.056,percent of total billed charges,38% of total billed charges,176.32,38,,141.056,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,417.6,90,,334.08,percent of total billed charges,90% of total billed charges,162.4,35,,129.92,percent of total billed charges,35% of total billed charges,312.16,67.275,,249.728,percent of total billed charges,67.275% of total billed charges,371.2,80,,296.96,percent of total billed charges,80% of total billed charges,178.08,38.38,,142.464,percent of total billed charges,38.38% of total billed charges,371.2,80,,296.96,percent of total billed charges,80% of total billed charges,286.47,61.74,,229.176,percent of total billed charges,61.74% of total billed charges,473.28,102,,378.624,percent of total billed charges,102% of total billed charges,176.32,38,,141.056,percent of total billed charges,38% of total billed charges,162.4,473.28,
HEPTIMAX HCV RNA,5000517,CDM,306,RC,87522,HCPCS,Outpatient,,,467,350.25,,364.26,78,,291.408,percent of total billed charges,78% of total billed charges,53.87,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,42.84,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,42.84,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,420.3,90,,336.24,percent of total billed charges,90% of total billed charges,56.56,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,314.17,67.275,,251.336,percent of total billed charges,67.275% of total billed charges,373.6,80,,298.88,percent of total billed charges,80% of total billed charges,43.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,373.6,80,,298.88,percent of total billed charges,80% of total billed charges,288.33,61.74,,230.664,percent of total billed charges,61.74% of total billed charges,54.95,102,,,Fee Schedule,102% of GA Medicaid Rate,42.84,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,42.84,420.3,
HEP B DNA QN PCR,5001709,CDM,306,RC,87517,HCPCS,Outpatient,,,467,350.25,,364.26,78,,291.408,percent of total billed charges,78% of total billed charges,53.87,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,42.84,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,42.84,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,420.3,90,,336.24,percent of total billed charges,90% of total billed charges,56.56,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,314.17,67.275,,251.336,percent of total billed charges,67.275% of total billed charges,373.6,80,,298.88,percent of total billed charges,80% of total billed charges,43.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,373.6,80,,298.88,percent of total billed charges,80% of total billed charges,288.33,61.74,,230.664,percent of total billed charges,61.74% of total billed charges,54.95,102,,,Fee Schedule,102% of GA Medicaid Rate,42.84,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,42.84,420.3,
"HEP C RNA,QUANT PCR",5001742,CDM,306,RC,87522,HCPCS,Outpatient,,,467,350.25,,364.26,78,,291.408,percent of total billed charges,78% of total billed charges,53.87,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,42.84,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,42.84,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,420.3,90,,336.24,percent of total billed charges,90% of total billed charges,56.56,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,314.17,67.275,,251.336,percent of total billed charges,67.275% of total billed charges,373.6,80,,298.88,percent of total billed charges,80% of total billed charges,43.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,373.6,80,,298.88,percent of total billed charges,80% of total billed charges,288.33,61.74,,230.664,percent of total billed charges,61.74% of total billed charges,54.95,102,,,Fee Schedule,102% of GA Medicaid Rate,42.84,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,42.84,420.3,
"EBV,QUANT, PCR",5002040,CDM,306,RC,87799,HCPCS,Outpatient,,,467,350.25,,364.26,78,,291.408,percent of total billed charges,78% of total billed charges,294.21,63,,235.368,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,42.84,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,42.84,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,420.3,90,,336.24,percent of total billed charges,90% of total billed charges,163.45,35,,130.76,percent of total billed charges,35% of total billed charges,314.17,67.275,,251.336,percent of total billed charges,67.275% of total billed charges,373.6,80,,298.88,percent of total billed charges,80% of total billed charges,43.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,373.6,80,,298.88,percent of total billed charges,80% of total billed charges,288.33,61.74,,230.664,percent of total billed charges,61.74% of total billed charges,476.34,102,,381.072,percent of total billed charges,102% of total billed charges,42.84,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,42.84,476.34,
"PROTHROMBIN ANTIBODY, IgG",5001664,CDM,302,RC,86849,HCPCS,Outpatient,,,475,356.25,,370.5,78,,296.4,percent of total billed charges,78% of total billed charges,68.04,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,180.5,38,,144.4,percent of total billed charges,38% of total billed charges,180.5,38,,144.4,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,427.5,90,,342,percent of total billed charges,90% of total billed charges,71.44,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,319.56,67.275,,255.648,percent of total billed charges,67.275% of total billed charges,380,80,,304,percent of total billed charges,80% of total billed charges,182.31,38.38,,145.848,percent of total billed charges,38.38% of total billed charges,380,80,,304,percent of total billed charges,80% of total billed charges,293.27,61.74,,234.616,percent of total billed charges,61.74% of total billed charges,69.4,102,,,Fee Schedule,102% of GA Medicaid Rate,180.5,38,,144.4,percent of total billed charges,38% of total billed charges,68.04,427.5,
"PROTHROMBIN ANTIBODY, IgM",5001669,CDM,302,RC,86849,HCPCS,Outpatient,,,475,356.25,,370.5,78,,296.4,percent of total billed charges,78% of total billed charges,68.04,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,180.5,38,,144.4,percent of total billed charges,38% of total billed charges,180.5,38,,144.4,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,427.5,90,,342,percent of total billed charges,90% of total billed charges,71.44,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,319.56,67.275,,255.648,percent of total billed charges,67.275% of total billed charges,380,80,,304,percent of total billed charges,80% of total billed charges,182.31,38.38,,145.848,percent of total billed charges,38.38% of total billed charges,380,80,,304,percent of total billed charges,80% of total billed charges,293.27,61.74,,234.616,percent of total billed charges,61.74% of total billed charges,69.4,102,,,Fee Schedule,102% of GA Medicaid Rate,180.5,38,,144.4,percent of total billed charges,38% of total billed charges,68.04,427.5,
INTERFERON BETA AB NEUTRALIZATION,5001670,CDM,300,RC,86849,HCPCS,Outpatient,,,475,356.25,,370.5,78,,296.4,percent of total billed charges,78% of total billed charges,68.04,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,180.5,38,,144.4,percent of total billed charges,38% of total billed charges,180.5,38,,144.4,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,427.5,90,,342,percent of total billed charges,90% of total billed charges,71.44,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,319.56,67.275,,255.648,percent of total billed charges,67.275% of total billed charges,380,80,,304,percent of total billed charges,80% of total billed charges,182.31,38.38,,145.848,percent of total billed charges,38.38% of total billed charges,380,80,,304,percent of total billed charges,80% of total billed charges,293.27,61.74,,234.616,percent of total billed charges,61.74% of total billed charges,69.4,102,,,Fee Schedule,102% of GA Medicaid Rate,180.5,38,,144.4,percent of total billed charges,38% of total billed charges,68.04,427.5,
VITAMIN K,5002007,CDM,301,RC,84597,HCPCS,Outpatient,,,475,356.25,,370.5,78,,296.4,percent of total billed charges,78% of total billed charges,17.24,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,13.72,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.72,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,427.5,90,,342,percent of total billed charges,90% of total billed charges,18.1,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,319.56,67.275,,255.648,percent of total billed charges,67.275% of total billed charges,380,80,,304,percent of total billed charges,80% of total billed charges,13.86,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,380,80,,304,percent of total billed charges,80% of total billed charges,293.27,61.74,,234.616,percent of total billed charges,61.74% of total billed charges,17.58,102,,,Fee Schedule,102% of GA Medicaid Rate,13.72,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,13.72,427.5,
Evaluation of speech sound production with evaluation of language comprehension,9000124,CDM,440,RC,92523,HCPCS,Outpatient,,,477,357.75,,372.06,78,,297.648,percent of total billed charges,78% of total billed charges,300.51,63,,240.408,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,181.26,38,,145.008,percent of total billed charges,38% of total billed charges,181.26,38,,145.008,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,429.3,90,,343.44,percent of total billed charges,90% of total billed charges,166.95,35,,133.56,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,381.6,80,,305.28,percent of total billed charges,80% of total billed charges,183.07,38.38,,146.456,percent of total billed charges,38.38% of total billed charges,381.6,80,,305.28,percent of total billed charges,80% of total billed charges,294.5,61.74,,235.6,percent of total billed charges,61.74% of total billed charges,486.54,102,,389.232,percent of total billed charges,102% of total billed charges,181.26,38,,145.008,percent of total billed charges,38% of total billed charges,145.93,486.54,
CYSTOSTOMY TUBE SIMPLE,1001114,CDM,450,RC,51705,HCPCS,Outpatient,,,483,362.25,,376.74,78,,301.392,percent of total billed charges,78% of total billed charges,304.29,63,,243.432,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,183.54,38,,146.832,percent of total billed charges,38% of total billed charges,183.54,38,,146.832,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,434.7,90,,347.76,percent of total billed charges,90% of total billed charges,169.05,35,,135.24,percent of total billed charges,35% of total billed charges,324.94,67.275,,259.952,percent of total billed charges,67.275% of total billed charges,386.4,80,,309.12,percent of total billed charges,80% of total billed charges,185.38,38.38,,148.304,percent of total billed charges,38.38% of total billed charges,386.4,80,,309.12,percent of total billed charges,80% of total billed charges,298.2,61.74,,238.56,percent of total billed charges,61.74% of total billed charges,492.66,102,,394.128,percent of total billed charges,102% of total billed charges,183.54,38,,146.832,percent of total billed charges,38% of total billed charges,169.05,492.66,
CYSTOSTOMY TUBE CHANGED,1200220,CDM,981,RC,51705,HCPCS,Outpatient,,,483,362.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,56.93,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,56.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,56.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,56.93,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,56.93,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,81.02,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,59.12,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,292.24,61.74,,233.792,percent of total billed charges,61.74% of total billed charges,77.16,102,,,Fee Schedule,102% of GA Medicaid Rate,56.93,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,56.93,292.24,
ANCHOR WEDGE 3.0 MM,3002113,CDM,270,RC,,,Outpatient,,,484.05,363.04,,377.56,78,,302.048,percent of total billed charges,78% of total billed charges,304.95,63,,243.96,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,183.94,38,,147.152,percent of total billed charges,38% of total billed charges,183.94,38,,147.152,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,435.65,90,,348.52,percent of total billed charges,90% of total billed charges,169.42,35,,135.536,percent of total billed charges,35% of total billed charges,325.64,67.275,,260.512,percent of total billed charges,67.275% of total billed charges,387.24,80,,309.792,percent of total billed charges,80% of total billed charges,185.78,38.38,,148.624,percent of total billed charges,38.38% of total billed charges,387.24,80,,309.792,percent of total billed charges,80% of total billed charges,298.85,61.74,,239.08,percent of total billed charges,61.74% of total billed charges,493.73,102,,394.984,percent of total billed charges,102% of total billed charges,183.94,38,,147.152,percent of total billed charges,38% of total billed charges,169.42,493.73,
PNEU-THOR WAYNE 14FR SET,3007001,CDM,270,RC,,,Outpatient,,,488.4,366.3,,380.95,78,,304.76,percent of total billed charges,78% of total billed charges,307.69,63,,246.152,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,185.59,38,,148.472,percent of total billed charges,38% of total billed charges,185.59,38,,148.472,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,439.56,90,,351.648,percent of total billed charges,90% of total billed charges,170.94,35,,136.752,percent of total billed charges,35% of total billed charges,328.57,67.275,,262.856,percent of total billed charges,67.275% of total billed charges,390.72,80,,312.576,percent of total billed charges,80% of total billed charges,187.45,38.38,,149.96,percent of total billed charges,38.38% of total billed charges,390.72,80,,312.576,percent of total billed charges,80% of total billed charges,301.54,61.74,,241.232,percent of total billed charges,61.74% of total billed charges,498.17,102,,398.536,percent of total billed charges,102% of total billed charges,185.59,38,,148.472,percent of total billed charges,38% of total billed charges,170.94,498.17,
US ARTER DUP UPPER EXT BILAT COMPLETE,7300028,CDM,921,RC,93930,HCPCS,Outpatient,,,489,366.75,,381.42,78,,305.136,percent of total billed charges,78% of total billed charges,308.07,63,,246.456,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,185.82,38,,148.656,percent of total billed charges,38% of total billed charges,185.82,38,,148.656,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,440.1,90,,352.08,percent of total billed charges,90% of total billed charges,171.15,35,,136.92,percent of total billed charges,35% of total billed charges,328.97,67.275,,263.176,percent of total billed charges,67.275% of total billed charges,391.2,80,,312.96,percent of total billed charges,80% of total billed charges,187.68,38.38,,150.144,percent of total billed charges,38.38% of total billed charges,391.2,80,,312.96,percent of total billed charges,80% of total billed charges,301.91,61.74,,241.528,percent of total billed charges,61.74% of total billed charges,498.78,102,,399.024,percent of total billed charges,102% of total billed charges,185.82,38,,148.656,percent of total billed charges,38% of total billed charges,171.15,498.78,
Complete bilateral study of the extremities,7300933,CDM,921,RC,93970,HCPCS,Outpatient,,,489,366.75,,381.42,78,,305.136,percent of total billed charges,78% of total billed charges,308.07,63,,246.456,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,185.82,38,,148.656,percent of total billed charges,38% of total billed charges,185.82,38,,148.656,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,440.1,90,,352.08,percent of total billed charges,90% of total billed charges,171.15,35,,136.92,percent of total billed charges,35% of total billed charges,328.97,67.275,,263.176,percent of total billed charges,67.275% of total billed charges,391.2,80,,312.96,percent of total billed charges,80% of total billed charges,187.68,38.38,,150.144,percent of total billed charges,38.38% of total billed charges,391.2,80,,312.96,percent of total billed charges,80% of total billed charges,301.91,61.74,,241.528,percent of total billed charges,61.74% of total billed charges,498.78,102,,399.024,percent of total billed charges,102% of total billed charges,185.82,38,,148.656,percent of total billed charges,38% of total billed charges,171.15,498.78,
One sided or limited bilateral study,7300009,CDM,921,RC,93971,HCPCS,Outpatient,,,500,375,,390,78,,312,percent of total billed charges,78% of total billed charges,315,63,,252,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,190,38,,152,percent of total billed charges,38% of total billed charges,190,38,,152,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,450,90,,360,percent of total billed charges,90% of total billed charges,175,35,,140,percent of total billed charges,35% of total billed charges,336.38,67.275,,269.104,percent of total billed charges,67.275% of total billed charges,400,80,,320,percent of total billed charges,80% of total billed charges,191.9,38.38,,153.52,percent of total billed charges,38.38% of total billed charges,400,80,,320,percent of total billed charges,80% of total billed charges,308.7,61.74,,246.96,percent of total billed charges,61.74% of total billed charges,510,102,,408,percent of total billed charges,102% of total billed charges,190,38,,152,percent of total billed charges,38% of total billed charges,175,510,
One sided or limited bilateral study,7300014,CDM,921,RC,93971,HCPCS,Outpatient,,,500,375,,390,78,,312,percent of total billed charges,78% of total billed charges,315,63,,252,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,190,38,,152,percent of total billed charges,38% of total billed charges,190,38,,152,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,450,90,,360,percent of total billed charges,90% of total billed charges,175,35,,140,percent of total billed charges,35% of total billed charges,336.38,67.275,,269.104,percent of total billed charges,67.275% of total billed charges,400,80,,320,percent of total billed charges,80% of total billed charges,191.9,38.38,,153.52,percent of total billed charges,38.38% of total billed charges,400,80,,320,percent of total billed charges,80% of total billed charges,308.7,61.74,,246.96,percent of total billed charges,61.74% of total billed charges,510,102,,408,percent of total billed charges,102% of total billed charges,190,38,,152,percent of total billed charges,38% of total billed charges,175,510,
One sided or limited bilateral study,7393971,CDM,921,RC,93971,HCPCS,Outpatient,,,500,375,,390,78,,312,percent of total billed charges,78% of total billed charges,315,63,,252,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,190,38,,152,percent of total billed charges,38% of total billed charges,190,38,,152,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,450,90,,360,percent of total billed charges,90% of total billed charges,175,35,,140,percent of total billed charges,35% of total billed charges,336.38,67.275,,269.104,percent of total billed charges,67.275% of total billed charges,400,80,,320,percent of total billed charges,80% of total billed charges,191.9,38.38,,153.52,percent of total billed charges,38.38% of total billed charges,400,80,,320,percent of total billed charges,80% of total billed charges,308.7,61.74,,246.96,percent of total billed charges,61.74% of total billed charges,510,102,,408,percent of total billed charges,102% of total billed charges,190,38,,152,percent of total billed charges,38% of total billed charges,175,510,
One sided or limited bilateral study,7393972,CDM,921,RC,93971,HCPCS,Outpatient,,,500,375,,390,78,,312,percent of total billed charges,78% of total billed charges,315,63,,252,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,190,38,,152,percent of total billed charges,38% of total billed charges,190,38,,152,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,450,90,,360,percent of total billed charges,90% of total billed charges,175,35,,140,percent of total billed charges,35% of total billed charges,336.38,67.275,,269.104,percent of total billed charges,67.275% of total billed charges,400,80,,320,percent of total billed charges,80% of total billed charges,191.9,38.38,,153.52,percent of total billed charges,38.38% of total billed charges,400,80,,320,percent of total billed charges,80% of total billed charges,308.7,61.74,,246.96,percent of total billed charges,61.74% of total billed charges,510,102,,408,percent of total billed charges,102% of total billed charges,190,38,,152,percent of total billed charges,38% of total billed charges,175,510,
SPINE SCOLIOSIS EVALUATION 2 VIEW,7000417,CDM,320,RC,72082,HCPCS,Outpatient,,,504,378,,393.12,78,,314.496,percent of total billed charges,78% of total billed charges,317.52,63,,254.016,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,191.52,38,,153.216,percent of total billed charges,38% of total billed charges,191.52,38,,153.216,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,453.6,90,,362.88,percent of total billed charges,90% of total billed charges,176.4,35,,141.12,percent of total billed charges,35% of total billed charges,339.07,67.275,,271.256,percent of total billed charges,67.275% of total billed charges,403.2,80,,322.56,percent of total billed charges,80% of total billed charges,193.44,38.38,,154.752,percent of total billed charges,38.38% of total billed charges,403.2,80,,322.56,percent of total billed charges,80% of total billed charges,311.17,61.74,,248.936,percent of total billed charges,61.74% of total billed charges,514.08,102,,411.264,percent of total billed charges,102% of total billed charges,191.52,38,,153.216,percent of total billed charges,38% of total billed charges,176.4,514.08,
SPINE SCOLIOSIS SERIES,7000424,CDM,320,RC,,,Outpatient,,,504,378,,393.12,78,,314.496,percent of total billed charges,78% of total billed charges,317.52,63,,254.016,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,191.52,38,,153.216,percent of total billed charges,38% of total billed charges,191.52,38,,153.216,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,453.6,90,,362.88,percent of total billed charges,90% of total billed charges,176.4,35,,141.12,percent of total billed charges,35% of total billed charges,339.07,67.275,,271.256,percent of total billed charges,67.275% of total billed charges,403.2,80,,322.56,percent of total billed charges,80% of total billed charges,193.44,38.38,,154.752,percent of total billed charges,38.38% of total billed charges,403.2,80,,322.56,percent of total billed charges,80% of total billed charges,311.17,61.74,,248.936,percent of total billed charges,61.74% of total billed charges,514.08,102,,411.264,percent of total billed charges,102% of total billed charges,191.52,38,,153.216,percent of total billed charges,38% of total billed charges,176.4,514.08,
I&D HEMATOMA/FLUID,1001170,CDM,450,RC,,,Outpatient,,,511,383.25,,398.58,78,,318.864,percent of total billed charges,78% of total billed charges,321.93,63,,257.544,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,194.18,38,,155.344,percent of total billed charges,38% of total billed charges,194.18,38,,155.344,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,459.9,90,,367.92,percent of total billed charges,90% of total billed charges,178.85,35,,143.08,percent of total billed charges,35% of total billed charges,343.78,67.275,,275.024,percent of total billed charges,67.275% of total billed charges,408.8,80,,327.04,percent of total billed charges,80% of total billed charges,196.12,38.38,,156.896,percent of total billed charges,38.38% of total billed charges,408.8,80,,327.04,percent of total billed charges,80% of total billed charges,315.49,61.74,,252.392,percent of total billed charges,61.74% of total billed charges,521.22,102,,416.976,percent of total billed charges,102% of total billed charges,194.18,38,,155.344,percent of total billed charges,38% of total billed charges,178.85,521.22,
TAP 2.7 X 125MM,3001106,CDM,270,RC,,,Outpatient,,,512.43,384.32,,399.7,78,,319.76,percent of total billed charges,78% of total billed charges,322.83,63,,258.264,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,194.72,38,,155.776,percent of total billed charges,38% of total billed charges,194.72,38,,155.776,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,461.19,90,,368.952,percent of total billed charges,90% of total billed charges,179.35,35,,143.48,percent of total billed charges,35% of total billed charges,344.74,67.275,,275.792,percent of total billed charges,67.275% of total billed charges,409.94,80,,327.952,percent of total billed charges,80% of total billed charges,196.67,38.38,,157.336,percent of total billed charges,38.38% of total billed charges,409.94,80,,327.952,percent of total billed charges,80% of total billed charges,316.37,61.74,,253.096,percent of total billed charges,61.74% of total billed charges,522.68,102,,418.144,percent of total billed charges,102% of total billed charges,194.72,38,,155.776,percent of total billed charges,38% of total billed charges,179.35,522.68,
Draining or injecting medication into a small joint/bursa without ultrasound,1200165,CDM,981,RC,20600,HCPCS,Outpatient,,,515,386.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,39.53,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,39.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,39.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,39.53,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,39.53,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,51.42,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,41.77,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,311.6,61.74,,249.28,percent of total billed charges,61.74% of total billed charges,48.97,102,,,Fee Schedule,102% of GA Medicaid Rate,39.53,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,39.53,311.6,
Draining or injecting medication into a major joint/bursa without ultrasound,1200166,CDM,981,RC,20610,HCPCS,Outpatient,,,515,386.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,50.29,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,50.29,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,50.29,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,50.29,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,50.29,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,66.41,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,52.78,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,311.6,61.74,,249.28,percent of total billed charges,61.74% of total billed charges,63.25,102,,,Fee Schedule,102% of GA Medicaid Rate,50.29,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,50.29,311.6,
Draining or injecting medication into a large joint/bursa without ultrasound,1200236,CDM,981,RC,20605,HCPCS,Outpatient,,,515,386.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,41.43,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,41.43,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,41.43,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,41.43,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,41.43,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,56.78,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,43.27,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,311.6,61.74,,249.28,percent of total billed charges,61.74% of total billed charges,54.08,102,,,Fee Schedule,102% of GA Medicaid Rate,41.43,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,41.43,311.6,
US EXT NON-VAS BILATERAL,7300020,CDM,402,RC,76881,HCPCS,Outpatient,,,516,387,,402.48,78,,321.984,percent of total billed charges,78% of total billed charges,325.08,63,,260.064,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,196.08,38,,156.864,percent of total billed charges,38% of total billed charges,196.08,38,,156.864,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,464.4,90,,371.52,percent of total billed charges,90% of total billed charges,180.6,35,,144.48,percent of total billed charges,35% of total billed charges,347.14,67.275,,277.712,percent of total billed charges,67.275% of total billed charges,412.8,80,,330.24,percent of total billed charges,80% of total billed charges,198.04,38.38,,158.432,percent of total billed charges,38.38% of total billed charges,412.8,80,,330.24,percent of total billed charges,80% of total billed charges,318.58,61.74,,254.864,percent of total billed charges,61.74% of total billed charges,526.32,102,,421.056,percent of total billed charges,102% of total billed charges,196.08,38,,156.864,percent of total billed charges,38% of total billed charges,180.6,526.32,
GASTRIC INTUBATION LAVAGE,1001110,CDM,450,RC,43753,HCPCS,Outpatient,,,523,392.25,,407.94,78,,326.352,percent of total billed charges,78% of total billed charges,329.49,63,,263.592,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,198.74,38,,158.992,percent of total billed charges,38% of total billed charges,198.74,38,,158.992,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,470.7,90,,376.56,percent of total billed charges,90% of total billed charges,183.05,35,,146.44,percent of total billed charges,35% of total billed charges,351.85,67.275,,281.48,percent of total billed charges,67.275% of total billed charges,418.4,80,,334.72,percent of total billed charges,80% of total billed charges,200.73,38.38,,160.584,percent of total billed charges,38.38% of total billed charges,418.4,80,,334.72,percent of total billed charges,80% of total billed charges,322.9,61.74,,258.32,percent of total billed charges,61.74% of total billed charges,533.46,102,,426.768,percent of total billed charges,102% of total billed charges,198.74,38,,158.992,percent of total billed charges,38% of total billed charges,183.05,533.46,
EEG SLEEP ONLY,8000090,CDM,740,RC,95822,HCPCS,Outpatient,,,523,392.25,,407.94,78,,326.352,percent of total billed charges,78% of total billed charges,329.49,63,,263.592,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,198.74,38,,158.992,percent of total billed charges,38% of total billed charges,198.74,38,,158.992,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,470.7,90,,376.56,percent of total billed charges,90% of total billed charges,183.05,35,,146.44,percent of total billed charges,35% of total billed charges,351.85,67.275,,281.48,percent of total billed charges,67.275% of total billed charges,418.4,80,,334.72,percent of total billed charges,80% of total billed charges,200.73,38.38,,160.584,percent of total billed charges,38.38% of total billed charges,418.4,80,,334.72,percent of total billed charges,80% of total billed charges,322.9,61.74,,258.32,percent of total billed charges,61.74% of total billed charges,533.46,102,,426.768,percent of total billed charges,102% of total billed charges,198.74,38,,158.992,percent of total billed charges,38% of total billed charges,183.05,533.46,
NERVE CONDUCTION STUDIES; 3-4 STUDIES,9600041,CDM,922,RC,95908,HCPCS,Outpatient,,,523,392.25,,407.94,78,,326.352,percent of total billed charges,78% of total billed charges,329.49,63,,263.592,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,198.74,38,,158.992,percent of total billed charges,38% of total billed charges,198.74,38,,158.992,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,470.7,90,,376.56,percent of total billed charges,90% of total billed charges,183.05,35,,146.44,percent of total billed charges,35% of total billed charges,351.85,67.275,,281.48,percent of total billed charges,67.275% of total billed charges,418.4,80,,334.72,percent of total billed charges,80% of total billed charges,200.73,38.38,,160.584,percent of total billed charges,38.38% of total billed charges,418.4,80,,334.72,percent of total billed charges,80% of total billed charges,322.9,61.74,,258.32,percent of total billed charges,61.74% of total billed charges,533.46,102,,426.768,percent of total billed charges,102% of total billed charges,198.74,38,,158.992,percent of total billed charges,38% of total billed charges,183.05,533.46,
NERVE CONDUCTION STUDIES; 5-6 STUDIES,9600042,CDM,922,RC,95909,HCPCS,Outpatient,,,523,392.25,,407.94,78,,326.352,percent of total billed charges,78% of total billed charges,329.49,63,,263.592,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,198.74,38,,158.992,percent of total billed charges,38% of total billed charges,198.74,38,,158.992,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,470.7,90,,376.56,percent of total billed charges,90% of total billed charges,183.05,35,,146.44,percent of total billed charges,35% of total billed charges,351.85,67.275,,281.48,percent of total billed charges,67.275% of total billed charges,418.4,80,,334.72,percent of total billed charges,80% of total billed charges,200.73,38.38,,160.584,percent of total billed charges,38.38% of total billed charges,418.4,80,,334.72,percent of total billed charges,80% of total billed charges,322.9,61.74,,258.32,percent of total billed charges,61.74% of total billed charges,533.46,102,,426.768,percent of total billed charges,102% of total billed charges,198.74,38,,158.992,percent of total billed charges,38% of total billed charges,183.05,533.46,
NERVE CONDUCTION STUDIES; 7-8 STUDIES,9600043,CDM,922,RC,95910,HCPCS,Outpatient,,,523,392.25,,407.94,78,,326.352,percent of total billed charges,78% of total billed charges,329.49,63,,263.592,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,198.74,38,,158.992,percent of total billed charges,38% of total billed charges,198.74,38,,158.992,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,470.7,90,,376.56,percent of total billed charges,90% of total billed charges,183.05,35,,146.44,percent of total billed charges,35% of total billed charges,351.85,67.275,,281.48,percent of total billed charges,67.275% of total billed charges,418.4,80,,334.72,percent of total billed charges,80% of total billed charges,200.73,38.38,,160.584,percent of total billed charges,38.38% of total billed charges,418.4,80,,334.72,percent of total billed charges,80% of total billed charges,322.9,61.74,,258.32,percent of total billed charges,61.74% of total billed charges,533.46,102,,426.768,percent of total billed charges,102% of total billed charges,198.74,38,,158.992,percent of total billed charges,38% of total billed charges,183.05,533.46,
CANNULATED DRILL BIT 2.3,3008003,CDM,270,RC,,,Outpatient,,,525,393.75,,409.5,78,,327.6,percent of total billed charges,78% of total billed charges,330.75,63,,264.6,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,199.5,38,,159.6,percent of total billed charges,38% of total billed charges,199.5,38,,159.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,472.5,90,,378,percent of total billed charges,90% of total billed charges,183.75,35,,147,percent of total billed charges,35% of total billed charges,353.19,67.275,,282.552,percent of total billed charges,67.275% of total billed charges,420,80,,336,percent of total billed charges,80% of total billed charges,201.5,38.38,,161.2,percent of total billed charges,38.38% of total billed charges,420,80,,336,percent of total billed charges,80% of total billed charges,324.14,61.74,,259.312,percent of total billed charges,61.74% of total billed charges,535.5,102,,428.4,percent of total billed charges,102% of total billed charges,199.5,38,,159.6,percent of total billed charges,38% of total billed charges,183.75,535.5,
"BARIUM ENEMA, THIN, CONTRAST,W/WO KUB",7000610,CDM,320,RC,74270,HCPCS,Outpatient,,,532,399,,414.96,78,,331.968,percent of total billed charges,78% of total billed charges,335.16,63,,268.128,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,202.16,38,,161.728,percent of total billed charges,38% of total billed charges,202.16,38,,161.728,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,478.8,90,,383.04,percent of total billed charges,90% of total billed charges,186.2,35,,148.96,percent of total billed charges,35% of total billed charges,357.9,67.275,,286.32,percent of total billed charges,67.275% of total billed charges,425.6,80,,340.48,percent of total billed charges,80% of total billed charges,204.18,38.38,,163.344,percent of total billed charges,38.38% of total billed charges,425.6,80,,340.48,percent of total billed charges,80% of total billed charges,328.46,61.74,,262.768,percent of total billed charges,61.74% of total billed charges,542.64,102,,434.112,percent of total billed charges,102% of total billed charges,202.16,38,,161.728,percent of total billed charges,38% of total billed charges,186.2,542.64,
CANCER SCRN-BE ALT TO SIG,7000611,CDM,320,RC,G0106,HCPCS,Outpatient,,,532,399,,414.96,78,,331.968,percent of total billed charges,78% of total billed charges,335.16,63,,268.128,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,202.16,38,,161.728,percent of total billed charges,38% of total billed charges,202.16,38,,161.728,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,478.8,90,,383.04,percent of total billed charges,90% of total billed charges,186.2,35,,148.96,percent of total billed charges,35% of total billed charges,357.9,67.275,,286.32,percent of total billed charges,67.275% of total billed charges,425.6,80,,340.48,percent of total billed charges,80% of total billed charges,204.18,38.38,,163.344,percent of total billed charges,38.38% of total billed charges,425.6,80,,340.48,percent of total billed charges,80% of total billed charges,328.46,61.74,,262.768,percent of total billed charges,61.74% of total billed charges,542.64,102,,434.112,percent of total billed charges,102% of total billed charges,202.16,38,,161.728,percent of total billed charges,38% of total billed charges,186.2,542.64,
"Colorectal cancer screening; alternative to g0105, screening colonoscopy, barium enema",7000612,CDM,320,RC,G0120,HCPCS,Outpatient,,,532,399,,414.96,78,,331.968,percent of total billed charges,78% of total billed charges,335.16,63,,268.128,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,202.16,38,,161.728,percent of total billed charges,38% of total billed charges,202.16,38,,161.728,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,478.8,90,,383.04,percent of total billed charges,90% of total billed charges,186.2,35,,148.96,percent of total billed charges,35% of total billed charges,357.9,67.275,,286.32,percent of total billed charges,67.275% of total billed charges,425.6,80,,340.48,percent of total billed charges,80% of total billed charges,204.18,38.38,,163.344,percent of total billed charges,38.38% of total billed charges,425.6,80,,340.48,percent of total billed charges,80% of total billed charges,328.46,61.74,,262.768,percent of total billed charges,61.74% of total billed charges,542.64,102,,434.112,percent of total billed charges,102% of total billed charges,202.16,38,,161.728,percent of total billed charges,38% of total billed charges,186.2,542.64,
"BE,AIR CNTRST W/HI-DNSTY BARIUM",7000615,CDM,320,RC,74280,HCPCS,Outpatient,,,532,399,,414.96,78,,331.968,percent of total billed charges,78% of total billed charges,335.16,63,,268.128,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,202.16,38,,161.728,percent of total billed charges,38% of total billed charges,202.16,38,,161.728,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,478.8,90,,383.04,percent of total billed charges,90% of total billed charges,186.2,35,,148.96,percent of total billed charges,35% of total billed charges,357.9,67.275,,286.32,percent of total billed charges,67.275% of total billed charges,425.6,80,,340.48,percent of total billed charges,80% of total billed charges,204.18,38.38,,163.344,percent of total billed charges,38.38% of total billed charges,425.6,80,,340.48,percent of total billed charges,80% of total billed charges,328.46,61.74,,262.768,percent of total billed charges,61.74% of total billed charges,542.64,102,,434.112,percent of total billed charges,102% of total billed charges,202.16,38,,161.728,percent of total billed charges,38% of total billed charges,186.2,542.64,
"GI W/ AIR CNTRST,W/KUB",7000620,CDM,320,RC,74247,HCPCS,Outpatient,,,532,399,,414.96,78,,331.968,percent of total billed charges,78% of total billed charges,335.16,63,,268.128,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,202.16,38,,161.728,percent of total billed charges,38% of total billed charges,202.16,38,,161.728,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,478.8,90,,383.04,percent of total billed charges,90% of total billed charges,186.2,35,,148.96,percent of total billed charges,35% of total billed charges,357.9,67.275,,286.32,percent of total billed charges,67.275% of total billed charges,425.6,80,,340.48,percent of total billed charges,80% of total billed charges,204.18,38.38,,163.344,percent of total billed charges,38.38% of total billed charges,425.6,80,,340.48,percent of total billed charges,80% of total billed charges,328.46,61.74,,262.768,percent of total billed charges,61.74% of total billed charges,542.64,102,,434.112,percent of total billed charges,102% of total billed charges,202.16,38,,161.728,percent of total billed charges,38% of total billed charges,186.2,542.64,
"GI (THIN),UPPER,W/KUB",7000621,CDM,320,RC,74241,HCPCS,Outpatient,,,532,399,,414.96,78,,331.968,percent of total billed charges,78% of total billed charges,335.16,63,,268.128,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,202.16,38,,161.728,percent of total billed charges,38% of total billed charges,202.16,38,,161.728,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,478.8,90,,383.04,percent of total billed charges,90% of total billed charges,186.2,35,,148.96,percent of total billed charges,35% of total billed charges,357.9,67.275,,286.32,percent of total billed charges,67.275% of total billed charges,425.6,80,,340.48,percent of total billed charges,80% of total billed charges,204.18,38.38,,163.344,percent of total billed charges,38.38% of total billed charges,425.6,80,,340.48,percent of total billed charges,80% of total billed charges,328.46,61.74,,262.768,percent of total billed charges,61.74% of total billed charges,542.64,102,,434.112,percent of total billed charges,102% of total billed charges,202.16,38,,161.728,percent of total billed charges,38% of total billed charges,186.2,542.64,
ESOPHAGRAM,7000630,CDM,320,RC,74220,HCPCS,Outpatient,,,532,399,,414.96,78,,331.968,percent of total billed charges,78% of total billed charges,335.16,63,,268.128,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,202.16,38,,161.728,percent of total billed charges,38% of total billed charges,202.16,38,,161.728,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,478.8,90,,383.04,percent of total billed charges,90% of total billed charges,186.2,35,,148.96,percent of total billed charges,35% of total billed charges,357.9,67.275,,286.32,percent of total billed charges,67.275% of total billed charges,425.6,80,,340.48,percent of total billed charges,80% of total billed charges,204.18,38.38,,163.344,percent of total billed charges,38.38% of total billed charges,425.6,80,,340.48,percent of total billed charges,80% of total billed charges,328.46,61.74,,262.768,percent of total billed charges,61.74% of total billed charges,542.64,102,,434.112,percent of total billed charges,102% of total billed charges,202.16,38,,161.728,percent of total billed charges,38% of total billed charges,186.2,542.64,
"GI,AIR CNTRST,W/FOLLOW-THROUGH",7000640,CDM,320,RC,74249,HCPCS,Outpatient,,,532,399,,414.96,78,,331.968,percent of total billed charges,78% of total billed charges,335.16,63,,268.128,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,202.16,38,,161.728,percent of total billed charges,38% of total billed charges,202.16,38,,161.728,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,478.8,90,,383.04,percent of total billed charges,90% of total billed charges,186.2,35,,148.96,percent of total billed charges,35% of total billed charges,357.9,67.275,,286.32,percent of total billed charges,67.275% of total billed charges,425.6,80,,340.48,percent of total billed charges,80% of total billed charges,204.18,38.38,,163.344,percent of total billed charges,38.38% of total billed charges,425.6,80,,340.48,percent of total billed charges,80% of total billed charges,328.46,61.74,,262.768,percent of total billed charges,61.74% of total billed charges,542.64,102,,434.112,percent of total billed charges,102% of total billed charges,202.16,38,,161.728,percent of total billed charges,38% of total billed charges,186.2,542.64,
EXC/BI/REMOVAL FB SUBCU,1001184,CDM,450,RC,,,Outpatient,,,538,403.5,,419.64,78,,335.712,percent of total billed charges,78% of total billed charges,338.94,63,,271.152,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,204.44,38,,163.552,percent of total billed charges,38% of total billed charges,204.44,38,,163.552,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,484.2,90,,387.36,percent of total billed charges,90% of total billed charges,188.3,35,,150.64,percent of total billed charges,35% of total billed charges,361.94,67.275,,289.552,percent of total billed charges,67.275% of total billed charges,430.4,80,,344.32,percent of total billed charges,80% of total billed charges,206.48,38.38,,165.184,percent of total billed charges,38.38% of total billed charges,430.4,80,,344.32,percent of total billed charges,80% of total billed charges,332.16,61.74,,265.728,percent of total billed charges,61.74% of total billed charges,548.76,102,,439.008,percent of total billed charges,102% of total billed charges,204.44,38,,163.552,percent of total billed charges,38% of total billed charges,188.3,548.76,
FLOSEAL,3008050,CDM,270,RC,,,Outpatient,,,539.7,404.78,,420.97,78,,336.776,percent of total billed charges,78% of total billed charges,340.01,63,,272.008,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,205.09,38,,164.072,percent of total billed charges,38% of total billed charges,205.09,38,,164.072,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,485.73,90,,388.584,percent of total billed charges,90% of total billed charges,188.9,35,,151.12,percent of total billed charges,35% of total billed charges,363.08,67.275,,290.464,percent of total billed charges,67.275% of total billed charges,431.76,80,,345.408,percent of total billed charges,80% of total billed charges,207.14,38.38,,165.712,percent of total billed charges,38.38% of total billed charges,431.76,80,,345.408,percent of total billed charges,80% of total billed charges,333.21,61.74,,266.568,percent of total billed charges,61.74% of total billed charges,550.49,102,,440.392,percent of total billed charges,102% of total billed charges,205.09,38,,164.072,percent of total billed charges,38% of total billed charges,188.9,550.49,
SPINE LUMBOSACRAL W/OBL & BENDING,7000423,CDM,320,RC,72114,HCPCS,Outpatient,,,540,405,,421.2,78,,336.96,percent of total billed charges,78% of total billed charges,340.2,63,,272.16,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,205.2,38,,164.16,percent of total billed charges,38% of total billed charges,205.2,38,,164.16,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,486,90,,388.8,percent of total billed charges,90% of total billed charges,189,35,,151.2,percent of total billed charges,35% of total billed charges,363.29,67.275,,290.632,percent of total billed charges,67.275% of total billed charges,432,80,,345.6,percent of total billed charges,80% of total billed charges,207.25,38.38,,165.8,percent of total billed charges,38.38% of total billed charges,432,80,,345.6,percent of total billed charges,80% of total billed charges,333.4,61.74,,266.72,percent of total billed charges,61.74% of total billed charges,550.8,102,,440.64,percent of total billed charges,102% of total billed charges,205.2,38,,164.16,percent of total billed charges,38% of total billed charges,189,550.8,
NMS DEVICE,9590102,CDM,420,RC,,,Outpatient,,,540,405,,421.2,78,,336.96,percent of total billed charges,78% of total billed charges,340.2,63,,272.16,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,205.2,38,,164.16,percent of total billed charges,38% of total billed charges,205.2,38,,164.16,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,486,90,,388.8,percent of total billed charges,90% of total billed charges,189,35,,151.2,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,432,80,,345.6,percent of total billed charges,80% of total billed charges,207.25,38.38,,165.8,percent of total billed charges,38.38% of total billed charges,432,80,,345.6,percent of total billed charges,80% of total billed charges,333.4,61.74,,266.72,percent of total billed charges,61.74% of total billed charges,550.8,102,,440.64,percent of total billed charges,102% of total billed charges,205.2,38,,164.16,percent of total billed charges,38% of total billed charges,145.93,550.8,
Pathology test,5001909,CDM,300,RC,88342,HCPCS,Outpatient,,,542,406.5,,422.76,78,,338.208,percent of total billed charges,78% of total billed charges,71.58,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,205.96,38,,164.768,percent of total billed charges,38% of total billed charges,205.96,38,,164.768,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,487.8,90,,390.24,percent of total billed charges,90% of total billed charges,75.16,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,364.63,67.275,,291.704,percent of total billed charges,67.275% of total billed charges,433.6,80,,346.88,percent of total billed charges,80% of total billed charges,208.02,38.38,,166.416,percent of total billed charges,38.38% of total billed charges,433.6,80,,346.88,percent of total billed charges,80% of total billed charges,334.63,61.74,,267.704,percent of total billed charges,61.74% of total billed charges,73.01,102,,,Fee Schedule,102% of GA Medicaid Rate,205.96,38,,164.768,percent of total billed charges,38% of total billed charges,71.58,487.8,
Pathology test,5003712,CDM,312,RC,88342,HCPCS,Outpatient,,,542,406.5,,422.76,78,,338.208,percent of total billed charges,78% of total billed charges,71.58,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,205.96,38,,164.768,percent of total billed charges,38% of total billed charges,205.96,38,,164.768,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,487.8,90,,390.24,percent of total billed charges,90% of total billed charges,75.16,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,364.63,67.275,,291.704,percent of total billed charges,67.275% of total billed charges,433.6,80,,346.88,percent of total billed charges,80% of total billed charges,208.02,38.38,,166.416,percent of total billed charges,38.38% of total billed charges,433.6,80,,346.88,percent of total billed charges,80% of total billed charges,334.63,61.74,,267.704,percent of total billed charges,61.74% of total billed charges,73.01,102,,,Fee Schedule,102% of GA Medicaid Rate,205.96,38,,164.768,percent of total billed charges,38% of total billed charges,71.58,487.8,
BONE LENGTH STUDIES,7000845,CDM,320,RC,77073,HCPCS,Outpatient,,,542,406.5,,422.76,78,,338.208,percent of total billed charges,78% of total billed charges,341.46,63,,273.168,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,205.96,38,,164.768,percent of total billed charges,38% of total billed charges,205.96,38,,164.768,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,487.8,90,,390.24,percent of total billed charges,90% of total billed charges,189.7,35,,151.76,percent of total billed charges,35% of total billed charges,364.63,67.275,,291.704,percent of total billed charges,67.275% of total billed charges,433.6,80,,346.88,percent of total billed charges,80% of total billed charges,208.02,38.38,,166.416,percent of total billed charges,38.38% of total billed charges,433.6,80,,346.88,percent of total billed charges,80% of total billed charges,334.63,61.74,,267.704,percent of total billed charges,61.74% of total billed charges,552.84,102,,442.272,percent of total billed charges,102% of total billed charges,205.96,38,,164.768,percent of total billed charges,38% of total billed charges,189.7,552.84,
SCREW LOCKING TITANIUM 2.7MM,3004017,CDM,270,RC,,,Outpatient,,,545.4,409.05,,425.41,78,,340.328,percent of total billed charges,78% of total billed charges,343.6,63,,274.88,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,207.25,38,,165.8,percent of total billed charges,38% of total billed charges,207.25,38,,165.8,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,490.86,90,,392.688,percent of total billed charges,90% of total billed charges,190.89,35,,152.712,percent of total billed charges,35% of total billed charges,366.92,67.275,,293.536,percent of total billed charges,67.275% of total billed charges,436.32,80,,349.056,percent of total billed charges,80% of total billed charges,209.32,38.38,,167.456,percent of total billed charges,38.38% of total billed charges,436.32,80,,349.056,percent of total billed charges,80% of total billed charges,336.73,61.74,,269.384,percent of total billed charges,61.74% of total billed charges,556.31,102,,445.048,percent of total billed charges,102% of total billed charges,207.25,38,,165.8,percent of total billed charges,38% of total billed charges,190.89,556.31,
BB RBC LR IRRID,5200011,CDM,390,RC,P9040,HCPCS,Outpatient,,,547,410.25,,426.66,78,,341.328,percent of total billed charges,78% of total billed charges,344.61,63,,275.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,207.86,38,,166.288,percent of total billed charges,38% of total billed charges,207.86,38,,166.288,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,492.3,90,,393.84,percent of total billed charges,90% of total billed charges,191.45,35,,153.16,percent of total billed charges,35% of total billed charges,367.99,67.275,,294.392,percent of total billed charges,67.275% of total billed charges,437.6,80,,350.08,percent of total billed charges,80% of total billed charges,209.94,38.38,,167.952,percent of total billed charges,38.38% of total billed charges,437.6,80,,350.08,percent of total billed charges,80% of total billed charges,337.72,61.74,,270.176,percent of total billed charges,61.74% of total billed charges,557.94,102,,446.352,percent of total billed charges,102% of total billed charges,207.86,38,,166.288,percent of total billed charges,38% of total billed charges,191.45,557.94,
ER VISIT LEVEL 2,1001012,CDM,450,RC,99282,HCPCS,Outpatient,,,550,412.5,,429,78,,343.2,percent of total billed charges,78% of total billed charges,346.5,63,,277.2,percent of total billed charges,63% of total billed charges,131,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,209,38,,167.2,percent of total billed charges,38% of total billed charges,209,38,,167.2,percent of total billed charges,38% of total billed charges,131,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,495,90,,396,percent of total billed charges,90% of total billed charges,192.5,35,,154,percent of total billed charges,35% of total billed charges,796.95,67.275,,637.56,percent of total billed charges,67.275% of total billed charges,440,80,,352,percent of total billed charges,80% of total billed charges,211.09,38.38,,168.872,percent of total billed charges,38.38% of total billed charges,440,80,,352,percent of total billed charges,80% of total billed charges,339.57,61.74,,271.656,percent of total billed charges,61.74% of total billed charges,561,102,,448.8,percent of total billed charges,102% of total billed charges,209,38,,167.2,percent of total billed charges,38% of total billed charges,131,796.95,
ER E&M L2 LOW TO MODERATE,1200102,CDM,981,RC,99282,HCPCS,Outpatient,,,550,412.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.4,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,47.4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,47.4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,47.4,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,47.4,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,28.35,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,49.99,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,305.61,61.74,,244.488,percent of total billed charges,61.74% of total billed charges,27,102,,,Fee Schedule,102% of GA Medicaid Rate,47.4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,27,305.61,
C P R,1001052,CDM,450,RC,92950,HCPCS,Outpatient,,,559,419.25,,436.02,78,,348.816,percent of total billed charges,78% of total billed charges,352.17,63,,281.736,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,212.42,38,,169.936,percent of total billed charges,38% of total billed charges,212.42,38,,169.936,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,503.1,90,,402.48,percent of total billed charges,90% of total billed charges,195.65,35,,156.52,percent of total billed charges,35% of total billed charges,376.07,67.275,,300.856,percent of total billed charges,67.275% of total billed charges,447.2,80,,357.76,percent of total billed charges,80% of total billed charges,214.54,38.38,,171.632,percent of total billed charges,38.38% of total billed charges,447.2,80,,357.76,percent of total billed charges,80% of total billed charges,345.13,61.74,,276.104,percent of total billed charges,61.74% of total billed charges,570.18,102,,456.144,percent of total billed charges,102% of total billed charges,212.42,38,,169.936,percent of total billed charges,38% of total billed charges,195.65,570.18,
CARDIO RESUSCIT,1200208,CDM,981,RC,92950,HCPCS,Outpatient,,,559,419.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,205.24,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,205.24,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,205.24,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,205.24,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,205.24,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,198.87,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,216.49,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,338.22,61.74,,270.576,percent of total billed charges,61.74% of total billed charges,189.4,102,,,Fee Schedule,102% of GA Medicaid Rate,205.24,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,189.4,338.22,
CPR (INPATIENT),8000026,CDM,480,RC,92950,HCPCS,Outpatient,,,559,419.25,,436.02,78,,348.816,percent of total billed charges,78% of total billed charges,352.17,63,,281.736,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,212.42,38,,169.936,percent of total billed charges,38% of total billed charges,212.42,38,,169.936,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,503.1,90,,402.48,percent of total billed charges,90% of total billed charges,195.65,35,,156.52,percent of total billed charges,35% of total billed charges,376.07,67.275,,300.856,percent of total billed charges,67.275% of total billed charges,447.2,80,,357.76,percent of total billed charges,80% of total billed charges,214.54,38.38,,171.632,percent of total billed charges,38.38% of total billed charges,447.2,80,,357.76,percent of total billed charges,80% of total billed charges,345.13,61.74,,276.104,percent of total billed charges,61.74% of total billed charges,570.18,102,,456.144,percent of total billed charges,102% of total billed charges,212.42,38,,169.936,percent of total billed charges,38% of total billed charges,195.65,570.18,
JEJUNOSTOMY TUBE 14 FR,3003049,CDM,270,RC,,,Outpatient,,,560.94,420.71,,437.53,78,,350.024,percent of total billed charges,78% of total billed charges,353.39,63,,282.712,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,213.16,38,,170.528,percent of total billed charges,38% of total billed charges,213.16,38,,170.528,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,504.85,90,,403.88,percent of total billed charges,90% of total billed charges,196.33,35,,157.064,percent of total billed charges,35% of total billed charges,377.37,67.275,,301.896,percent of total billed charges,67.275% of total billed charges,448.75,80,,359,percent of total billed charges,80% of total billed charges,215.29,38.38,,172.232,percent of total billed charges,38.38% of total billed charges,448.75,80,,359,percent of total billed charges,80% of total billed charges,346.32,61.74,,277.056,percent of total billed charges,61.74% of total billed charges,572.16,102,,457.728,percent of total billed charges,102% of total billed charges,213.16,38,,170.528,percent of total billed charges,38% of total billed charges,196.33,572.16,
BK VIRUS URINE DNA QUANT PCR,5009170,CDM,301,RC,87799,HCPCS,Outpatient,,,564.68,423.51,,440.45,78,,352.36,percent of total billed charges,78% of total billed charges,355.75,63,,284.6,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,42.84,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,42.84,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,508.21,90,,406.568,percent of total billed charges,90% of total billed charges,197.64,35,,158.112,percent of total billed charges,35% of total billed charges,379.89,67.275,,303.912,percent of total billed charges,67.275% of total billed charges,451.74,80,,361.392,percent of total billed charges,80% of total billed charges,43.27,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,451.74,80,,361.392,percent of total billed charges,80% of total billed charges,348.63,61.74,,278.904,percent of total billed charges,61.74% of total billed charges,575.97,102,,460.776,percent of total billed charges,102% of total billed charges,42.84,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,42.84,575.97,
PERINEAL ABSCESS NONOBSTE,1200146,CDM,981,RC,56405,HCPCS,Outpatient,,,565,423.75,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,139.7,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,139.7,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,139.7,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,139.7,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,139.7,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,101.01,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,145.22,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,341.85,61.74,,273.48,percent of total billed charges,61.74% of total billed charges,96.2,102,,,Fee Schedule,102% of GA Medicaid Rate,139.7,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,96.2,341.85,
BB PLATELET CONC EA UNIT,5200004,CDM,390,RC,P9019,HCPCS,Outpatient,,,565,423.75,,440.7,78,,352.56,percent of total billed charges,78% of total billed charges,355.95,63,,284.76,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,214.7,38,,171.76,percent of total billed charges,38% of total billed charges,214.7,38,,171.76,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,508.5,90,,406.8,percent of total billed charges,90% of total billed charges,197.75,35,,158.2,percent of total billed charges,35% of total billed charges,380.1,67.275,,304.08,percent of total billed charges,67.275% of total billed charges,452,80,,361.6,percent of total billed charges,80% of total billed charges,216.85,38.38,,173.48,percent of total billed charges,38.38% of total billed charges,452,80,,361.6,percent of total billed charges,80% of total billed charges,348.83,61.74,,279.064,percent of total billed charges,61.74% of total billed charges,576.3,102,,461.04,percent of total billed charges,102% of total billed charges,214.7,38,,171.76,percent of total billed charges,38% of total billed charges,197.75,576.3,
"HIV-1 RNA,QN PCR",5001903,CDM,306,RC,87536,HCPCS,Outpatient,,,566,424.5,,441.48,78,,353.184,percent of total billed charges,78% of total billed charges,56.5,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,85.1,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,85.1,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,509.4,90,,407.52,percent of total billed charges,90% of total billed charges,59.33,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,380.78,67.275,,304.624,percent of total billed charges,67.275% of total billed charges,452.8,80,,362.24,percent of total billed charges,80% of total billed charges,85.95,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,452.8,80,,362.24,percent of total billed charges,80% of total billed charges,349.45,61.74,,279.56,percent of total billed charges,61.74% of total billed charges,57.63,102,,,Fee Schedule,102% of GA Medicaid Rate,85.1,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,56.5,509.4,
"HIV 1 RNA, QN bDNA",5001904,CDM,306,RC,87536,HCPCS,Outpatient,,,566,424.5,,441.48,78,,353.184,percent of total billed charges,78% of total billed charges,56.5,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,85.1,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,85.1,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,509.4,90,,407.52,percent of total billed charges,90% of total billed charges,59.33,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,380.78,67.275,,304.624,percent of total billed charges,67.275% of total billed charges,452.8,80,,362.24,percent of total billed charges,80% of total billed charges,85.95,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,452.8,80,,362.24,percent of total billed charges,80% of total billed charges,349.45,61.74,,279.56,percent of total billed charges,61.74% of total billed charges,57.63,102,,,Fee Schedule,102% of GA Medicaid Rate,85.1,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,56.5,509.4,
NON LOCKING SCREW 3.0  20MM,3001002,CDM,270,RC,,,Outpatient,,,567,425.25,,442.26,78,,353.808,percent of total billed charges,78% of total billed charges,357.21,63,,285.768,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,215.46,38,,172.368,percent of total billed charges,38% of total billed charges,215.46,38,,172.368,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,510.3,90,,408.24,percent of total billed charges,90% of total billed charges,198.45,35,,158.76,percent of total billed charges,35% of total billed charges,381.45,67.275,,305.16,percent of total billed charges,67.275% of total billed charges,453.6,80,,362.88,percent of total billed charges,80% of total billed charges,217.61,38.38,,174.088,percent of total billed charges,38.38% of total billed charges,453.6,80,,362.88,percent of total billed charges,80% of total billed charges,350.07,61.74,,280.056,percent of total billed charges,61.74% of total billed charges,578.34,102,,462.672,percent of total billed charges,102% of total billed charges,215.46,38,,172.368,percent of total billed charges,38% of total billed charges,198.45,578.34,
HEMOCHROMATOSIS,5002039,CDM,301,RC,81256,HCPCS,Outpatient,,,578,433.5,,450.84,78,,360.672,percent of total billed charges,78% of total billed charges,40,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,65.36,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,65.36,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,520.2,90,,416.16,percent of total billed charges,90% of total billed charges,42,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,388.85,67.275,,311.08,percent of total billed charges,67.275% of total billed charges,462.4,80,,369.92,percent of total billed charges,80% of total billed charges,66.01,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,462.4,80,,369.92,percent of total billed charges,80% of total billed charges,356.86,61.74,,285.488,percent of total billed charges,61.74% of total billed charges,40.8,102,,,Fee Schedule,102% of GA Medicaid Rate,65.36,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,40,520.2,
HFE GENE,5081256,CDM,300,RC,81256,HCPCS,Outpatient,,,578,433.5,,450.84,78,,360.672,percent of total billed charges,78% of total billed charges,40,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,65.36,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,65.36,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,520.2,90,,416.16,percent of total billed charges,90% of total billed charges,42,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,388.85,67.275,,311.08,percent of total billed charges,67.275% of total billed charges,462.4,80,,369.92,percent of total billed charges,80% of total billed charges,66.01,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,462.4,80,,369.92,percent of total billed charges,80% of total billed charges,356.86,61.74,,285.488,percent of total billed charges,61.74% of total billed charges,40.8,102,,,Fee Schedule,102% of GA Medicaid Rate,65.36,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,40,520.2,
SCREW    5.0X60,3006050,CDM,270,RC,,,Outpatient,,,579.36,434.52,,451.9,78,,361.52,percent of total billed charges,78% of total billed charges,365,63,,292,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,220.16,38,,176.128,percent of total billed charges,38% of total billed charges,220.16,38,,176.128,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,521.42,90,,417.136,percent of total billed charges,90% of total billed charges,202.78,35,,162.224,percent of total billed charges,35% of total billed charges,389.76,67.275,,311.808,percent of total billed charges,67.275% of total billed charges,463.49,80,,370.792,percent of total billed charges,80% of total billed charges,222.36,38.38,,177.888,percent of total billed charges,38.38% of total billed charges,463.49,80,,370.792,percent of total billed charges,80% of total billed charges,357.7,61.74,,286.16,percent of total billed charges,61.74% of total billed charges,590.95,102,,472.76,percent of total billed charges,102% of total billed charges,220.16,38,,176.128,percent of total billed charges,38% of total billed charges,202.78,590.95,
ENDOPATH PROBE HD EPH01,3004104,CDM,270,RC,,,Outpatient,,,584.26,438.2,,455.72,78,,364.576,percent of total billed charges,78% of total billed charges,368.08,63,,294.464,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,222.02,38,,177.616,percent of total billed charges,38% of total billed charges,222.02,38,,177.616,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,525.83,90,,420.664,percent of total billed charges,90% of total billed charges,204.49,35,,163.592,percent of total billed charges,35% of total billed charges,393.06,67.275,,314.448,percent of total billed charges,67.275% of total billed charges,467.41,80,,373.928,percent of total billed charges,80% of total billed charges,224.24,38.38,,179.392,percent of total billed charges,38.38% of total billed charges,467.41,80,,373.928,percent of total billed charges,80% of total billed charges,360.72,61.74,,288.576,percent of total billed charges,61.74% of total billed charges,595.95,102,,476.76,percent of total billed charges,102% of total billed charges,222.02,38,,177.616,percent of total billed charges,38% of total billed charges,204.49,595.95,
"VITAMIN D 1,25-DIHYDROXY",5002101,CDM,301,RC,82652,HCPCS,Outpatient,,,588,441,,458.64,78,,366.912,percent of total billed charges,78% of total billed charges,48.4,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,38.5,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,38.5,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,529.2,90,,423.36,percent of total billed charges,90% of total billed charges,50.82,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,395.58,67.275,,316.464,percent of total billed charges,67.275% of total billed charges,470.4,80,,376.32,percent of total billed charges,80% of total billed charges,38.89,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,470.4,80,,376.32,percent of total billed charges,80% of total billed charges,363.03,61.74,,290.424,percent of total billed charges,61.74% of total billed charges,49.37,102,,,Fee Schedule,102% of GA Medicaid Rate,38.5,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,38.5,529.2,
BB RBC IRRADIATE,5200007,CDM,390,RC,P9038,HCPCS,Outpatient,,,594,445.5,,463.32,78,,370.656,percent of total billed charges,78% of total billed charges,374.22,63,,299.376,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,225.72,38,,180.576,percent of total billed charges,38% of total billed charges,225.72,38,,180.576,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,534.6,90,,427.68,percent of total billed charges,90% of total billed charges,207.9,35,,166.32,percent of total billed charges,35% of total billed charges,399.61,67.275,,319.688,percent of total billed charges,67.275% of total billed charges,475.2,80,,380.16,percent of total billed charges,80% of total billed charges,227.98,38.38,,182.384,percent of total billed charges,38.38% of total billed charges,475.2,80,,380.16,percent of total billed charges,80% of total billed charges,366.74,61.74,,293.392,percent of total billed charges,61.74% of total billed charges,605.88,102,,484.704,percent of total billed charges,102% of total billed charges,225.72,38,,180.576,percent of total billed charges,38% of total billed charges,207.9,605.88,
INJECTION RABIES VACCINE IM,1001125,CDM,450,RC,90675,HCPCS,Outpatient,,,599,449.25,,467.22,78,,373.776,percent of total billed charges,78% of total billed charges,328.55,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,227.62,38,,182.096,percent of total billed charges,38% of total billed charges,227.62,38,,182.096,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,539.1,90,,431.28,percent of total billed charges,90% of total billed charges,344.98,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,402.98,67.275,,322.384,percent of total billed charges,67.275% of total billed charges,479.2,80,,383.36,percent of total billed charges,80% of total billed charges,229.9,38.38,,183.92,percent of total billed charges,38.38% of total billed charges,479.2,80,,383.36,percent of total billed charges,80% of total billed charges,369.82,61.74,,295.856,percent of total billed charges,61.74% of total billed charges,335.12,102,,,Fee Schedule,102% of GA Medicaid Rate,227.62,38,,182.096,percent of total billed charges,38% of total billed charges,227.62,539.1,
Complete bilateral study of the extremities,7300008,CDM,921,RC,93970,HCPCS,Outpatient,,,600,450,,468,78,,374.4,percent of total billed charges,78% of total billed charges,378,63,,302.4,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,228,38,,182.4,percent of total billed charges,38% of total billed charges,228,38,,182.4,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,540,90,,432,percent of total billed charges,90% of total billed charges,210,35,,168,percent of total billed charges,35% of total billed charges,403.65,67.275,,322.92,percent of total billed charges,67.275% of total billed charges,480,80,,384,percent of total billed charges,80% of total billed charges,230.28,38.38,,184.224,percent of total billed charges,38.38% of total billed charges,480,80,,384,percent of total billed charges,80% of total billed charges,370.44,61.74,,296.352,percent of total billed charges,61.74% of total billed charges,612,102,,489.6,percent of total billed charges,102% of total billed charges,228,38,,182.4,percent of total billed charges,38% of total billed charges,210,612,
"CT THORACIC, LIMITED",7400824,CDM,352,RC,72128,HCPCS,Outpatient,,,601,450.75,,468.78,78,,375.024,percent of total billed charges,78% of total billed charges,378.63,63,,302.904,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,228.38,38,,182.704,percent of total billed charges,38% of total billed charges,228.38,38,,182.704,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,540.9,90,,432.72,percent of total billed charges,90% of total billed charges,210.35,35,,168.28,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,480.8,80,,384.64,percent of total billed charges,80% of total billed charges,230.66,38.38,,184.528,percent of total billed charges,38.38% of total billed charges,480.8,80,,384.64,percent of total billed charges,80% of total billed charges,371.06,61.74,,296.848,percent of total billed charges,61.74% of total billed charges,613.02,102,,490.416,percent of total billed charges,102% of total billed charges,228.38,38,,182.704,percent of total billed charges,38% of total billed charges,210.35,613.02,
CT scan of lower spine without dye,7400827,CDM,352,RC,72131,HCPCS,Outpatient,,,601,450.75,,468.78,78,,375.024,percent of total billed charges,78% of total billed charges,378.63,63,,302.904,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,228.38,38,,182.704,percent of total billed charges,38% of total billed charges,228.38,38,,182.704,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,540.9,90,,432.72,percent of total billed charges,90% of total billed charges,210.35,35,,168.28,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,480.8,80,,384.64,percent of total billed charges,80% of total billed charges,230.66,38.38,,184.528,percent of total billed charges,38.38% of total billed charges,480.8,80,,384.64,percent of total billed charges,80% of total billed charges,371.06,61.74,,296.848,percent of total billed charges,61.74% of total billed charges,613.02,102,,490.416,percent of total billed charges,102% of total billed charges,228.38,38,,182.704,percent of total billed charges,38% of total billed charges,210.35,613.02,
J-TUBE 12 FR,3000101,CDM,270,RC,,,Outpatient,,,615,461.25,,479.7,78,,383.76,percent of total billed charges,78% of total billed charges,387.45,63,,309.96,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,233.7,38,,186.96,percent of total billed charges,38% of total billed charges,233.7,38,,186.96,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,553.5,90,,442.8,percent of total billed charges,90% of total billed charges,215.25,35,,172.2,percent of total billed charges,35% of total billed charges,413.74,67.275,,330.992,percent of total billed charges,67.275% of total billed charges,492,80,,393.6,percent of total billed charges,80% of total billed charges,236.04,38.38,,188.832,percent of total billed charges,38.38% of total billed charges,492,80,,393.6,percent of total billed charges,80% of total billed charges,379.7,61.74,,303.76,percent of total billed charges,61.74% of total billed charges,627.3,102,,501.84,percent of total billed charges,102% of total billed charges,233.7,38,,186.96,percent of total billed charges,38% of total billed charges,215.25,627.3,
J-TUBE 8.5 FR,3006033,CDM,270,RC,,,Outpatient,,,615,461.25,,479.7,78,,383.76,percent of total billed charges,78% of total billed charges,387.45,63,,309.96,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,233.7,38,,186.96,percent of total billed charges,38% of total billed charges,233.7,38,,186.96,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,553.5,90,,442.8,percent of total billed charges,90% of total billed charges,215.25,35,,172.2,percent of total billed charges,35% of total billed charges,413.74,67.275,,330.992,percent of total billed charges,67.275% of total billed charges,492,80,,393.6,percent of total billed charges,80% of total billed charges,236.04,38.38,,188.832,percent of total billed charges,38.38% of total billed charges,492,80,,393.6,percent of total billed charges,80% of total billed charges,379.7,61.74,,303.76,percent of total billed charges,61.74% of total billed charges,627.3,102,,501.84,percent of total billed charges,102% of total billed charges,233.7,38,,186.96,percent of total billed charges,38% of total billed charges,215.25,627.3,
INTERFERON NEUTRAL AB,5000341,CDM,302,RC,86382,HCPCS,Outpatient,,,622,466.5,,485.16,78,,388.128,percent of total billed charges,78% of total billed charges,21.26,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,16.91,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.91,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,559.8,90,,447.84,percent of total billed charges,90% of total billed charges,22.32,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,418.45,67.275,,334.76,percent of total billed charges,67.275% of total billed charges,497.6,80,,398.08,percent of total billed charges,80% of total billed charges,17.08,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,497.6,80,,398.08,percent of total billed charges,80% of total billed charges,384.02,61.74,,307.216,percent of total billed charges,61.74% of total billed charges,21.69,102,,,Fee Schedule,102% of GA Medicaid Rate,16.91,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,16.91,559.8,
PEG TRAY 24 FR   6648,3001531,CDM,270,RC,,,Outpatient,,,622.5,466.88,,485.55,78,,388.44,percent of total billed charges,78% of total billed charges,392.18,63,,313.744,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,236.55,38,,189.24,percent of total billed charges,38% of total billed charges,236.55,38,,189.24,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,560.25,90,,448.2,percent of total billed charges,90% of total billed charges,217.88,35,,174.304,percent of total billed charges,35% of total billed charges,418.79,67.275,,335.032,percent of total billed charges,67.275% of total billed charges,498,80,,398.4,percent of total billed charges,80% of total billed charges,238.92,38.38,,191.136,percent of total billed charges,38.38% of total billed charges,498,80,,398.4,percent of total billed charges,80% of total billed charges,384.33,61.74,,307.464,percent of total billed charges,61.74% of total billed charges,634.95,102,,507.96,percent of total billed charges,102% of total billed charges,236.55,38,,189.24,percent of total billed charges,38% of total billed charges,217.88,634.95,
CPAP VENTILATION DAY 1,8094660,CDM,410,RC,94660,HCPCS,Outpatient,,,623,467.25,,485.94,78,,388.752,percent of total billed charges,78% of total billed charges,392.49,63,,313.992,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,236.74,38,,189.392,percent of total billed charges,38% of total billed charges,236.74,38,,189.392,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,560.7,90,,448.56,percent of total billed charges,90% of total billed charges,218.05,35,,174.44,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,498.4,80,,398.72,percent of total billed charges,80% of total billed charges,239.11,38.38,,191.288,percent of total billed charges,38.38% of total billed charges,498.4,80,,398.72,percent of total billed charges,80% of total billed charges,384.64,61.74,,307.712,percent of total billed charges,61.74% of total billed charges,635.46,102,,508.368,percent of total billed charges,102% of total billed charges,236.74,38,,189.392,percent of total billed charges,38% of total billed charges,145.93,635.46,
VARIAX 2.7MM LOCKING SCREW 8MM,3005035,CDM,270,RC,,,Outpatient,,,626.4,469.8,,488.59,78,,390.872,percent of total billed charges,78% of total billed charges,394.63,63,,315.704,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,238.03,38,,190.424,percent of total billed charges,38% of total billed charges,238.03,38,,190.424,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,563.76,90,,451.008,percent of total billed charges,90% of total billed charges,219.24,35,,175.392,percent of total billed charges,35% of total billed charges,421.41,67.275,,337.128,percent of total billed charges,67.275% of total billed charges,501.12,80,,400.896,percent of total billed charges,80% of total billed charges,240.41,38.38,,192.328,percent of total billed charges,38.38% of total billed charges,501.12,80,,400.896,percent of total billed charges,80% of total billed charges,386.74,61.74,,309.392,percent of total billed charges,61.74% of total billed charges,638.93,102,,511.144,percent of total billed charges,102% of total billed charges,238.03,38,,190.424,percent of total billed charges,38% of total billed charges,219.24,638.93,
VARIAX 2.7MM LOCKING SCREW 10MM,3005040,CDM,270,RC,,,Outpatient,,,626.4,469.8,,488.59,78,,390.872,percent of total billed charges,78% of total billed charges,394.63,63,,315.704,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,238.03,38,,190.424,percent of total billed charges,38% of total billed charges,238.03,38,,190.424,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,563.76,90,,451.008,percent of total billed charges,90% of total billed charges,219.24,35,,175.392,percent of total billed charges,35% of total billed charges,421.41,67.275,,337.128,percent of total billed charges,67.275% of total billed charges,501.12,80,,400.896,percent of total billed charges,80% of total billed charges,240.41,38.38,,192.328,percent of total billed charges,38.38% of total billed charges,501.12,80,,400.896,percent of total billed charges,80% of total billed charges,386.74,61.74,,309.392,percent of total billed charges,61.74% of total billed charges,638.93,102,,511.144,percent of total billed charges,102% of total billed charges,238.03,38,,190.424,percent of total billed charges,38% of total billed charges,219.24,638.93,
VARIAX 2.7MM LOCKING SCREW 16MM,3005045,CDM,270,RC,,,Outpatient,,,626.4,469.8,,488.59,78,,390.872,percent of total billed charges,78% of total billed charges,394.63,63,,315.704,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,238.03,38,,190.424,percent of total billed charges,38% of total billed charges,238.03,38,,190.424,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,563.76,90,,451.008,percent of total billed charges,90% of total billed charges,219.24,35,,175.392,percent of total billed charges,35% of total billed charges,421.41,67.275,,337.128,percent of total billed charges,67.275% of total billed charges,501.12,80,,400.896,percent of total billed charges,80% of total billed charges,240.41,38.38,,192.328,percent of total billed charges,38.38% of total billed charges,501.12,80,,400.896,percent of total billed charges,80% of total billed charges,386.74,61.74,,309.392,percent of total billed charges,61.74% of total billed charges,638.93,102,,511.144,percent of total billed charges,102% of total billed charges,238.03,38,,190.424,percent of total billed charges,38% of total billed charges,219.24,638.93,
VARIAX 2.7MM LOCKING SCREW 18MM,3005050,CDM,270,RC,,,Outpatient,,,626.4,469.8,,488.59,78,,390.872,percent of total billed charges,78% of total billed charges,394.63,63,,315.704,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,238.03,38,,190.424,percent of total billed charges,38% of total billed charges,238.03,38,,190.424,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,563.76,90,,451.008,percent of total billed charges,90% of total billed charges,219.24,35,,175.392,percent of total billed charges,35% of total billed charges,421.41,67.275,,337.128,percent of total billed charges,67.275% of total billed charges,501.12,80,,400.896,percent of total billed charges,80% of total billed charges,240.41,38.38,,192.328,percent of total billed charges,38.38% of total billed charges,501.12,80,,400.896,percent of total billed charges,80% of total billed charges,386.74,61.74,,309.392,percent of total billed charges,61.74% of total billed charges,638.93,102,,511.144,percent of total billed charges,102% of total billed charges,238.03,38,,190.424,percent of total billed charges,38% of total billed charges,219.24,638.93,
US AAA SCREENING,7300974,CDM,402,RC,76706,HCPCS,Outpatient,,,630,472.5,,491.4,78,,393.12,percent of total billed charges,78% of total billed charges,396.9,63,,317.52,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,239.4,38,,191.52,percent of total billed charges,38% of total billed charges,239.4,38,,191.52,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,567,90,,453.6,percent of total billed charges,90% of total billed charges,220.5,35,,176.4,percent of total billed charges,35% of total billed charges,423.83,67.275,,339.064,percent of total billed charges,67.275% of total billed charges,504,80,,403.2,percent of total billed charges,80% of total billed charges,241.79,38.38,,193.432,percent of total billed charges,38.38% of total billed charges,504,80,,403.2,percent of total billed charges,80% of total billed charges,388.96,61.74,,311.168,percent of total billed charges,61.74% of total billed charges,642.6,102,,514.08,percent of total billed charges,102% of total billed charges,239.4,38,,191.52,percent of total billed charges,38% of total billed charges,220.5,642.6,
SKULL COMPLETE SERIES,7000145,CDM,320,RC,70260,HCPCS,Outpatient,,,636,477,,496.08,78,,396.864,percent of total billed charges,78% of total billed charges,400.68,63,,320.544,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,241.68,38,,193.344,percent of total billed charges,38% of total billed charges,241.68,38,,193.344,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,572.4,90,,457.92,percent of total billed charges,90% of total billed charges,222.6,35,,178.08,percent of total billed charges,35% of total billed charges,427.87,67.275,,342.296,percent of total billed charges,67.275% of total billed charges,508.8,80,,407.04,percent of total billed charges,80% of total billed charges,244.1,38.38,,195.28,percent of total billed charges,38.38% of total billed charges,508.8,80,,407.04,percent of total billed charges,80% of total billed charges,392.67,61.74,,314.136,percent of total billed charges,61.74% of total billed charges,648.72,102,,518.976,percent of total billed charges,102% of total billed charges,241.68,38,,193.344,percent of total billed charges,38% of total billed charges,222.6,648.72,
RIBS BI W/PA CHEST 4,7000221,CDM,320,RC,71111,HCPCS,Outpatient,,,636,477,,496.08,78,,396.864,percent of total billed charges,78% of total billed charges,400.68,63,,320.544,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,241.68,38,,193.344,percent of total billed charges,38% of total billed charges,241.68,38,,193.344,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,572.4,90,,457.92,percent of total billed charges,90% of total billed charges,222.6,35,,178.08,percent of total billed charges,35% of total billed charges,427.87,67.275,,342.296,percent of total billed charges,67.275% of total billed charges,508.8,80,,407.04,percent of total billed charges,80% of total billed charges,244.1,38.38,,195.28,percent of total billed charges,38.38% of total billed charges,508.8,80,,407.04,percent of total billed charges,80% of total billed charges,392.67,61.74,,314.136,percent of total billed charges,61.74% of total billed charges,648.72,102,,518.976,percent of total billed charges,102% of total billed charges,241.68,38,,193.344,percent of total billed charges,38% of total billed charges,222.6,648.72,
US ECHOCARDIOGRAPHY,7300935,CDM,480,RC,,,Outpatient,,,641,480.75,,499.98,78,,399.984,percent of total billed charges,78% of total billed charges,403.83,63,,323.064,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,243.58,38,,194.864,percent of total billed charges,38% of total billed charges,243.58,38,,194.864,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,576.9,90,,461.52,percent of total billed charges,90% of total billed charges,224.35,35,,179.48,percent of total billed charges,35% of total billed charges,431.23,67.275,,344.984,percent of total billed charges,67.275% of total billed charges,512.8,80,,410.24,percent of total billed charges,80% of total billed charges,246.02,38.38,,196.816,percent of total billed charges,38.38% of total billed charges,512.8,80,,410.24,percent of total billed charges,80% of total billed charges,395.75,61.74,,316.6,percent of total billed charges,61.74% of total billed charges,653.82,102,,523.056,percent of total billed charges,102% of total billed charges,243.58,38,,194.864,percent of total billed charges,38% of total billed charges,224.35,653.82,
WIRE 1.8 OLIVE 400MM,3006008,CDM,270,RC,,,Outpatient,,,642,481.5,,500.76,78,,400.608,percent of total billed charges,78% of total billed charges,404.46,63,,323.568,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,243.96,38,,195.168,percent of total billed charges,38% of total billed charges,243.96,38,,195.168,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,577.8,90,,462.24,percent of total billed charges,90% of total billed charges,224.7,35,,179.76,percent of total billed charges,35% of total billed charges,431.91,67.275,,345.528,percent of total billed charges,67.275% of total billed charges,513.6,80,,410.88,percent of total billed charges,80% of total billed charges,246.4,38.38,,197.12,percent of total billed charges,38.38% of total billed charges,513.6,80,,410.88,percent of total billed charges,80% of total billed charges,396.37,61.74,,317.096,percent of total billed charges,61.74% of total billed charges,654.84,102,,523.872,percent of total billed charges,102% of total billed charges,243.96,38,,195.168,percent of total billed charges,38% of total billed charges,224.7,654.84,
OR LEVEL 2 EA ADDL 15 MIN,400115,CDM,360,RC,,,Outpatient,,,651,488.25,,507.78,78,,406.224,percent of total billed charges,78% of total billed charges,410.13,63,,328.104,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,247.38,38,,197.904,percent of total billed charges,38% of total billed charges,247.38,38,,197.904,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,585.9,90,,468.72,percent of total billed charges,90% of total billed charges,227.85,35,,182.28,percent of total billed charges,35% of total billed charges,437.96,67.275,,350.368,percent of total billed charges,67.275% of total billed charges,520.8,80,,416.64,percent of total billed charges,80% of total billed charges,249.85,38.38,,199.88,percent of total billed charges,38.38% of total billed charges,520.8,80,,416.64,percent of total billed charges,80% of total billed charges,401.93,61.74,,321.544,percent of total billed charges,61.74% of total billed charges,664.02,102,,531.216,percent of total billed charges,102% of total billed charges,247.38,38,,197.904,percent of total billed charges,38% of total billed charges,227.85,664.02,
SUTURING SIMPLE 12.6 TO 20 CM,1200116,CDM,981,RC,12005,HCPCS,Outpatient,,,654,490.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,107.54,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,107.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,107.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,107.54,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,107.54,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,177.71,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,115.44,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,395.7,61.74,,316.56,percent of total billed charges,61.74% of total billed charges,169.25,102,,,Fee Schedule,102% of GA Medicaid Rate,107.54,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,107.54,395.7,
LAYER CLOSURE UP TO 2.5 CM,1200117,CDM,981,RC,12031,HCPCS,Outpatient,,,654,490.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,165.42,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,165.42,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,165.42,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,165.42,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,165.42,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,132.92,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,169.58,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,395.7,61.74,,316.56,percent of total billed charges,61.74% of total billed charges,126.59,102,,,Fee Schedule,102% of GA Medicaid Rate,165.42,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,126.59,395.7,
LAYER CLOSURE 2.6 TO 7.5 CM,1200118,CDM,981,RC,12032,HCPCS,Outpatient,,,654,490.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,206.83,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,206.83,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,206.83,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,206.83,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,206.83,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,151.44,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,211.16,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,395.7,61.74,,316.56,percent of total billed charges,61.74% of total billed charges,144.23,102,,,Fee Schedule,102% of GA Medicaid Rate,206.83,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,144.23,395.7,
LAYER CLOSURE 7.6 TO 12.5 CM,1200119,CDM,981,RC,12034,HCPCS,Outpatient,,,654,490.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,225.29,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,225.29,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,225.29,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,225.29,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,225.29,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,180.4,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,232.57,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,395.7,61.74,,316.56,percent of total billed charges,61.74% of total billed charges,171.81,102,,,Fee Schedule,102% of GA Medicaid Rate,225.29,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,171.81,395.7,
LAYER CLOSURE 12.6 TO 20 CM,1200120,CDM,981,RC,12035,HCPCS,Outpatient,,,654,490.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,266.08,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,266.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,266.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,266.08,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,266.08,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,207.66,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,277.7,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,395.7,61.74,,316.56,percent of total billed charges,61.74% of total billed charges,197.77,102,,,Fee Schedule,102% of GA Medicaid Rate,266.08,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,197.77,395.7,
LAYER CLOSURE UP TO 2.5 CM,1200121,CDM,981,RC,12041,HCPCS,Outpatient,,,654,490.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,159.07,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,159.07,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,159.07,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,159.07,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,159.07,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,148.11,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,162.73,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,395.7,61.74,,316.56,percent of total billed charges,61.74% of total billed charges,141.06,102,,,Fee Schedule,102% of GA Medicaid Rate,159.07,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,141.06,395.7,
LAYER CLOSURE 2.6 TO 7.5 CM,1200122,CDM,981,RC,12042,HCPCS,Outpatient,,,654,490.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,213.68,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,213.68,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,213.68,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,213.68,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,213.68,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,166.6,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,220.08,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,395.7,61.74,,316.56,percent of total billed charges,61.74% of total billed charges,158.67,102,,,Fee Schedule,102% of GA Medicaid Rate,213.68,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,158.67,395.7,
SIMPLE REPAIR 12.6 TO 20 CM,1200129,CDM,981,RC,12016,HCPCS,Outpatient,,,654,490.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,145.56,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,145.56,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,145.56,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,145.56,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,145.56,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,239.04,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,156.42,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,395.7,61.74,,316.56,percent of total billed charges,61.74% of total billed charges,227.66,102,,,Fee Schedule,102% of GA Medicaid Rate,145.56,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,145.56,395.7,
LAYER CLOSURE UP TO 2.5 CM,1200130,CDM,981,RC,12051,HCPCS,Outpatient,,,654,490.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,185.4,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,185.4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,185.4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,185.4,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,185.4,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,153.42,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,190.2,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,395.7,61.74,,316.56,percent of total billed charges,61.74% of total billed charges,146.11,102,,,Fee Schedule,102% of GA Medicaid Rate,185.4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,146.11,395.7,
LAYER CLOSURE 2.6 TO 5.0 CM,1200131,CDM,981,RC,12052,HCPCS,Outpatient,,,654,490.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,218.73,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,218.73,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,218.73,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,218.73,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,218.73,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,171.98,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,224.34,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,395.7,61.74,,316.56,percent of total billed charges,61.74% of total billed charges,163.79,102,,,Fee Schedule,102% of GA Medicaid Rate,218.73,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,163.79,395.7,
LAYER CLOSURE 5.1 TO 7.5 CM,1200132,CDM,981,RC,12053,HCPCS,Outpatient,,,654,490.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,236.57,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,236.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,236.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,236.57,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,236.57,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,192.37,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,242.71,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,395.7,61.74,,316.56,percent of total billed charges,61.74% of total billed charges,183.21,102,,,Fee Schedule,102% of GA Medicaid Rate,236.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,183.21,395.7,
LAYER CLOSURE 7.6 TO 12.5 CM,1200133,CDM,981,RC,12054,HCPCS,Outpatient,,,654,490.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,243.58,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,243.58,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,243.58,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,243.58,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,243.58,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,225.89,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,252.46,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,395.7,61.74,,316.56,percent of total billed charges,61.74% of total billed charges,215.13,102,,,Fee Schedule,102% of GA Medicaid Rate,243.58,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,215.13,395.7,
LAYER CLOSURE 12.6 TO 20 CM,1200134,CDM,981,RC,12055,HCPCS,Outpatient,,,654,490.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,332.09,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,332.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,332.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,332.09,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,332.09,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,285.29,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,344.35,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,395.7,61.74,,316.56,percent of total billed charges,61.74% of total billed charges,271.7,102,,,Fee Schedule,102% of GA Medicaid Rate,332.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,271.7,395.7,
INCIS/REMOVAL FB/SUBCUT,1200170,CDM,981,RC,10120,HCPCS,Outpatient,,,654,490.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,114.34,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,114.34,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,114.34,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,114.34,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,114.34,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,80.39,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,114.92,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,395.7,61.74,,316.56,percent of total billed charges,61.74% of total billed charges,76.56,102,,,Fee Schedule,102% of GA Medicaid Rate,114.34,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,76.56,395.7,
"LARGE, DRESS/DEBRID BURN INIT/SUBSEQ",1200184,CDM,981,RC,16030,HCPCS,Outpatient,,,654,490.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,145.97,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,145.97,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,145.97,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,145.97,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,145.97,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,126.13,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,153.16,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,395.7,61.74,,316.56,percent of total billed charges,61.74% of total billed charges,120.12,102,,,Fee Schedule,102% of GA Medicaid Rate,145.97,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,120.12,395.7,
SUTURING SIMPLE 20.1 TO 30 CM,1200222,CDM,981,RC,12006,HCPCS,Outpatient,,,654,490.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,132.27,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,132.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,132.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,132.27,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,132.27,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,232.62,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,141.44,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,395.7,61.74,,316.56,percent of total billed charges,61.74% of total billed charges,221.54,102,,,Fee Schedule,102% of GA Medicaid Rate,132.27,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,132.27,395.7,
LAYER CLOSURE 20.1 TO 30 CM,1200226,CDM,981,RC,12046,HCPCS,Outpatient,,,654,490.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,351.39,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,351.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,351.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,351.39,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,351.39,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,284.83,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,372.75,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,395.7,61.74,,316.56,percent of total billed charges,61.74% of total billed charges,271.27,102,,,Fee Schedule,102% of GA Medicaid Rate,351.39,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,271.27,395.7,
SIMPLE REPAIR 20.1 TO 30 CM,1200228,CDM,981,RC,12017,HCPCS,Outpatient,,,654,490.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,175.09,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,175.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,175.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,175.09,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,175.09,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,316.87,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,185.97,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,395.7,61.74,,316.56,percent of total billed charges,61.74% of total billed charges,301.78,102,,,Fee Schedule,102% of GA Medicaid Rate,175.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,175.09,395.7,
"TX OF SUPERFICIAL WOUND DEHIS, W/PACKING",1200231,CDM,981,RC,12021,HCPCS,Outpatient,,,654,490.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,154.87,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,154.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,154.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,154.87,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,154.87,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,109.97,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,160.6,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,395.7,61.74,,316.56,percent of total billed charges,61.74% of total billed charges,104.73,102,,,Fee Schedule,102% of GA Medicaid Rate,154.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,104.73,395.7,
LAYER CLOSURE 20.1 TO 30 CM,1200232,CDM,981,RC,12056,HCPCS,Outpatient,,,654,490.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,423.33,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,423.33,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,423.33,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,423.33,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,423.33,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,366.22,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,440.81,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,395.7,61.74,,316.56,percent of total billed charges,61.74% of total billed charges,348.78,102,,,Fee Schedule,102% of GA Medicaid Rate,423.33,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,348.78,440.81,
LAYER CLOSURE OVER 30 CM,1200233,CDM,981,RC,12057,HCPCS,Outpatient,,,654,490.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,462.62,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,462.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,462.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,462.62,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,462.62,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,405.09,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,482.44,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,395.7,61.74,,316.56,percent of total billed charges,61.74% of total billed charges,385.8,102,,,Fee Schedule,102% of GA Medicaid Rate,462.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,385.8,482.44,
"I&D ABSCESS, COMP/MULTIPLE",1200234,CDM,981,RC,10061,HCPCS,Outpatient,,,654,490.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,200.72,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,200.72,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,200.72,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,200.72,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,200.72,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,127.63,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,207.47,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,395.7,61.74,,316.56,percent of total billed charges,61.74% of total billed charges,121.55,102,,,Fee Schedule,102% of GA Medicaid Rate,200.72,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,121.55,395.7,
EXCISION OF NAIL MATRIX PARTIAL,1200241,CDM,981,RC,11750,HCPCS,Outpatient,,,654,490.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,110.61,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,110.61,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,110.61,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,110.61,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,110.61,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,127.85,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,114.31,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,395.7,61.74,,316.56,percent of total billed charges,61.74% of total billed charges,121.76,102,,,Fee Schedule,102% of GA Medicaid Rate,110.61,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,110.61,395.7,
PT WOUND VAC/CARE > 50 SQ CM (DME),9000611,CDM,420,RC,97606,HCPCS,Outpatient,,,654,490.5,,510.12,78,,408.096,percent of total billed charges,78% of total billed charges,412.02,63,,329.616,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,248.52,38,,198.816,percent of total billed charges,38% of total billed charges,248.52,38,,198.816,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,588.6,90,,470.88,percent of total billed charges,90% of total billed charges,228.9,35,,183.12,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,523.2,80,,418.56,percent of total billed charges,80% of total billed charges,251.01,38.38,,200.808,percent of total billed charges,38.38% of total billed charges,523.2,80,,418.56,percent of total billed charges,80% of total billed charges,403.78,61.74,,323.024,percent of total billed charges,61.74% of total billed charges,667.08,102,,533.664,percent of total billed charges,102% of total billed charges,248.52,38,,198.816,percent of total billed charges,38% of total billed charges,145.93,667.08,
PT WOUND VAC/CARE <= 50 SQ CM (NON-DME),9000615,CDM,420,RC,97607,HCPCS,Outpatient,,,654,490.5,,510.12,78,,408.096,percent of total billed charges,78% of total billed charges,412.02,63,,329.616,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,248.52,38,,198.816,percent of total billed charges,38% of total billed charges,248.52,38,,198.816,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,588.6,90,,470.88,percent of total billed charges,90% of total billed charges,228.9,35,,183.12,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,523.2,80,,418.56,percent of total billed charges,80% of total billed charges,251.01,38.38,,200.808,percent of total billed charges,38.38% of total billed charges,523.2,80,,418.56,percent of total billed charges,80% of total billed charges,403.78,61.74,,323.024,percent of total billed charges,61.74% of total billed charges,667.08,102,,533.664,percent of total billed charges,102% of total billed charges,248.52,38,,198.816,percent of total billed charges,38% of total billed charges,145.93,667.08,
PT WOUND VAC/CARE > 50 SQ CM (NON-DME),9000616,CDM,420,RC,97608,HCPCS,Outpatient,,,654,490.5,,510.12,78,,408.096,percent of total billed charges,78% of total billed charges,412.02,63,,329.616,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,248.52,38,,198.816,percent of total billed charges,38% of total billed charges,248.52,38,,198.816,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,588.6,90,,470.88,percent of total billed charges,90% of total billed charges,228.9,35,,183.12,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,523.2,80,,418.56,percent of total billed charges,80% of total billed charges,251.01,38.38,,200.808,percent of total billed charges,38.38% of total billed charges,523.2,80,,418.56,percent of total billed charges,80% of total billed charges,403.78,61.74,,323.024,percent of total billed charges,61.74% of total billed charges,667.08,102,,533.664,percent of total billed charges,102% of total billed charges,248.52,38,,198.816,percent of total billed charges,38% of total billed charges,145.93,667.08,
CVL PERCU AGE > 5 YRS,1001138,CDM,450,RC,36556,HCPCS,Outpatient,,,658,493.5,,513.24,78,,410.592,percent of total billed charges,78% of total billed charges,414.54,63,,331.632,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,250.04,38,,200.032,percent of total billed charges,38% of total billed charges,250.04,38,,200.032,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,592.2,90,,473.76,percent of total billed charges,90% of total billed charges,230.3,35,,184.24,percent of total billed charges,35% of total billed charges,442.67,67.275,,354.136,percent of total billed charges,67.275% of total billed charges,526.4,80,,421.12,percent of total billed charges,80% of total billed charges,252.54,38.38,,202.032,percent of total billed charges,38.38% of total billed charges,526.4,80,,421.12,percent of total billed charges,80% of total billed charges,406.25,61.74,,325,percent of total billed charges,61.74% of total billed charges,671.16,102,,536.928,percent of total billed charges,102% of total billed charges,250.04,38,,200.032,percent of total billed charges,38% of total billed charges,230.3,671.16,
Ultrasound of head and neck,7000931,CDM,402,RC,76536,HCPCS,Outpatient,,,672,504,,524.16,78,,419.328,percent of total billed charges,78% of total billed charges,423.36,63,,338.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,255.36,38,,204.288,percent of total billed charges,38% of total billed charges,255.36,38,,204.288,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,604.8,90,,483.84,percent of total billed charges,90% of total billed charges,235.2,35,,188.16,percent of total billed charges,35% of total billed charges,452.09,67.275,,361.672,percent of total billed charges,67.275% of total billed charges,537.6,80,,430.08,percent of total billed charges,80% of total billed charges,257.91,38.38,,206.328,percent of total billed charges,38.38% of total billed charges,537.6,80,,430.08,percent of total billed charges,80% of total billed charges,414.89,61.74,,331.912,percent of total billed charges,61.74% of total billed charges,685.44,102,,548.352,percent of total billed charges,102% of total billed charges,255.36,38,,204.288,percent of total billed charges,38% of total billed charges,235.2,685.44,
Ultrasound of the scrotum,7300003,CDM,402,RC,76870,HCPCS,Outpatient,,,672,504,,524.16,78,,419.328,percent of total billed charges,78% of total billed charges,423.36,63,,338.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,255.36,38,,204.288,percent of total billed charges,38% of total billed charges,255.36,38,,204.288,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,604.8,90,,483.84,percent of total billed charges,90% of total billed charges,235.2,35,,188.16,percent of total billed charges,35% of total billed charges,452.09,67.275,,361.672,percent of total billed charges,67.275% of total billed charges,537.6,80,,430.08,percent of total billed charges,80% of total billed charges,257.91,38.38,,206.328,percent of total billed charges,38.38% of total billed charges,537.6,80,,430.08,percent of total billed charges,80% of total billed charges,414.89,61.74,,331.912,percent of total billed charges,61.74% of total billed charges,685.44,102,,548.352,percent of total billed charges,102% of total billed charges,255.36,38,,204.288,percent of total billed charges,38% of total billed charges,235.2,685.44,
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,7300010,CDM,402,RC,76805,HCPCS,Outpatient,,,672,504,,524.16,78,,419.328,percent of total billed charges,78% of total billed charges,423.36,63,,338.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,255.36,38,,204.288,percent of total billed charges,38% of total billed charges,255.36,38,,204.288,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,604.8,90,,483.84,percent of total billed charges,90% of total billed charges,235.2,35,,188.16,percent of total billed charges,35% of total billed charges,452.09,67.275,,361.672,percent of total billed charges,67.275% of total billed charges,537.6,80,,430.08,percent of total billed charges,80% of total billed charges,257.91,38.38,,206.328,percent of total billed charges,38.38% of total billed charges,537.6,80,,430.08,percent of total billed charges,80% of total billed charges,414.89,61.74,,331.912,percent of total billed charges,61.74% of total billed charges,685.44,102,,548.352,percent of total billed charges,102% of total billed charges,255.36,38,,204.288,percent of total billed charges,38% of total billed charges,235.2,685.44,
Transvaginal ultrasound of uterus,7300016,CDM,402,RC,76817,HCPCS,Outpatient,,,672,504,,524.16,78,,419.328,percent of total billed charges,78% of total billed charges,423.36,63,,338.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,255.36,38,,204.288,percent of total billed charges,38% of total billed charges,255.36,38,,204.288,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,604.8,90,,483.84,percent of total billed charges,90% of total billed charges,235.2,35,,188.16,percent of total billed charges,35% of total billed charges,452.09,67.275,,361.672,percent of total billed charges,67.275% of total billed charges,537.6,80,,430.08,percent of total billed charges,80% of total billed charges,257.91,38.38,,206.328,percent of total billed charges,38.38% of total billed charges,537.6,80,,430.08,percent of total billed charges,80% of total billed charges,414.89,61.74,,331.912,percent of total billed charges,61.74% of total billed charges,685.44,102,,548.352,percent of total billed charges,102% of total billed charges,255.36,38,,204.288,percent of total billed charges,38% of total billed charges,235.2,685.44,
Abdominal ultrasound of pregnant uterus (less than 14 weeks) single or first fetus,7300017,CDM,402,RC,76801,HCPCS,Outpatient,,,672,504,,524.16,78,,419.328,percent of total billed charges,78% of total billed charges,423.36,63,,338.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,255.36,38,,204.288,percent of total billed charges,38% of total billed charges,255.36,38,,204.288,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,604.8,90,,483.84,percent of total billed charges,90% of total billed charges,235.2,35,,188.16,percent of total billed charges,35% of total billed charges,452.09,67.275,,361.672,percent of total billed charges,67.275% of total billed charges,537.6,80,,430.08,percent of total billed charges,80% of total billed charges,257.91,38.38,,206.328,percent of total billed charges,38.38% of total billed charges,537.6,80,,430.08,percent of total billed charges,80% of total billed charges,414.89,61.74,,331.912,percent of total billed charges,61.74% of total billed charges,685.44,102,,548.352,percent of total billed charges,102% of total billed charges,255.36,38,,204.288,percent of total billed charges,38% of total billed charges,235.2,685.44,
Ultrasound of fetus with limited views,7300019,CDM,402,RC,76815,HCPCS,Outpatient,,,672,504,,524.16,78,,419.328,percent of total billed charges,78% of total billed charges,423.36,63,,338.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,255.36,38,,204.288,percent of total billed charges,38% of total billed charges,255.36,38,,204.288,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,604.8,90,,483.84,percent of total billed charges,90% of total billed charges,235.2,35,,188.16,percent of total billed charges,35% of total billed charges,452.09,67.275,,361.672,percent of total billed charges,67.275% of total billed charges,537.6,80,,430.08,percent of total billed charges,80% of total billed charges,257.91,38.38,,206.328,percent of total billed charges,38.38% of total billed charges,537.6,80,,430.08,percent of total billed charges,80% of total billed charges,414.89,61.74,,331.912,percent of total billed charges,61.74% of total billed charges,685.44,102,,548.352,percent of total billed charges,102% of total billed charges,255.36,38,,204.288,percent of total billed charges,38% of total billed charges,235.2,685.44,
Complete ultrasound of the pelvis,7300930,CDM,402,RC,76856,HCPCS,Outpatient,,,672,504,,524.16,78,,419.328,percent of total billed charges,78% of total billed charges,423.36,63,,338.688,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,255.36,38,,204.288,percent of total billed charges,38% of total billed charges,255.36,38,,204.288,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,604.8,90,,483.84,percent of total billed charges,90% of total billed charges,235.2,35,,188.16,percent of total billed charges,35% of total billed charges,452.09,67.275,,361.672,percent of total billed charges,67.275% of total billed charges,537.6,80,,430.08,percent of total billed charges,80% of total billed charges,257.91,38.38,,206.328,percent of total billed charges,38.38% of total billed charges,537.6,80,,430.08,percent of total billed charges,80% of total billed charges,414.89,61.74,,331.912,percent of total billed charges,61.74% of total billed charges,685.44,102,,548.352,percent of total billed charges,102% of total billed charges,255.36,38,,204.288,percent of total billed charges,38% of total billed charges,235.2,685.44,
MESH HERNIA GORE CHRISTIE PLUG,3004284,CDM,270,RC,,,Outpatient,,,675,506.25,,526.5,78,,421.2,percent of total billed charges,78% of total billed charges,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,256.5,38,,205.2,percent of total billed charges,38% of total billed charges,256.5,38,,205.2,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,607.5,90,,486,percent of total billed charges,90% of total billed charges,236.25,35,,189,percent of total billed charges,35% of total billed charges,454.11,67.275,,363.288,percent of total billed charges,67.275% of total billed charges,540,80,,432,percent of total billed charges,80% of total billed charges,259.07,38.38,,207.256,percent of total billed charges,38.38% of total billed charges,540,80,,432,percent of total billed charges,80% of total billed charges,416.75,61.74,,333.4,percent of total billed charges,61.74% of total billed charges,688.5,102,,550.8,percent of total billed charges,102% of total billed charges,256.5,38,,205.2,percent of total billed charges,38% of total billed charges,236.25,688.5,
ZP COMPRESSION 3.2x16MM,3008001,CDM,270,RC,,,Outpatient,,,675,506.25,,526.5,78,,421.2,percent of total billed charges,78% of total billed charges,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,256.5,38,,205.2,percent of total billed charges,38% of total billed charges,256.5,38,,205.2,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,607.5,90,,486,percent of total billed charges,90% of total billed charges,236.25,35,,189,percent of total billed charges,35% of total billed charges,454.11,67.275,,363.288,percent of total billed charges,67.275% of total billed charges,540,80,,432,percent of total billed charges,80% of total billed charges,259.07,38.38,,207.256,percent of total billed charges,38.38% of total billed charges,540,80,,432,percent of total billed charges,80% of total billed charges,416.75,61.74,,333.4,percent of total billed charges,61.74% of total billed charges,688.5,102,,550.8,percent of total billed charges,102% of total billed charges,256.5,38,,205.2,percent of total billed charges,38% of total billed charges,236.25,688.5,
Limited ultrasound of the breast,7300941,CDM,402,RC,76642,HCPCS,Outpatient,,,679,509.25,,529.62,78,,423.696,percent of total billed charges,78% of total billed charges,427.77,63,,342.216,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,258.02,38,,206.416,percent of total billed charges,38% of total billed charges,258.02,38,,206.416,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,611.1,90,,488.88,percent of total billed charges,90% of total billed charges,237.65,35,,190.12,percent of total billed charges,35% of total billed charges,456.8,67.275,,365.44,percent of total billed charges,67.275% of total billed charges,543.2,80,,434.56,percent of total billed charges,80% of total billed charges,260.6,38.38,,208.48,percent of total billed charges,38.38% of total billed charges,543.2,80,,434.56,percent of total billed charges,80% of total billed charges,419.21,61.74,,335.368,percent of total billed charges,61.74% of total billed charges,692.58,102,,554.064,percent of total billed charges,102% of total billed charges,258.02,38,,206.416,percent of total billed charges,38% of total billed charges,237.65,692.58,
MENORRHAGIA PANEL,5001881,CDM,305,RC,,,Outpatient,,,687,515.25,,535.86,78,,428.688,percent of total billed charges,78% of total billed charges,432.81,63,,346.248,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,261.06,38,,208.848,percent of total billed charges,38% of total billed charges,261.06,38,,208.848,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,618.3,90,,494.64,percent of total billed charges,90% of total billed charges,240.45,35,,192.36,percent of total billed charges,35% of total billed charges,462.18,67.275,,369.744,percent of total billed charges,67.275% of total billed charges,549.6,80,,439.68,percent of total billed charges,80% of total billed charges,263.67,38.38,,210.936,percent of total billed charges,38.38% of total billed charges,549.6,80,,439.68,percent of total billed charges,80% of total billed charges,424.15,61.74,,339.32,percent of total billed charges,61.74% of total billed charges,700.74,102,,560.592,percent of total billed charges,102% of total billed charges,261.06,38,,208.848,percent of total billed charges,38% of total billed charges,240.45,700.74,
PATH LEVEL V,5002014,CDM,312,RC,88307,HCPCS,Outpatient,,,687,515.25,,535.86,78,,428.688,percent of total billed charges,78% of total billed charges,133.3,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,261.06,38,,208.848,percent of total billed charges,38% of total billed charges,261.06,38,,208.848,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,618.3,90,,494.64,percent of total billed charges,90% of total billed charges,139.97,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,462.18,67.275,,369.744,percent of total billed charges,67.275% of total billed charges,549.6,80,,439.68,percent of total billed charges,80% of total billed charges,263.67,38.38,,210.936,percent of total billed charges,38.38% of total billed charges,549.6,80,,439.68,percent of total billed charges,80% of total billed charges,424.15,61.74,,339.32,percent of total billed charges,61.74% of total billed charges,135.97,102,,,Fee Schedule,102% of GA Medicaid Rate,261.06,38,,208.848,percent of total billed charges,38% of total billed charges,133.3,618.3,
DRILL BIT 3.5,3006051,CDM,270,RC,,,Outpatient,,,688.8,516.6,,537.26,78,,429.808,percent of total billed charges,78% of total billed charges,433.94,63,,347.152,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,261.74,38,,209.392,percent of total billed charges,38% of total billed charges,261.74,38,,209.392,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,619.92,90,,495.936,percent of total billed charges,90% of total billed charges,241.08,35,,192.864,percent of total billed charges,35% of total billed charges,463.39,67.275,,370.712,percent of total billed charges,67.275% of total billed charges,551.04,80,,440.832,percent of total billed charges,80% of total billed charges,264.36,38.38,,211.488,percent of total billed charges,38.38% of total billed charges,551.04,80,,440.832,percent of total billed charges,80% of total billed charges,425.27,61.74,,340.216,percent of total billed charges,61.74% of total billed charges,702.58,102,,562.064,percent of total billed charges,102% of total billed charges,261.74,38,,209.392,percent of total billed charges,38% of total billed charges,241.08,702.58,
PHARYNX/REMOVE FB,1200174,CDM,981,RC,42809,HCPCS,Outpatient,,,694,520.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,140.25,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,140.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,140.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,140.25,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,140.25,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,124.49,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,145.72,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,419.91,61.74,,335.928,percent of total billed charges,61.74% of total billed charges,118.56,102,,,Fee Schedule,102% of GA Medicaid Rate,140.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,118.56,419.91,
REMOVE CORNEAL FB/WO SLIT LAMP,1200177,CDM,981,RC,65220,HCPCS,Outpatient,,,694,520.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.03,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,46.03,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,46.03,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,46.03,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,46.03,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,158.34,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.28,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,419.91,61.74,,335.928,percent of total billed charges,61.74% of total billed charges,150.8,102,,,Fee Schedule,102% of GA Medicaid Rate,46.03,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,46.03,419.91,
VENOUS CUTDOWN (OVER AGE ONE),1200199,CDM,981,RC,36425,HCPCS,Outpatient,,,694,520.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,44.21,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,44.21,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,44.21,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,44.21,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,44.21,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,72.49,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,47.02,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,419.91,61.74,,335.928,percent of total billed charges,61.74% of total billed charges,69.04,102,,,Fee Schedule,102% of GA Medicaid Rate,44.21,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,44.21,419.91,
"Emergency department visit, moderately severe problem",1001013,CDM,450,RC,99283,HCPCS,Outpatient,,,700,525,,546,78,,436.8,percent of total billed charges,78% of total billed charges,441,63,,352.8,percent of total billed charges,63% of total billed charges,375,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,266,38,,212.8,percent of total billed charges,38% of total billed charges,266,38,,212.8,percent of total billed charges,38% of total billed charges,375,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,630,90,,504,percent of total billed charges,90% of total billed charges,245,35,,196,percent of total billed charges,35% of total billed charges,796.95,67.275,,637.56,percent of total billed charges,67.275% of total billed charges,560,80,,448,percent of total billed charges,80% of total billed charges,268.66,38.38,,214.928,percent of total billed charges,38.38% of total billed charges,560,80,,448,percent of total billed charges,80% of total billed charges,432.18,61.74,,345.744,percent of total billed charges,61.74% of total billed charges,714,102,,571.2,percent of total billed charges,102% of total billed charges,266,38,,212.8,percent of total billed charges,38% of total billed charges,245,796.95,
"Emergency department visit, moderately severe problem",1200103,CDM,981,RC,99283,HCPCS,Outpatient,,,700,525,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,81.48,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,81.48,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,81.48,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,81.48,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,81.48,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,57.54,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,85.32,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,388.96,61.74,,311.168,percent of total billed charges,61.74% of total billed charges,54.8,102,,,Fee Schedule,102% of GA Medicaid Rate,81.48,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,54.8,388.96,
CRICOTHYROTOMY CATHETER SET,3000109,CDM,270,RC,,,Outpatient,,,716.01,537.01,,558.49,78,,446.792,percent of total billed charges,78% of total billed charges,451.09,63,,360.872,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,272.08,38,,217.664,percent of total billed charges,38% of total billed charges,272.08,38,,217.664,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,644.41,90,,515.528,percent of total billed charges,90% of total billed charges,250.6,35,,200.48,percent of total billed charges,35% of total billed charges,481.7,67.275,,385.36,percent of total billed charges,67.275% of total billed charges,572.81,80,,458.248,percent of total billed charges,80% of total billed charges,274.8,38.38,,219.84,percent of total billed charges,38.38% of total billed charges,572.81,80,,458.248,percent of total billed charges,80% of total billed charges,442.06,61.74,,353.648,percent of total billed charges,61.74% of total billed charges,730.33,102,,584.264,percent of total billed charges,102% of total billed charges,272.08,38,,217.664,percent of total billed charges,38% of total billed charges,250.6,730.33,
LYMPHOCYTE SUBSET PANEL 4,5000737,CDM,302,RC,86360,HCPCS,Outpatient,,,717,537.75,,559.26,78,,447.408,percent of total billed charges,78% of total billed charges,59.09,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,46.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,46.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,645.3,90,,516.24,percent of total billed charges,90% of total billed charges,62.04,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,482.36,67.275,,385.888,percent of total billed charges,67.275% of total billed charges,573.6,80,,458.88,percent of total billed charges,80% of total billed charges,47.45,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,573.6,80,,458.88,percent of total billed charges,80% of total billed charges,442.68,61.74,,354.144,percent of total billed charges,61.74% of total billed charges,60.27,102,,,Fee Schedule,102% of GA Medicaid Rate,46.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,46.98,645.3,
ABSOLUTE CD3 & CD4 COUNT,5001926,CDM,302,RC,86360,HCPCS,Outpatient,,,717,537.75,,559.26,78,,447.408,percent of total billed charges,78% of total billed charges,59.09,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,46.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,46.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,645.3,90,,516.24,percent of total billed charges,90% of total billed charges,62.04,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,482.36,67.275,,385.888,percent of total billed charges,67.275% of total billed charges,573.6,80,,458.88,percent of total billed charges,80% of total billed charges,47.45,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,573.6,80,,458.88,percent of total billed charges,80% of total billed charges,442.68,61.74,,354.144,percent of total billed charges,61.74% of total billed charges,60.27,102,,,Fee Schedule,102% of GA Medicaid Rate,46.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,46.98,645.3,
BB RBC EA UNIT,5200008,CDM,390,RC,P9021,HCPCS,Outpatient,,,727,545.25,,567.06,78,,453.648,percent of total billed charges,78% of total billed charges,458.01,63,,366.408,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,276.26,38,,221.008,percent of total billed charges,38% of total billed charges,276.26,38,,221.008,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,654.3,90,,523.44,percent of total billed charges,90% of total billed charges,254.45,35,,203.56,percent of total billed charges,35% of total billed charges,489.09,67.275,,391.272,percent of total billed charges,67.275% of total billed charges,581.6,80,,465.28,percent of total billed charges,80% of total billed charges,279.02,38.38,,223.216,percent of total billed charges,38.38% of total billed charges,581.6,80,,465.28,percent of total billed charges,80% of total billed charges,448.85,61.74,,359.08,percent of total billed charges,61.74% of total billed charges,741.54,102,,593.232,percent of total billed charges,102% of total billed charges,276.26,38,,221.008,percent of total billed charges,38% of total billed charges,254.45,741.54,
OR LEVEL 3 EA ADDL 15 MIN,400125,CDM,360,RC,,,Outpatient,,,730,547.5,,569.4,78,,455.52,percent of total billed charges,78% of total billed charges,459.9,63,,367.92,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,277.4,38,,221.92,percent of total billed charges,38% of total billed charges,277.4,38,,221.92,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,657,90,,525.6,percent of total billed charges,90% of total billed charges,255.5,35,,204.4,percent of total billed charges,35% of total billed charges,491.11,67.275,,392.888,percent of total billed charges,67.275% of total billed charges,584,80,,467.2,percent of total billed charges,80% of total billed charges,280.17,38.38,,224.136,percent of total billed charges,38.38% of total billed charges,584,80,,467.2,percent of total billed charges,80% of total billed charges,450.7,61.74,,360.56,percent of total billed charges,61.74% of total billed charges,744.6,102,,595.68,percent of total billed charges,102% of total billed charges,277.4,38,,221.92,percent of total billed charges,38% of total billed charges,255.5,744.6,
CLIP APPLIER SMALL,3000248,CDM,270,RC,,,Outpatient,,,741.96,556.47,,578.73,78,,462.984,percent of total billed charges,78% of total billed charges,467.43,63,,373.944,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,281.94,38,,225.552,percent of total billed charges,38% of total billed charges,281.94,38,,225.552,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,667.76,90,,534.208,percent of total billed charges,90% of total billed charges,259.69,35,,207.752,percent of total billed charges,35% of total billed charges,499.15,67.275,,399.32,percent of total billed charges,67.275% of total billed charges,593.57,80,,474.856,percent of total billed charges,80% of total billed charges,284.76,38.38,,227.808,percent of total billed charges,38.38% of total billed charges,593.57,80,,474.856,percent of total billed charges,80% of total billed charges,458.09,61.74,,366.472,percent of total billed charges,61.74% of total billed charges,756.8,102,,605.44,percent of total billed charges,102% of total billed charges,281.94,38,,225.552,percent of total billed charges,38% of total billed charges,259.69,756.8,
PEG TRAY 20 FR   6646,3001530,CDM,270,RC,,,Outpatient,,,744,558,,580.32,78,,464.256,percent of total billed charges,78% of total billed charges,468.72,63,,374.976,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,282.72,38,,226.176,percent of total billed charges,38% of total billed charges,282.72,38,,226.176,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,669.6,90,,535.68,percent of total billed charges,90% of total billed charges,260.4,35,,208.32,percent of total billed charges,35% of total billed charges,500.53,67.275,,400.424,percent of total billed charges,67.275% of total billed charges,595.2,80,,476.16,percent of total billed charges,80% of total billed charges,285.55,38.38,,228.44,percent of total billed charges,38.38% of total billed charges,595.2,80,,476.16,percent of total billed charges,80% of total billed charges,459.35,61.74,,367.48,percent of total billed charges,61.74% of total billed charges,758.88,102,,607.104,percent of total billed charges,102% of total billed charges,282.72,38,,226.176,percent of total billed charges,38% of total billed charges,260.4,758.88,
CANNULATED SCREW 6.5X100MM,3007005,CDM,270,RC,,,Outpatient,,,745.59,559.19,,581.56,78,,465.248,percent of total billed charges,78% of total billed charges,469.72,63,,375.776,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,283.32,38,,226.656,percent of total billed charges,38% of total billed charges,283.32,38,,226.656,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,671.03,90,,536.824,percent of total billed charges,90% of total billed charges,260.96,35,,208.768,percent of total billed charges,35% of total billed charges,501.6,67.275,,401.28,percent of total billed charges,67.275% of total billed charges,596.47,80,,477.176,percent of total billed charges,80% of total billed charges,286.16,38.38,,228.928,percent of total billed charges,38.38% of total billed charges,596.47,80,,477.176,percent of total billed charges,80% of total billed charges,460.33,61.74,,368.264,percent of total billed charges,61.74% of total billed charges,760.5,102,,608.4,percent of total billed charges,102% of total billed charges,283.32,38,,226.656,percent of total billed charges,38% of total billed charges,260.96,760.5,
ASNIS 3.2 DRILL BIT,3005063,CDM,270,RC,,,Outpatient,,,745.8,559.35,,581.72,78,,465.376,percent of total billed charges,78% of total billed charges,469.85,63,,375.88,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,283.4,38,,226.72,percent of total billed charges,38% of total billed charges,283.4,38,,226.72,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,671.22,90,,536.976,percent of total billed charges,90% of total billed charges,261.03,35,,208.824,percent of total billed charges,35% of total billed charges,501.74,67.275,,401.392,percent of total billed charges,67.275% of total billed charges,596.64,80,,477.312,percent of total billed charges,80% of total billed charges,286.24,38.38,,228.992,percent of total billed charges,38.38% of total billed charges,596.64,80,,477.312,percent of total billed charges,80% of total billed charges,460.46,61.74,,368.368,percent of total billed charges,61.74% of total billed charges,760.72,102,,608.576,percent of total billed charges,102% of total billed charges,283.4,38,,226.72,percent of total billed charges,38% of total billed charges,261.03,760.72,
CT ORBITS W/O CONTRAST,7400912,CDM,351,RC,70480,HCPCS,Outpatient,,,748,561,,583.44,78,,466.752,percent of total billed charges,78% of total billed charges,471.24,63,,376.992,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,284.24,38,,227.392,percent of total billed charges,38% of total billed charges,284.24,38,,227.392,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,673.2,90,,538.56,percent of total billed charges,90% of total billed charges,261.8,35,,209.44,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,598.4,80,,478.72,percent of total billed charges,80% of total billed charges,287.08,38.38,,229.664,percent of total billed charges,38.38% of total billed charges,598.4,80,,478.72,percent of total billed charges,80% of total billed charges,461.82,61.74,,369.456,percent of total billed charges,61.74% of total billed charges,762.96,102,,610.368,percent of total billed charges,102% of total billed charges,284.24,38,,227.392,percent of total billed charges,38% of total billed charges,261.8,762.96,
US ARTER DUP LWR EXT BILAT COMPLETE,7300027,CDM,921,RC,93925,HCPCS,Outpatient,,,749,561.75,,584.22,78,,467.376,percent of total billed charges,78% of total billed charges,471.87,63,,377.496,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,284.62,38,,227.696,percent of total billed charges,38% of total billed charges,284.62,38,,227.696,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,674.1,90,,539.28,percent of total billed charges,90% of total billed charges,262.15,35,,209.72,percent of total billed charges,35% of total billed charges,503.89,67.275,,403.112,percent of total billed charges,67.275% of total billed charges,599.2,80,,479.36,percent of total billed charges,80% of total billed charges,287.47,38.38,,229.976,percent of total billed charges,38.38% of total billed charges,599.2,80,,479.36,percent of total billed charges,80% of total billed charges,462.43,61.74,,369.944,percent of total billed charges,61.74% of total billed charges,763.98,102,,611.184,percent of total billed charges,102% of total billed charges,284.62,38,,227.696,percent of total billed charges,38% of total billed charges,262.15,763.98,
Study of vessels on both sides of the head and neck,7300004,CDM,921,RC,93880,HCPCS,Outpatient,,,751,563.25,,585.78,78,,468.624,percent of total billed charges,78% of total billed charges,473.13,63,,378.504,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,285.38,38,,228.304,percent of total billed charges,38% of total billed charges,285.38,38,,228.304,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,675.9,90,,540.72,percent of total billed charges,90% of total billed charges,262.85,35,,210.28,percent of total billed charges,35% of total billed charges,505.24,67.275,,404.192,percent of total billed charges,67.275% of total billed charges,600.8,80,,480.64,percent of total billed charges,80% of total billed charges,288.23,38.38,,230.584,percent of total billed charges,38.38% of total billed charges,600.8,80,,480.64,percent of total billed charges,80% of total billed charges,463.67,61.74,,370.936,percent of total billed charges,61.74% of total billed charges,766.02,102,,612.816,percent of total billed charges,102% of total billed charges,285.38,38,,228.304,percent of total billed charges,38% of total billed charges,262.85,766.02,
PROTHROMBIN FACTOR II 20210G,5002075,CDM,301,RC,81240,HCPCS,Outpatient,,,752,564,,586.56,78,,469.248,percent of total billed charges,78% of total billed charges,40,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,65.69,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,65.69,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,676.8,90,,541.44,percent of total billed charges,90% of total billed charges,42,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,505.91,67.275,,404.728,percent of total billed charges,67.275% of total billed charges,601.6,80,,481.28,percent of total billed charges,80% of total billed charges,66.35,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,601.6,80,,481.28,percent of total billed charges,80% of total billed charges,464.28,61.74,,371.424,percent of total billed charges,61.74% of total billed charges,40.8,102,,,Fee Schedule,102% of GA Medicaid Rate,65.69,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,40,676.8,
FRAGILE X DNA PROBE,5003725,CDM,301,RC,81240,HCPCS,Outpatient,,,752,564,,586.56,78,,469.248,percent of total billed charges,78% of total billed charges,40,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,65.69,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,65.69,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,676.8,90,,541.44,percent of total billed charges,90% of total billed charges,42,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,505.91,67.275,,404.728,percent of total billed charges,67.275% of total billed charges,601.6,80,,481.28,percent of total billed charges,80% of total billed charges,66.35,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,601.6,80,,481.28,percent of total billed charges,80% of total billed charges,464.28,61.74,,371.424,percent of total billed charges,61.74% of total billed charges,40.8,102,,,Fee Schedule,102% of GA Medicaid Rate,65.69,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,40,676.8,
GORE BIO-A HERNIA  PLUG,3004287,CDM,270,RC,,,Outpatient,,,759,569.25,,592.02,78,,473.616,percent of total billed charges,78% of total billed charges,478.17,63,,382.536,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,288.42,38,,230.736,percent of total billed charges,38% of total billed charges,288.42,38,,230.736,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,683.1,90,,546.48,percent of total billed charges,90% of total billed charges,265.65,35,,212.52,percent of total billed charges,35% of total billed charges,510.62,67.275,,408.496,percent of total billed charges,67.275% of total billed charges,607.2,80,,485.76,percent of total billed charges,80% of total billed charges,291.3,38.38,,233.04,percent of total billed charges,38.38% of total billed charges,607.2,80,,485.76,percent of total billed charges,80% of total billed charges,468.61,61.74,,374.888,percent of total billed charges,61.74% of total billed charges,774.18,102,,619.344,percent of total billed charges,102% of total billed charges,288.42,38,,230.736,percent of total billed charges,38% of total billed charges,265.65,774.18,
ASNIS 5.0MM PARTIAL CANNULATED SCREW,3005061,CDM,270,RC,,,Outpatient,,,766.8,575.1,,598.1,78,,478.48,percent of total billed charges,78% of total billed charges,483.08,63,,386.464,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,291.38,38,,233.104,percent of total billed charges,38% of total billed charges,291.38,38,,233.104,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,690.12,90,,552.096,percent of total billed charges,90% of total billed charges,268.38,35,,214.704,percent of total billed charges,35% of total billed charges,515.86,67.275,,412.688,percent of total billed charges,67.275% of total billed charges,613.44,80,,490.752,percent of total billed charges,80% of total billed charges,294.3,38.38,,235.44,percent of total billed charges,38.38% of total billed charges,613.44,80,,490.752,percent of total billed charges,80% of total billed charges,473.42,61.74,,378.736,percent of total billed charges,61.74% of total billed charges,782.14,102,,625.712,percent of total billed charges,102% of total billed charges,291.38,38,,233.104,percent of total billed charges,38% of total billed charges,268.38,782.14,
CHANGE GASTROSTOMY TUBE,1001104,CDM,450,RC,43760,HCPCS,Outpatient,,,771,578.25,,601.38,78,,481.104,percent of total billed charges,78% of total billed charges,485.73,63,,388.584,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,292.98,38,,234.384,percent of total billed charges,38% of total billed charges,292.98,38,,234.384,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,693.9,90,,555.12,percent of total billed charges,90% of total billed charges,269.85,35,,215.88,percent of total billed charges,35% of total billed charges,518.69,67.275,,414.952,percent of total billed charges,67.275% of total billed charges,616.8,80,,493.44,percent of total billed charges,80% of total billed charges,295.91,38.38,,236.728,percent of total billed charges,38.38% of total billed charges,616.8,80,,493.44,percent of total billed charges,80% of total billed charges,476.02,61.74,,380.816,percent of total billed charges,61.74% of total billed charges,786.42,102,,629.136,percent of total billed charges,102% of total billed charges,292.98,38,,234.384,percent of total billed charges,38% of total billed charges,269.85,786.42,
IV PYELOGRAM UROGRAPHY,7000545,CDM,320,RC,74400,HCPCS,Outpatient,,,773,579.75,,602.94,78,,482.352,percent of total billed charges,78% of total billed charges,486.99,63,,389.592,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,293.74,38,,234.992,percent of total billed charges,38% of total billed charges,293.74,38,,234.992,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,695.7,90,,556.56,percent of total billed charges,90% of total billed charges,270.55,35,,216.44,percent of total billed charges,35% of total billed charges,520.04,67.275,,416.032,percent of total billed charges,67.275% of total billed charges,618.4,80,,494.72,percent of total billed charges,80% of total billed charges,296.68,38.38,,237.344,percent of total billed charges,38.38% of total billed charges,618.4,80,,494.72,percent of total billed charges,80% of total billed charges,477.25,61.74,,381.8,percent of total billed charges,61.74% of total billed charges,788.46,102,,630.768,percent of total billed charges,102% of total billed charges,293.74,38,,234.992,percent of total billed charges,38% of total billed charges,270.55,788.46,
HARMONIC WAVE 18 CM,3006017,CDM,270,RC,,,Outpatient,,,773.16,579.87,,603.06,78,,482.448,percent of total billed charges,78% of total billed charges,487.09,63,,389.672,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,293.8,38,,235.04,percent of total billed charges,38% of total billed charges,293.8,38,,235.04,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,695.84,90,,556.672,percent of total billed charges,90% of total billed charges,270.61,35,,216.488,percent of total billed charges,35% of total billed charges,520.14,67.275,,416.112,percent of total billed charges,67.275% of total billed charges,618.53,80,,494.824,percent of total billed charges,80% of total billed charges,296.74,38.38,,237.392,percent of total billed charges,38.38% of total billed charges,618.53,80,,494.824,percent of total billed charges,80% of total billed charges,477.35,61.74,,381.88,percent of total billed charges,61.74% of total billed charges,788.62,102,,630.896,percent of total billed charges,102% of total billed charges,293.8,38,,235.04,percent of total billed charges,38% of total billed charges,270.61,788.62,
CT ORBITS W/CONTRAST,7400911,CDM,351,RC,70481,HCPCS,Outpatient,,,779,584.25,,607.62,78,,486.096,percent of total billed charges,78% of total billed charges,490.77,63,,392.616,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,296.02,38,,236.816,percent of total billed charges,38% of total billed charges,296.02,38,,236.816,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,701.1,90,,560.88,percent of total billed charges,90% of total billed charges,272.65,35,,218.12,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,623.2,80,,498.56,percent of total billed charges,80% of total billed charges,298.98,38.38,,239.184,percent of total billed charges,38.38% of total billed charges,623.2,80,,498.56,percent of total billed charges,80% of total billed charges,480.95,61.74,,384.76,percent of total billed charges,61.74% of total billed charges,794.58,102,,635.664,percent of total billed charges,102% of total billed charges,296.02,38,,236.816,percent of total billed charges,38% of total billed charges,272.65,794.58,
"Flouroscopy, or x-ray ""movie"" that takes less than an hour",7000810,CDM,320,RC,76000,HCPCS,Outpatient,,,783,587.25,,610.74,78,,488.592,percent of total billed charges,78% of total billed charges,493.29,63,,394.632,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,297.54,38,,238.032,percent of total billed charges,38% of total billed charges,297.54,38,,238.032,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,704.7,90,,563.76,percent of total billed charges,90% of total billed charges,274.05,35,,219.24,percent of total billed charges,35% of total billed charges,526.76,67.275,,421.408,percent of total billed charges,67.275% of total billed charges,626.4,80,,501.12,percent of total billed charges,80% of total billed charges,300.52,38.38,,240.416,percent of total billed charges,38.38% of total billed charges,626.4,80,,501.12,percent of total billed charges,80% of total billed charges,483.42,61.74,,386.736,percent of total billed charges,61.74% of total billed charges,798.66,102,,638.928,percent of total billed charges,102% of total billed charges,297.54,38,,238.032,percent of total billed charges,38% of total billed charges,274.05,798.66,
BB ADMIN RBC BLD,5200001,CDM,391,RC,36430,HCPCS,Outpatient,,,789,591.75,,615.42,78,,492.336,percent of total billed charges,78% of total billed charges,497.07,63,,397.656,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,299.82,38,,239.856,percent of total billed charges,38% of total billed charges,299.82,38,,239.856,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,710.1,90,,568.08,percent of total billed charges,90% of total billed charges,276.15,35,,220.92,percent of total billed charges,35% of total billed charges,530.8,67.275,,424.64,percent of total billed charges,67.275% of total billed charges,631.2,80,,504.96,percent of total billed charges,80% of total billed charges,302.82,38.38,,242.256,percent of total billed charges,38.38% of total billed charges,631.2,80,,504.96,percent of total billed charges,80% of total billed charges,487.13,61.74,,389.704,percent of total billed charges,61.74% of total billed charges,804.78,102,,643.824,percent of total billed charges,102% of total billed charges,299.82,38,,239.856,percent of total billed charges,38% of total billed charges,276.15,804.78,
BB BLOOD-DIRECTED DONATION,5200006,CDM,391,RC,36430,HCPCS,Outpatient,,,789,591.75,,615.42,78,,492.336,percent of total billed charges,78% of total billed charges,497.07,63,,397.656,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,299.82,38,,239.856,percent of total billed charges,38% of total billed charges,299.82,38,,239.856,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,710.1,90,,568.08,percent of total billed charges,90% of total billed charges,276.15,35,,220.92,percent of total billed charges,35% of total billed charges,530.8,67.275,,424.64,percent of total billed charges,67.275% of total billed charges,631.2,80,,504.96,percent of total billed charges,80% of total billed charges,302.82,38.38,,242.256,percent of total billed charges,38.38% of total billed charges,631.2,80,,504.96,percent of total billed charges,80% of total billed charges,487.13,61.74,,389.704,percent of total billed charges,61.74% of total billed charges,804.78,102,,643.824,percent of total billed charges,102% of total billed charges,299.82,38,,239.856,percent of total billed charges,38% of total billed charges,276.15,804.78,
CHOLANGIOGRAM OPERATIVE,7000655,CDM,320,RC,74320,HCPCS,Outpatient,,,806,604.5,,628.68,78,,502.944,percent of total billed charges,78% of total billed charges,507.78,63,,406.224,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,306.28,38,,245.024,percent of total billed charges,38% of total billed charges,306.28,38,,245.024,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,725.4,90,,580.32,percent of total billed charges,90% of total billed charges,282.1,35,,225.68,percent of total billed charges,35% of total billed charges,542.24,67.275,,433.792,percent of total billed charges,67.275% of total billed charges,644.8,80,,515.84,percent of total billed charges,80% of total billed charges,309.34,38.38,,247.472,percent of total billed charges,38.38% of total billed charges,644.8,80,,515.84,percent of total billed charges,80% of total billed charges,497.62,61.74,,398.096,percent of total billed charges,61.74% of total billed charges,822.12,102,,657.696,percent of total billed charges,102% of total billed charges,306.28,38,,245.024,percent of total billed charges,38% of total billed charges,282.1,822.12,
CT Scan of the face and jaw without dye,7400910,CDM,351,RC,70486,HCPCS,Outpatient,,,808,606,,630.24,78,,504.192,percent of total billed charges,78% of total billed charges,509.04,63,,407.232,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,307.04,38,,245.632,percent of total billed charges,38% of total billed charges,307.04,38,,245.632,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,727.2,90,,581.76,percent of total billed charges,90% of total billed charges,282.8,35,,226.24,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,646.4,80,,517.12,percent of total billed charges,80% of total billed charges,310.11,38.38,,248.088,percent of total billed charges,38.38% of total billed charges,646.4,80,,517.12,percent of total billed charges,80% of total billed charges,498.86,61.74,,399.088,percent of total billed charges,61.74% of total billed charges,824.16,102,,659.328,percent of total billed charges,102% of total billed charges,307.04,38,,245.632,percent of total billed charges,38% of total billed charges,282.8,824.16,
CT Scan of the face and jaw without dye,7400939,CDM,351,RC,70486,HCPCS,Outpatient,,,808,606,,630.24,78,,504.192,percent of total billed charges,78% of total billed charges,509.04,63,,407.232,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,307.04,38,,245.632,percent of total billed charges,38% of total billed charges,307.04,38,,245.632,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,727.2,90,,581.76,percent of total billed charges,90% of total billed charges,282.8,35,,226.24,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,646.4,80,,517.12,percent of total billed charges,80% of total billed charges,310.11,38.38,,248.088,percent of total billed charges,38.38% of total billed charges,646.4,80,,517.12,percent of total billed charges,80% of total billed charges,498.86,61.74,,399.088,percent of total billed charges,61.74% of total billed charges,824.16,102,,659.328,percent of total billed charges,102% of total billed charges,307.04,38,,245.632,percent of total billed charges,38% of total billed charges,282.8,824.16,
CT Scan of the face and jaw without dye,7401010,CDM,351,RC,70486,HCPCS,Outpatient,,,808,606,,630.24,78,,504.192,percent of total billed charges,78% of total billed charges,509.04,63,,407.232,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,307.04,38,,245.632,percent of total billed charges,38% of total billed charges,307.04,38,,245.632,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,727.2,90,,581.76,percent of total billed charges,90% of total billed charges,282.8,35,,226.24,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,646.4,80,,517.12,percent of total billed charges,80% of total billed charges,310.11,38.38,,248.088,percent of total billed charges,38.38% of total billed charges,646.4,80,,517.12,percent of total billed charges,80% of total billed charges,498.86,61.74,,399.088,percent of total billed charges,61.74% of total billed charges,824.16,102,,659.328,percent of total billed charges,102% of total billed charges,307.04,38,,245.632,percent of total billed charges,38% of total billed charges,282.8,824.16,
ARTICULATING ENDO LINEAR CUTTER 45M,3000235,CDM,270,RC,,,Outpatient,,,823.11,617.33,,642.03,78,,513.624,percent of total billed charges,78% of total billed charges,518.56,63,,414.848,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,312.78,38,,250.224,percent of total billed charges,38% of total billed charges,312.78,38,,250.224,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,740.8,90,,592.64,percent of total billed charges,90% of total billed charges,288.09,35,,230.472,percent of total billed charges,35% of total billed charges,553.75,67.275,,443,percent of total billed charges,67.275% of total billed charges,658.49,80,,526.792,percent of total billed charges,80% of total billed charges,315.91,38.38,,252.728,percent of total billed charges,38.38% of total billed charges,658.49,80,,526.792,percent of total billed charges,80% of total billed charges,508.19,61.74,,406.552,percent of total billed charges,61.74% of total billed charges,839.57,102,,671.656,percent of total billed charges,102% of total billed charges,312.78,38,,250.224,percent of total billed charges,38% of total billed charges,288.09,839.57,
LOCKING SCREW 3.0  14MM,3001003,CDM,270,RC,,,Outpatient,,,823.5,617.63,,642.33,78,,513.864,percent of total billed charges,78% of total billed charges,518.81,63,,415.048,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,312.93,38,,250.344,percent of total billed charges,38% of total billed charges,312.93,38,,250.344,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,741.15,90,,592.92,percent of total billed charges,90% of total billed charges,288.23,35,,230.584,percent of total billed charges,35% of total billed charges,554.01,67.275,,443.208,percent of total billed charges,67.275% of total billed charges,658.8,80,,527.04,percent of total billed charges,80% of total billed charges,316.06,38.38,,252.848,percent of total billed charges,38.38% of total billed charges,658.8,80,,527.04,percent of total billed charges,80% of total billed charges,508.43,61.74,,406.744,percent of total billed charges,61.74% of total billed charges,839.97,102,,671.976,percent of total billed charges,102% of total billed charges,312.93,38,,250.344,percent of total billed charges,38% of total billed charges,288.23,839.97,
LOCKING SCREW 3.0  16MM,3001004,CDM,270,RC,,,Outpatient,,,823.5,617.63,,642.33,78,,513.864,percent of total billed charges,78% of total billed charges,518.81,63,,415.048,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,312.93,38,,250.344,percent of total billed charges,38% of total billed charges,312.93,38,,250.344,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,741.15,90,,592.92,percent of total billed charges,90% of total billed charges,288.23,35,,230.584,percent of total billed charges,35% of total billed charges,554.01,67.275,,443.208,percent of total billed charges,67.275% of total billed charges,658.8,80,,527.04,percent of total billed charges,80% of total billed charges,316.06,38.38,,252.848,percent of total billed charges,38.38% of total billed charges,658.8,80,,527.04,percent of total billed charges,80% of total billed charges,508.43,61.74,,406.744,percent of total billed charges,61.74% of total billed charges,839.97,102,,671.976,percent of total billed charges,102% of total billed charges,312.93,38,,250.344,percent of total billed charges,38% of total billed charges,288.23,839.97,
LOCKING SCREW 3.0  18MM,3001005,CDM,270,RC,,,Outpatient,,,823.5,617.63,,642.33,78,,513.864,percent of total billed charges,78% of total billed charges,518.81,63,,415.048,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,312.93,38,,250.344,percent of total billed charges,38% of total billed charges,312.93,38,,250.344,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,741.15,90,,592.92,percent of total billed charges,90% of total billed charges,288.23,35,,230.584,percent of total billed charges,35% of total billed charges,554.01,67.275,,443.208,percent of total billed charges,67.275% of total billed charges,658.8,80,,527.04,percent of total billed charges,80% of total billed charges,316.06,38.38,,252.848,percent of total billed charges,38.38% of total billed charges,658.8,80,,527.04,percent of total billed charges,80% of total billed charges,508.43,61.74,,406.744,percent of total billed charges,61.74% of total billed charges,839.97,102,,671.976,percent of total billed charges,102% of total billed charges,312.93,38,,250.344,percent of total billed charges,38% of total billed charges,288.23,839.97,
LOCKING SCREW 3.0  20MM,3001010,CDM,270,RC,,,Outpatient,,,823.5,617.63,,642.33,78,,513.864,percent of total billed charges,78% of total billed charges,518.81,63,,415.048,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,312.93,38,,250.344,percent of total billed charges,38% of total billed charges,312.93,38,,250.344,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,741.15,90,,592.92,percent of total billed charges,90% of total billed charges,288.23,35,,230.584,percent of total billed charges,35% of total billed charges,554.01,67.275,,443.208,percent of total billed charges,67.275% of total billed charges,658.8,80,,527.04,percent of total billed charges,80% of total billed charges,316.06,38.38,,252.848,percent of total billed charges,38.38% of total billed charges,658.8,80,,527.04,percent of total billed charges,80% of total billed charges,508.43,61.74,,406.744,percent of total billed charges,61.74% of total billed charges,839.97,102,,671.976,percent of total billed charges,102% of total billed charges,312.93,38,,250.344,percent of total billed charges,38% of total billed charges,288.23,839.97,
CT UPPER ET WO C LT,7400931,CDM,352,RC,73200,HCPCS,Outpatient,,,835,626.25,,651.3,78,,521.04,percent of total billed charges,78% of total billed charges,526.05,63,,420.84,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,317.3,38,,253.84,percent of total billed charges,38% of total billed charges,317.3,38,,253.84,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,751.5,90,,601.2,percent of total billed charges,90% of total billed charges,292.25,35,,233.8,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,668,80,,534.4,percent of total billed charges,80% of total billed charges,320.47,38.38,,256.376,percent of total billed charges,38.38% of total billed charges,668,80,,534.4,percent of total billed charges,80% of total billed charges,515.53,61.74,,412.424,percent of total billed charges,61.74% of total billed charges,851.7,102,,681.36,percent of total billed charges,102% of total billed charges,317.3,38,,253.84,percent of total billed charges,38% of total billed charges,292.25,851.7,
CT UPPER ET WO C RT,7400932,CDM,352,RC,73200,HCPCS,Outpatient,,,835,626.25,,651.3,78,,521.04,percent of total billed charges,78% of total billed charges,526.05,63,,420.84,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,317.3,38,,253.84,percent of total billed charges,38% of total billed charges,317.3,38,,253.84,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,751.5,90,,601.2,percent of total billed charges,90% of total billed charges,292.25,35,,233.8,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,668,80,,534.4,percent of total billed charges,80% of total billed charges,320.47,38.38,,256.376,percent of total billed charges,38.38% of total billed charges,668,80,,534.4,percent of total billed charges,80% of total billed charges,515.53,61.74,,412.424,percent of total billed charges,61.74% of total billed charges,851.7,102,,681.36,percent of total billed charges,102% of total billed charges,317.3,38,,253.84,percent of total billed charges,38% of total billed charges,292.25,851.7,
CT THORACIC SPINE W/O CON,7400924,CDM,352,RC,72128,HCPCS,Outpatient,,,839,629.25,,654.42,78,,523.536,percent of total billed charges,78% of total billed charges,528.57,63,,422.856,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,318.82,38,,255.056,percent of total billed charges,38% of total billed charges,318.82,38,,255.056,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,755.1,90,,604.08,percent of total billed charges,90% of total billed charges,293.65,35,,234.92,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,671.2,80,,536.96,percent of total billed charges,80% of total billed charges,322.01,38.38,,257.608,percent of total billed charges,38.38% of total billed charges,671.2,80,,536.96,percent of total billed charges,80% of total billed charges,518,61.74,,414.4,percent of total billed charges,61.74% of total billed charges,855.78,102,,684.624,percent of total billed charges,102% of total billed charges,318.82,38,,255.056,percent of total billed charges,38% of total billed charges,293.65,855.78,
"CT GUIDANCE, NEEDLE PLACEMENT",7400888,CDM,352,RC,77012,HCPCS,Outpatient,,,847,635.25,,660.66,78,,528.528,percent of total billed charges,78% of total billed charges,533.61,63,,426.888,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,321.86,38,,257.488,percent of total billed charges,38% of total billed charges,321.86,38,,257.488,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,762.3,90,,609.84,percent of total billed charges,90% of total billed charges,296.45,35,,237.16,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,677.6,80,,542.08,percent of total billed charges,80% of total billed charges,325.08,38.38,,260.064,percent of total billed charges,38.38% of total billed charges,677.6,80,,542.08,percent of total billed charges,80% of total billed charges,522.94,61.74,,418.352,percent of total billed charges,61.74% of total billed charges,863.94,102,,691.152,percent of total billed charges,102% of total billed charges,321.86,38,,257.488,percent of total billed charges,38% of total billed charges,296.45,863.94,
"Emergency department visit, problem of high severity",1001014,CDM,450,RC,99284,HCPCS,Outpatient,,,850,637.5,,663,78,,530.4,percent of total billed charges,78% of total billed charges,535.5,63,,428.4,percent of total billed charges,63% of total billed charges,375,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,323,38,,258.4,percent of total billed charges,38% of total billed charges,323,38,,258.4,percent of total billed charges,38% of total billed charges,375,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,765,90,,612,percent of total billed charges,90% of total billed charges,297.5,35,,238,percent of total billed charges,35% of total billed charges,796.95,67.275,,637.56,percent of total billed charges,67.275% of total billed charges,680,80,,544,percent of total billed charges,80% of total billed charges,326.23,38.38,,260.984,percent of total billed charges,38.38% of total billed charges,680,80,,544,percent of total billed charges,80% of total billed charges,524.79,61.74,,419.832,percent of total billed charges,61.74% of total billed charges,867,102,,693.6,percent of total billed charges,102% of total billed charges,323,38,,258.4,percent of total billed charges,38% of total billed charges,297.5,867,
"Emergency department visit, problem of high severity",1200104,CDM,981,RC,99284,HCPCS,Outpatient,,,850,637.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,137.02,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,137.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,137.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,137.02,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,137.02,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,88.42,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,143.77,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,472.31,61.74,,377.848,percent of total billed charges,61.74% of total billed charges,84.21,102,,,Fee Schedule,102% of GA Medicaid Rate,137.02,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,84.21,472.31,
LINEAR CUTTER 35MM,3004237,CDM,270,RC,,,Outpatient,,,853.11,639.83,,665.43,78,,532.344,percent of total billed charges,78% of total billed charges,537.46,63,,429.968,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,324.18,38,,259.344,percent of total billed charges,38% of total billed charges,324.18,38,,259.344,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,767.8,90,,614.24,percent of total billed charges,90% of total billed charges,298.59,35,,238.872,percent of total billed charges,35% of total billed charges,573.93,67.275,,459.144,percent of total billed charges,67.275% of total billed charges,682.49,80,,545.992,percent of total billed charges,80% of total billed charges,327.42,38.38,,261.936,percent of total billed charges,38.38% of total billed charges,682.49,80,,545.992,percent of total billed charges,80% of total billed charges,526.71,61.74,,421.368,percent of total billed charges,61.74% of total billed charges,870.17,102,,696.136,percent of total billed charges,102% of total billed charges,324.18,38,,259.344,percent of total billed charges,38% of total billed charges,298.59,870.17,
BB RBC WASHED,5200016,CDM,390,RC,P9022,HCPCS,Outpatient,,,864,648,,673.92,78,,539.136,percent of total billed charges,78% of total billed charges,544.32,63,,435.456,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,328.32,38,,262.656,percent of total billed charges,38% of total billed charges,328.32,38,,262.656,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,777.6,90,,622.08,percent of total billed charges,90% of total billed charges,302.4,35,,241.92,percent of total billed charges,35% of total billed charges,581.26,67.275,,465.008,percent of total billed charges,67.275% of total billed charges,691.2,80,,552.96,percent of total billed charges,80% of total billed charges,331.6,38.38,,265.28,percent of total billed charges,38.38% of total billed charges,691.2,80,,552.96,percent of total billed charges,80% of total billed charges,533.43,61.74,,426.744,percent of total billed charges,61.74% of total billed charges,881.28,102,,705.024,percent of total billed charges,102% of total billed charges,328.32,38,,262.656,percent of total billed charges,38% of total billed charges,302.4,881.28,
A diagnostic procedure that allows a provider to see the organs and other structures in the abdomen,7300970,CDM,402,RC,76705,HCPCS,Outpatient,,,864,648,,673.92,78,,539.136,percent of total billed charges,78% of total billed charges,544.32,63,,435.456,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,328.32,38,,262.656,percent of total billed charges,38% of total billed charges,328.32,38,,262.656,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,777.6,90,,622.08,percent of total billed charges,90% of total billed charges,302.4,35,,241.92,percent of total billed charges,35% of total billed charges,581.26,67.275,,465.008,percent of total billed charges,67.275% of total billed charges,691.2,80,,552.96,percent of total billed charges,80% of total billed charges,331.6,38.38,,265.28,percent of total billed charges,38.38% of total billed charges,691.2,80,,552.96,percent of total billed charges,80% of total billed charges,533.43,61.74,,426.744,percent of total billed charges,61.74% of total billed charges,881.28,102,,705.024,percent of total billed charges,102% of total billed charges,328.32,38,,262.656,percent of total billed charges,38% of total billed charges,302.4,881.28,
CT scan of leg without dye,7400933,CDM,352,RC,73700,HCPCS,Outpatient,,,864,648,,673.92,78,,539.136,percent of total billed charges,78% of total billed charges,544.32,63,,435.456,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,328.32,38,,262.656,percent of total billed charges,38% of total billed charges,328.32,38,,262.656,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,777.6,90,,622.08,percent of total billed charges,90% of total billed charges,302.4,35,,241.92,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,691.2,80,,552.96,percent of total billed charges,80% of total billed charges,331.6,38.38,,265.28,percent of total billed charges,38.38% of total billed charges,691.2,80,,552.96,percent of total billed charges,80% of total billed charges,533.43,61.74,,426.744,percent of total billed charges,61.74% of total billed charges,881.28,102,,705.024,percent of total billed charges,102% of total billed charges,328.32,38,,262.656,percent of total billed charges,38% of total billed charges,302.4,881.28,
CT scan of leg without dye,7400934,CDM,352,RC,73700,HCPCS,Outpatient,,,864,648,,673.92,78,,539.136,percent of total billed charges,78% of total billed charges,544.32,63,,435.456,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,328.32,38,,262.656,percent of total billed charges,38% of total billed charges,328.32,38,,262.656,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,777.6,90,,622.08,percent of total billed charges,90% of total billed charges,302.4,35,,241.92,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,691.2,80,,552.96,percent of total billed charges,80% of total billed charges,331.6,38.38,,265.28,percent of total billed charges,38.38% of total billed charges,691.2,80,,552.96,percent of total billed charges,80% of total billed charges,533.43,61.74,,426.744,percent of total billed charges,61.74% of total billed charges,881.28,102,,705.024,percent of total billed charges,102% of total billed charges,328.32,38,,262.656,percent of total billed charges,38% of total billed charges,302.4,881.28,
CT MAXILLOFACIAL W/CONTRAST,7400948,CDM,351,RC,70487,HCPCS,Outpatient,,,870,652.5,,678.6,78,,542.88,percent of total billed charges,78% of total billed charges,548.1,63,,438.48,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,330.6,38,,264.48,percent of total billed charges,38% of total billed charges,330.6,38,,264.48,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,783,90,,626.4,percent of total billed charges,90% of total billed charges,304.5,35,,243.6,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,696,80,,556.8,percent of total billed charges,80% of total billed charges,333.91,38.38,,267.128,percent of total billed charges,38.38% of total billed charges,696,80,,556.8,percent of total billed charges,80% of total billed charges,537.14,61.74,,429.712,percent of total billed charges,61.74% of total billed charges,887.4,102,,709.92,percent of total billed charges,102% of total billed charges,330.6,38,,264.48,percent of total billed charges,38% of total billed charges,304.5,887.4,
CT ANGIOGRAPHY PELVIS,7400823,CDM,352,RC,72191,HCPCS,Outpatient,,,875,656.25,,682.5,78,,546,percent of total billed charges,78% of total billed charges,551.25,63,,441,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,332.5,38,,266,percent of total billed charges,38% of total billed charges,332.5,38,,266,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,787.5,90,,630,percent of total billed charges,90% of total billed charges,306.25,35,,245,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,700,80,,560,percent of total billed charges,80% of total billed charges,335.83,38.38,,268.664,percent of total billed charges,38.38% of total billed charges,700,80,,560,percent of total billed charges,80% of total billed charges,540.23,61.74,,432.184,percent of total billed charges,61.74% of total billed charges,892.5,102,,714,percent of total billed charges,102% of total billed charges,332.5,38,,266,percent of total billed charges,38% of total billed charges,306.25,892.5,
OR LEVEL 1 - FIRST HOUR,400100,CDM,360,RC,,,Outpatient,,,879,659.25,,685.62,78,,548.496,percent of total billed charges,78% of total billed charges,553.77,63,,443.016,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,334.02,38,,267.216,percent of total billed charges,38% of total billed charges,334.02,38,,267.216,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,791.1,90,,632.88,percent of total billed charges,90% of total billed charges,307.65,35,,246.12,percent of total billed charges,35% of total billed charges,591.35,67.275,,473.08,percent of total billed charges,67.275% of total billed charges,703.2,80,,562.56,percent of total billed charges,80% of total billed charges,337.36,38.38,,269.888,percent of total billed charges,38.38% of total billed charges,703.2,80,,562.56,percent of total billed charges,80% of total billed charges,542.69,61.74,,434.152,percent of total billed charges,61.74% of total billed charges,896.58,102,,717.264,percent of total billed charges,102% of total billed charges,334.02,38,,267.216,percent of total billed charges,38% of total billed charges,307.65,896.58,
CT SOFT TISSUE NECK W/O CONTRAST,7400941,CDM,351,RC,70490,HCPCS,Outpatient,,,898,673.5,,700.44,78,,560.352,percent of total billed charges,78% of total billed charges,565.74,63,,452.592,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,341.24,38,,272.992,percent of total billed charges,38% of total billed charges,341.24,38,,272.992,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,808.2,90,,646.56,percent of total billed charges,90% of total billed charges,314.3,35,,251.44,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,718.4,80,,574.72,percent of total billed charges,80% of total billed charges,344.65,38.38,,275.72,percent of total billed charges,38.38% of total billed charges,718.4,80,,574.72,percent of total billed charges,80% of total billed charges,554.43,61.74,,443.544,percent of total billed charges,61.74% of total billed charges,915.96,102,,732.768,percent of total billed charges,102% of total billed charges,341.24,38,,272.992,percent of total billed charges,38% of total billed charges,314.3,915.96,
"BONE SURVEY,OSSEOUS,LIMITED",7000780,CDM,320,RC,77074,HCPCS,Outpatient,,,904,678,,705.12,78,,564.096,percent of total billed charges,78% of total billed charges,569.52,63,,455.616,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,343.52,38,,274.816,percent of total billed charges,38% of total billed charges,343.52,38,,274.816,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,813.6,90,,650.88,percent of total billed charges,90% of total billed charges,316.4,35,,253.12,percent of total billed charges,35% of total billed charges,608.17,67.275,,486.536,percent of total billed charges,67.275% of total billed charges,723.2,80,,578.56,percent of total billed charges,80% of total billed charges,346.96,38.38,,277.568,percent of total billed charges,38.38% of total billed charges,723.2,80,,578.56,percent of total billed charges,80% of total billed charges,558.13,61.74,,446.504,percent of total billed charges,61.74% of total billed charges,922.08,102,,737.664,percent of total billed charges,102% of total billed charges,343.52,38,,274.816,percent of total billed charges,38% of total billed charges,316.4,922.08,
CURVED INTRA LUMINAL STAPLER 29MM,3004086,CDM,270,RC,,,Outpatient,,,926.24,694.68,,722.47,78,,577.976,percent of total billed charges,78% of total billed charges,583.53,63,,466.824,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,351.97,38,,281.576,percent of total billed charges,38% of total billed charges,351.97,38,,281.576,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,833.62,90,,666.896,percent of total billed charges,90% of total billed charges,324.18,35,,259.344,percent of total billed charges,35% of total billed charges,623.13,67.275,,498.504,percent of total billed charges,67.275% of total billed charges,740.99,80,,592.792,percent of total billed charges,80% of total billed charges,355.49,38.38,,284.392,percent of total billed charges,38.38% of total billed charges,740.99,80,,592.792,percent of total billed charges,80% of total billed charges,571.86,61.74,,457.488,percent of total billed charges,61.74% of total billed charges,944.76,102,,755.808,percent of total billed charges,102% of total billed charges,351.97,38,,281.576,percent of total billed charges,38% of total billed charges,324.18,944.76,
CT of abdomen with dye,7400967,CDM,352,RC,74160,HCPCS,Outpatient,,,928,696,,723.84,78,,579.072,percent of total billed charges,78% of total billed charges,584.64,63,,467.712,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,352.64,38,,282.112,percent of total billed charges,38% of total billed charges,352.64,38,,282.112,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,835.2,90,,668.16,percent of total billed charges,90% of total billed charges,324.8,35,,259.84,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,742.4,80,,593.92,percent of total billed charges,80% of total billed charges,356.17,38.38,,284.936,percent of total billed charges,38.38% of total billed charges,742.4,80,,593.92,percent of total billed charges,80% of total billed charges,572.95,61.74,,458.36,percent of total billed charges,61.74% of total billed charges,946.56,102,,757.248,percent of total billed charges,102% of total billed charges,352.64,38,,282.112,percent of total billed charges,38% of total billed charges,324.8,946.56,
NERVE CONDUCTION STUDIES; 9-10 STUDIES,9600044,CDM,922,RC,95911,HCPCS,Outpatient,,,935,701.25,,729.3,78,,583.44,percent of total billed charges,78% of total billed charges,589.05,63,,471.24,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,355.3,38,,284.24,percent of total billed charges,38% of total billed charges,355.3,38,,284.24,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,841.5,90,,673.2,percent of total billed charges,90% of total billed charges,327.25,35,,261.8,percent of total billed charges,35% of total billed charges,629.02,67.275,,503.216,percent of total billed charges,67.275% of total billed charges,748,80,,598.4,percent of total billed charges,80% of total billed charges,358.85,38.38,,287.08,percent of total billed charges,38.38% of total billed charges,748,80,,598.4,percent of total billed charges,80% of total billed charges,577.27,61.74,,461.816,percent of total billed charges,61.74% of total billed charges,953.7,102,,762.96,percent of total billed charges,102% of total billed charges,355.3,38,,284.24,percent of total billed charges,38% of total billed charges,327.25,953.7,
NERVE CONDUCTION STUDIES; 11-12 STUDIES,9600045,CDM,922,RC,95912,HCPCS,Outpatient,,,935,701.25,,729.3,78,,583.44,percent of total billed charges,78% of total billed charges,589.05,63,,471.24,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,355.3,38,,284.24,percent of total billed charges,38% of total billed charges,355.3,38,,284.24,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,841.5,90,,673.2,percent of total billed charges,90% of total billed charges,327.25,35,,261.8,percent of total billed charges,35% of total billed charges,629.02,67.275,,503.216,percent of total billed charges,67.275% of total billed charges,748,80,,598.4,percent of total billed charges,80% of total billed charges,358.85,38.38,,287.08,percent of total billed charges,38.38% of total billed charges,748,80,,598.4,percent of total billed charges,80% of total billed charges,577.27,61.74,,461.816,percent of total billed charges,61.74% of total billed charges,953.7,102,,762.96,percent of total billed charges,102% of total billed charges,355.3,38,,284.24,percent of total billed charges,38% of total billed charges,327.25,953.7,
NERVE CONDUCTION STUDIES; 13 OR MORE,9600046,CDM,922,RC,95913,HCPCS,Outpatient,,,935,701.25,,729.3,78,,583.44,percent of total billed charges,78% of total billed charges,589.05,63,,471.24,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,355.3,38,,284.24,percent of total billed charges,38% of total billed charges,355.3,38,,284.24,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,841.5,90,,673.2,percent of total billed charges,90% of total billed charges,327.25,35,,261.8,percent of total billed charges,35% of total billed charges,629.02,67.275,,503.216,percent of total billed charges,67.275% of total billed charges,748,80,,598.4,percent of total billed charges,80% of total billed charges,358.85,38.38,,287.08,percent of total billed charges,38.38% of total billed charges,748,80,,598.4,percent of total billed charges,80% of total billed charges,577.27,61.74,,461.816,percent of total billed charges,61.74% of total billed charges,953.7,102,,762.96,percent of total billed charges,102% of total billed charges,355.3,38,,284.24,percent of total billed charges,38% of total billed charges,327.25,953.7,
Ultrasound of back wall of the abdomen with all areas viewed,7300002,CDM,402,RC,76770,HCPCS,Outpatient,,,941,705.75,,733.98,78,,587.184,percent of total billed charges,78% of total billed charges,592.83,63,,474.264,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,357.58,38,,286.064,percent of total billed charges,38% of total billed charges,357.58,38,,286.064,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,846.9,90,,677.52,percent of total billed charges,90% of total billed charges,329.35,35,,263.48,percent of total billed charges,35% of total billed charges,633.06,67.275,,506.448,percent of total billed charges,67.275% of total billed charges,752.8,80,,602.24,percent of total billed charges,80% of total billed charges,361.16,38.38,,288.928,percent of total billed charges,38.38% of total billed charges,752.8,80,,602.24,percent of total billed charges,80% of total billed charges,580.97,61.74,,464.776,percent of total billed charges,61.74% of total billed charges,959.82,102,,767.856,percent of total billed charges,102% of total billed charges,357.58,38,,286.064,percent of total billed charges,38% of total billed charges,329.35,959.82,
QUANTIFERON TB GOLD,5001679,CDM,302,RC,86480,HCPCS,Outpatient,,,946,709.5,,737.88,78,,590.304,percent of total billed charges,78% of total billed charges,77.93,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,61.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,61.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,851.4,90,,681.12,percent of total billed charges,90% of total billed charges,81.83,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,636.42,67.275,,509.136,percent of total billed charges,67.275% of total billed charges,756.8,80,,605.44,percent of total billed charges,80% of total billed charges,62.6,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,756.8,80,,605.44,percent of total billed charges,80% of total billed charges,584.06,61.74,,467.248,percent of total billed charges,61.74% of total billed charges,79.49,102,,,Fee Schedule,102% of GA Medicaid Rate,61.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,61.98,851.4,
BB RBC DEGLYCERO,5200029,CDM,390,RC,P9039,HCPCS,Outpatient,,,950,712.5,,741,78,,592.8,percent of total billed charges,78% of total billed charges,598.5,63,,478.8,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,361,38,,288.8,percent of total billed charges,38% of total billed charges,361,38,,288.8,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,855,90,,684,percent of total billed charges,90% of total billed charges,332.5,35,,266,percent of total billed charges,35% of total billed charges,639.11,67.275,,511.288,percent of total billed charges,67.275% of total billed charges,760,80,,608,percent of total billed charges,80% of total billed charges,364.61,38.38,,291.688,percent of total billed charges,38.38% of total billed charges,760,80,,608,percent of total billed charges,80% of total billed charges,586.53,61.74,,469.224,percent of total billed charges,61.74% of total billed charges,969,102,,775.2,percent of total billed charges,102% of total billed charges,361,38,,288.8,percent of total billed charges,38% of total billed charges,332.5,969,
HIV-1 GENOTYPE,5001660,CDM,306,RC,87901,HCPCS,Outpatient,,,951,713.25,,741.78,78,,593.424,percent of total billed charges,78% of total billed charges,109.67,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,257.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,257.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,855.9,90,,684.72,percent of total billed charges,90% of total billed charges,115.15,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,639.79,67.275,,511.832,percent of total billed charges,67.275% of total billed charges,760.8,80,,608.64,percent of total billed charges,80% of total billed charges,260.02,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,760.8,80,,608.64,percent of total billed charges,80% of total billed charges,587.15,61.74,,469.72,percent of total billed charges,61.74% of total billed charges,111.86,102,,,Fee Schedule,102% of GA Medicaid Rate,257.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,109.67,855.9,
HEPATITIS C GENOTYPING,5001786,CDM,306,RC,87902,HCPCS,Outpatient,,,951,713.25,,741.78,78,,593.424,percent of total billed charges,78% of total billed charges,109.67,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,257.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,257.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,855.9,90,,684.72,percent of total billed charges,90% of total billed charges,115.15,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,639.79,67.275,,511.832,percent of total billed charges,67.275% of total billed charges,760.8,80,,608.64,percent of total billed charges,80% of total billed charges,260.02,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,760.8,80,,608.64,percent of total billed charges,80% of total billed charges,587.15,61.74,,469.72,percent of total billed charges,61.74% of total billed charges,111.86,102,,,Fee Schedule,102% of GA Medicaid Rate,257.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,109.67,855.9,
HIV-1 PHENOTYPE FOR DRUG RESISTANCE,5002082,CDM,306,RC,87901,HCPCS,Outpatient,,,951,713.25,,741.78,78,,593.424,percent of total billed charges,78% of total billed charges,109.67,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,257.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,257.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,855.9,90,,684.72,percent of total billed charges,90% of total billed charges,115.15,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,639.79,67.275,,511.832,percent of total billed charges,67.275% of total billed charges,760.8,80,,608.64,percent of total billed charges,80% of total billed charges,260.02,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,760.8,80,,608.64,percent of total billed charges,80% of total billed charges,587.15,61.74,,469.72,percent of total billed charges,61.74% of total billed charges,111.86,102,,,Fee Schedule,102% of GA Medicaid Rate,257.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,109.67,855.9,
US BREAST RT COMPLETE,7300942,CDM,402,RC,76641,HCPCS,Outpatient,,,951,713.25,,741.78,78,,593.424,percent of total billed charges,78% of total billed charges,599.13,63,,479.304,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,361.38,38,,289.104,percent of total billed charges,38% of total billed charges,361.38,38,,289.104,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,855.9,90,,684.72,percent of total billed charges,90% of total billed charges,332.85,35,,266.28,percent of total billed charges,35% of total billed charges,639.79,67.275,,511.832,percent of total billed charges,67.275% of total billed charges,760.8,80,,608.64,percent of total billed charges,80% of total billed charges,364.99,38.38,,291.992,percent of total billed charges,38.38% of total billed charges,760.8,80,,608.64,percent of total billed charges,80% of total billed charges,587.15,61.74,,469.72,percent of total billed charges,61.74% of total billed charges,970.02,102,,776.016,percent of total billed charges,102% of total billed charges,361.38,38,,289.104,percent of total billed charges,38% of total billed charges,332.85,970.02,
US BREAST LT COMPLETE,7300943,CDM,402,RC,76641,HCPCS,Outpatient,,,951,713.25,,741.78,78,,593.424,percent of total billed charges,78% of total billed charges,599.13,63,,479.304,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,361.38,38,,289.104,percent of total billed charges,38% of total billed charges,361.38,38,,289.104,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,855.9,90,,684.72,percent of total billed charges,90% of total billed charges,332.85,35,,266.28,percent of total billed charges,35% of total billed charges,639.79,67.275,,511.832,percent of total billed charges,67.275% of total billed charges,760.8,80,,608.64,percent of total billed charges,80% of total billed charges,364.99,38.38,,291.992,percent of total billed charges,38.38% of total billed charges,760.8,80,,608.64,percent of total billed charges,80% of total billed charges,587.15,61.74,,469.72,percent of total billed charges,61.74% of total billed charges,970.02,102,,776.016,percent of total billed charges,102% of total billed charges,361.38,38,,289.104,percent of total billed charges,38% of total billed charges,332.85,970.02,
CT CERVICAL SPINE W/CONT,7400920,CDM,352,RC,72126,HCPCS,Outpatient,,,960,720,,748.8,78,,599.04,percent of total billed charges,78% of total billed charges,604.8,63,,483.84,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,364.8,38,,291.84,percent of total billed charges,38% of total billed charges,364.8,38,,291.84,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,864,90,,691.2,percent of total billed charges,90% of total billed charges,336,35,,268.8,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,768,80,,614.4,percent of total billed charges,80% of total billed charges,368.45,38.38,,294.76,percent of total billed charges,38.38% of total billed charges,768,80,,614.4,percent of total billed charges,80% of total billed charges,592.7,61.74,,474.16,percent of total billed charges,61.74% of total billed charges,979.2,102,,783.36,percent of total billed charges,102% of total billed charges,364.8,38,,291.84,percent of total billed charges,38% of total billed charges,336,979.2,
CT LUMBAR SPINE W/CONT,7400926,CDM,352,RC,72132,HCPCS,Outpatient,,,960,720,,748.8,78,,599.04,percent of total billed charges,78% of total billed charges,604.8,63,,483.84,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,364.8,38,,291.84,percent of total billed charges,38% of total billed charges,364.8,38,,291.84,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,864,90,,691.2,percent of total billed charges,90% of total billed charges,336,35,,268.8,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,768,80,,614.4,percent of total billed charges,80% of total billed charges,368.45,38.38,,294.76,percent of total billed charges,38.38% of total billed charges,768,80,,614.4,percent of total billed charges,80% of total billed charges,592.7,61.74,,474.16,percent of total billed charges,61.74% of total billed charges,979.2,102,,783.36,percent of total billed charges,102% of total billed charges,364.8,38,,291.84,percent of total billed charges,38% of total billed charges,336,979.2,
"TRACHEOSTOMY EMERGENCY, CRICOTHROTOMY",1200193,CDM,981,RC,31605,HCPCS,Outpatient,,,967,725.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,374.77,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,374.77,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,374.77,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,374.77,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,374.77,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,222.88,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,400.1,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,585.09,61.74,,468.072,percent of total billed charges,61.74% of total billed charges,212.27,102,,,Fee Schedule,102% of GA Medicaid Rate,374.77,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,212.27,585.09,
"VENTILATOR MGT,INITIAL DAY,INPATIENT",8000074,CDM,410,RC,94002,HCPCS,Outpatient,,,969,726.75,,755.82,78,,604.656,percent of total billed charges,78% of total billed charges,610.47,63,,488.376,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,368.22,38,,294.576,percent of total billed charges,38% of total billed charges,368.22,38,,294.576,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,872.1,90,,697.68,percent of total billed charges,90% of total billed charges,339.15,35,,271.32,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,775.2,80,,620.16,percent of total billed charges,80% of total billed charges,371.9,38.38,,297.52,percent of total billed charges,38.38% of total billed charges,775.2,80,,620.16,percent of total billed charges,80% of total billed charges,598.26,61.74,,478.608,percent of total billed charges,61.74% of total billed charges,988.38,102,,790.704,percent of total billed charges,102% of total billed charges,368.22,38,,294.576,percent of total billed charges,38% of total billed charges,145.93,988.38,
"VENTILATOR MGT, SUBSEQ DAY, INPATIENT",8000076,CDM,410,RC,94003,HCPCS,Outpatient,,,969,726.75,,755.82,78,,604.656,percent of total billed charges,78% of total billed charges,610.47,63,,488.376,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,368.22,38,,294.576,percent of total billed charges,38% of total billed charges,368.22,38,,294.576,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,872.1,90,,697.68,percent of total billed charges,90% of total billed charges,339.15,35,,271.32,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,775.2,80,,620.16,percent of total billed charges,80% of total billed charges,371.9,38.38,,297.52,percent of total billed charges,38.38% of total billed charges,775.2,80,,620.16,percent of total billed charges,80% of total billed charges,598.26,61.74,,478.608,percent of total billed charges,61.74% of total billed charges,988.38,102,,790.704,percent of total billed charges,102% of total billed charges,368.22,38,,294.576,percent of total billed charges,38% of total billed charges,145.93,988.38,
CT ORBITS W/WO CONTRAST,7400913,CDM,351,RC,70482,HCPCS,Outpatient,,,970,727.5,,756.6,78,,605.28,percent of total billed charges,78% of total billed charges,611.1,63,,488.88,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,368.6,38,,294.88,percent of total billed charges,38% of total billed charges,368.6,38,,294.88,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,873,90,,698.4,percent of total billed charges,90% of total billed charges,339.5,35,,271.6,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,776,80,,620.8,percent of total billed charges,80% of total billed charges,372.29,38.38,,297.832,percent of total billed charges,38.38% of total billed charges,776,80,,620.8,percent of total billed charges,80% of total billed charges,598.88,61.74,,479.104,percent of total billed charges,61.74% of total billed charges,989.4,102,,791.52,percent of total billed charges,102% of total billed charges,368.6,38,,294.88,percent of total billed charges,38% of total billed charges,339.5,989.4,
"A procedure most commonly ordered to detect areas of abnormal bone growth due to fractures, tumors, infection, or other bone issues",7400907,CDM,341,RC,78306,HCPCS,Outpatient,,,971,728.25,,757.38,78,,605.904,percent of total billed charges,78% of total billed charges,611.73,63,,489.384,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,368.98,38,,295.184,percent of total billed charges,38% of total billed charges,368.98,38,,295.184,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,873.9,90,,699.12,percent of total billed charges,90% of total billed charges,339.85,35,,271.88,percent of total billed charges,35% of total billed charges,,,,,Other,Not Separately reimbursable,776.8,80,,621.44,percent of total billed charges,80% of total billed charges,372.67,38.38,,298.136,percent of total billed charges,38.38% of total billed charges,776.8,80,,621.44,percent of total billed charges,80% of total billed charges,599.5,61.74,,479.6,percent of total billed charges,61.74% of total billed charges,990.42,102,,792.336,percent of total billed charges,102% of total billed charges,368.98,38,,295.184,percent of total billed charges,38% of total billed charges,339.85,990.42,
US BREAST BILAT COMPLETE,7300944,CDM,402,RC,76641,HCPCS,Outpatient,,,979,734.25,,763.62,78,,610.896,percent of total billed charges,78% of total billed charges,616.77,63,,493.416,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,372.02,38,,297.616,percent of total billed charges,38% of total billed charges,372.02,38,,297.616,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,881.1,90,,704.88,percent of total billed charges,90% of total billed charges,342.65,35,,274.12,percent of total billed charges,35% of total billed charges,658.62,67.275,,526.896,percent of total billed charges,67.275% of total billed charges,783.2,80,,626.56,percent of total billed charges,80% of total billed charges,375.74,38.38,,300.592,percent of total billed charges,38.38% of total billed charges,783.2,80,,626.56,percent of total billed charges,80% of total billed charges,604.43,61.74,,483.544,percent of total billed charges,61.74% of total billed charges,998.58,102,,798.864,percent of total billed charges,102% of total billed charges,372.02,38,,297.616,percent of total billed charges,38% of total billed charges,342.65,998.58,
OR LEVEL 4 EA ADDL 15 MIN,400135,CDM,360,RC,,,Outpatient,,,980,735,,764.4,78,,611.52,percent of total billed charges,78% of total billed charges,617.4,63,,493.92,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,372.4,38,,297.92,percent of total billed charges,38% of total billed charges,372.4,38,,297.92,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,882,90,,705.6,percent of total billed charges,90% of total billed charges,343,35,,274.4,percent of total billed charges,35% of total billed charges,659.3,67.275,,527.44,percent of total billed charges,67.275% of total billed charges,784,80,,627.2,percent of total billed charges,80% of total billed charges,376.12,38.38,,300.896,percent of total billed charges,38.38% of total billed charges,784,80,,627.2,percent of total billed charges,80% of total billed charges,605.05,61.74,,484.04,percent of total billed charges,61.74% of total billed charges,999.6,102,,799.68,percent of total billed charges,102% of total billed charges,372.4,38,,297.92,percent of total billed charges,38% of total billed charges,343,999.6,
EMERG TRACH/CRICOTHYROID,1001060,CDM,450,RC,31605,HCPCS,Outpatient,,,981,735.75,,765.18,78,,612.144,percent of total billed charges,78% of total billed charges,618.03,63,,494.424,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,372.78,38,,298.224,percent of total billed charges,38% of total billed charges,372.78,38,,298.224,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,882.9,90,,706.32,percent of total billed charges,90% of total billed charges,343.35,35,,274.68,percent of total billed charges,35% of total billed charges,659.97,67.275,,527.976,percent of total billed charges,67.275% of total billed charges,784.8,80,,627.84,percent of total billed charges,80% of total billed charges,376.51,38.38,,301.208,percent of total billed charges,38.38% of total billed charges,784.8,80,,627.84,percent of total billed charges,80% of total billed charges,605.67,61.74,,484.536,percent of total billed charges,61.74% of total billed charges,1000.62,102,,800.496,percent of total billed charges,102% of total billed charges,372.78,38,,298.224,percent of total billed charges,38% of total billed charges,343.35,1000.62,
PROCEED SMALL HERNIA PATCH 4.3x4.3,3001911,CDM,270,RC,,,Outpatient,,,987.1,740.33,,769.94,78,,615.952,percent of total billed charges,78% of total billed charges,621.87,63,,497.496,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,375.1,38,,300.08,percent of total billed charges,38% of total billed charges,375.1,38,,300.08,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,888.39,90,,710.712,percent of total billed charges,90% of total billed charges,345.49,35,,276.392,percent of total billed charges,35% of total billed charges,664.07,67.275,,531.256,percent of total billed charges,67.275% of total billed charges,789.68,80,,631.744,percent of total billed charges,80% of total billed charges,378.85,38.38,,303.08,percent of total billed charges,38.38% of total billed charges,789.68,80,,631.744,percent of total billed charges,80% of total billed charges,609.44,61.74,,487.552,percent of total billed charges,61.74% of total billed charges,1006.84,102,,805.472,percent of total billed charges,102% of total billed charges,375.1,38,,300.08,percent of total billed charges,38% of total billed charges,345.49,1006.84,
CT MAXILLOFACIAL W/WO CONTRAST,7400949,CDM,351,RC,70488,HCPCS,Outpatient,,,992,744,,773.76,78,,619.008,percent of total billed charges,78% of total billed charges,624.96,63,,499.968,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,376.96,38,,301.568,percent of total billed charges,38% of total billed charges,376.96,38,,301.568,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,892.8,90,,714.24,percent of total billed charges,90% of total billed charges,347.2,35,,277.76,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,793.6,80,,634.88,percent of total billed charges,80% of total billed charges,380.73,38.38,,304.584,percent of total billed charges,38.38% of total billed charges,793.6,80,,634.88,percent of total billed charges,80% of total billed charges,612.46,61.74,,489.968,percent of total billed charges,61.74% of total billed charges,1011.84,102,,809.472,percent of total billed charges,102% of total billed charges,376.96,38,,301.568,percent of total billed charges,38% of total billed charges,347.2,1011.84,
"Emergency department visit, problem with significant threat to life or function",1001015,CDM,450,RC,99285,HCPCS,Outpatient,,,1000,750,,780,78,,624,percent of total billed charges,78% of total billed charges,630,63,,504,percent of total billed charges,63% of total billed charges,1071.64,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,380,38,,304,percent of total billed charges,38% of total billed charges,380,38,,304,percent of total billed charges,38% of total billed charges,1071.64,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,900,90,,720,percent of total billed charges,90% of total billed charges,350,35,,280,percent of total billed charges,35% of total billed charges,796.95,67.275,,637.56,percent of total billed charges,67.275% of total billed charges,800,80,,640,percent of total billed charges,80% of total billed charges,383.8,38.38,,307.04,percent of total billed charges,38.38% of total billed charges,800,80,,640,percent of total billed charges,80% of total billed charges,617.4,61.74,,493.92,percent of total billed charges,61.74% of total billed charges,1020,102,,816,percent of total billed charges,102% of total billed charges,380,38,,304,percent of total billed charges,38% of total billed charges,350,1071.64,
"Emergency department visit, problem with significant threat to life or function",1200215,CDM,981,RC,99285,HCPCS,Outpatient,,,1000,750,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,199.62,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,199.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,199.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,199.62,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,199.62,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,139.03,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,209.13,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,555.66,61.74,,444.528,percent of total billed charges,61.74% of total billed charges,132.41,102,,,Fee Schedule,102% of GA Medicaid Rate,199.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,132.41,555.66,
CT LUMBAR SPINE W/WO CONT,7400928,CDM,352,RC,72133,HCPCS,Outpatient,,,1007,755.25,,785.46,78,,628.368,percent of total billed charges,78% of total billed charges,634.41,63,,507.528,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,382.66,38,,306.128,percent of total billed charges,38% of total billed charges,382.66,38,,306.128,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,906.3,90,,725.04,percent of total billed charges,90% of total billed charges,352.45,35,,281.96,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,805.6,80,,644.48,percent of total billed charges,80% of total billed charges,386.49,38.38,,309.192,percent of total billed charges,38.38% of total billed charges,805.6,80,,644.48,percent of total billed charges,80% of total billed charges,621.72,61.74,,497.376,percent of total billed charges,61.74% of total billed charges,1027.14,102,,821.712,percent of total billed charges,102% of total billed charges,382.66,38,,306.128,percent of total billed charges,38% of total billed charges,352.45,1027.14,
MRI of leg without dye,7500973,CDM,610,RC,73718,HCPCS,Outpatient,,,1007,755.25,,785.46,78,,628.368,percent of total billed charges,78% of total billed charges,634.41,63,,507.528,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,382.66,38,,306.128,percent of total billed charges,38% of total billed charges,382.66,38,,306.128,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,906.3,90,,725.04,percent of total billed charges,90% of total billed charges,352.45,35,,281.96,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,805.6,80,,644.48,percent of total billed charges,80% of total billed charges,386.49,38.38,,309.192,percent of total billed charges,38.38% of total billed charges,805.6,80,,644.48,percent of total billed charges,80% of total billed charges,621.72,61.74,,497.376,percent of total billed charges,61.74% of total billed charges,1027.14,102,,821.712,percent of total billed charges,102% of total billed charges,382.66,38,,306.128,percent of total billed charges,38% of total billed charges,352.45,1027.14,
MRI UPR EXT OTHER THAN JNT W/O CONTRAST,7500978,CDM,610,RC,73218,HCPCS,Outpatient,,,1007,755.25,,785.46,78,,628.368,percent of total billed charges,78% of total billed charges,634.41,63,,507.528,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,382.66,38,,306.128,percent of total billed charges,38% of total billed charges,382.66,38,,306.128,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,906.3,90,,725.04,percent of total billed charges,90% of total billed charges,352.45,35,,281.96,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,805.6,80,,644.48,percent of total billed charges,80% of total billed charges,386.49,38.38,,309.192,percent of total billed charges,38.38% of total billed charges,805.6,80,,644.48,percent of total billed charges,80% of total billed charges,621.72,61.74,,497.376,percent of total billed charges,61.74% of total billed charges,1027.14,102,,821.712,percent of total billed charges,102% of total billed charges,382.66,38,,306.128,percent of total billed charges,38% of total billed charges,352.45,1027.14,
MRI of abdomen without dye,7501009,CDM,610,RC,74181,HCPCS,Outpatient,,,1007,755.25,,785.46,78,,628.368,percent of total billed charges,78% of total billed charges,634.41,63,,507.528,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,382.66,38,,306.128,percent of total billed charges,38% of total billed charges,382.66,38,,306.128,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,906.3,90,,725.04,percent of total billed charges,90% of total billed charges,352.45,35,,281.96,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,805.6,80,,644.48,percent of total billed charges,80% of total billed charges,386.49,38.38,,309.192,percent of total billed charges,38.38% of total billed charges,805.6,80,,644.48,percent of total billed charges,80% of total billed charges,621.72,61.74,,497.376,percent of total billed charges,61.74% of total billed charges,1027.14,102,,821.712,percent of total billed charges,102% of total billed charges,382.66,38,,306.128,percent of total billed charges,38% of total billed charges,352.45,1027.14,
CT of pelvis without dye,7400915,CDM,352,RC,72192,HCPCS,Outpatient,,,1025,768.75,,799.5,78,,639.6,percent of total billed charges,78% of total billed charges,645.75,63,,516.6,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,389.5,38,,311.6,percent of total billed charges,38% of total billed charges,389.5,38,,311.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,922.5,90,,738,percent of total billed charges,90% of total billed charges,358.75,35,,287,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,820,80,,656,percent of total billed charges,80% of total billed charges,393.4,38.38,,314.72,percent of total billed charges,38.38% of total billed charges,820,80,,656,percent of total billed charges,80% of total billed charges,632.84,61.74,,506.272,percent of total billed charges,61.74% of total billed charges,1045.5,102,,836.4,percent of total billed charges,102% of total billed charges,389.5,38,,311.6,percent of total billed charges,38% of total billed charges,358.75,1045.5,
CT of pelvis without dye,7400994,CDM,352,RC,72192,HCPCS,Outpatient,,,1025,768.75,,799.5,78,,639.6,percent of total billed charges,78% of total billed charges,645.75,63,,516.6,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,389.5,38,,311.6,percent of total billed charges,38% of total billed charges,389.5,38,,311.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,922.5,90,,738,percent of total billed charges,90% of total billed charges,358.75,35,,287,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,820,80,,656,percent of total billed charges,80% of total billed charges,393.4,38.38,,314.72,percent of total billed charges,38.38% of total billed charges,820,80,,656,percent of total billed charges,80% of total billed charges,632.84,61.74,,506.272,percent of total billed charges,61.74% of total billed charges,1045.5,102,,836.4,percent of total billed charges,102% of total billed charges,389.5,38,,311.6,percent of total billed charges,38% of total billed charges,358.75,1045.5,
CT CER SPINE W/WO CONT,7400922,CDM,352,RC,72127,HCPCS,Outpatient,,,1026,769.5,,800.28,78,,640.224,percent of total billed charges,78% of total billed charges,646.38,63,,517.104,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,389.88,38,,311.904,percent of total billed charges,38% of total billed charges,389.88,38,,311.904,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,923.4,90,,738.72,percent of total billed charges,90% of total billed charges,359.1,35,,287.28,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,820.8,80,,656.64,percent of total billed charges,80% of total billed charges,393.78,38.38,,315.024,percent of total billed charges,38.38% of total billed charges,820.8,80,,656.64,percent of total billed charges,80% of total billed charges,633.45,61.74,,506.76,percent of total billed charges,61.74% of total billed charges,1046.52,102,,837.216,percent of total billed charges,102% of total billed charges,389.88,38,,311.904,percent of total billed charges,38% of total billed charges,359.1,1046.52,
LAYER CLOSURE 7.6 TO 12.5 CM,1200123,CDM,981,RC,12044,HCPCS,Outpatient,,,1027,770.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,235.09,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,235.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,235.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,235.09,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,235.09,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,191.25,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,242.64,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,621.39,61.74,,497.112,percent of total billed charges,61.74% of total billed charges,182.14,102,,,Fee Schedule,102% of GA Medicaid Rate,235.09,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,182.14,621.39,
LAYER CLOSURE 12.6 TO 20 CM,1200124,CDM,981,RC,12045,HCPCS,Outpatient,,,1027,770.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,302.07,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,302.07,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,302.07,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,302.07,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,302.07,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,224.29,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,310.35,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,621.39,61.74,,497.112,percent of total billed charges,61.74% of total billed charges,213.61,102,,,Fee Schedule,102% of GA Medicaid Rate,302.07,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,213.61,621.39,
Removal of infected skin,1200179,CDM,981,RC,11000,HCPCS,Outpatient,,,1027,770.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,30.45,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,30.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,30.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,30.45,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,30.45,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,37.02,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,32.35,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,621.39,61.74,,497.112,percent of total billed charges,61.74% of total billed charges,35.26,102,,,Fee Schedule,102% of GA Medicaid Rate,30.45,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,30.45,621.39,
LAYER CLOSURE 20.1 TO 30 CM,1200224,CDM,981,RC,12036,HCPCS,Outpatient,,,1027,770.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,311.71,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,311.71,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,311.71,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,311.71,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,311.71,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,269.45,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,330.34,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,621.39,61.74,,497.112,percent of total billed charges,61.74% of total billed charges,256.62,102,,,Fee Schedule,102% of GA Medicaid Rate,311.71,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,256.62,621.39,
"TX OF SUPERFICIAL WOUND DEHIS, SIMPLE",1200230,CDM,981,RC,12020,HCPCS,Outpatient,,,1027,770.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,207.58,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,207.58,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,207.58,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,207.58,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,207.58,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,158.51,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,214.38,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,621.39,61.74,,497.112,percent of total billed charges,61.74% of total billed charges,150.96,102,,,Fee Schedule,102% of GA Medicaid Rate,207.58,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,150.96,621.39,
CT THORACIC SPINE W/CONT,7400923,CDM,352,RC,72129,HCPCS,Outpatient,,,1030,772.5,,803.4,78,,642.72,percent of total billed charges,78% of total billed charges,648.9,63,,519.12,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,391.4,38,,313.12,percent of total billed charges,38% of total billed charges,391.4,38,,313.12,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,927,90,,741.6,percent of total billed charges,90% of total billed charges,360.5,35,,288.4,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,824,80,,659.2,percent of total billed charges,80% of total billed charges,395.31,38.38,,316.248,percent of total billed charges,38.38% of total billed charges,824,80,,659.2,percent of total billed charges,80% of total billed charges,635.92,61.74,,508.736,percent of total billed charges,61.74% of total billed charges,1050.6,102,,840.48,percent of total billed charges,102% of total billed charges,391.4,38,,313.12,percent of total billed charges,38% of total billed charges,360.18,1050.6,
POWER PORT ISP IMPLANT 6FR,3005001,CDM,270,RC,,,Outpatient,,,1039.5,779.63,,810.81,78,,648.648,percent of total billed charges,78% of total billed charges,654.89,63,,523.912,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,395.01,38,,316.008,percent of total billed charges,38% of total billed charges,395.01,38,,316.008,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,935.55,90,,748.44,percent of total billed charges,90% of total billed charges,363.83,35,,291.064,percent of total billed charges,35% of total billed charges,699.32,67.275,,559.456,percent of total billed charges,67.275% of total billed charges,831.6,80,,665.28,percent of total billed charges,80% of total billed charges,398.96,38.38,,319.168,percent of total billed charges,38.38% of total billed charges,831.6,80,,665.28,percent of total billed charges,80% of total billed charges,641.79,61.74,,513.432,percent of total billed charges,61.74% of total billed charges,1060.29,102,,848.232,percent of total billed charges,102% of total billed charges,395.01,38,,316.008,percent of total billed charges,38% of total billed charges,363.83,1060.29,
TOPAZ MICRO DEBRIDER,3004021,CDM,270,RC,,,Outpatient,,,1050,787.5,,819,78,,655.2,percent of total billed charges,78% of total billed charges,661.5,63,,529.2,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,399,38,,319.2,percent of total billed charges,38% of total billed charges,399,38,,319.2,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,945,90,,756,percent of total billed charges,90% of total billed charges,367.5,35,,294,percent of total billed charges,35% of total billed charges,706.39,67.275,,565.112,percent of total billed charges,67.275% of total billed charges,840,80,,672,percent of total billed charges,80% of total billed charges,402.99,38.38,,322.392,percent of total billed charges,38.38% of total billed charges,840,80,,672,percent of total billed charges,80% of total billed charges,648.27,61.74,,518.616,percent of total billed charges,61.74% of total billed charges,1071,102,,856.8,percent of total billed charges,102% of total billed charges,399,38,,319.2,percent of total billed charges,38% of total billed charges,367.5,1071,
BB PLATELET PHERESIS,5200003,CDM,390,RC,P9034,HCPCS,Outpatient,,,1076,807,,839.28,78,,671.424,percent of total billed charges,78% of total billed charges,677.88,63,,542.304,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,408.88,38,,327.104,percent of total billed charges,38% of total billed charges,408.88,38,,327.104,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,968.4,90,,774.72,percent of total billed charges,90% of total billed charges,376.6,35,,301.28,percent of total billed charges,35% of total billed charges,723.88,67.275,,579.104,percent of total billed charges,67.275% of total billed charges,860.8,80,,688.64,percent of total billed charges,80% of total billed charges,412.97,38.38,,330.376,percent of total billed charges,38.38% of total billed charges,860.8,80,,688.64,percent of total billed charges,80% of total billed charges,664.32,61.74,,531.456,percent of total billed charges,61.74% of total billed charges,1097.52,102,,878.016,percent of total billed charges,102% of total billed charges,408.88,38,,327.104,percent of total billed charges,38% of total billed charges,376.6,1097.52,
TEMP EXTERNAL PACING,1001054,CDM,450,RC,92953,HCPCS,Outpatient,,,1078,808.5,,840.84,78,,672.672,percent of total billed charges,78% of total billed charges,679.14,63,,543.312,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,409.64,38,,327.712,percent of total billed charges,38% of total billed charges,409.64,38,,327.712,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,970.2,90,,776.16,percent of total billed charges,90% of total billed charges,377.3,35,,301.84,percent of total billed charges,35% of total billed charges,725.22,67.275,,580.176,percent of total billed charges,67.275% of total billed charges,862.4,80,,689.92,percent of total billed charges,80% of total billed charges,413.74,38.38,,330.992,percent of total billed charges,38.38% of total billed charges,862.4,80,,689.92,percent of total billed charges,80% of total billed charges,665.56,61.74,,532.448,percent of total billed charges,61.74% of total billed charges,1099.56,102,,879.648,percent of total billed charges,102% of total billed charges,409.64,38,,327.712,percent of total billed charges,38% of total billed charges,377.3,1099.56,
INSERT TEMP PACEMAKER,1200197,CDM,981,RC,92953,HCPCS,Outpatient,,,1078,808.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.13,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,1.13,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,1.13,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,1.13,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,1.13,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,13.57,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.28,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,652.25,61.74,,521.8,percent of total billed charges,61.74% of total billed charges,12.92,102,,,Fee Schedule,102% of GA Medicaid Rate,1.13,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,1.13,652.25,
CT ANGIOGRAPHY LOWER EXT W/WO CONTRAST,7400810,CDM,352,RC,73706,HCPCS,Outpatient,,,1097,822.75,,855.66,78,,684.528,percent of total billed charges,78% of total billed charges,691.11,63,,552.888,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,416.86,38,,333.488,percent of total billed charges,38% of total billed charges,416.86,38,,333.488,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,987.3,90,,789.84,percent of total billed charges,90% of total billed charges,383.95,35,,307.16,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,877.6,80,,702.08,percent of total billed charges,80% of total billed charges,421.03,38.38,,336.824,percent of total billed charges,38.38% of total billed charges,877.6,80,,702.08,percent of total billed charges,80% of total billed charges,677.29,61.74,,541.832,percent of total billed charges,61.74% of total billed charges,1118.94,102,,895.152,percent of total billed charges,102% of total billed charges,416.86,38,,333.488,percent of total billed charges,38% of total billed charges,360.18,1118.94,
CT UPP EXT WITH CON LT,7400935,CDM,352,RC,73201,HCPCS,Outpatient,,,1100,825,,858,78,,686.4,percent of total billed charges,78% of total billed charges,693,63,,554.4,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,418,38,,334.4,percent of total billed charges,38% of total billed charges,418,38,,334.4,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,990,90,,792,percent of total billed charges,90% of total billed charges,385,35,,308,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,880,80,,704,percent of total billed charges,80% of total billed charges,422.18,38.38,,337.744,percent of total billed charges,38.38% of total billed charges,880,80,,704,percent of total billed charges,80% of total billed charges,679.14,61.74,,543.312,percent of total billed charges,61.74% of total billed charges,1122,102,,897.6,percent of total billed charges,102% of total billed charges,418,38,,334.4,percent of total billed charges,38% of total billed charges,360.18,1122,
CT UPP EXT WITH CON RT,7400936,CDM,352,RC,73201,HCPCS,Outpatient,,,1100,825,,858,78,,686.4,percent of total billed charges,78% of total billed charges,693,63,,554.4,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,418,38,,334.4,percent of total billed charges,38% of total billed charges,418,38,,334.4,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,990,90,,792,percent of total billed charges,90% of total billed charges,385,35,,308,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,880,80,,704,percent of total billed charges,80% of total billed charges,422.18,38.38,,337.744,percent of total billed charges,38.38% of total billed charges,880,80,,704,percent of total billed charges,80% of total billed charges,679.14,61.74,,543.312,percent of total billed charges,61.74% of total billed charges,1122,102,,897.6,percent of total billed charges,102% of total billed charges,418,38,,334.4,percent of total billed charges,38% of total billed charges,360.18,1122,
CT LOW EXT W/CON LT,7400937,CDM,352,RC,73701,HCPCS,Outpatient,,,1100,825,,858,78,,686.4,percent of total billed charges,78% of total billed charges,693,63,,554.4,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,418,38,,334.4,percent of total billed charges,38% of total billed charges,418,38,,334.4,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,990,90,,792,percent of total billed charges,90% of total billed charges,385,35,,308,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,880,80,,704,percent of total billed charges,80% of total billed charges,422.18,38.38,,337.744,percent of total billed charges,38.38% of total billed charges,880,80,,704,percent of total billed charges,80% of total billed charges,679.14,61.74,,543.312,percent of total billed charges,61.74% of total billed charges,1122,102,,897.6,percent of total billed charges,102% of total billed charges,418,38,,334.4,percent of total billed charges,38% of total billed charges,360.18,1122,
CT LOW EXT W/CON RT,7400938,CDM,352,RC,73701,HCPCS,Outpatient,,,1100,825,,858,78,,686.4,percent of total billed charges,78% of total billed charges,693,63,,554.4,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,418,38,,334.4,percent of total billed charges,38% of total billed charges,418,38,,334.4,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,990,90,,792,percent of total billed charges,90% of total billed charges,385,35,,308,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,880,80,,704,percent of total billed charges,80% of total billed charges,422.18,38.38,,337.744,percent of total billed charges,38.38% of total billed charges,880,80,,704,percent of total billed charges,80% of total billed charges,679.14,61.74,,543.312,percent of total billed charges,61.74% of total billed charges,1122,102,,897.6,percent of total billed charges,102% of total billed charges,418,38,,334.4,percent of total billed charges,38% of total billed charges,360.18,1122,
CT scan of neck with dye,7400940,CDM,351,RC,70491,HCPCS,Outpatient,,,1108,831,,864.24,78,,691.392,percent of total billed charges,78% of total billed charges,698.04,63,,558.432,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,421.04,38,,336.832,percent of total billed charges,38% of total billed charges,421.04,38,,336.832,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,997.2,90,,797.76,percent of total billed charges,90% of total billed charges,387.8,35,,310.24,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,886.4,80,,709.12,percent of total billed charges,80% of total billed charges,425.25,38.38,,340.2,percent of total billed charges,38.38% of total billed charges,886.4,80,,709.12,percent of total billed charges,80% of total billed charges,684.08,61.74,,547.264,percent of total billed charges,61.74% of total billed charges,1130.16,102,,904.128,percent of total billed charges,102% of total billed charges,421.04,38,,336.832,percent of total billed charges,38% of total billed charges,360.18,1130.16,
MRI of chest and spine without dye,7500954,CDM,612,RC,72146,HCPCS,Outpatient,,,1108,831,,864.24,78,,691.392,percent of total billed charges,78% of total billed charges,698.04,63,,558.432,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,421.04,38,,336.832,percent of total billed charges,38% of total billed charges,421.04,38,,336.832,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,997.2,90,,797.76,percent of total billed charges,90% of total billed charges,387.8,35,,310.24,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,886.4,80,,709.12,percent of total billed charges,80% of total billed charges,425.25,38.38,,340.2,percent of total billed charges,38.38% of total billed charges,886.4,80,,709.12,percent of total billed charges,80% of total billed charges,684.08,61.74,,547.264,percent of total billed charges,61.74% of total billed charges,1130.16,102,,904.128,percent of total billed charges,102% of total billed charges,421.04,38,,336.832,percent of total billed charges,38% of total billed charges,387.8,1130.16,
MRI scan of lower spinal canal,7500956,CDM,612,RC,72148,HCPCS,Outpatient,,,1108,831,,864.24,78,,691.392,percent of total billed charges,78% of total billed charges,698.04,63,,558.432,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,421.04,38,,336.832,percent of total billed charges,38% of total billed charges,421.04,38,,336.832,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,997.2,90,,797.76,percent of total billed charges,90% of total billed charges,387.8,35,,310.24,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,886.4,80,,709.12,percent of total billed charges,80% of total billed charges,425.25,38.38,,340.2,percent of total billed charges,38.38% of total billed charges,886.4,80,,709.12,percent of total billed charges,80% of total billed charges,684.08,61.74,,547.264,percent of total billed charges,61.74% of total billed charges,1130.16,102,,904.128,percent of total billed charges,102% of total billed charges,421.04,38,,336.832,percent of total billed charges,38% of total billed charges,387.8,1130.16,
PATH LEVEL VI,5002015,CDM,312,RC,88309,HCPCS,Outpatient,,,1138,853.5,,887.64,78,,710.112,percent of total billed charges,78% of total billed charges,187.78,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,432.44,38,,345.952,percent of total billed charges,38% of total billed charges,432.44,38,,345.952,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1024.2,90,,819.36,percent of total billed charges,90% of total billed charges,197.17,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,765.59,67.275,,612.472,percent of total billed charges,67.275% of total billed charges,910.4,80,,728.32,percent of total billed charges,80% of total billed charges,436.76,38.38,,349.408,percent of total billed charges,38.38% of total billed charges,910.4,80,,728.32,percent of total billed charges,80% of total billed charges,702.6,61.74,,562.08,percent of total billed charges,61.74% of total billed charges,191.54,102,,,Fee Schedule,102% of GA Medicaid Rate,432.44,38,,345.952,percent of total billed charges,38% of total billed charges,187.78,1024.2,
"PATH CYTOLOGIC EXAM (TOUCH PREP, SQUASH)",5003137,CDM,312,RC,88333,HCPCS,Outpatient,,,1138,853.5,,887.64,78,,710.112,percent of total billed charges,78% of total billed charges,75.49,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,432.44,38,,345.952,percent of total billed charges,38% of total billed charges,432.44,38,,345.952,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1024.2,90,,819.36,percent of total billed charges,90% of total billed charges,79.26,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,765.59,67.275,,612.472,percent of total billed charges,67.275% of total billed charges,910.4,80,,728.32,percent of total billed charges,80% of total billed charges,436.76,38.38,,349.408,percent of total billed charges,38.38% of total billed charges,910.4,80,,728.32,percent of total billed charges,80% of total billed charges,702.6,61.74,,562.08,percent of total billed charges,61.74% of total billed charges,77,102,,,Fee Schedule,102% of GA Medicaid Rate,432.44,38,,345.952,percent of total billed charges,38% of total billed charges,75.49,1024.2,
PATH BONE MARROW DIFF,5003215,CDM,310,RC,85097,HCPCS,Outpatient,,,1138,853.5,,887.64,78,,710.112,percent of total billed charges,78% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,432.44,38,,345.952,percent of total billed charges,38% of total billed charges,432.44,38,,345.952,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1024.2,90,,819.36,percent of total billed charges,90% of total billed charges,,,,,Other,Not Separately reimbursable,765.59,67.275,,612.472,percent of total billed charges,67.275% of total billed charges,910.4,80,,728.32,percent of total billed charges,80% of total billed charges,436.76,38.38,,349.408,percent of total billed charges,38.38% of total billed charges,910.4,80,,728.32,percent of total billed charges,80% of total billed charges,702.6,61.74,,562.08,percent of total billed charges,61.74% of total billed charges,,,,,Other,Not Separately reimbursable,432.44,38,,345.952,percent of total billed charges,38% of total billed charges,432.44,1024.2,
PATH MYELOPEROX STAIN,5003714,CDM,312,RC,88319,HCPCS,Outpatient,,,1138,853.5,,887.64,78,,710.112,percent of total billed charges,78% of total billed charges,86.63,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,432.44,38,,345.952,percent of total billed charges,38% of total billed charges,432.44,38,,345.952,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1024.2,90,,819.36,percent of total billed charges,90% of total billed charges,90.96,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,765.59,67.275,,612.472,percent of total billed charges,67.275% of total billed charges,910.4,80,,728.32,percent of total billed charges,80% of total billed charges,436.76,38.38,,349.408,percent of total billed charges,38.38% of total billed charges,910.4,80,,728.32,percent of total billed charges,80% of total billed charges,702.6,61.74,,562.08,percent of total billed charges,61.74% of total billed charges,88.36,102,,,Fee Schedule,102% of GA Medicaid Rate,432.44,38,,345.952,percent of total billed charges,38% of total billed charges,86.63,1024.2,
SCREW COMPRESSION 4.5MM,3006022,CDM,270,RC,,,Outpatient,,,1140,855,,889.2,78,,711.36,percent of total billed charges,78% of total billed charges,718.2,63,,574.56,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,433.2,38,,346.56,percent of total billed charges,38% of total billed charges,433.2,38,,346.56,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1026,90,,820.8,percent of total billed charges,90% of total billed charges,399,35,,319.2,percent of total billed charges,35% of total billed charges,766.94,67.275,,613.552,percent of total billed charges,67.275% of total billed charges,912,80,,729.6,percent of total billed charges,80% of total billed charges,437.53,38.38,,350.024,percent of total billed charges,38.38% of total billed charges,912,80,,729.6,percent of total billed charges,80% of total billed charges,703.84,61.74,,563.072,percent of total billed charges,61.74% of total billed charges,1162.8,102,,930.24,percent of total billed charges,102% of total billed charges,433.2,38,,346.56,percent of total billed charges,38% of total billed charges,399,1162.8,
SCREW CORTEX 4.5MMX34MM,3006025,CDM,270,RC,,,Outpatient,,,1140,855,,889.2,78,,711.36,percent of total billed charges,78% of total billed charges,718.2,63,,574.56,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,433.2,38,,346.56,percent of total billed charges,38% of total billed charges,433.2,38,,346.56,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1026,90,,820.8,percent of total billed charges,90% of total billed charges,399,35,,319.2,percent of total billed charges,35% of total billed charges,766.94,67.275,,613.552,percent of total billed charges,67.275% of total billed charges,912,80,,729.6,percent of total billed charges,80% of total billed charges,437.53,38.38,,350.024,percent of total billed charges,38.38% of total billed charges,912,80,,729.6,percent of total billed charges,80% of total billed charges,703.84,61.74,,563.072,percent of total billed charges,61.74% of total billed charges,1162.8,102,,930.24,percent of total billed charges,102% of total billed charges,433.2,38,,346.56,percent of total billed charges,38% of total billed charges,399,1162.8,
SCREW CORTEX 4.5MMX32MM,3006034,CDM,270,RC,,,Outpatient,,,1140,855,,889.2,78,,711.36,percent of total billed charges,78% of total billed charges,718.2,63,,574.56,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,433.2,38,,346.56,percent of total billed charges,38% of total billed charges,433.2,38,,346.56,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1026,90,,820.8,percent of total billed charges,90% of total billed charges,399,35,,319.2,percent of total billed charges,35% of total billed charges,766.94,67.275,,613.552,percent of total billed charges,67.275% of total billed charges,912,80,,729.6,percent of total billed charges,80% of total billed charges,437.53,38.38,,350.024,percent of total billed charges,38.38% of total billed charges,912,80,,729.6,percent of total billed charges,80% of total billed charges,703.84,61.74,,563.072,percent of total billed charges,61.74% of total billed charges,1162.8,102,,930.24,percent of total billed charges,102% of total billed charges,433.2,38,,346.56,percent of total billed charges,38% of total billed charges,399,1162.8,
SEMI TUBULAR PLATE 6 HOLE,3006035,CDM,270,RC,,,Outpatient,,,1140,855,,889.2,78,,711.36,percent of total billed charges,78% of total billed charges,718.2,63,,574.56,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,433.2,38,,346.56,percent of total billed charges,38% of total billed charges,433.2,38,,346.56,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1026,90,,820.8,percent of total billed charges,90% of total billed charges,399,35,,319.2,percent of total billed charges,35% of total billed charges,766.94,67.275,,613.552,percent of total billed charges,67.275% of total billed charges,912,80,,729.6,percent of total billed charges,80% of total billed charges,437.53,38.38,,350.024,percent of total billed charges,38.38% of total billed charges,912,80,,729.6,percent of total billed charges,80% of total billed charges,703.84,61.74,,563.072,percent of total billed charges,61.74% of total billed charges,1162.8,102,,930.24,percent of total billed charges,102% of total billed charges,433.2,38,,346.56,percent of total billed charges,38% of total billed charges,399,1162.8,
SEMI TUBULAR PLATE 5 HOLE,3006036,CDM,270,RC,,,Outpatient,,,1140,855,,889.2,78,,711.36,percent of total billed charges,78% of total billed charges,718.2,63,,574.56,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,433.2,38,,346.56,percent of total billed charges,38% of total billed charges,433.2,38,,346.56,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1026,90,,820.8,percent of total billed charges,90% of total billed charges,399,35,,319.2,percent of total billed charges,35% of total billed charges,766.94,67.275,,613.552,percent of total billed charges,67.275% of total billed charges,912,80,,729.6,percent of total billed charges,80% of total billed charges,437.53,38.38,,350.024,percent of total billed charges,38.38% of total billed charges,912,80,,729.6,percent of total billed charges,80% of total billed charges,703.84,61.74,,563.072,percent of total billed charges,61.74% of total billed charges,1162.8,102,,930.24,percent of total billed charges,102% of total billed charges,433.2,38,,346.56,percent of total billed charges,38% of total billed charges,399,1162.8,
LUMBAR TAP DIAGNOSTIC,1200207,CDM,981,RC,62270,HCPCS,Outpatient,,,1143,857.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,70.71,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,70.71,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,70.71,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,70.71,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,70.71,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,112.65,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,73.56,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,691.57,61.74,,553.256,percent of total billed charges,61.74% of total billed charges,107.29,102,,,Fee Schedule,102% of GA Medicaid Rate,70.71,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,70.71,691.57,
HARMONIC ACE 5MM X 36CM,3004273,CDM,270,RC,,,Outpatient,,,1143.18,857.39,,891.68,78,,713.344,percent of total billed charges,78% of total billed charges,720.2,63,,576.16,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,434.41,38,,347.528,percent of total billed charges,38% of total billed charges,434.41,38,,347.528,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1028.86,90,,823.088,percent of total billed charges,90% of total billed charges,400.11,35,,320.088,percent of total billed charges,35% of total billed charges,769.07,67.275,,615.256,percent of total billed charges,67.275% of total billed charges,914.54,80,,731.632,percent of total billed charges,80% of total billed charges,438.75,38.38,,351,percent of total billed charges,38.38% of total billed charges,914.54,80,,731.632,percent of total billed charges,80% of total billed charges,705.8,61.74,,564.64,percent of total billed charges,61.74% of total billed charges,1166.04,102,,932.832,percent of total billed charges,102% of total billed charges,434.41,38,,347.528,percent of total billed charges,38% of total billed charges,400.11,1166.04,
CT scan head or brain without dye,7400903,CDM,351,RC,70450,HCPCS,Outpatient,,,1144,858,,892.32,78,,713.856,percent of total billed charges,78% of total billed charges,720.72,63,,576.576,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,434.72,38,,347.776,percent of total billed charges,38% of total billed charges,434.72,38,,347.776,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1029.6,90,,823.68,percent of total billed charges,90% of total billed charges,400.4,35,,320.32,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,915.2,80,,732.16,percent of total billed charges,80% of total billed charges,439.07,38.38,,351.256,percent of total billed charges,38.38% of total billed charges,915.2,80,,732.16,percent of total billed charges,80% of total billed charges,706.31,61.74,,565.048,percent of total billed charges,61.74% of total billed charges,1166.88,102,,933.504,percent of total billed charges,102% of total billed charges,434.72,38,,347.776,percent of total billed charges,38% of total billed charges,360.18,1166.88,
CT scan head or brain without dye,7470450,CDM,351,RC,70450,HCPCS,Outpatient,,,1144,858,,892.32,78,,713.856,percent of total billed charges,78% of total billed charges,720.72,63,,576.576,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,434.72,38,,347.776,percent of total billed charges,38% of total billed charges,434.72,38,,347.776,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1029.6,90,,823.68,percent of total billed charges,90% of total billed charges,400.4,35,,320.32,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,915.2,80,,732.16,percent of total billed charges,80% of total billed charges,439.07,38.38,,351.256,percent of total billed charges,38.38% of total billed charges,915.2,80,,732.16,percent of total billed charges,80% of total billed charges,706.31,61.74,,565.048,percent of total billed charges,61.74% of total billed charges,1166.88,102,,933.504,percent of total billed charges,102% of total billed charges,434.72,38,,347.776,percent of total billed charges,38% of total billed charges,360.18,1166.88,
CT scan of the thorax without dye,7400918,CDM,352,RC,71250,HCPCS,Outpatient,,,1152,864,,898.56,78,,718.848,percent of total billed charges,78% of total billed charges,725.76,63,,580.608,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,437.76,38,,350.208,percent of total billed charges,38% of total billed charges,437.76,38,,350.208,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1036.8,90,,829.44,percent of total billed charges,90% of total billed charges,403.2,35,,322.56,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,921.6,80,,737.28,percent of total billed charges,80% of total billed charges,442.14,38.38,,353.712,percent of total billed charges,38.38% of total billed charges,921.6,80,,737.28,percent of total billed charges,80% of total billed charges,711.24,61.74,,568.992,percent of total billed charges,61.74% of total billed charges,1175.04,102,,940.032,percent of total billed charges,102% of total billed charges,437.76,38,,350.208,percent of total billed charges,38% of total billed charges,360.18,1175.04,
CT ANGIOGRAPHY RUNOFF BIL LE/ABD AORTA,7400811,CDM,352,RC,75635,HCPCS,Outpatient,,,1161,870.75,,905.58,78,,724.464,percent of total billed charges,78% of total billed charges,731.43,63,,585.144,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,441.18,38,,352.944,percent of total billed charges,38% of total billed charges,441.18,38,,352.944,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1044.9,90,,835.92,percent of total billed charges,90% of total billed charges,406.35,35,,325.08,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,928.8,80,,743.04,percent of total billed charges,80% of total billed charges,445.59,38.38,,356.472,percent of total billed charges,38.38% of total billed charges,928.8,80,,743.04,percent of total billed charges,80% of total billed charges,716.8,61.74,,573.44,percent of total billed charges,61.74% of total billed charges,1184.22,102,,947.376,percent of total billed charges,102% of total billed charges,441.18,38,,352.944,percent of total billed charges,38% of total billed charges,360.18,1184.22,
FIXIOS 34 - TEMPORARY PIN,3001015,CDM,270,RC,,,Outpatient,,,1163.4,872.55,,907.45,78,,725.96,percent of total billed charges,78% of total billed charges,732.94,63,,586.352,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,442.09,38,,353.672,percent of total billed charges,38% of total billed charges,442.09,38,,353.672,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1047.06,90,,837.648,percent of total billed charges,90% of total billed charges,407.19,35,,325.752,percent of total billed charges,35% of total billed charges,782.68,67.275,,626.144,percent of total billed charges,67.275% of total billed charges,930.72,80,,744.576,percent of total billed charges,80% of total billed charges,446.51,38.38,,357.208,percent of total billed charges,38.38% of total billed charges,930.72,80,,744.576,percent of total billed charges,80% of total billed charges,718.28,61.74,,574.624,percent of total billed charges,61.74% of total billed charges,1186.67,102,,949.336,percent of total billed charges,102% of total billed charges,442.09,38,,353.672,percent of total billed charges,38% of total billed charges,407.19,1186.67,
MRI CHEST W/O CONTRAST,7500950,CDM,610,RC,71550,HCPCS,Outpatient,,,1171,878.25,,913.38,78,,730.704,percent of total billed charges,78% of total billed charges,737.73,63,,590.184,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,444.98,38,,355.984,percent of total billed charges,38% of total billed charges,444.98,38,,355.984,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1053.9,90,,843.12,percent of total billed charges,90% of total billed charges,409.85,35,,327.88,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,936.8,80,,749.44,percent of total billed charges,80% of total billed charges,449.43,38.38,,359.544,percent of total billed charges,38.38% of total billed charges,936.8,80,,749.44,percent of total billed charges,80% of total billed charges,722.98,61.74,,578.384,percent of total billed charges,61.74% of total billed charges,1194.42,102,,955.536,percent of total billed charges,102% of total billed charges,444.98,38,,355.984,percent of total billed charges,38% of total billed charges,409.85,1194.42,
MRI of upper extremity without dye,7500961,CDM,610,RC,73221,HCPCS,Outpatient,,,1171,878.25,,913.38,78,,730.704,percent of total billed charges,78% of total billed charges,737.73,63,,590.184,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,444.98,38,,355.984,percent of total billed charges,38% of total billed charges,444.98,38,,355.984,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1053.9,90,,843.12,percent of total billed charges,90% of total billed charges,409.85,35,,327.88,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,936.8,80,,749.44,percent of total billed charges,80% of total billed charges,449.43,38.38,,359.544,percent of total billed charges,38.38% of total billed charges,936.8,80,,749.44,percent of total billed charges,80% of total billed charges,722.98,61.74,,578.384,percent of total billed charges,61.74% of total billed charges,1194.42,102,,955.536,percent of total billed charges,102% of total billed charges,444.98,38,,355.984,percent of total billed charges,38% of total billed charges,409.85,1194.42,
MRI of lower extremity joint (knee/ankle) without dye,7500963,CDM,610,RC,73721,HCPCS,Outpatient,,,1171,878.25,,913.38,78,,730.704,percent of total billed charges,78% of total billed charges,737.73,63,,590.184,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,444.98,38,,355.984,percent of total billed charges,38% of total billed charges,444.98,38,,355.984,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1053.9,90,,843.12,percent of total billed charges,90% of total billed charges,409.85,35,,327.88,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,936.8,80,,749.44,percent of total billed charges,80% of total billed charges,449.43,38.38,,359.544,percent of total billed charges,38.38% of total billed charges,936.8,80,,749.44,percent of total billed charges,80% of total billed charges,722.98,61.74,,578.384,percent of total billed charges,61.74% of total billed charges,1194.42,102,,955.536,percent of total billed charges,102% of total billed charges,444.98,38,,355.984,percent of total billed charges,38% of total billed charges,409.85,1194.42,
MRI of lower extremity joint (knee/ankle) without dye,7500964,CDM,610,RC,73721,HCPCS,Outpatient,,,1171,878.25,,913.38,78,,730.704,percent of total billed charges,78% of total billed charges,737.73,63,,590.184,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,444.98,38,,355.984,percent of total billed charges,38% of total billed charges,444.98,38,,355.984,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1053.9,90,,843.12,percent of total billed charges,90% of total billed charges,409.85,35,,327.88,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,936.8,80,,749.44,percent of total billed charges,80% of total billed charges,449.43,38.38,,359.544,percent of total billed charges,38.38% of total billed charges,936.8,80,,749.44,percent of total billed charges,80% of total billed charges,722.98,61.74,,578.384,percent of total billed charges,61.74% of total billed charges,1194.42,102,,955.536,percent of total billed charges,102% of total billed charges,444.98,38,,355.984,percent of total billed charges,38% of total billed charges,409.85,1194.42,
MRI of upper extremity without dye,7500966,CDM,610,RC,73221,HCPCS,Outpatient,,,1171,878.25,,913.38,78,,730.704,percent of total billed charges,78% of total billed charges,737.73,63,,590.184,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,444.98,38,,355.984,percent of total billed charges,38% of total billed charges,444.98,38,,355.984,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1053.9,90,,843.12,percent of total billed charges,90% of total billed charges,409.85,35,,327.88,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,936.8,80,,749.44,percent of total billed charges,80% of total billed charges,449.43,38.38,,359.544,percent of total billed charges,38.38% of total billed charges,936.8,80,,749.44,percent of total billed charges,80% of total billed charges,722.98,61.74,,578.384,percent of total billed charges,61.74% of total billed charges,1194.42,102,,955.536,percent of total billed charges,102% of total billed charges,444.98,38,,355.984,percent of total billed charges,38% of total billed charges,409.85,1194.42,
"CT scan, pelvis, with contrast",7400914,CDM,352,RC,72193,HCPCS,Outpatient,,,1178,883.5,,918.84,78,,735.072,percent of total billed charges,78% of total billed charges,742.14,63,,593.712,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,447.64,38,,358.112,percent of total billed charges,38% of total billed charges,447.64,38,,358.112,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1060.2,90,,848.16,percent of total billed charges,90% of total billed charges,412.3,35,,329.84,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,942.4,80,,753.92,percent of total billed charges,80% of total billed charges,452.12,38.38,,361.696,percent of total billed charges,38.38% of total billed charges,942.4,80,,753.92,percent of total billed charges,80% of total billed charges,727.3,61.74,,581.84,percent of total billed charges,61.74% of total billed charges,1201.56,102,,961.248,percent of total billed charges,102% of total billed charges,447.64,38,,358.112,percent of total billed charges,38% of total billed charges,360.18,1201.56,
"CT scan, pelvis, with contrast",7400995,CDM,352,RC,72193,HCPCS,Outpatient,,,1178,883.5,,918.84,78,,735.072,percent of total billed charges,78% of total billed charges,742.14,63,,593.712,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,447.64,38,,358.112,percent of total billed charges,38% of total billed charges,447.64,38,,358.112,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1060.2,90,,848.16,percent of total billed charges,90% of total billed charges,412.3,35,,329.84,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,942.4,80,,753.92,percent of total billed charges,80% of total billed charges,452.12,38.38,,361.696,percent of total billed charges,38.38% of total billed charges,942.4,80,,753.92,percent of total billed charges,80% of total billed charges,727.3,61.74,,581.84,percent of total billed charges,61.74% of total billed charges,1201.56,102,,961.248,percent of total billed charges,102% of total billed charges,447.64,38,,358.112,percent of total billed charges,38% of total billed charges,360.18,1201.56,
PROCEED MED HERNIA PATCH 6.4x6.4,3007002,CDM,270,RC,,,Outpatient,,,1180.58,885.44,,920.85,78,,736.68,percent of total billed charges,78% of total billed charges,743.77,63,,595.016,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,448.62,38,,358.896,percent of total billed charges,38% of total billed charges,448.62,38,,358.896,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1062.52,90,,850.016,percent of total billed charges,90% of total billed charges,413.2,35,,330.56,percent of total billed charges,35% of total billed charges,794.24,67.275,,635.392,percent of total billed charges,67.275% of total billed charges,944.46,80,,755.568,percent of total billed charges,80% of total billed charges,453.11,38.38,,362.488,percent of total billed charges,38.38% of total billed charges,944.46,80,,755.568,percent of total billed charges,80% of total billed charges,728.89,61.74,,583.112,percent of total billed charges,61.74% of total billed charges,1204.19,102,,963.352,percent of total billed charges,102% of total billed charges,448.62,38,,358.896,percent of total billed charges,38% of total billed charges,413.2,1204.19,
GORE BIO-A TISSUE MESH,3004311,CDM,270,RC,,,Outpatient,,,1185,888.75,,924.3,78,,739.44,percent of total billed charges,78% of total billed charges,746.55,63,,597.24,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,450.3,38,,360.24,percent of total billed charges,38% of total billed charges,450.3,38,,360.24,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1066.5,90,,853.2,percent of total billed charges,90% of total billed charges,414.75,35,,331.8,percent of total billed charges,35% of total billed charges,797.21,67.275,,637.768,percent of total billed charges,67.275% of total billed charges,948,80,,758.4,percent of total billed charges,80% of total billed charges,454.8,38.38,,363.84,percent of total billed charges,38.38% of total billed charges,948,80,,758.4,percent of total billed charges,80% of total billed charges,731.62,61.74,,585.296,percent of total billed charges,61.74% of total billed charges,1208.7,102,,966.96,percent of total billed charges,102% of total billed charges,450.3,38,,360.24,percent of total billed charges,38% of total billed charges,414.75,1208.7,
RESP VIRUS MULTIBE TYPES 12-25,5087633,CDM,306,RC,87633,HCPCS,Outpatient,,,1200,900,,936,78,,748.8,percent of total billed charges,78% of total billed charges,193.9,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,416.78,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,416.78,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,1080,90,,864,percent of total billed charges,90% of total billed charges,203.6,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,807.3,67.275,,645.84,percent of total billed charges,67.275% of total billed charges,960,80,,768,percent of total billed charges,80% of total billed charges,420.95,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,960,80,,768,percent of total billed charges,80% of total billed charges,740.88,61.74,,592.704,percent of total billed charges,61.74% of total billed charges,197.78,102,,,Fee Schedule,102% of GA Medicaid Rate,416.78,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,193.9,1080,
GASTROINTESTINAL PROFILE,5587507,CDM,306,RC,87507,HCPCS,Outpatient,,,1200,900,,936,78,,748.8,percent of total billed charges,78% of total billed charges,333.42,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,416.78,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,416.78,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,1080,90,,864,percent of total billed charges,90% of total billed charges,350.09,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,807.3,67.275,,645.84,percent of total billed charges,67.275% of total billed charges,960,80,,768,percent of total billed charges,80% of total billed charges,420.95,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,960,80,,768,percent of total billed charges,80% of total billed charges,740.88,61.74,,592.704,percent of total billed charges,61.74% of total billed charges,340.09,102,,,Fee Schedule,102% of GA Medicaid Rate,416.78,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,333.42,1080,
PILONIDAL CYST SIMPLE,1200138,CDM,981,RC,10080,HCPCS,Outpatient,,,1205,903.75,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,113.76,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,113.76,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,113.76,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,113.76,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,113.76,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,83.15,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,118.08,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,729.09,61.74,,583.272,percent of total billed charges,61.74% of total billed charges,79.19,102,,,Fee Schedule,102% of GA Medicaid Rate,113.76,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,79.19,729.09,
PARONYCHIA,1200139,CDM,981,RC,10080,HCPCS,Outpatient,,,1205,903.75,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,113.76,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,113.76,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,113.76,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,113.76,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,113.76,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,83.15,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,118.08,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,729.09,61.74,,583.272,percent of total billed charges,61.74% of total billed charges,79.19,102,,,Fee Schedule,102% of GA Medicaid Rate,113.76,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,79.19,729.09,
PILONIDAL CYST COMPLICATED,1200235,CDM,981,RC,10081,HCPCS,Outpatient,,,1205,903.75,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,188.98,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,188.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,188.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,188.98,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,188.98,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,152.34,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,197.03,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,729.09,61.74,,583.272,percent of total billed charges,61.74% of total billed charges,145.09,102,,,Fee Schedule,102% of GA Medicaid Rate,188.98,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,145.09,729.09,
MRI of the neck or spine without dye,7500952,CDM,612,RC,72141,HCPCS,Outpatient,,,1208,906,,942.24,78,,753.792,percent of total billed charges,78% of total billed charges,761.04,63,,608.832,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,459.04,38,,367.232,percent of total billed charges,38% of total billed charges,459.04,38,,367.232,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1087.2,90,,869.76,percent of total billed charges,90% of total billed charges,422.8,35,,338.24,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,966.4,80,,773.12,percent of total billed charges,80% of total billed charges,463.63,38.38,,370.904,percent of total billed charges,38.38% of total billed charges,966.4,80,,773.12,percent of total billed charges,80% of total billed charges,745.82,61.74,,596.656,percent of total billed charges,61.74% of total billed charges,1232.16,102,,985.728,percent of total billed charges,102% of total billed charges,459.04,38,,367.232,percent of total billed charges,38% of total billed charges,422.8,1232.16,
MRI of pelvis without dye,7500958,CDM,612,RC,72195,HCPCS,Outpatient,,,1208,906,,942.24,78,,753.792,percent of total billed charges,78% of total billed charges,761.04,63,,608.832,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,459.04,38,,367.232,percent of total billed charges,38% of total billed charges,459.04,38,,367.232,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1087.2,90,,869.76,percent of total billed charges,90% of total billed charges,422.8,35,,338.24,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,966.4,80,,773.12,percent of total billed charges,80% of total billed charges,463.63,38.38,,370.904,percent of total billed charges,38.38% of total billed charges,966.4,80,,773.12,percent of total billed charges,80% of total billed charges,745.82,61.74,,596.656,percent of total billed charges,61.74% of total billed charges,1232.16,102,,985.728,percent of total billed charges,102% of total billed charges,459.04,38,,367.232,percent of total billed charges,38% of total billed charges,422.8,1232.16,
CANNULATED DRILL BIT 4.9MM,3007004,CDM,270,RC,,,Outpatient,,,1217.04,912.78,,949.29,78,,759.432,percent of total billed charges,78% of total billed charges,766.74,63,,613.392,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,462.48,38,,369.984,percent of total billed charges,38% of total billed charges,462.48,38,,369.984,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1095.34,90,,876.272,percent of total billed charges,90% of total billed charges,425.96,35,,340.768,percent of total billed charges,35% of total billed charges,818.76,67.275,,655.008,percent of total billed charges,67.275% of total billed charges,973.63,80,,778.904,percent of total billed charges,80% of total billed charges,467.1,38.38,,373.68,percent of total billed charges,38.38% of total billed charges,973.63,80,,778.904,percent of total billed charges,80% of total billed charges,751.4,61.74,,601.12,percent of total billed charges,61.74% of total billed charges,1241.38,102,,993.104,percent of total billed charges,102% of total billed charges,462.48,38,,369.984,percent of total billed charges,38% of total billed charges,425.96,1241.38,
OR MINOR PROCEDURE,400050,CDM,360,RC,,,Outpatient,,,1239,929.25,,966.42,78,,773.136,percent of total billed charges,78% of total billed charges,780.57,63,,624.456,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,470.82,38,,376.656,percent of total billed charges,38% of total billed charges,470.82,38,,376.656,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1115.1,90,,892.08,percent of total billed charges,90% of total billed charges,433.65,35,,346.92,percent of total billed charges,35% of total billed charges,833.54,67.275,,666.832,percent of total billed charges,67.275% of total billed charges,991.2,80,,792.96,percent of total billed charges,80% of total billed charges,475.53,38.38,,380.424,percent of total billed charges,38.38% of total billed charges,991.2,80,,792.96,percent of total billed charges,80% of total billed charges,764.96,61.74,,611.968,percent of total billed charges,61.74% of total billed charges,1263.78,102,,1011.024,percent of total billed charges,102% of total billed charges,470.82,38,,376.656,percent of total billed charges,38% of total billed charges,433.65,1263.78,
CPAP VENTILATION DAY 2+,8094661,CDM,410,RC,94660,HCPCS,Outpatient,,,1245,933.75,,971.1,78,,776.88,percent of total billed charges,78% of total billed charges,784.35,63,,627.48,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,473.1,38,,378.48,percent of total billed charges,38% of total billed charges,473.1,38,,378.48,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1120.5,90,,896.4,percent of total billed charges,90% of total billed charges,435.75,35,,348.6,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,996,80,,796.8,percent of total billed charges,80% of total billed charges,477.83,38.38,,382.264,percent of total billed charges,38.38% of total billed charges,996,80,,796.8,percent of total billed charges,80% of total billed charges,768.66,61.74,,614.928,percent of total billed charges,61.74% of total billed charges,1269.9,102,,1015.92,percent of total billed charges,102% of total billed charges,473.1,38,,378.48,percent of total billed charges,38% of total billed charges,145.93,1269.9,
Diagnostic Radiology (Diagnostic Imaging) Procedures of the Chest,7400815,CDM,352,RC,71275,HCPCS,Outpatient,,,1261,945.75,,983.58,78,,786.864,percent of total billed charges,78% of total billed charges,794.43,63,,635.544,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,479.18,38,,383.344,percent of total billed charges,38% of total billed charges,479.18,38,,383.344,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1134.9,90,,907.92,percent of total billed charges,90% of total billed charges,441.35,35,,353.08,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,1008.8,80,,807.04,percent of total billed charges,80% of total billed charges,483.97,38.38,,387.176,percent of total billed charges,38.38% of total billed charges,1008.8,80,,807.04,percent of total billed charges,80% of total billed charges,778.54,61.74,,622.832,percent of total billed charges,61.74% of total billed charges,1286.22,102,,1028.976,percent of total billed charges,102% of total billed charges,479.18,38,,383.344,percent of total billed charges,38% of total billed charges,360.18,1286.22,
CT ANGIOGRAPHY ABDOMEN,7400820,CDM,352,RC,74175,HCPCS,Outpatient,,,1261,945.75,,983.58,78,,786.864,percent of total billed charges,78% of total billed charges,794.43,63,,635.544,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,479.18,38,,383.344,percent of total billed charges,38% of total billed charges,479.18,38,,383.344,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1134.9,90,,907.92,percent of total billed charges,90% of total billed charges,441.35,35,,353.08,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,1008.8,80,,807.04,percent of total billed charges,80% of total billed charges,483.97,38.38,,387.176,percent of total billed charges,38.38% of total billed charges,1008.8,80,,807.04,percent of total billed charges,80% of total billed charges,778.54,61.74,,622.832,percent of total billed charges,61.74% of total billed charges,1286.22,102,,1028.976,percent of total billed charges,102% of total billed charges,479.18,38,,383.344,percent of total billed charges,38% of total billed charges,360.18,1286.22,
MRI C-SPINE W/CONTRAST,7500953,CDM,612,RC,72142,HCPCS,Outpatient,,,1279,959.25,,997.62,78,,798.096,percent of total billed charges,78% of total billed charges,805.77,63,,644.616,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,486.02,38,,388.816,percent of total billed charges,38% of total billed charges,486.02,38,,388.816,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1151.1,90,,920.88,percent of total billed charges,90% of total billed charges,447.65,35,,358.12,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,1023.2,80,,818.56,percent of total billed charges,80% of total billed charges,490.88,38.38,,392.704,percent of total billed charges,38.38% of total billed charges,1023.2,80,,818.56,percent of total billed charges,80% of total billed charges,789.65,61.74,,631.72,percent of total billed charges,61.74% of total billed charges,1304.58,102,,1043.664,percent of total billed charges,102% of total billed charges,486.02,38,,388.816,percent of total billed charges,38% of total billed charges,447.65,1304.58,
MRI T-SPINE W/CONTRAST,7500955,CDM,612,RC,72147,HCPCS,Outpatient,,,1279,959.25,,997.62,78,,798.096,percent of total billed charges,78% of total billed charges,805.77,63,,644.616,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,486.02,38,,388.816,percent of total billed charges,38% of total billed charges,486.02,38,,388.816,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1151.1,90,,920.88,percent of total billed charges,90% of total billed charges,447.65,35,,358.12,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,1023.2,80,,818.56,percent of total billed charges,80% of total billed charges,490.88,38.38,,392.704,percent of total billed charges,38.38% of total billed charges,1023.2,80,,818.56,percent of total billed charges,80% of total billed charges,789.65,61.74,,631.72,percent of total billed charges,61.74% of total billed charges,1304.58,102,,1043.664,percent of total billed charges,102% of total billed charges,486.02,38,,388.816,percent of total billed charges,38% of total billed charges,447.65,1304.58,
MRI PELVIS W/ CONTRAST,7500959,CDM,612,RC,72196,HCPCS,Outpatient,,,1279,959.25,,997.62,78,,798.096,percent of total billed charges,78% of total billed charges,805.77,63,,644.616,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,486.02,38,,388.816,percent of total billed charges,38% of total billed charges,486.02,38,,388.816,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1151.1,90,,920.88,percent of total billed charges,90% of total billed charges,447.65,35,,358.12,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,1023.2,80,,818.56,percent of total billed charges,80% of total billed charges,490.88,38.38,,392.704,percent of total billed charges,38.38% of total billed charges,1023.2,80,,818.56,percent of total billed charges,80% of total billed charges,789.65,61.74,,631.72,percent of total billed charges,61.74% of total billed charges,1304.58,102,,1043.664,percent of total billed charges,102% of total billed charges,486.02,38,,388.816,percent of total billed charges,38% of total billed charges,447.65,1304.58,
MRI ABDOMEN WITH CONTRAST,7501020,CDM,610,RC,74182,HCPCS,Outpatient,,,1279,959.25,,997.62,78,,798.096,percent of total billed charges,78% of total billed charges,805.77,63,,644.616,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,486.02,38,,388.816,percent of total billed charges,38% of total billed charges,486.02,38,,388.816,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1151.1,90,,920.88,percent of total billed charges,90% of total billed charges,447.65,35,,358.12,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,1023.2,80,,818.56,percent of total billed charges,80% of total billed charges,490.88,38.38,,392.704,percent of total billed charges,38.38% of total billed charges,1023.2,80,,818.56,percent of total billed charges,80% of total billed charges,789.65,61.74,,631.72,percent of total billed charges,61.74% of total billed charges,1304.58,102,,1043.664,percent of total billed charges,102% of total billed charges,486.02,38,,388.816,percent of total billed charges,38% of total billed charges,447.65,1304.58,
CVL CUTDOWN AGE < 5 YRS,1001140,CDM,450,RC,36568,HCPCS,Outpatient,,,1289,966.75,,1005.42,78,,804.336,percent of total billed charges,78% of total billed charges,812.07,63,,649.656,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,489.82,38,,391.856,percent of total billed charges,38% of total billed charges,489.82,38,,391.856,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1160.1,90,,928.08,percent of total billed charges,90% of total billed charges,451.15,35,,360.92,percent of total billed charges,35% of total billed charges,867.17,67.275,,693.736,percent of total billed charges,67.275% of total billed charges,1031.2,80,,824.96,percent of total billed charges,80% of total billed charges,494.72,38.38,,395.776,percent of total billed charges,38.38% of total billed charges,1031.2,80,,824.96,percent of total billed charges,80% of total billed charges,795.83,61.74,,636.664,percent of total billed charges,61.74% of total billed charges,1314.78,102,,1051.824,percent of total billed charges,102% of total billed charges,489.82,38,,391.856,percent of total billed charges,38% of total billed charges,451.15,1314.78,
CT ANGIOGRAPHY ABD/PELVIS,7400822,CDM,352,RC,74174,HCPCS,Outpatient,,,1309,981.75,,1021.02,78,,816.816,percent of total billed charges,78% of total billed charges,824.67,63,,659.736,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,497.42,38,,397.936,percent of total billed charges,38% of total billed charges,497.42,38,,397.936,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1178.1,90,,942.48,percent of total billed charges,90% of total billed charges,458.15,35,,366.52,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,1047.2,80,,837.76,percent of total billed charges,80% of total billed charges,502.39,38.38,,401.912,percent of total billed charges,38.38% of total billed charges,1047.2,80,,837.76,percent of total billed charges,80% of total billed charges,808.18,61.74,,646.544,percent of total billed charges,61.74% of total billed charges,1335.18,102,,1068.144,percent of total billed charges,102% of total billed charges,497.42,38,,397.936,percent of total billed charges,38% of total billed charges,360.18,1335.18,
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function",7300945,CDM,483,RC,93306,HCPCS,Outpatient,,,1341,1005.75,,1045.98,78,,836.784,percent of total billed charges,78% of total billed charges,844.83,63,,675.864,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,509.58,38,,407.664,percent of total billed charges,38% of total billed charges,509.58,38,,407.664,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1206.9,90,,965.52,percent of total billed charges,90% of total billed charges,469.35,35,,375.48,percent of total billed charges,35% of total billed charges,902.16,67.275,,721.728,percent of total billed charges,67.275% of total billed charges,1072.8,80,,858.24,percent of total billed charges,80% of total billed charges,514.68,38.38,,411.744,percent of total billed charges,38.38% of total billed charges,1072.8,80,,858.24,percent of total billed charges,80% of total billed charges,827.93,61.74,,662.344,percent of total billed charges,61.74% of total billed charges,1367.82,102,,1094.256,percent of total billed charges,102% of total billed charges,509.58,38,,407.664,percent of total billed charges,38% of total billed charges,469.35,1367.82,
LOCKING 3.5MMX15MM,3006029,CDM,270,RC,,,Outpatient,,,1344,1008,,1048.32,78,,838.656,percent of total billed charges,78% of total billed charges,846.72,63,,677.376,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,510.72,38,,408.576,percent of total billed charges,38% of total billed charges,510.72,38,,408.576,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1209.6,90,,967.68,percent of total billed charges,90% of total billed charges,470.4,35,,376.32,percent of total billed charges,35% of total billed charges,904.18,67.275,,723.344,percent of total billed charges,67.275% of total billed charges,1075.2,80,,860.16,percent of total billed charges,80% of total billed charges,515.83,38.38,,412.664,percent of total billed charges,38.38% of total billed charges,1075.2,80,,860.16,percent of total billed charges,80% of total billed charges,829.79,61.74,,663.832,percent of total billed charges,61.74% of total billed charges,1370.88,102,,1096.704,percent of total billed charges,102% of total billed charges,510.72,38,,408.576,percent of total billed charges,38% of total billed charges,470.4,1370.88,
CT of abdomen and pelvis without dye,7400953,CDM,352,RC,74176,HCPCS,Outpatient,,,1347,1010.25,,1050.66,78,,840.528,percent of total billed charges,78% of total billed charges,848.61,63,,678.888,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,511.86,38,,409.488,percent of total billed charges,38% of total billed charges,511.86,38,,409.488,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1212.3,90,,969.84,percent of total billed charges,90% of total billed charges,471.45,35,,377.16,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,1077.6,80,,862.08,percent of total billed charges,80% of total billed charges,516.98,38.38,,413.584,percent of total billed charges,38.38% of total billed charges,1077.6,80,,862.08,percent of total billed charges,80% of total billed charges,831.64,61.74,,665.312,percent of total billed charges,61.74% of total billed charges,1373.94,102,,1099.152,percent of total billed charges,102% of total billed charges,511.86,38,,409.488,percent of total billed charges,38% of total billed charges,360.18,1373.94,
CT of abdomen and pelvis without dye,7400956,CDM,352,RC,74176,HCPCS,Outpatient,,,1347,1010.25,,1050.66,78,,840.528,percent of total billed charges,78% of total billed charges,848.61,63,,678.888,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,511.86,38,,409.488,percent of total billed charges,38% of total billed charges,511.86,38,,409.488,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1212.3,90,,969.84,percent of total billed charges,90% of total billed charges,471.45,35,,377.16,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,1077.6,80,,862.08,percent of total billed charges,80% of total billed charges,516.98,38.38,,413.584,percent of total billed charges,38.38% of total billed charges,1077.6,80,,862.08,percent of total billed charges,80% of total billed charges,831.64,61.74,,665.312,percent of total billed charges,61.74% of total billed charges,1373.94,102,,1099.152,percent of total billed charges,102% of total billed charges,511.86,38,,409.488,percent of total billed charges,38% of total billed charges,360.18,1373.94,
CT of abdomen and pelvis without dye,7400957,CDM,352,RC,74176,HCPCS,Outpatient,,,1347,1010.25,,1050.66,78,,840.528,percent of total billed charges,78% of total billed charges,848.61,63,,678.888,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,511.86,38,,409.488,percent of total billed charges,38% of total billed charges,511.86,38,,409.488,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1212.3,90,,969.84,percent of total billed charges,90% of total billed charges,471.45,35,,377.16,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,1077.6,80,,862.08,percent of total billed charges,80% of total billed charges,516.98,38.38,,413.584,percent of total billed charges,38.38% of total billed charges,1077.6,80,,862.08,percent of total billed charges,80% of total billed charges,831.64,61.74,,665.312,percent of total billed charges,61.74% of total billed charges,1373.94,102,,1099.152,percent of total billed charges,102% of total billed charges,511.86,38,,409.488,percent of total billed charges,38% of total billed charges,360.18,1373.94,
CT THORACIC SPINE W/WO CON,7400925,CDM,352,RC,72130,HCPCS,Outpatient,,,1356,1017,,1057.68,78,,846.144,percent of total billed charges,78% of total billed charges,854.28,63,,683.424,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,515.28,38,,412.224,percent of total billed charges,38% of total billed charges,515.28,38,,412.224,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1220.4,90,,976.32,percent of total billed charges,90% of total billed charges,474.6,35,,379.68,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,1084.8,80,,867.84,percent of total billed charges,80% of total billed charges,520.43,38.38,,416.344,percent of total billed charges,38.38% of total billed charges,1084.8,80,,867.84,percent of total billed charges,80% of total billed charges,837.19,61.74,,669.752,percent of total billed charges,61.74% of total billed charges,1383.12,102,,1106.496,percent of total billed charges,102% of total billed charges,515.28,38,,412.224,percent of total billed charges,38% of total billed charges,360.18,1383.12,
CT PELVIS W/WO CONTRAST,7400916,CDM,352,RC,72194,HCPCS,Outpatient,,,1360,1020,,1060.8,78,,848.64,percent of total billed charges,78% of total billed charges,856.8,63,,685.44,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,516.8,38,,413.44,percent of total billed charges,38% of total billed charges,516.8,38,,413.44,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1224,90,,979.2,percent of total billed charges,90% of total billed charges,476,35,,380.8,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,1088,80,,870.4,percent of total billed charges,80% of total billed charges,521.97,38.38,,417.576,percent of total billed charges,38.38% of total billed charges,1088,80,,870.4,percent of total billed charges,80% of total billed charges,839.66,61.74,,671.728,percent of total billed charges,61.74% of total billed charges,1387.2,102,,1109.76,percent of total billed charges,102% of total billed charges,516.8,38,,413.44,percent of total billed charges,38% of total billed charges,360.18,1387.2,
CT SOFT TISSUE NECK W/WO CONTRAST,7400942,CDM,351,RC,70492,HCPCS,Outpatient,,,1375,1031.25,,1072.5,78,,858,percent of total billed charges,78% of total billed charges,866.25,63,,693,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,522.5,38,,418,percent of total billed charges,38% of total billed charges,522.5,38,,418,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1237.5,90,,990,percent of total billed charges,90% of total billed charges,481.25,35,,385,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,1100,80,,880,percent of total billed charges,80% of total billed charges,527.73,38.38,,422.184,percent of total billed charges,38.38% of total billed charges,1100,80,,880,percent of total billed charges,80% of total billed charges,848.93,61.74,,679.144,percent of total billed charges,61.74% of total billed charges,1402.5,102,,1122,percent of total billed charges,102% of total billed charges,522.5,38,,418,percent of total billed charges,38% of total billed charges,360.18,1402.5,
MRA ABDOMEN WITH OR WITHOUT CONTRAST,7501000,CDM,610,RC,74185,HCPCS,Outpatient,,,1384,1038,,1079.52,78,,863.616,percent of total billed charges,78% of total billed charges,871.92,63,,697.536,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,525.92,38,,420.736,percent of total billed charges,38% of total billed charges,525.92,38,,420.736,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1245.6,90,,996.48,percent of total billed charges,90% of total billed charges,484.4,35,,387.52,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,1107.2,80,,885.76,percent of total billed charges,80% of total billed charges,531.18,38.38,,424.944,percent of total billed charges,38.38% of total billed charges,1107.2,80,,885.76,percent of total billed charges,80% of total billed charges,854.48,61.74,,683.584,percent of total billed charges,61.74% of total billed charges,1411.68,102,,1129.344,percent of total billed charges,102% of total billed charges,525.92,38,,420.736,percent of total billed charges,38% of total billed charges,484.4,1411.68,
CT LOW EXT W/WO CON RT,7400909,CDM,352,RC,73702,HCPCS,Outpatient,,,1392,1044,,1085.76,78,,868.608,percent of total billed charges,78% of total billed charges,876.96,63,,701.568,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,528.96,38,,423.168,percent of total billed charges,38% of total billed charges,528.96,38,,423.168,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1252.8,90,,1002.24,percent of total billed charges,90% of total billed charges,487.2,35,,389.76,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,1113.6,80,,890.88,percent of total billed charges,80% of total billed charges,534.25,38.38,,427.4,percent of total billed charges,38.38% of total billed charges,1113.6,80,,890.88,percent of total billed charges,80% of total billed charges,859.42,61.74,,687.536,percent of total billed charges,61.74% of total billed charges,1419.84,102,,1135.872,percent of total billed charges,102% of total billed charges,528.96,38,,423.168,percent of total billed charges,38% of total billed charges,360.18,1419.84,
CT scan of lower spine without dye,7400927,CDM,352,RC,72131,HCPCS,Outpatient,,,1392,1044,,1085.76,78,,868.608,percent of total billed charges,78% of total billed charges,876.96,63,,701.568,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,528.96,38,,423.168,percent of total billed charges,38% of total billed charges,528.96,38,,423.168,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1252.8,90,,1002.24,percent of total billed charges,90% of total billed charges,487.2,35,,389.76,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,1113.6,80,,890.88,percent of total billed charges,80% of total billed charges,534.25,38.38,,427.4,percent of total billed charges,38.38% of total billed charges,1113.6,80,,890.88,percent of total billed charges,80% of total billed charges,859.42,61.74,,687.536,percent of total billed charges,61.74% of total billed charges,1419.84,102,,1135.872,percent of total billed charges,102% of total billed charges,528.96,38,,423.168,percent of total billed charges,38% of total billed charges,360.18,1419.84,
CT LOW EXT W/WO CON LT,7400929,CDM,352,RC,73702,HCPCS,Outpatient,,,1392,1044,,1085.76,78,,868.608,percent of total billed charges,78% of total billed charges,876.96,63,,701.568,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,528.96,38,,423.168,percent of total billed charges,38% of total billed charges,528.96,38,,423.168,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1252.8,90,,1002.24,percent of total billed charges,90% of total billed charges,487.2,35,,389.76,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,1113.6,80,,890.88,percent of total billed charges,80% of total billed charges,534.25,38.38,,427.4,percent of total billed charges,38.38% of total billed charges,1113.6,80,,890.88,percent of total billed charges,80% of total billed charges,859.42,61.74,,687.536,percent of total billed charges,61.74% of total billed charges,1419.84,102,,1135.872,percent of total billed charges,102% of total billed charges,528.96,38,,423.168,percent of total billed charges,38% of total billed charges,360.18,1419.84,
COMPRESSION PLATE - 6 HOLE,3005075,CDM,270,RC,,,Outpatient,,,1417.5,1063.13,,1105.65,78,,884.52,percent of total billed charges,78% of total billed charges,893.03,63,,714.424,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,538.65,38,,430.92,percent of total billed charges,38% of total billed charges,538.65,38,,430.92,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1275.75,90,,1020.6,percent of total billed charges,90% of total billed charges,496.13,35,,396.904,percent of total billed charges,35% of total billed charges,953.62,67.275,,762.896,percent of total billed charges,67.275% of total billed charges,1134,80,,907.2,percent of total billed charges,80% of total billed charges,544.04,38.38,,435.232,percent of total billed charges,38.38% of total billed charges,1134,80,,907.2,percent of total billed charges,80% of total billed charges,875.16,61.74,,700.128,percent of total billed charges,61.74% of total billed charges,1445.85,102,,1156.68,percent of total billed charges,102% of total billed charges,538.65,38,,430.92,percent of total billed charges,38% of total billed charges,496.13,1445.85,
MRI CHEST W/CONTRAST,7500951,CDM,610,RC,71551,HCPCS,Outpatient,,,1434,1075.5,,1118.52,78,,894.816,percent of total billed charges,78% of total billed charges,903.42,63,,722.736,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,544.92,38,,435.936,percent of total billed charges,38% of total billed charges,544.92,38,,435.936,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1290.6,90,,1032.48,percent of total billed charges,90% of total billed charges,501.9,35,,401.52,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,1147.2,80,,917.76,percent of total billed charges,80% of total billed charges,550.37,38.38,,440.296,percent of total billed charges,38.38% of total billed charges,1147.2,80,,917.76,percent of total billed charges,80% of total billed charges,885.35,61.74,,708.28,percent of total billed charges,61.74% of total billed charges,1462.68,102,,1170.144,percent of total billed charges,102% of total billed charges,544.92,38,,435.936,percent of total billed charges,38% of total billed charges,501.9,1462.68,
MRI of lower extremity joint (knee/ankle) with dye,7501008,CDM,610,RC,73722,HCPCS,Outpatient,,,1434,1075.5,,1118.52,78,,894.816,percent of total billed charges,78% of total billed charges,903.42,63,,722.736,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,544.92,38,,435.936,percent of total billed charges,38% of total billed charges,544.92,38,,435.936,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1290.6,90,,1032.48,percent of total billed charges,90% of total billed charges,501.9,35,,401.52,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,1147.2,80,,917.76,percent of total billed charges,80% of total billed charges,550.37,38.38,,440.296,percent of total billed charges,38.38% of total billed charges,1147.2,80,,917.76,percent of total billed charges,80% of total billed charges,885.35,61.74,,708.28,percent of total billed charges,61.74% of total billed charges,1462.68,102,,1170.144,percent of total billed charges,102% of total billed charges,544.92,38,,435.936,percent of total billed charges,38% of total billed charges,501.9,1462.68,
CT UPPER ET W/WO C RT,7400908,CDM,352,RC,73202,HCPCS,Outpatient,,,1440,1080,,1123.2,78,,898.56,percent of total billed charges,78% of total billed charges,907.2,63,,725.76,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,547.2,38,,437.76,percent of total billed charges,38% of total billed charges,547.2,38,,437.76,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1296,90,,1036.8,percent of total billed charges,90% of total billed charges,504,35,,403.2,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,1152,80,,921.6,percent of total billed charges,80% of total billed charges,552.67,38.38,,442.136,percent of total billed charges,38.38% of total billed charges,1152,80,,921.6,percent of total billed charges,80% of total billed charges,889.06,61.74,,711.248,percent of total billed charges,61.74% of total billed charges,1468.8,102,,1175.04,percent of total billed charges,102% of total billed charges,547.2,38,,437.76,percent of total billed charges,38% of total billed charges,360.18,1468.8,
CT UPPER ET W/WO C LT,7400930,CDM,352,RC,73202,HCPCS,Outpatient,,,1440,1080,,1123.2,78,,898.56,percent of total billed charges,78% of total billed charges,907.2,63,,725.76,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,547.2,38,,437.76,percent of total billed charges,38% of total billed charges,547.2,38,,437.76,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1296,90,,1036.8,percent of total billed charges,90% of total billed charges,504,35,,403.2,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,1152,80,,921.6,percent of total billed charges,80% of total billed charges,552.67,38.38,,442.136,percent of total billed charges,38.38% of total billed charges,1152,80,,921.6,percent of total billed charges,80% of total billed charges,889.06,61.74,,711.248,percent of total billed charges,61.74% of total billed charges,1468.8,102,,1175.04,percent of total billed charges,102% of total billed charges,547.2,38,,437.76,percent of total billed charges,38% of total billed charges,360.18,1468.8,
MRI L-SPINE W/CONTRAST,7500957,CDM,612,RC,72149,HCPCS,Outpatient,,,1446,1084.5,,1127.88,78,,902.304,percent of total billed charges,78% of total billed charges,910.98,63,,728.784,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,549.48,38,,439.584,percent of total billed charges,38% of total billed charges,549.48,38,,439.584,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1301.4,90,,1041.12,percent of total billed charges,90% of total billed charges,506.1,35,,404.88,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,1156.8,80,,925.44,percent of total billed charges,80% of total billed charges,554.97,38.38,,443.976,percent of total billed charges,38.38% of total billed charges,1156.8,80,,925.44,percent of total billed charges,80% of total billed charges,892.76,61.74,,714.208,percent of total billed charges,61.74% of total billed charges,1474.92,102,,1179.936,percent of total billed charges,102% of total billed charges,549.48,38,,439.584,percent of total billed charges,38% of total billed charges,506.1,1474.92,
CT of abdomen without dye,7400904,CDM,352,RC,74150,HCPCS,Outpatient,,,1468,1101,,1145.04,78,,916.032,percent of total billed charges,78% of total billed charges,924.84,63,,739.872,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,557.84,38,,446.272,percent of total billed charges,38% of total billed charges,557.84,38,,446.272,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1321.2,90,,1056.96,percent of total billed charges,90% of total billed charges,513.8,35,,411.04,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,1174.4,80,,939.52,percent of total billed charges,80% of total billed charges,563.42,38.38,,450.736,percent of total billed charges,38.38% of total billed charges,1174.4,80,,939.52,percent of total billed charges,80% of total billed charges,906.34,61.74,,725.072,percent of total billed charges,61.74% of total billed charges,1497.36,102,,1197.888,percent of total billed charges,102% of total billed charges,557.84,38,,446.272,percent of total billed charges,38% of total billed charges,360.18,1497.36,
CT of abdomen without dye,7400996,CDM,352,RC,74150,HCPCS,Outpatient,,,1468,1101,,1145.04,78,,916.032,percent of total billed charges,78% of total billed charges,924.84,63,,739.872,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,557.84,38,,446.272,percent of total billed charges,38% of total billed charges,557.84,38,,446.272,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1321.2,90,,1056.96,percent of total billed charges,90% of total billed charges,513.8,35,,411.04,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,1174.4,80,,939.52,percent of total billed charges,80% of total billed charges,563.42,38.38,,450.736,percent of total billed charges,38.38% of total billed charges,1174.4,80,,939.52,percent of total billed charges,80% of total billed charges,906.34,61.74,,725.072,percent of total billed charges,61.74% of total billed charges,1497.36,102,,1197.888,percent of total billed charges,102% of total billed charges,557.84,38,,446.272,percent of total billed charges,38% of total billed charges,360.18,1497.36,
CT CERVICAL SPINE W/O CON,7400921,CDM,352,RC,72125,HCPCS,Outpatient,,,1472,1104,,1148.16,78,,918.528,percent of total billed charges,78% of total billed charges,927.36,63,,741.888,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,559.36,38,,447.488,percent of total billed charges,38% of total billed charges,559.36,38,,447.488,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1324.8,90,,1059.84,percent of total billed charges,90% of total billed charges,515.2,35,,412.16,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,1177.6,80,,942.08,percent of total billed charges,80% of total billed charges,564.95,38.38,,451.96,percent of total billed charges,38.38% of total billed charges,1177.6,80,,942.08,percent of total billed charges,80% of total billed charges,908.81,61.74,,727.048,percent of total billed charges,61.74% of total billed charges,1501.44,102,,1201.152,percent of total billed charges,102% of total billed charges,559.36,38,,447.488,percent of total billed charges,38% of total billed charges,360.18,1501.44,
PROCTOSIGMOIDOSCOPY,1200167,CDM,981,RC,45300,HCPCS,Outpatient,,,1493,1119.75,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,53.43,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,53.43,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,53.43,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,53.43,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,53.43,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,57.41,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,55.1,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,903.34,61.74,,722.672,percent of total billed charges,61.74% of total billed charges,54.68,102,,,Fee Schedule,102% of GA Medicaid Rate,53.43,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,53.43,903.34,
MESH HERNIA GORE CHRISTIE,3005025,CDM,270,RC,,,Outpatient,,,1494,1120.5,,1165.32,78,,932.256,percent of total billed charges,78% of total billed charges,941.22,63,,752.976,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,567.72,38,,454.176,percent of total billed charges,38% of total billed charges,567.72,38,,454.176,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1344.6,90,,1075.68,percent of total billed charges,90% of total billed charges,522.9,35,,418.32,percent of total billed charges,35% of total billed charges,1005.09,67.275,,804.072,percent of total billed charges,67.275% of total billed charges,1195.2,80,,956.16,percent of total billed charges,80% of total billed charges,573.4,38.38,,458.72,percent of total billed charges,38.38% of total billed charges,1195.2,80,,956.16,percent of total billed charges,80% of total billed charges,922.4,61.74,,737.92,percent of total billed charges,61.74% of total billed charges,1523.88,102,,1219.104,percent of total billed charges,102% of total billed charges,567.72,38,,454.176,percent of total billed charges,38% of total billed charges,522.9,1523.88,
"BONE SURVEY, COMPLETE",7000788,CDM,320,RC,77075,HCPCS,Outpatient,,,1500,1125,,1170,78,,936,percent of total billed charges,78% of total billed charges,945,63,,756,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,570,38,,456,percent of total billed charges,38% of total billed charges,570,38,,456,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1350,90,,1080,percent of total billed charges,90% of total billed charges,525,35,,420,percent of total billed charges,35% of total billed charges,1009.13,67.275,,807.304,percent of total billed charges,67.275% of total billed charges,1200,80,,960,percent of total billed charges,80% of total billed charges,575.7,38.38,,460.56,percent of total billed charges,38.38% of total billed charges,1200,80,,960,percent of total billed charges,80% of total billed charges,926.1,61.74,,740.88,percent of total billed charges,61.74% of total billed charges,1530,102,,1224,percent of total billed charges,102% of total billed charges,570,38,,456,percent of total billed charges,38% of total billed charges,525,1530,
US TESTICU DUPLEX ART/VEN ABD PELV RETRO,7300913,CDM,921,RC,93975,HCPCS,Outpatient,,,1520,1140,,1185.6,78,,948.48,percent of total billed charges,78% of total billed charges,957.6,63,,766.08,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,577.6,38,,462.08,percent of total billed charges,38% of total billed charges,577.6,38,,462.08,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1368,90,,1094.4,percent of total billed charges,90% of total billed charges,532,35,,425.6,percent of total billed charges,35% of total billed charges,1022.58,67.275,,818.064,percent of total billed charges,67.275% of total billed charges,1216,80,,972.8,percent of total billed charges,80% of total billed charges,583.38,38.38,,466.704,percent of total billed charges,38.38% of total billed charges,1216,80,,972.8,percent of total billed charges,80% of total billed charges,938.45,61.74,,750.76,percent of total billed charges,61.74% of total billed charges,1550.4,102,,1240.32,percent of total billed charges,102% of total billed charges,577.6,38,,462.08,percent of total billed charges,38% of total billed charges,532,1550.4,
RECOVERY FIRST HOUR,600001,CDM,710,RC,,,Outpatient,,,1533,1149.75,,1195.74,78,,956.592,percent of total billed charges,78% of total billed charges,965.79,63,,772.632,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,582.54,38,,466.032,percent of total billed charges,38% of total billed charges,582.54,38,,466.032,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1379.7,90,,1103.76,percent of total billed charges,90% of total billed charges,536.55,35,,429.24,percent of total billed charges,35% of total billed charges,1031.33,67.275,,825.064,percent of total billed charges,67.275% of total billed charges,1226.4,80,,981.12,percent of total billed charges,80% of total billed charges,588.37,38.38,,470.696,percent of total billed charges,38.38% of total billed charges,1226.4,80,,981.12,percent of total billed charges,80% of total billed charges,946.47,61.74,,757.176,percent of total billed charges,61.74% of total billed charges,1563.66,102,,1250.928,percent of total billed charges,102% of total billed charges,582.54,38,,466.032,percent of total billed charges,38% of total billed charges,536.55,1563.66,
ER VISIT CRITICAL CARE,1001016,CDM,450,RC,99291,HCPCS,Outpatient,,,1543,1157.25,,1203.54,78,,962.832,percent of total billed charges,78% of total billed charges,972.09,63,,777.672,percent of total billed charges,63% of total billed charges,1071.64,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,586.34,38,,469.072,percent of total billed charges,38% of total billed charges,586.34,38,,469.072,percent of total billed charges,38% of total billed charges,1071.64,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,1388.7,90,,1110.96,percent of total billed charges,90% of total billed charges,540.05,35,,432.04,percent of total billed charges,35% of total billed charges,796.95,67.275,,637.56,percent of total billed charges,67.275% of total billed charges,1234.4,80,,987.52,percent of total billed charges,80% of total billed charges,592.2,38.38,,473.76,percent of total billed charges,38.38% of total billed charges,1234.4,80,,987.52,percent of total billed charges,80% of total billed charges,952.65,61.74,,762.12,percent of total billed charges,61.74% of total billed charges,1573.86,102,,1259.088,percent of total billed charges,102% of total billed charges,586.34,38,,469.072,percent of total billed charges,38% of total billed charges,540.05,1573.86,
ER MD CRITICARE 30-74 MIN,1200105,CDM,981,RC,99291,HCPCS,Outpatient,,,1543,1157.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,239.69,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,239.69,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,239.69,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,239.69,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,239.69,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,171.65,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,252.18,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,857.38,61.74,,685.904,percent of total billed charges,61.74% of total billed charges,163.48,102,,,Fee Schedule,102% of GA Medicaid Rate,239.69,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,163.48,857.38,
CARDIOVERSION EXTERNAL,1001056,CDM,450,RC,92960,HCPCS,Outpatient,,,1544,1158,,1204.32,78,,963.456,percent of total billed charges,78% of total billed charges,972.72,63,,778.176,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,586.72,38,,469.376,percent of total billed charges,38% of total billed charges,586.72,38,,469.376,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1389.6,90,,1111.68,percent of total billed charges,90% of total billed charges,540.4,35,,432.32,percent of total billed charges,35% of total billed charges,1038.73,67.275,,830.984,percent of total billed charges,67.275% of total billed charges,1235.2,80,,988.16,percent of total billed charges,80% of total billed charges,592.59,38.38,,474.072,percent of total billed charges,38.38% of total billed charges,1235.2,80,,988.16,percent of total billed charges,80% of total billed charges,953.27,61.74,,762.616,percent of total billed charges,61.74% of total billed charges,1574.88,102,,1259.904,percent of total billed charges,102% of total billed charges,586.72,38,,469.376,percent of total billed charges,38% of total billed charges,540.4,1574.88,
CARDIOVERSION,1200209,CDM,981,RC,92960,HCPCS,Outpatient,,,1544,1158,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,119.68,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,119.68,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,119.68,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,119.68,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,119.68,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,145.11,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,123.49,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,934.2,61.74,,747.36,percent of total billed charges,61.74% of total billed charges,138.2,102,,,Fee Schedule,102% of GA Medicaid Rate,119.68,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,119.68,934.2,
CT scan of abdomen and pelvis with contrast,7400954,CDM,352,RC,74177,HCPCS,Outpatient,,,1546,1159.5,,1205.88,78,,964.704,percent of total billed charges,78% of total billed charges,973.98,63,,779.184,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,587.48,38,,469.984,percent of total billed charges,38% of total billed charges,587.48,38,,469.984,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1391.4,90,,1113.12,percent of total billed charges,90% of total billed charges,541.1,35,,432.88,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,1236.8,80,,989.44,percent of total billed charges,80% of total billed charges,593.35,38.38,,474.68,percent of total billed charges,38.38% of total billed charges,1236.8,80,,989.44,percent of total billed charges,80% of total billed charges,954.5,61.74,,763.6,percent of total billed charges,61.74% of total billed charges,1576.92,102,,1261.536,percent of total billed charges,102% of total billed charges,587.48,38,,469.984,percent of total billed charges,38% of total billed charges,360.18,1576.92,
CT scan of abdomen and pelvis with contrast,7400958,CDM,352,RC,74177,HCPCS,Outpatient,,,1546,1159.5,,1205.88,78,,964.704,percent of total billed charges,78% of total billed charges,973.98,63,,779.184,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,587.48,38,,469.984,percent of total billed charges,38% of total billed charges,587.48,38,,469.984,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1391.4,90,,1113.12,percent of total billed charges,90% of total billed charges,541.1,35,,432.88,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,1236.8,80,,989.44,percent of total billed charges,80% of total billed charges,593.35,38.38,,474.68,percent of total billed charges,38.38% of total billed charges,1236.8,80,,989.44,percent of total billed charges,80% of total billed charges,954.5,61.74,,763.6,percent of total billed charges,61.74% of total billed charges,1576.92,102,,1261.536,percent of total billed charges,102% of total billed charges,587.48,38,,469.984,percent of total billed charges,38% of total billed charges,360.18,1576.92,
CT scan of abdomen and pelvis with contrast,7471260,CDM,352,RC,74177,HCPCS,Outpatient,,,1546,1159.5,,1205.88,78,,964.704,percent of total billed charges,78% of total billed charges,973.98,63,,779.184,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,587.48,38,,469.984,percent of total billed charges,38% of total billed charges,587.48,38,,469.984,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1391.4,90,,1113.12,percent of total billed charges,90% of total billed charges,541.1,35,,432.88,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,1236.8,80,,989.44,percent of total billed charges,80% of total billed charges,593.35,38.38,,474.68,percent of total billed charges,38.38% of total billed charges,1236.8,80,,989.44,percent of total billed charges,80% of total billed charges,954.5,61.74,,763.6,percent of total billed charges,61.74% of total billed charges,1576.92,102,,1261.536,percent of total billed charges,102% of total billed charges,587.48,38,,469.984,percent of total billed charges,38% of total billed charges,360.18,1576.92,
CT scan of abdomen and pelvis with contrast,7474177,CDM,352,RC,74177,HCPCS,Outpatient,,,1546,1159.5,,1205.88,78,,964.704,percent of total billed charges,78% of total billed charges,973.98,63,,779.184,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,587.48,38,,469.984,percent of total billed charges,38% of total billed charges,587.48,38,,469.984,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1391.4,90,,1113.12,percent of total billed charges,90% of total billed charges,541.1,35,,432.88,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,1236.8,80,,989.44,percent of total billed charges,80% of total billed charges,593.35,38.38,,474.68,percent of total billed charges,38.38% of total billed charges,1236.8,80,,989.44,percent of total billed charges,80% of total billed charges,954.5,61.74,,763.6,percent of total billed charges,61.74% of total billed charges,1576.92,102,,1261.536,percent of total billed charges,102% of total billed charges,587.48,38,,469.984,percent of total billed charges,38% of total billed charges,360.18,1576.92,
"Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sections ",7474178,CDM,352,RC,74178,HCPCS,Outpatient,,,1546,1159.5,,1205.88,78,,964.704,percent of total billed charges,78% of total billed charges,973.98,63,,779.184,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,587.48,38,,469.984,percent of total billed charges,38% of total billed charges,587.48,38,,469.984,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1391.4,90,,1113.12,percent of total billed charges,90% of total billed charges,541.1,35,,432.88,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,1236.8,80,,989.44,percent of total billed charges,80% of total billed charges,593.35,38.38,,474.68,percent of total billed charges,38.38% of total billed charges,1236.8,80,,989.44,percent of total billed charges,80% of total billed charges,954.5,61.74,,763.6,percent of total billed charges,61.74% of total billed charges,1576.92,102,,1261.536,percent of total billed charges,102% of total billed charges,587.48,38,,469.984,percent of total billed charges,38% of total billed charges,360.18,1576.92,
INTESTINAL BLEEDING TUBE,1001108,CDM,450,RC,44500,HCPCS,Outpatient,,,1564,1173,,1219.92,78,,975.936,percent of total billed charges,78% of total billed charges,985.32,63,,788.256,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,594.32,38,,475.456,percent of total billed charges,38% of total billed charges,594.32,38,,475.456,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1407.6,90,,1126.08,percent of total billed charges,90% of total billed charges,547.4,35,,437.92,percent of total billed charges,35% of total billed charges,1052.18,67.275,,841.744,percent of total billed charges,67.275% of total billed charges,1251.2,80,,1000.96,percent of total billed charges,80% of total billed charges,600.26,38.38,,480.208,percent of total billed charges,38.38% of total billed charges,1251.2,80,,1000.96,percent of total billed charges,80% of total billed charges,965.61,61.74,,772.488,percent of total billed charges,61.74% of total billed charges,1595.28,102,,1276.224,percent of total billed charges,102% of total billed charges,594.32,38,,475.456,percent of total billed charges,38% of total billed charges,547.4,1595.28,
CT of abdomen with dye,7400905,CDM,352,RC,74160,HCPCS,Outpatient,,,1608,1206,,1254.24,78,,1003.392,percent of total billed charges,78% of total billed charges,1013.04,63,,810.432,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,611.04,38,,488.832,percent of total billed charges,38% of total billed charges,611.04,38,,488.832,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1447.2,90,,1157.76,percent of total billed charges,90% of total billed charges,562.8,35,,450.24,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,1286.4,80,,1029.12,percent of total billed charges,80% of total billed charges,617.15,38.38,,493.72,percent of total billed charges,38.38% of total billed charges,1286.4,80,,1029.12,percent of total billed charges,80% of total billed charges,992.78,61.74,,794.224,percent of total billed charges,61.74% of total billed charges,1640.16,102,,1312.128,percent of total billed charges,102% of total billed charges,611.04,38,,488.832,percent of total billed charges,38% of total billed charges,360.18,1640.16,
CT of abdomen with dye,7400997,CDM,352,RC,74160,HCPCS,Outpatient,,,1608,1206,,1254.24,78,,1003.392,percent of total billed charges,78% of total billed charges,1013.04,63,,810.432,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,611.04,38,,488.832,percent of total billed charges,38% of total billed charges,611.04,38,,488.832,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1447.2,90,,1157.76,percent of total billed charges,90% of total billed charges,562.8,35,,450.24,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,1286.4,80,,1029.12,percent of total billed charges,80% of total billed charges,617.15,38.38,,493.72,percent of total billed charges,38.38% of total billed charges,1286.4,80,,1029.12,percent of total billed charges,80% of total billed charges,992.78,61.74,,794.224,percent of total billed charges,61.74% of total billed charges,1640.16,102,,1312.128,percent of total billed charges,102% of total billed charges,611.04,38,,488.832,percent of total billed charges,38% of total billed charges,360.18,1640.16,
CT BRAIN WITH CONTRAST,7401004,CDM,351,RC,70460,HCPCS,Outpatient,,,1608,1206,,1254.24,78,,1003.392,percent of total billed charges,78% of total billed charges,1013.04,63,,810.432,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,611.04,38,,488.832,percent of total billed charges,38% of total billed charges,611.04,38,,488.832,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1447.2,90,,1157.76,percent of total billed charges,90% of total billed charges,562.8,35,,450.24,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,1286.4,80,,1029.12,percent of total billed charges,80% of total billed charges,617.15,38.38,,493.72,percent of total billed charges,38.38% of total billed charges,1286.4,80,,1029.12,percent of total billed charges,80% of total billed charges,992.78,61.74,,794.224,percent of total billed charges,61.74% of total billed charges,1640.16,102,,1312.128,percent of total billed charges,102% of total billed charges,611.04,38,,488.832,percent of total billed charges,38% of total billed charges,360.18,1640.16,
MRI ORBIT FACE & NECK W/OUT CONTRAST,7500965,CDM,611,RC,70540,HCPCS,Outpatient,,,1678,1258.5,,1308.84,78,,1047.072,percent of total billed charges,78% of total billed charges,1057.14,63,,845.712,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,637.64,38,,510.112,percent of total billed charges,38% of total billed charges,637.64,38,,510.112,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1510.2,90,,1208.16,percent of total billed charges,90% of total billed charges,587.3,35,,469.84,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,1342.4,80,,1073.92,percent of total billed charges,80% of total billed charges,644.02,38.38,,515.216,percent of total billed charges,38.38% of total billed charges,1342.4,80,,1073.92,percent of total billed charges,80% of total billed charges,1036,61.74,,828.8,percent of total billed charges,61.74% of total billed charges,1711.56,102,,1369.248,percent of total billed charges,102% of total billed charges,637.64,38,,510.112,percent of total billed charges,38% of total billed charges,587.3,1711.56,
BIPAP VENTILATION DAY 2+,8000055,CDM,410,RC,94660,HCPCS,Outpatient,,,1678,1258.5,,1308.84,78,,1047.072,percent of total billed charges,78% of total billed charges,1057.14,63,,845.712,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,637.64,38,,510.112,percent of total billed charges,38% of total billed charges,637.64,38,,510.112,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1510.2,90,,1208.16,percent of total billed charges,90% of total billed charges,587.3,35,,469.84,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,1342.4,80,,1073.92,percent of total billed charges,80% of total billed charges,644.02,38.38,,515.216,percent of total billed charges,38.38% of total billed charges,1342.4,80,,1073.92,percent of total billed charges,80% of total billed charges,1036,61.74,,828.8,percent of total billed charges,61.74% of total billed charges,1711.56,102,,1369.248,percent of total billed charges,102% of total billed charges,637.64,38,,510.112,percent of total billed charges,38% of total billed charges,145.93,1711.56,
BIPAP VENTILATION DAY 1,8000056,CDM,410,RC,94660,HCPCS,Outpatient,,,1678,1258.5,,1308.84,78,,1047.072,percent of total billed charges,78% of total billed charges,1057.14,63,,845.712,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,637.64,38,,510.112,percent of total billed charges,38% of total billed charges,637.64,38,,510.112,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1510.2,90,,1208.16,percent of total billed charges,90% of total billed charges,587.3,35,,469.84,percent of total billed charges,35% of total billed charges,145.93,67.275,,116.744,percent of total billed charges,67.275% of total billed charges,1342.4,80,,1073.92,percent of total billed charges,80% of total billed charges,644.02,38.38,,515.216,percent of total billed charges,38.38% of total billed charges,1342.4,80,,1073.92,percent of total billed charges,80% of total billed charges,1036,61.74,,828.8,percent of total billed charges,61.74% of total billed charges,1711.56,102,,1369.248,percent of total billed charges,102% of total billed charges,637.64,38,,510.112,percent of total billed charges,38% of total billed charges,145.93,1711.56,
VARIAX L PLATE LEFT,3005028,CDM,270,RC,,,Outpatient,,,1711.8,1283.85,,1335.2,78,,1068.16,percent of total billed charges,78% of total billed charges,1078.43,63,,862.744,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,650.48,38,,520.384,percent of total billed charges,38% of total billed charges,650.48,38,,520.384,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1540.62,90,,1232.496,percent of total billed charges,90% of total billed charges,599.13,35,,479.304,percent of total billed charges,35% of total billed charges,1151.61,67.275,,921.288,percent of total billed charges,67.275% of total billed charges,1369.44,80,,1095.552,percent of total billed charges,80% of total billed charges,656.99,38.38,,525.592,percent of total billed charges,38.38% of total billed charges,1369.44,80,,1095.552,percent of total billed charges,80% of total billed charges,1056.87,61.74,,845.496,percent of total billed charges,61.74% of total billed charges,1746.04,102,,1396.832,percent of total billed charges,102% of total billed charges,650.48,38,,520.384,percent of total billed charges,38% of total billed charges,599.13,1746.04,
CT scan of the thorax with dye,7400917,CDM,352,RC,71260,HCPCS,Outpatient,,,1712,1284,,1335.36,78,,1068.288,percent of total billed charges,78% of total billed charges,1078.56,63,,862.848,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,650.56,38,,520.448,percent of total billed charges,38% of total billed charges,650.56,38,,520.448,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1540.8,90,,1232.64,percent of total billed charges,90% of total billed charges,599.2,35,,479.36,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,1369.6,80,,1095.68,percent of total billed charges,80% of total billed charges,657.07,38.38,,525.656,percent of total billed charges,38.38% of total billed charges,1369.6,80,,1095.68,percent of total billed charges,80% of total billed charges,1056.99,61.74,,845.592,percent of total billed charges,61.74% of total billed charges,1746.24,102,,1396.992,percent of total billed charges,102% of total billed charges,650.56,38,,520.448,percent of total billed charges,38% of total billed charges,360.18,1746.24,
SECURESTRAP,3001733,CDM,270,RC,,,Outpatient,,,1725,1293.75,,1345.5,78,,1076.4,percent of total billed charges,78% of total billed charges,1086.75,63,,869.4,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,655.5,38,,524.4,percent of total billed charges,38% of total billed charges,655.5,38,,524.4,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1552.5,90,,1242,percent of total billed charges,90% of total billed charges,603.75,35,,483,percent of total billed charges,35% of total billed charges,1160.49,67.275,,928.392,percent of total billed charges,67.275% of total billed charges,1380,80,,1104,percent of total billed charges,80% of total billed charges,662.06,38.38,,529.648,percent of total billed charges,38.38% of total billed charges,1380,80,,1104,percent of total billed charges,80% of total billed charges,1065.02,61.74,,852.016,percent of total billed charges,61.74% of total billed charges,1759.5,102,,1407.6,percent of total billed charges,102% of total billed charges,655.5,38,,524.4,percent of total billed charges,38% of total billed charges,603.75,1759.5,
PLATE HOOK 3.5 MM LCP,3006024,CDM,270,RC,,,Outpatient,,,1800,1350,,1404,78,,1123.2,percent of total billed charges,78% of total billed charges,1134,63,,907.2,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,684,38,,547.2,percent of total billed charges,38% of total billed charges,684,38,,547.2,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1620,90,,1296,percent of total billed charges,90% of total billed charges,630,35,,504,percent of total billed charges,35% of total billed charges,1210.95,67.275,,968.76,percent of total billed charges,67.275% of total billed charges,1440,80,,1152,percent of total billed charges,80% of total billed charges,690.84,38.38,,552.672,percent of total billed charges,38.38% of total billed charges,1440,80,,1152,percent of total billed charges,80% of total billed charges,1111.32,61.74,,889.056,percent of total billed charges,61.74% of total billed charges,1836,102,,1468.8,percent of total billed charges,102% of total billed charges,684,38,,547.2,percent of total billed charges,38% of total billed charges,630,1836,
VAGINAL DELIVERY,1001260,CDM,450,RC,,,Outpatient,,,1819,1364.25,,1418.82,78,,1135.056,percent of total billed charges,78% of total billed charges,1145.97,63,,916.776,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,691.22,38,,552.976,percent of total billed charges,38% of total billed charges,691.22,38,,552.976,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1637.1,90,,1309.68,percent of total billed charges,90% of total billed charges,636.65,35,,509.32,percent of total billed charges,35% of total billed charges,1223.73,67.275,,978.984,percent of total billed charges,67.275% of total billed charges,1455.2,80,,1164.16,percent of total billed charges,80% of total billed charges,698.13,38.38,,558.504,percent of total billed charges,38.38% of total billed charges,1455.2,80,,1164.16,percent of total billed charges,80% of total billed charges,1123.05,61.74,,898.44,percent of total billed charges,61.74% of total billed charges,1855.38,102,,1484.304,percent of total billed charges,102% of total billed charges,691.22,38,,552.976,percent of total billed charges,38% of total billed charges,636.65,1855.38,
CT of abdomen with and without dye,7400906,CDM,352,RC,74170,HCPCS,Outpatient,,,1907,1430.25,,1487.46,78,,1189.968,percent of total billed charges,78% of total billed charges,1201.41,63,,961.128,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,724.66,38,,579.728,percent of total billed charges,38% of total billed charges,724.66,38,,579.728,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1716.3,90,,1373.04,percent of total billed charges,90% of total billed charges,667.45,35,,533.96,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,1525.6,80,,1220.48,percent of total billed charges,80% of total billed charges,731.91,38.38,,585.528,percent of total billed charges,38.38% of total billed charges,1525.6,80,,1220.48,percent of total billed charges,80% of total billed charges,1177.38,61.74,,941.904,percent of total billed charges,61.74% of total billed charges,1945.14,102,,1556.112,percent of total billed charges,102% of total billed charges,724.66,38,,579.728,percent of total billed charges,38% of total billed charges,360.18,1945.14,
"Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sections ",7400955,CDM,352,RC,74178,HCPCS,Outpatient,,,1927,1445.25,,1503.06,78,,1202.448,percent of total billed charges,78% of total billed charges,1214.01,63,,971.208,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,732.26,38,,585.808,percent of total billed charges,38% of total billed charges,732.26,38,,585.808,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1734.3,90,,1387.44,percent of total billed charges,90% of total billed charges,674.45,35,,539.56,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,1541.6,80,,1233.28,percent of total billed charges,80% of total billed charges,739.58,38.38,,591.664,percent of total billed charges,38.38% of total billed charges,1541.6,80,,1233.28,percent of total billed charges,80% of total billed charges,1189.73,61.74,,951.784,percent of total billed charges,61.74% of total billed charges,1965.54,102,,1572.432,percent of total billed charges,102% of total billed charges,732.26,38,,585.808,percent of total billed charges,38% of total billed charges,360.18,1965.54,
MRI of brain stem without dye,7500948,CDM,611,RC,70551,HCPCS,Outpatient,,,1930,1447.5,,1505.4,78,,1204.32,percent of total billed charges,78% of total billed charges,1215.9,63,,972.72,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,733.4,38,,586.72,percent of total billed charges,38% of total billed charges,733.4,38,,586.72,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1737,90,,1389.6,percent of total billed charges,90% of total billed charges,675.5,35,,540.4,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,1544,80,,1235.2,percent of total billed charges,80% of total billed charges,740.73,38.38,,592.584,percent of total billed charges,38.38% of total billed charges,1544,80,,1235.2,percent of total billed charges,80% of total billed charges,1191.58,61.74,,953.264,percent of total billed charges,61.74% of total billed charges,1968.6,102,,1574.88,percent of total billed charges,102% of total billed charges,733.4,38,,586.72,percent of total billed charges,38% of total billed charges,675.5,1968.6,
MRA HEAD WITHOUT CONTRAST,7501005,CDM,611,RC,70544,HCPCS,Outpatient,,,1930,1447.5,,1505.4,78,,1204.32,percent of total billed charges,78% of total billed charges,1215.9,63,,972.72,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,733.4,38,,586.72,percent of total billed charges,38% of total billed charges,733.4,38,,586.72,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1737,90,,1389.6,percent of total billed charges,90% of total billed charges,675.5,35,,540.4,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,1544,80,,1235.2,percent of total billed charges,80% of total billed charges,740.73,38.38,,592.584,percent of total billed charges,38.38% of total billed charges,1544,80,,1235.2,percent of total billed charges,80% of total billed charges,1191.58,61.74,,953.264,percent of total billed charges,61.74% of total billed charges,1968.6,102,,1574.88,percent of total billed charges,102% of total billed charges,733.4,38,,586.72,percent of total billed charges,38% of total billed charges,675.5,1968.6,
MRA NECK W/O CONTRAST,7501011,CDM,610,RC,70547,HCPCS,Outpatient,,,1930,1447.5,,1505.4,78,,1204.32,percent of total billed charges,78% of total billed charges,1215.9,63,,972.72,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,733.4,38,,586.72,percent of total billed charges,38% of total billed charges,733.4,38,,586.72,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1737,90,,1389.6,percent of total billed charges,90% of total billed charges,675.5,35,,540.4,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,1544,80,,1235.2,percent of total billed charges,80% of total billed charges,740.73,38.38,,592.584,percent of total billed charges,38.38% of total billed charges,1544,80,,1235.2,percent of total billed charges,80% of total billed charges,1191.58,61.74,,953.264,percent of total billed charges,61.74% of total billed charges,1968.6,102,,1574.88,percent of total billed charges,102% of total billed charges,733.4,38,,586.72,percent of total billed charges,38% of total billed charges,675.5,1968.6,
CT ANGIOGRAPHY NECK W/WO CONTRAST,7400805,CDM,352,RC,70498,HCPCS,Outpatient,,,1969,1476.75,,1535.82,78,,1228.656,percent of total billed charges,78% of total billed charges,1240.47,63,,992.376,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,748.22,38,,598.576,percent of total billed charges,38% of total billed charges,748.22,38,,598.576,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1772.1,90,,1417.68,percent of total billed charges,90% of total billed charges,689.15,35,,551.32,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,1575.2,80,,1260.16,percent of total billed charges,80% of total billed charges,755.7,38.38,,604.56,percent of total billed charges,38.38% of total billed charges,1575.2,80,,1260.16,percent of total billed charges,80% of total billed charges,1215.66,61.74,,972.528,percent of total billed charges,61.74% of total billed charges,2008.38,102,,1606.704,percent of total billed charges,102% of total billed charges,748.22,38,,598.576,percent of total billed charges,38% of total billed charges,360.18,2008.38,
PERIRECTAL ABSCESS,1200144,CDM,981,RC,46040,HCPCS,Outpatient,,,1970,1477.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,469.57,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,469.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,469.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,469.57,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,469.57,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,294.95,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,494.09,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,1191.95,61.74,,953.56,percent of total billed charges,61.74% of total billed charges,280.9,102,,,Fee Schedule,102% of GA Medicaid Rate,469.57,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,280.9,1191.95,
THROMBOSED EXTERNAL,1200145,CDM,981,RC,46320,HCPCS,Outpatient,,,1970,1477.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,125.05,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,125.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,125.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,125.05,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,125.05,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,131.03,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,131.1,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,1191.95,61.74,,953.56,percent of total billed charges,61.74% of total billed charges,124.79,102,,,Fee Schedule,102% of GA Medicaid Rate,125.05,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,124.79,1191.95,
AVAMAX CEMENT GUN,3004250,CDM,270,RC,,,Outpatient,,,2008.5,1506.38,,1566.63,78,,1253.304,percent of total billed charges,78% of total billed charges,1265.36,63,,1012.288,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,763.23,38,,610.584,percent of total billed charges,38% of total billed charges,763.23,38,,610.584,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1807.65,90,,1446.12,percent of total billed charges,90% of total billed charges,702.98,35,,562.384,percent of total billed charges,35% of total billed charges,1351.22,67.275,,1080.976,percent of total billed charges,67.275% of total billed charges,1606.8,80,,1285.44,percent of total billed charges,80% of total billed charges,770.86,38.38,,616.688,percent of total billed charges,38.38% of total billed charges,1606.8,80,,1285.44,percent of total billed charges,80% of total billed charges,1240.05,61.74,,992.04,percent of total billed charges,61.74% of total billed charges,2048.67,102,,1638.936,percent of total billed charges,102% of total billed charges,763.23,38,,610.584,percent of total billed charges,38% of total billed charges,702.98,2048.67,
CT CHEST W/WO CONTRAST,7400919,CDM,352,RC,71270,HCPCS,Outpatient,,,2031,1523.25,,1584.18,78,,1267.344,percent of total billed charges,78% of total billed charges,1279.53,63,,1023.624,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,771.78,38,,617.424,percent of total billed charges,38% of total billed charges,771.78,38,,617.424,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1827.9,90,,1462.32,percent of total billed charges,90% of total billed charges,710.85,35,,568.68,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,1624.8,80,,1299.84,percent of total billed charges,80% of total billed charges,779.5,38.38,,623.6,percent of total billed charges,38.38% of total billed charges,1624.8,80,,1299.84,percent of total billed charges,80% of total billed charges,1253.94,61.74,,1003.152,percent of total billed charges,61.74% of total billed charges,2071.62,102,,1657.296,percent of total billed charges,102% of total billed charges,771.78,38,,617.424,percent of total billed charges,38% of total billed charges,360.18,2071.62,
CT BRAIN WITH AND WITHOUT CONTRAST,7400902,CDM,351,RC,70470,HCPCS,Outpatient,,,2055,1541.25,,1602.9,78,,1282.32,percent of total billed charges,78% of total billed charges,1294.65,63,,1035.72,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,780.9,38,,624.72,percent of total billed charges,38% of total billed charges,780.9,38,,624.72,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1849.5,90,,1479.6,percent of total billed charges,90% of total billed charges,719.25,35,,575.4,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,1644,80,,1315.2,percent of total billed charges,80% of total billed charges,788.71,38.38,,630.968,percent of total billed charges,38.38% of total billed charges,1644,80,,1315.2,percent of total billed charges,80% of total billed charges,1268.76,61.74,,1015.008,percent of total billed charges,61.74% of total billed charges,2096.1,102,,1676.88,percent of total billed charges,102% of total billed charges,780.9,38,,624.72,percent of total billed charges,38% of total billed charges,360.18,2096.1,
CT ANGIOGRAPHY HEAD W/WO CONTRAST,7400800,CDM,352,RC,70496,HCPCS,Outpatient,,,2059,1544.25,,1606.02,78,,1284.816,percent of total billed charges,78% of total billed charges,1297.17,63,,1037.736,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,782.42,38,,625.936,percent of total billed charges,38% of total billed charges,782.42,38,,625.936,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1853.1,90,,1482.48,percent of total billed charges,90% of total billed charges,720.65,35,,576.52,percent of total billed charges,35% of total billed charges,360.18,67.275,,288.144,percent of total billed charges,67.275% of total billed charges,1647.2,80,,1317.76,percent of total billed charges,80% of total billed charges,790.24,38.38,,632.192,percent of total billed charges,38.38% of total billed charges,1647.2,80,,1317.76,percent of total billed charges,80% of total billed charges,1271.23,61.74,,1016.984,percent of total billed charges,61.74% of total billed charges,2100.18,102,,1680.144,percent of total billed charges,102% of total billed charges,782.42,38,,625.936,percent of total billed charges,38% of total billed charges,360.18,2100.18,
CVL PERCU AGE < 5 YRS,1001136,CDM,450,RC,36555,HCPCS,Outpatient,,,2068,1551,,1613.04,78,,1290.432,percent of total billed charges,78% of total billed charges,1302.84,63,,1042.272,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,785.84,38,,628.672,percent of total billed charges,38% of total billed charges,785.84,38,,628.672,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,723.8,35,,579.04,percent of total billed charges,35% of total billed charges,1391.25,67.275,,1113,percent of total billed charges,67.275% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,80% of total billed charges,793.7,38.38,,634.96,percent of total billed charges,38.38% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,80% of total billed charges,1276.78,61.74,,1021.424,percent of total billed charges,61.74% of total billed charges,2109.36,102,,1687.488,percent of total billed charges,102% of total billed charges,785.84,38,,628.672,percent of total billed charges,38% of total billed charges,723.8,2109.36,
CVL CUTDOWN AGE > 5 YRS,1001142,CDM,450,RC,36569,HCPCS,Outpatient,,,2068,1551,,1613.04,78,,1290.432,percent of total billed charges,78% of total billed charges,1302.84,63,,1042.272,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,785.84,38,,628.672,percent of total billed charges,38% of total billed charges,785.84,38,,628.672,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,723.8,35,,579.04,percent of total billed charges,35% of total billed charges,1391.25,67.275,,1113,percent of total billed charges,67.275% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,80% of total billed charges,793.7,38.38,,634.96,percent of total billed charges,38.38% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,80% of total billed charges,1276.78,61.74,,1021.424,percent of total billed charges,61.74% of total billed charges,2109.36,102,,1687.488,percent of total billed charges,102% of total billed charges,785.84,38,,628.672,percent of total billed charges,38% of total billed charges,723.8,2109.36,
TUBE THORACOSTOMY/WATER,1200195,CDM,981,RC,32551,HCPCS,Outpatient,,,2068,1551,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,174.1,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,174.1,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,174.1,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,174.1,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,174.1,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,137.11,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,186.83,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,1251.25,61.74,,1001,percent of total billed charges,61.74% of total billed charges,130.58,102,,,Fee Schedule,102% of GA Medicaid Rate,174.1,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,130.58,1251.25,
PERICARDIOCENTESIS,1200196,CDM,981,RC,33010,HCPCS,Outpatient,,,2068,1551,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1251.25,61.74,,1001,percent of total billed charges,61.74% of total billed charges,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1251.25,1251.25,
"CENTRAL VENOUS CATH, OVER AGE 5",1200200,CDM,981,RC,36556,HCPCS,Outpatient,,,2068,1551,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,94.4,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,94.4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,94.4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,94.4,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,94.4,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,292.2,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,99.41,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,1251.25,61.74,,1001,percent of total billed charges,61.74% of total billed charges,278.29,102,,,Fee Schedule,102% of GA Medicaid Rate,94.4,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,94.4,1251.25,
BIO-A 9 X 15,3001812,CDM,270,RC,,,Outpatient,,,2085,1563.75,,1626.3,78,,1301.04,percent of total billed charges,78% of total billed charges,1313.55,63,,1050.84,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,792.3,38,,633.84,percent of total billed charges,38% of total billed charges,792.3,38,,633.84,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1876.5,90,,1501.2,percent of total billed charges,90% of total billed charges,729.75,35,,583.8,percent of total billed charges,35% of total billed charges,1402.68,67.275,,1122.144,percent of total billed charges,67.275% of total billed charges,1668,80,,1334.4,percent of total billed charges,80% of total billed charges,800.22,38.38,,640.176,percent of total billed charges,38.38% of total billed charges,1668,80,,1334.4,percent of total billed charges,80% of total billed charges,1287.28,61.74,,1029.824,percent of total billed charges,61.74% of total billed charges,2126.7,102,,1701.36,percent of total billed charges,102% of total billed charges,792.3,38,,633.84,percent of total billed charges,38% of total billed charges,729.75,2126.7,
MRI ORBIT FACE NECK W/ CONTRAST,7500969,CDM,611,RC,70542,HCPCS,Outpatient,,,2096,1572,,1634.88,78,,1307.904,percent of total billed charges,78% of total billed charges,1320.48,63,,1056.384,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,796.48,38,,637.184,percent of total billed charges,38% of total billed charges,796.48,38,,637.184,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1886.4,90,,1509.12,percent of total billed charges,90% of total billed charges,733.6,35,,586.88,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,1676.8,80,,1341.44,percent of total billed charges,80% of total billed charges,804.44,38.38,,643.552,percent of total billed charges,38.38% of total billed charges,1676.8,80,,1341.44,percent of total billed charges,80% of total billed charges,1294.07,61.74,,1035.256,percent of total billed charges,61.74% of total billed charges,2137.92,102,,1710.336,percent of total billed charges,102% of total billed charges,796.48,38,,637.184,percent of total billed charges,38% of total billed charges,733.6,2137.92,
MRI UPR EXT RT-W/WO CONTRAST,7500960,CDM,610,RC,73220,HCPCS,Outpatient,,,2180,1635,,1700.4,78,,1360.32,percent of total billed charges,78% of total billed charges,1373.4,63,,1098.72,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,828.4,38,,662.72,percent of total billed charges,38% of total billed charges,828.4,38,,662.72,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1962,90,,1569.6,percent of total billed charges,90% of total billed charges,763,35,,610.4,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,1744,80,,1395.2,percent of total billed charges,80% of total billed charges,836.68,38.38,,669.344,percent of total billed charges,38.38% of total billed charges,1744,80,,1395.2,percent of total billed charges,80% of total billed charges,1345.93,61.74,,1076.744,percent of total billed charges,61.74% of total billed charges,2223.6,102,,1778.88,percent of total billed charges,102% of total billed charges,828.4,38,,662.72,percent of total billed charges,38% of total billed charges,763,2223.6,
MRI LWR EXT-RT W/WO CONTRAST,7500962,CDM,610,RC,73720,HCPCS,Outpatient,,,2180,1635,,1700.4,78,,1360.32,percent of total billed charges,78% of total billed charges,1373.4,63,,1098.72,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,828.4,38,,662.72,percent of total billed charges,38% of total billed charges,828.4,38,,662.72,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1962,90,,1569.6,percent of total billed charges,90% of total billed charges,763,35,,610.4,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,1744,80,,1395.2,percent of total billed charges,80% of total billed charges,836.68,38.38,,669.344,percent of total billed charges,38.38% of total billed charges,1744,80,,1395.2,percent of total billed charges,80% of total billed charges,1345.93,61.74,,1076.744,percent of total billed charges,61.74% of total billed charges,2223.6,102,,1778.88,percent of total billed charges,102% of total billed charges,828.4,38,,662.72,percent of total billed charges,38% of total billed charges,763,2223.6,
MRI LWR EXT-LT W/WO CONTRAST,7500967,CDM,610,RC,73720,HCPCS,Outpatient,,,2180,1635,,1700.4,78,,1360.32,percent of total billed charges,78% of total billed charges,1373.4,63,,1098.72,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,828.4,38,,662.72,percent of total billed charges,38% of total billed charges,828.4,38,,662.72,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1962,90,,1569.6,percent of total billed charges,90% of total billed charges,763,35,,610.4,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,1744,80,,1395.2,percent of total billed charges,80% of total billed charges,836.68,38.38,,669.344,percent of total billed charges,38.38% of total billed charges,1744,80,,1395.2,percent of total billed charges,80% of total billed charges,1345.93,61.74,,1076.744,percent of total billed charges,61.74% of total billed charges,2223.6,102,,1778.88,percent of total billed charges,102% of total billed charges,828.4,38,,662.72,percent of total billed charges,38% of total billed charges,763,2223.6,
MRI UPR EXT LT-W/WO CONTRAST,7500968,CDM,610,RC,73220,HCPCS,Outpatient,,,2180,1635,,1700.4,78,,1360.32,percent of total billed charges,78% of total billed charges,1373.4,63,,1098.72,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,828.4,38,,662.72,percent of total billed charges,38% of total billed charges,828.4,38,,662.72,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,1962,90,,1569.6,percent of total billed charges,90% of total billed charges,763,35,,610.4,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,1744,80,,1395.2,percent of total billed charges,80% of total billed charges,836.68,38.38,,669.344,percent of total billed charges,38.38% of total billed charges,1744,80,,1395.2,percent of total billed charges,80% of total billed charges,1345.93,61.74,,1076.744,percent of total billed charges,61.74% of total billed charges,2223.6,102,,1778.88,percent of total billed charges,102% of total billed charges,828.4,38,,662.72,percent of total billed charges,38% of total billed charges,763,2223.6,
CARBON FOOT PLATE,3006001,CDM,270,RC,,,Outpatient,,,2250,1687.5,,1755,78,,1404,percent of total billed charges,78% of total billed charges,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,855,38,,684,percent of total billed charges,38% of total billed charges,855,38,,684,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,2025,90,,1620,percent of total billed charges,90% of total billed charges,787.5,35,,630,percent of total billed charges,35% of total billed charges,1513.69,67.275,,1210.952,percent of total billed charges,67.275% of total billed charges,1800,80,,1440,percent of total billed charges,80% of total billed charges,863.55,38.38,,690.84,percent of total billed charges,38.38% of total billed charges,1800,80,,1440,percent of total billed charges,80% of total billed charges,1389.15,61.74,,1111.32,percent of total billed charges,61.74% of total billed charges,2295,102,,1836,percent of total billed charges,102% of total billed charges,855,38,,684,percent of total billed charges,38% of total billed charges,787.5,2295,
MRA NECK W/ CONTRAST,7501012,CDM,610,RC,70548,HCPCS,Outpatient,,,2306,1729.5,,1798.68,78,,1438.944,percent of total billed charges,78% of total billed charges,1452.78,63,,1162.224,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,876.28,38,,701.024,percent of total billed charges,38% of total billed charges,876.28,38,,701.024,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,2075.4,90,,1660.32,percent of total billed charges,90% of total billed charges,807.1,35,,645.68,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,1844.8,80,,1475.84,percent of total billed charges,80% of total billed charges,885.04,38.38,,708.032,percent of total billed charges,38.38% of total billed charges,1844.8,80,,1475.84,percent of total billed charges,80% of total billed charges,1423.72,61.74,,1138.976,percent of total billed charges,61.74% of total billed charges,2352.12,102,,1881.696,percent of total billed charges,102% of total billed charges,876.28,38,,701.024,percent of total billed charges,38% of total billed charges,807.1,2352.12,
ALUMAFIX FOOT PLATE,3006014,CDM,270,RC,,,Outpatient,,,2370,1777.5,,1848.6,78,,1478.88,percent of total billed charges,78% of total billed charges,1493.1,63,,1194.48,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,900.6,38,,720.48,percent of total billed charges,38% of total billed charges,900.6,38,,720.48,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,2133,90,,1706.4,percent of total billed charges,90% of total billed charges,829.5,35,,663.6,percent of total billed charges,35% of total billed charges,1594.42,67.275,,1275.536,percent of total billed charges,67.275% of total billed charges,1896,80,,1516.8,percent of total billed charges,80% of total billed charges,909.61,38.38,,727.688,percent of total billed charges,38.38% of total billed charges,1896,80,,1516.8,percent of total billed charges,80% of total billed charges,1463.24,61.74,,1170.592,percent of total billed charges,61.74% of total billed charges,2417.4,102,,1933.92,percent of total billed charges,102% of total billed charges,900.6,38,,720.48,percent of total billed charges,38% of total billed charges,829.5,2417.4,
EMERG TRACH/TRANSTRACHEAL,1001058,CDM,450,RC,31603,HCPCS,Outpatient,,,2394,1795.5,,1867.32,78,,1493.856,percent of total billed charges,78% of total billed charges,1508.22,63,,1206.576,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,909.72,38,,727.776,percent of total billed charges,38% of total billed charges,909.72,38,,727.776,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,2154.6,90,,1723.68,percent of total billed charges,90% of total billed charges,837.9,35,,670.32,percent of total billed charges,35% of total billed charges,1610.56,67.275,,1288.448,percent of total billed charges,67.275% of total billed charges,1915.2,80,,1532.16,percent of total billed charges,80% of total billed charges,918.82,38.38,,735.056,percent of total billed charges,38.38% of total billed charges,1915.2,80,,1532.16,percent of total billed charges,80% of total billed charges,1478.06,61.74,,1182.448,percent of total billed charges,61.74% of total billed charges,2441.88,102,,1953.504,percent of total billed charges,102% of total billed charges,909.72,38,,727.776,percent of total billed charges,38% of total billed charges,837.9,2441.88,
"TRACHEOSTOMY EMERGENCY, TRANSTRACHEAL",1200239,CDM,981,RC,31603,HCPCS,Outpatient,,,2394,1795.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,360.07,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,360.07,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,360.07,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,360.07,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,360.07,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,257.3,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,381.49,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,1448.49,61.74,,1158.792,percent of total billed charges,61.74% of total billed charges,245.05,102,,,Fee Schedule,102% of GA Medicaid Rate,360.07,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,245.05,1448.49,
MRI CHEST W/WO CONTRAST,7500940,CDM,610,RC,71552,HCPCS,Outpatient,,,2406,1804.5,,1876.68,78,,1501.344,percent of total billed charges,78% of total billed charges,1515.78,63,,1212.624,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,914.28,38,,731.424,percent of total billed charges,38% of total billed charges,914.28,38,,731.424,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,2165.4,90,,1732.32,percent of total billed charges,90% of total billed charges,842.1,35,,673.68,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,1924.8,80,,1539.84,percent of total billed charges,80% of total billed charges,923.42,38.38,,738.736,percent of total billed charges,38.38% of total billed charges,1924.8,80,,1539.84,percent of total billed charges,80% of total billed charges,1485.46,61.74,,1188.368,percent of total billed charges,61.74% of total billed charges,2454.12,102,,1963.296,percent of total billed charges,102% of total billed charges,914.28,38,,731.424,percent of total billed charges,38% of total billed charges,842.1,2454.12,
MRI of pelvis before and after dye,7500988,CDM,612,RC,72197,HCPCS,Outpatient,,,2406,1804.5,,1876.68,78,,1501.344,percent of total billed charges,78% of total billed charges,1515.78,63,,1212.624,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,914.28,38,,731.424,percent of total billed charges,38% of total billed charges,914.28,38,,731.424,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,2165.4,90,,1732.32,percent of total billed charges,90% of total billed charges,842.1,35,,673.68,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,1924.8,80,,1539.84,percent of total billed charges,80% of total billed charges,923.42,38.38,,738.736,percent of total billed charges,38.38% of total billed charges,1924.8,80,,1539.84,percent of total billed charges,80% of total billed charges,1485.46,61.74,,1188.368,percent of total billed charges,61.74% of total billed charges,2454.12,102,,1963.296,percent of total billed charges,102% of total billed charges,914.28,38,,731.424,percent of total billed charges,38% of total billed charges,842.1,2454.12,
MRI of abdomen without and with dye,7501010,CDM,610,RC,74183,HCPCS,Outpatient,,,2406,1804.5,,1876.68,78,,1501.344,percent of total billed charges,78% of total billed charges,1515.78,63,,1212.624,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,914.28,38,,731.424,percent of total billed charges,38% of total billed charges,914.28,38,,731.424,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,2165.4,90,,1732.32,percent of total billed charges,90% of total billed charges,842.1,35,,673.68,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,1924.8,80,,1539.84,percent of total billed charges,80% of total billed charges,923.42,38.38,,738.736,percent of total billed charges,38.38% of total billed charges,1924.8,80,,1539.84,percent of total billed charges,80% of total billed charges,1485.46,61.74,,1188.368,percent of total billed charges,61.74% of total billed charges,2454.12,102,,1963.296,percent of total billed charges,102% of total billed charges,914.28,38,,731.424,percent of total billed charges,38% of total billed charges,842.1,2454.12,
MRI BRAIN W/CONTRAST,7500949,CDM,611,RC,70552,HCPCS,Outpatient,,,2410,1807.5,,1879.8,78,,1503.84,percent of total billed charges,78% of total billed charges,1518.3,63,,1214.64,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,915.8,38,,732.64,percent of total billed charges,38% of total billed charges,915.8,38,,732.64,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,2169,90,,1735.2,percent of total billed charges,90% of total billed charges,843.5,35,,674.8,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,1928,80,,1542.4,percent of total billed charges,80% of total billed charges,924.96,38.38,,739.968,percent of total billed charges,38.38% of total billed charges,1928,80,,1542.4,percent of total billed charges,80% of total billed charges,1487.93,61.74,,1190.344,percent of total billed charges,61.74% of total billed charges,2458.2,102,,1966.56,percent of total billed charges,102% of total billed charges,915.8,38,,732.64,percent of total billed charges,38% of total billed charges,843.5,2458.2,
MRI of chest and spine with and without dye,7501002,CDM,612,RC,72157,HCPCS,Outpatient,,,2446,1834.5,,1907.88,78,,1526.304,percent of total billed charges,78% of total billed charges,1540.98,63,,1232.784,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,929.48,38,,743.584,percent of total billed charges,38% of total billed charges,929.48,38,,743.584,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,2201.4,90,,1761.12,percent of total billed charges,90% of total billed charges,856.1,35,,684.88,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,1956.8,80,,1565.44,percent of total billed charges,80% of total billed charges,938.77,38.38,,751.016,percent of total billed charges,38.38% of total billed charges,1956.8,80,,1565.44,percent of total billed charges,80% of total billed charges,1510.16,61.74,,1208.128,percent of total billed charges,61.74% of total billed charges,2494.92,102,,1995.936,percent of total billed charges,102% of total billed charges,929.48,38,,743.584,percent of total billed charges,38% of total billed charges,855.95,2494.92,
OR LEVEL 2 FIRST HOUR,400110,CDM,360,RC,,,Outpatient,,,2478,1858.5,,1932.84,78,,1546.272,percent of total billed charges,78% of total billed charges,1561.14,63,,1248.912,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,941.64,38,,753.312,percent of total billed charges,38% of total billed charges,941.64,38,,753.312,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,2230.2,90,,1784.16,percent of total billed charges,90% of total billed charges,867.3,35,,693.84,percent of total billed charges,35% of total billed charges,1667.07,67.275,,1333.656,percent of total billed charges,67.275% of total billed charges,1982.4,80,,1585.92,percent of total billed charges,80% of total billed charges,951.06,38.38,,760.848,percent of total billed charges,38.38% of total billed charges,1982.4,80,,1585.92,percent of total billed charges,80% of total billed charges,1529.92,61.74,,1223.936,percent of total billed charges,61.74% of total billed charges,2527.56,102,,2022.048,percent of total billed charges,102% of total billed charges,941.64,38,,753.312,percent of total billed charges,38% of total billed charges,867.3,2527.56,
MRI of lower extremity joint (knee/ankle) with and without dye,7501007,CDM,610,RC,73723,HCPCS,Outpatient,,,2507,1880.25,,1955.46,78,,1564.368,percent of total billed charges,78% of total billed charges,1579.41,63,,1263.528,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,952.66,38,,762.128,percent of total billed charges,38% of total billed charges,952.66,38,,762.128,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,2256.3,90,,1805.04,percent of total billed charges,90% of total billed charges,877.45,35,,701.96,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,2005.6,80,,1604.48,percent of total billed charges,80% of total billed charges,962.19,38.38,,769.752,percent of total billed charges,38.38% of total billed charges,2005.6,80,,1604.48,percent of total billed charges,80% of total billed charges,1547.82,61.74,,1238.256,percent of total billed charges,61.74% of total billed charges,2557.14,102,,2045.712,percent of total billed charges,102% of total billed charges,952.66,38,,762.128,percent of total billed charges,38% of total billed charges,855.95,2557.14,
MRI of neck/spine with and without dye,7501001,CDM,612,RC,72156,HCPCS,Outpatient,,,2557,1917.75,,1994.46,78,,1595.568,percent of total billed charges,78% of total billed charges,1610.91,63,,1288.728,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,971.66,38,,777.328,percent of total billed charges,38% of total billed charges,971.66,38,,777.328,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,2301.3,90,,1841.04,percent of total billed charges,90% of total billed charges,894.95,35,,715.96,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,2045.6,80,,1636.48,percent of total billed charges,80% of total billed charges,981.38,38.38,,785.104,percent of total billed charges,38.38% of total billed charges,2045.6,80,,1636.48,percent of total billed charges,80% of total billed charges,1578.69,61.74,,1262.952,percent of total billed charges,61.74% of total billed charges,2608.14,102,,2086.512,percent of total billed charges,102% of total billed charges,971.66,38,,777.328,percent of total billed charges,38% of total billed charges,855.95,2608.14,
BB THERAPEUTIC PLASMA PHERESIS,5200035,CDM,940,RC,36514,HCPCS,Outpatient,,,2570,1927.5,,2004.6,78,,1603.68,percent of total billed charges,78% of total billed charges,1619.1,63,,1295.28,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,976.6,38,,781.28,percent of total billed charges,38% of total billed charges,976.6,38,,781.28,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,2313,90,,1850.4,percent of total billed charges,90% of total billed charges,899.5,35,,719.6,percent of total billed charges,35% of total billed charges,1728.97,67.275,,1383.176,percent of total billed charges,67.275% of total billed charges,2056,80,,1644.8,percent of total billed charges,80% of total billed charges,986.37,38.38,,789.096,percent of total billed charges,38.38% of total billed charges,2056,80,,1644.8,percent of total billed charges,80% of total billed charges,1586.72,61.74,,1269.376,percent of total billed charges,61.74% of total billed charges,2621.4,102,,2097.12,percent of total billed charges,102% of total billed charges,976.6,38,,781.28,percent of total billed charges,38% of total billed charges,899.5,2621.4,
IMPLANT 7MM,3008004,CDM,270,RC,,,Outpatient,,,2625,1968.75,,2047.5,78,,1638,percent of total billed charges,78% of total billed charges,1653.75,63,,1323,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,997.5,38,,798,percent of total billed charges,38% of total billed charges,997.5,38,,798,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,2362.5,90,,1890,percent of total billed charges,90% of total billed charges,918.75,35,,735,percent of total billed charges,35% of total billed charges,1765.97,67.275,,1412.776,percent of total billed charges,67.275% of total billed charges,2100,80,,1680,percent of total billed charges,80% of total billed charges,1007.48,38.38,,805.984,percent of total billed charges,38.38% of total billed charges,2100,80,,1680,percent of total billed charges,80% of total billed charges,1620.68,61.74,,1296.544,percent of total billed charges,61.74% of total billed charges,2677.5,102,,2142,percent of total billed charges,102% of total billed charges,997.5,38,,798,percent of total billed charges,38% of total billed charges,918.75,2677.5,
PUTTY 5CC DBX,3006032,CDM,270,RC,,,Outpatient,,,2640,1980,,2059.2,78,,1647.36,percent of total billed charges,78% of total billed charges,1663.2,63,,1330.56,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,1003.2,38,,802.56,percent of total billed charges,38% of total billed charges,1003.2,38,,802.56,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,2376,90,,1900.8,percent of total billed charges,90% of total billed charges,924,35,,739.2,percent of total billed charges,35% of total billed charges,1776.06,67.275,,1420.848,percent of total billed charges,67.275% of total billed charges,2112,80,,1689.6,percent of total billed charges,80% of total billed charges,1013.23,38.38,,810.584,percent of total billed charges,38.38% of total billed charges,2112,80,,1689.6,percent of total billed charges,80% of total billed charges,1629.94,61.74,,1303.952,percent of total billed charges,61.74% of total billed charges,2692.8,102,,2154.24,percent of total billed charges,102% of total billed charges,1003.2,38,,802.56,percent of total billed charges,38% of total billed charges,924,2692.8,
MRI of lower back with and without dye,7500971,CDM,612,RC,72158,HCPCS,Outpatient,,,2668,2001,,2081.04,78,,1664.832,percent of total billed charges,78% of total billed charges,1680.84,63,,1344.672,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,1013.84,38,,811.072,percent of total billed charges,38% of total billed charges,1013.84,38,,811.072,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,2401.2,90,,1920.96,percent of total billed charges,90% of total billed charges,933.8,35,,747.04,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,2134.4,80,,1707.52,percent of total billed charges,80% of total billed charges,1023.98,38.38,,819.184,percent of total billed charges,38.38% of total billed charges,2134.4,80,,1707.52,percent of total billed charges,80% of total billed charges,1647.22,61.74,,1317.776,percent of total billed charges,61.74% of total billed charges,2721.36,102,,2177.088,percent of total billed charges,102% of total billed charges,1013.84,38,,811.072,percent of total billed charges,38% of total billed charges,855.95,2721.36,
MRI of lower back with and without dye,7501003,CDM,612,RC,72158,HCPCS,Outpatient,,,2668,2001,,2081.04,78,,1664.832,percent of total billed charges,78% of total billed charges,1680.84,63,,1344.672,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,1013.84,38,,811.072,percent of total billed charges,38% of total billed charges,1013.84,38,,811.072,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,2401.2,90,,1920.96,percent of total billed charges,90% of total billed charges,933.8,35,,747.04,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,2134.4,80,,1707.52,percent of total billed charges,80% of total billed charges,1023.98,38.38,,819.184,percent of total billed charges,38.38% of total billed charges,2134.4,80,,1707.52,percent of total billed charges,80% of total billed charges,1647.22,61.74,,1317.776,percent of total billed charges,61.74% of total billed charges,2721.36,102,,2177.088,percent of total billed charges,102% of total billed charges,1013.84,38,,811.072,percent of total billed charges,38% of total billed charges,855.95,2721.36,
VARIAX PLATE 6 HOLE CURVED,3004018,CDM,270,RC,,,Outpatient,,,2689.2,2016.9,,2097.58,78,,1678.064,percent of total billed charges,78% of total billed charges,1694.2,63,,1355.36,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,1021.9,38,,817.52,percent of total billed charges,38% of total billed charges,1021.9,38,,817.52,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,2420.28,90,,1936.224,percent of total billed charges,90% of total billed charges,941.22,35,,752.976,percent of total billed charges,35% of total billed charges,1809.16,67.275,,1447.328,percent of total billed charges,67.275% of total billed charges,2151.36,80,,1721.088,percent of total billed charges,80% of total billed charges,1032.11,38.38,,825.688,percent of total billed charges,38.38% of total billed charges,2151.36,80,,1721.088,percent of total billed charges,80% of total billed charges,1660.31,61.74,,1328.248,percent of total billed charges,61.74% of total billed charges,2742.98,102,,2194.384,percent of total billed charges,102% of total billed charges,1021.9,38,,817.52,percent of total billed charges,38% of total billed charges,941.22,2742.98,
BONE MARROW BIOPSY,1001256,CDM,450,RC,38221,HCPCS,Outpatient,,,2836,2127,,2212.08,78,,1769.664,percent of total billed charges,78% of total billed charges,1786.68,63,,1429.344,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,1077.68,38,,862.144,percent of total billed charges,38% of total billed charges,1077.68,38,,862.144,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,2552.4,90,,2041.92,percent of total billed charges,90% of total billed charges,992.6,35,,794.08,percent of total billed charges,35% of total billed charges,1907.92,67.275,,1526.336,percent of total billed charges,67.275% of total billed charges,2268.8,80,,1815.04,percent of total billed charges,80% of total billed charges,1088.46,38.38,,870.768,percent of total billed charges,38.38% of total billed charges,2268.8,80,,1815.04,percent of total billed charges,80% of total billed charges,1750.95,61.74,,1400.76,percent of total billed charges,61.74% of total billed charges,2892.72,102,,2314.176,percent of total billed charges,102% of total billed charges,1077.68,38,,862.144,percent of total billed charges,38% of total billed charges,992.6,2892.72,
"Incision and drainage of hematoma, seroma or fluid collection",1200140,CDM,981,RC,10140,HCPCS,Outpatient,,,2836,2127,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,128.87,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,128.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,128.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,128.87,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,128.87,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,84.45,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,133.42,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,1715.93,61.74,,1372.744,percent of total billed charges,61.74% of total billed charges,80.43,102,,,Fee Schedule,102% of GA Medicaid Rate,128.87,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,80.43,1715.93,
INCIS/REMOVAL FB/COMPLICATED,1200171,CDM,981,RC,10121,HCPCS,Outpatient,,,2836,2127,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,202.48,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,202.48,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,202.48,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,202.48,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,202.48,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,158.41,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,210.53,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,1715.93,61.74,,1372.744,percent of total billed charges,61.74% of total billed charges,150.87,102,,,Fee Schedule,102% of GA Medicaid Rate,202.48,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,150.87,1715.93,
MUSCLE SIMPLE REMOVE FB,1200172,CDM,981,RC,20520,HCPCS,Outpatient,,,2836,2127,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,161.28,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,161.28,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,161.28,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,161.28,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,161.28,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,154.04,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,166.95,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,1715.93,61.74,,1372.744,percent of total billed charges,61.74% of total billed charges,146.7,102,,,Fee Schedule,102% of GA Medicaid Rate,161.28,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,146.7,1715.93,
OR LEVEL 3 FIRST HOUR,400120,CDM,360,RC,,,Outpatient,,,2915,2186.25,,2273.7,78,,1818.96,percent of total billed charges,78% of total billed charges,1836.45,63,,1469.16,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,1107.7,38,,886.16,percent of total billed charges,38% of total billed charges,1107.7,38,,886.16,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,2623.5,90,,2098.8,percent of total billed charges,90% of total billed charges,1020.25,35,,816.2,percent of total billed charges,35% of total billed charges,1961.07,67.275,,1568.856,percent of total billed charges,67.275% of total billed charges,2332,80,,1865.6,percent of total billed charges,80% of total billed charges,1118.78,38.38,,895.024,percent of total billed charges,38.38% of total billed charges,2332,80,,1865.6,percent of total billed charges,80% of total billed charges,1799.72,61.74,,1439.776,percent of total billed charges,61.74% of total billed charges,2973.3,102,,2378.64,percent of total billed charges,102% of total billed charges,1107.7,38,,886.16,percent of total billed charges,38% of total billed charges,1020.25,2973.3,
HERNIA MESH - FLEX COMPOSITE PAREL,3001235,CDM,270,RC,,,Outpatient,,,3087.5,2315.63,,2408.25,78,,1926.6,percent of total billed charges,78% of total billed charges,1945.13,63,,1556.104,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,1173.25,38,,938.6,percent of total billed charges,38% of total billed charges,1173.25,38,,938.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,2778.75,90,,2223,percent of total billed charges,90% of total billed charges,1080.63,35,,864.504,percent of total billed charges,35% of total billed charges,2077.12,67.275,,1661.696,percent of total billed charges,67.275% of total billed charges,2470,80,,1976,percent of total billed charges,80% of total billed charges,1184.98,38.38,,947.984,percent of total billed charges,38.38% of total billed charges,2470,80,,1976,percent of total billed charges,80% of total billed charges,1906.22,61.74,,1524.976,percent of total billed charges,61.74% of total billed charges,3149.25,102,,2519.4,percent of total billed charges,102% of total billed charges,1173.25,38,,938.6,percent of total billed charges,38% of total billed charges,1080.63,3149.25,
ENDOSCOPY LEVEL I,400140,CDM,360,RC,,,Outpatient,,,3094,2320.5,,2413.32,78,,1930.656,percent of total billed charges,78% of total billed charges,1949.22,63,,1559.376,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,1175.72,38,,940.576,percent of total billed charges,38% of total billed charges,1175.72,38,,940.576,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,2784.6,90,,2227.68,percent of total billed charges,90% of total billed charges,1082.9,35,,866.32,percent of total billed charges,35% of total billed charges,2081.49,67.275,,1665.192,percent of total billed charges,67.275% of total billed charges,2475.2,80,,1980.16,percent of total billed charges,80% of total billed charges,1187.48,38.38,,949.984,percent of total billed charges,38.38% of total billed charges,2475.2,80,,1980.16,percent of total billed charges,80% of total billed charges,1910.24,61.74,,1528.192,percent of total billed charges,61.74% of total billed charges,3155.88,102,,2524.704,percent of total billed charges,102% of total billed charges,1175.72,38,,940.576,percent of total billed charges,38% of total billed charges,1082.9,3155.88,
IMPLANT SIZE 1  08MM,3006015,CDM,270,RC,,,Outpatient,,,3125,2343.75,,2437.5,78,,1950,percent of total billed charges,78% of total billed charges,1968.75,63,,1575,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,1187.5,38,,950,percent of total billed charges,38% of total billed charges,1187.5,38,,950,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,2812.5,90,,2250,percent of total billed charges,90% of total billed charges,1093.75,35,,875,percent of total billed charges,35% of total billed charges,2102.34,67.275,,1681.872,percent of total billed charges,67.275% of total billed charges,2500,80,,2000,percent of total billed charges,80% of total billed charges,1199.38,38.38,,959.504,percent of total billed charges,38.38% of total billed charges,2500,80,,2000,percent of total billed charges,80% of total billed charges,1929.38,61.74,,1543.504,percent of total billed charges,61.74% of total billed charges,3187.5,102,,2550,percent of total billed charges,102% of total billed charges,1187.5,38,,950,percent of total billed charges,38% of total billed charges,1093.75,3187.5,
LAYER CLOSURE OVER 30 CM,1200225,CDM,981,RC,12037,HCPCS,Outpatient,,,3299,2474.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,362.86,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,362.86,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,362.86,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,362.86,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,362.86,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,308.83,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,383.19,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,1996.07,61.74,,1596.856,percent of total billed charges,61.74% of total billed charges,294.12,102,,,Fee Schedule,102% of GA Medicaid Rate,362.86,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,294.12,1996.07,
LAYER CLOSURE OVER 30 CM,1200227,CDM,981,RC,12047,HCPCS,Outpatient,,,3299,2474.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,391.69,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,391.69,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,391.69,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,391.69,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,391.69,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,325,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,415.69,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,1996.07,61.74,,1596.856,percent of total billed charges,61.74% of total billed charges,309.52,102,,,Fee Schedule,102% of GA Medicaid Rate,391.69,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,309.52,1996.07,
ENDOSCOPY LEVEL II,400150,CDM,360,RC,,,Outpatient,,,3359,2519.25,,2620.02,78,,2096.016,percent of total billed charges,78% of total billed charges,2116.17,63,,1692.936,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,1276.42,38,,1021.136,percent of total billed charges,38% of total billed charges,1276.42,38,,1021.136,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,3023.1,90,,2418.48,percent of total billed charges,90% of total billed charges,1175.65,35,,940.52,percent of total billed charges,35% of total billed charges,2259.77,67.275,,1807.816,percent of total billed charges,67.275% of total billed charges,2687.2,80,,2149.76,percent of total billed charges,80% of total billed charges,1289.18,38.38,,1031.344,percent of total billed charges,38.38% of total billed charges,2687.2,80,,2149.76,percent of total billed charges,80% of total billed charges,2073.85,61.74,,1659.08,percent of total billed charges,61.74% of total billed charges,3426.18,102,,2740.944,percent of total billed charges,102% of total billed charges,1276.42,38,,1021.136,percent of total billed charges,38% of total billed charges,1175.65,3426.18,
ENDOSCOPY LEVEL III,400160,CDM,360,RC,,,Outpatient,,,3400,2550,,2652,78,,2121.6,percent of total billed charges,78% of total billed charges,2142,63,,1713.6,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,1292,38,,1033.6,percent of total billed charges,38% of total billed charges,1292,38,,1033.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,3060,90,,2448,percent of total billed charges,90% of total billed charges,1190,35,,952,percent of total billed charges,35% of total billed charges,2287.35,67.275,,1829.88,percent of total billed charges,67.275% of total billed charges,2720,80,,2176,percent of total billed charges,80% of total billed charges,1304.92,38.38,,1043.936,percent of total billed charges,38.38% of total billed charges,2720,80,,2176,percent of total billed charges,80% of total billed charges,2099.16,61.74,,1679.328,percent of total billed charges,61.74% of total billed charges,3468,102,,2774.4,percent of total billed charges,102% of total billed charges,1292,38,,1033.6,percent of total billed charges,38% of total billed charges,1190,3468,
MRI ORBIT FACE NECK W & W/O CONTRAST,7500970,CDM,611,RC,70543,HCPCS,Outpatient,,,3633,2724.75,,2833.74,78,,2266.992,percent of total billed charges,78% of total billed charges,2288.79,63,,1831.032,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,1380.54,38,,1104.432,percent of total billed charges,38% of total billed charges,1380.54,38,,1104.432,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,3269.7,90,,2615.76,percent of total billed charges,90% of total billed charges,1271.55,35,,1017.24,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,2906.4,80,,2325.12,percent of total billed charges,80% of total billed charges,1394.35,38.38,,1115.48,percent of total billed charges,38.38% of total billed charges,2906.4,80,,2325.12,percent of total billed charges,80% of total billed charges,2243.01,61.74,,1794.408,percent of total billed charges,61.74% of total billed charges,3705.66,102,,2964.528,percent of total billed charges,102% of total billed charges,1380.54,38,,1104.432,percent of total billed charges,38% of total billed charges,855.95,3705.66,
MRA HEAD W/WO CONTRAST,7501004,CDM,611,RC,70546,HCPCS,Outpatient,,,3633,2724.75,,2833.74,78,,2266.992,percent of total billed charges,78% of total billed charges,2288.79,63,,1831.032,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,1380.54,38,,1104.432,percent of total billed charges,38% of total billed charges,1380.54,38,,1104.432,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,3269.7,90,,2615.76,percent of total billed charges,90% of total billed charges,1271.55,35,,1017.24,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,2906.4,80,,2325.12,percent of total billed charges,80% of total billed charges,1394.35,38.38,,1115.48,percent of total billed charges,38.38% of total billed charges,2906.4,80,,2325.12,percent of total billed charges,80% of total billed charges,2243.01,61.74,,1794.408,percent of total billed charges,61.74% of total billed charges,3705.66,102,,2964.528,percent of total billed charges,102% of total billed charges,1380.54,38,,1104.432,percent of total billed charges,38% of total billed charges,855.95,3705.66,
MRI PITUITARY,7501006,CDM,611,RC,70543,HCPCS,Outpatient,,,3633,2724.75,,2833.74,78,,2266.992,percent of total billed charges,78% of total billed charges,2288.79,63,,1831.032,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,1380.54,38,,1104.432,percent of total billed charges,38% of total billed charges,1380.54,38,,1104.432,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,3269.7,90,,2615.76,percent of total billed charges,90% of total billed charges,1271.55,35,,1017.24,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,2906.4,80,,2325.12,percent of total billed charges,80% of total billed charges,1394.35,38.38,,1115.48,percent of total billed charges,38.38% of total billed charges,2906.4,80,,2325.12,percent of total billed charges,80% of total billed charges,2243.01,61.74,,1794.408,percent of total billed charges,61.74% of total billed charges,3705.66,102,,2964.528,percent of total billed charges,102% of total billed charges,1380.54,38,,1104.432,percent of total billed charges,38% of total billed charges,855.95,3705.66,
PHENOSENSE GT,5002076,CDM,306,RC,87903,HCPCS,Outpatient,,,3691,2768.25,,2878.98,78,,2303.184,percent of total billed charges,78% of total billed charges,425.3,100,,,Fee Schedule,100% of GA Mediciad Fee Schedule,,,,,Other,Not Separately reimbursable,488.66,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,488.66,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,,,,,Other,Not Separately reimbursable,3321.9,90,,2657.52,percent of total billed charges,90% of total billed charges,446.57,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,2483.12,67.275,,1986.496,percent of total billed charges,67.275% of total billed charges,2952.8,80,,2362.24,percent of total billed charges,80% of total billed charges,493.55,101,,,Fee Schedule,101% of CMS Medicare OPPS rate,2952.8,80,,2362.24,percent of total billed charges,80% of total billed charges,2278.82,61.74,,1823.056,percent of total billed charges,61.74% of total billed charges,433.81,102,,,Fee Schedule,102% of GA Medicaid Rate,488.66,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,425.3,3321.9,
OR LEVEL 4 FIRST HOUR,400130,CDM,360,RC,,,Outpatient,,,3915,2936.25,,3053.7,78,,2442.96,percent of total billed charges,78% of total billed charges,2466.45,63,,1973.16,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,1487.7,38,,1190.16,percent of total billed charges,38% of total billed charges,1487.7,38,,1190.16,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,3523.5,90,,2818.8,percent of total billed charges,90% of total billed charges,1370.25,35,,1096.2,percent of total billed charges,35% of total billed charges,2633.82,67.275,,2107.056,percent of total billed charges,67.275% of total billed charges,3132,80,,2505.6,percent of total billed charges,80% of total billed charges,1502.58,38.38,,1202.064,percent of total billed charges,38.38% of total billed charges,3132,80,,2505.6,percent of total billed charges,80% of total billed charges,2417.12,61.74,,1933.696,percent of total billed charges,61.74% of total billed charges,3993.3,102,,3194.64,percent of total billed charges,102% of total billed charges,1487.7,38,,1190.16,percent of total billed charges,38% of total billed charges,1370.25,3993.3,
MRA NECK W/WO CONTRAST,7501013,CDM,610,RC,70549,HCPCS,Outpatient,,,3996,2997,,3116.88,78,,2493.504,percent of total billed charges,78% of total billed charges,2517.48,63,,2013.984,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,1518.48,38,,1214.784,percent of total billed charges,38% of total billed charges,1518.48,38,,1214.784,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,3596.4,90,,2877.12,percent of total billed charges,90% of total billed charges,1398.6,35,,1118.88,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,3196.8,80,,2557.44,percent of total billed charges,80% of total billed charges,1533.66,38.38,,1226.928,percent of total billed charges,38.38% of total billed charges,3196.8,80,,2557.44,percent of total billed charges,80% of total billed charges,2467.13,61.74,,1973.704,percent of total billed charges,61.74% of total billed charges,4075.92,102,,3260.736,percent of total billed charges,102% of total billed charges,1518.48,38,,1214.784,percent of total billed charges,38% of total billed charges,855.95,4075.92,
NITINOL BONE IMPLANT 2X3MM,3007008,CDM,270,RC,,,Outpatient,,,3997.5,2998.13,,3118.05,78,,2494.44,percent of total billed charges,78% of total billed charges,2518.43,63,,2014.744,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,1519.05,38,,1215.24,percent of total billed charges,38% of total billed charges,1519.05,38,,1215.24,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,3597.75,90,,2878.2,percent of total billed charges,90% of total billed charges,1399.13,35,,1119.304,percent of total billed charges,35% of total billed charges,2689.32,67.275,,2151.456,percent of total billed charges,67.275% of total billed charges,3198,80,,2558.4,percent of total billed charges,80% of total billed charges,1534.24,38.38,,1227.392,percent of total billed charges,38.38% of total billed charges,3198,80,,2558.4,percent of total billed charges,80% of total billed charges,2468.06,61.74,,1974.448,percent of total billed charges,61.74% of total billed charges,4077.45,102,,3261.96,percent of total billed charges,102% of total billed charges,1519.05,38,,1215.24,percent of total billed charges,38% of total billed charges,1399.13,4077.45,
MRI scan of brain before and after contrast,7500972,CDM,611,RC,70553,HCPCS,Outpatient,,,4262,3196.5,,3324.36,78,,2659.488,percent of total billed charges,78% of total billed charges,2685.06,63,,2148.048,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,1619.56,38,,1295.648,percent of total billed charges,38% of total billed charges,1619.56,38,,1295.648,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,3835.8,90,,3068.64,percent of total billed charges,90% of total billed charges,1491.7,35,,1193.36,percent of total billed charges,35% of total billed charges,855.95,67.275,,684.76,percent of total billed charges,67.275% of total billed charges,3409.6,80,,2727.68,percent of total billed charges,80% of total billed charges,1635.76,38.38,,1308.608,percent of total billed charges,38.38% of total billed charges,3409.6,80,,2727.68,percent of total billed charges,80% of total billed charges,2631.36,61.74,,2105.088,percent of total billed charges,61.74% of total billed charges,4347.24,102,,3477.792,percent of total billed charges,102% of total billed charges,1619.56,38,,1295.648,percent of total billed charges,38% of total billed charges,855.95,4347.24,
HEMI GREAT TOE IMPLANT - EXTRA SMALL,3003106,CDM,270,RC,,,Outpatient,,,4600,3450,,3588,78,,2870.4,percent of total billed charges,78% of total billed charges,2898,63,,2318.4,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,1748,38,,1398.4,percent of total billed charges,38% of total billed charges,1748,38,,1398.4,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,4140,90,,3312,percent of total billed charges,90% of total billed charges,1610,35,,1288,percent of total billed charges,35% of total billed charges,3094.65,67.275,,2475.72,percent of total billed charges,67.275% of total billed charges,3680,80,,2944,percent of total billed charges,80% of total billed charges,1765.48,38.38,,1412.384,percent of total billed charges,38.38% of total billed charges,3680,80,,2944,percent of total billed charges,80% of total billed charges,2840.04,61.74,,2272.032,percent of total billed charges,61.74% of total billed charges,4692,102,,3753.6,percent of total billed charges,102% of total billed charges,1748,38,,1398.4,percent of total billed charges,38% of total billed charges,1610,4692,
Vaginal delivery,1200169,CDM,981,RC,59409,HCPCS,Outpatient,,,4781,3585.75,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,909.25,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,909.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,909.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,909.25,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,909.25,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,837.3,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,970.89,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,2892.75,61.74,,2314.2,percent of total billed charges,61.74% of total billed charges,797.43,102,,,Fee Schedule,102% of GA Medicaid Rate,909.25,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,797.43,2892.75,
CULDOCENTESIS,1200205,CDM,981,RC,57020,HCPCS,Outpatient,,,4781,3585.75,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,89.62,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,89.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,89.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,89.62,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,89.62,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,88.84,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,94.45,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,2892.75,61.74,,2314.2,percent of total billed charges,61.74% of total billed charges,84.61,102,,,Fee Schedule,102% of GA Medicaid Rate,89.62,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,84.61,2892.75,
HYSTEROSALPINGOGRAPHY,7000555,CDM,320,RC,58345,HCPCS,Outpatient,,,4781,3585.75,,3729.18,78,,2983.344,percent of total billed charges,78% of total billed charges,3012.03,63,,2409.624,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,1816.78,38,,1453.424,percent of total billed charges,38% of total billed charges,1816.78,38,,1453.424,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,4302.9,90,,3442.32,percent of total billed charges,90% of total billed charges,1673.35,35,,1338.68,percent of total billed charges,35% of total billed charges,3216.42,67.275,,2573.136,percent of total billed charges,67.275% of total billed charges,3824.8,80,,3059.84,percent of total billed charges,80% of total billed charges,1834.95,38.38,,1467.96,percent of total billed charges,38.38% of total billed charges,3824.8,80,,3059.84,percent of total billed charges,80% of total billed charges,2951.79,61.74,,2361.432,percent of total billed charges,61.74% of total billed charges,4876.62,102,,3901.296,percent of total billed charges,102% of total billed charges,1816.78,38,,1453.424,percent of total billed charges,38% of total billed charges,1673.35,4876.62,
FISTULOTOMY SUBCUTANEOUS,1200143,CDM,981,RC,46270,HCPCS,Outpatient,,,4871,3653.25,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,441.49,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,441.49,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,441.49,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,441.49,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,441.49,115,,,Fee Schedule,115% of CMS Medicare OPPS rate,247.63,105,,,Fee Schedule,105% of Medicaid GA Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,461.64,116.15,,,Fee Schedule,116.15% of CMS RBRVS Fee Schedule,,,,,Other,Not Separately reimbursable,2947.21,61.74,,2357.768,percent of total billed charges,61.74% of total billed charges,235.84,102,,,Fee Schedule,102% of GA Medicaid Rate,441.49,100,,,Fee Schedule,100% of CMS Medicare OPPS rate,235.84,2947.21,
HYPROCURE TARSI STENT,3006044,CDM,270,RC,,,Outpatient,,,4975,3731.25,,3880.5,78,,3104.4,percent of total billed charges,78% of total billed charges,3134.25,63,,2507.4,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,1890.5,38,,1512.4,percent of total billed charges,38% of total billed charges,1890.5,38,,1512.4,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,4477.5,90,,3582,percent of total billed charges,90% of total billed charges,1741.25,35,,1393,percent of total billed charges,35% of total billed charges,3346.93,67.275,,2677.544,percent of total billed charges,67.275% of total billed charges,3980,80,,3184,percent of total billed charges,80% of total billed charges,1909.41,38.38,,1527.528,percent of total billed charges,38.38% of total billed charges,3980,80,,3184,percent of total billed charges,80% of total billed charges,3071.57,61.74,,2457.256,percent of total billed charges,61.74% of total billed charges,5074.5,102,,4059.6,percent of total billed charges,102% of total billed charges,1890.5,38,,1512.4,percent of total billed charges,38% of total billed charges,1741.25,5074.5,
BIOCUE  PLATELET CONCENTRATION KIT,3007006,CDM,270,RC,,,Outpatient,,,5400,4050,,4212,78,,3369.6,percent of total billed charges,78% of total billed charges,3402,63,,2721.6,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2052,38,,1641.6,percent of total billed charges,38% of total billed charges,2052,38,,1641.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,4860,90,,3888,percent of total billed charges,90% of total billed charges,1890,35,,1512,percent of total billed charges,35% of total billed charges,3632.85,67.275,,2906.28,percent of total billed charges,67.275% of total billed charges,4320,80,,3456,percent of total billed charges,80% of total billed charges,2072.52,38.38,,1658.016,percent of total billed charges,38.38% of total billed charges,4320,80,,3456,percent of total billed charges,80% of total billed charges,3333.96,61.74,,2667.168,percent of total billed charges,61.74% of total billed charges,5508,102,,4406.4,percent of total billed charges,102% of total billed charges,2052,38,,1641.6,percent of total billed charges,38% of total billed charges,1890,5508,
L PLATE (STRYKER),3001001,CDM,270,RC,,,Outpatient,,,6112.8,4584.6,,4767.98,78,,3814.384,percent of total billed charges,78% of total billed charges,3851.06,63,,3080.848,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2322.86,38,,1858.288,percent of total billed charges,38% of total billed charges,2322.86,38,,1858.288,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,5501.52,90,,4401.216,percent of total billed charges,90% of total billed charges,2139.48,35,,1711.584,percent of total billed charges,35% of total billed charges,4112.39,67.275,,3289.912,percent of total billed charges,67.275% of total billed charges,4890.24,80,,3912.192,percent of total billed charges,80% of total billed charges,2346.09,38.38,,1876.872,percent of total billed charges,38.38% of total billed charges,4890.24,80,,3912.192,percent of total billed charges,80% of total billed charges,3774.04,61.74,,3019.232,percent of total billed charges,61.74% of total billed charges,6235.06,102,,4988.048,percent of total billed charges,102% of total billed charges,2322.86,38,,1858.288,percent of total billed charges,38% of total billed charges,2139.48,6235.06,
HEMI GREAT TOE IMPLANT - LARGE,3003104,CDM,270,RC,,,Outpatient,,,6125,4593.75,,4777.5,78,,3822,percent of total billed charges,78% of total billed charges,3858.75,63,,3087,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2327.5,38,,1862,percent of total billed charges,38% of total billed charges,2327.5,38,,1862,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,5512.5,90,,4410,percent of total billed charges,90% of total billed charges,2143.75,35,,1715,percent of total billed charges,35% of total billed charges,4120.59,67.275,,3296.472,percent of total billed charges,67.275% of total billed charges,4900,80,,3920,percent of total billed charges,80% of total billed charges,2350.78,38.38,,1880.624,percent of total billed charges,38.38% of total billed charges,4900,80,,3920,percent of total billed charges,80% of total billed charges,3781.58,61.74,,3025.264,percent of total billed charges,61.74% of total billed charges,6247.5,102,,4998,percent of total billed charges,102% of total billed charges,2327.5,38,,1862,percent of total billed charges,38% of total billed charges,2143.75,6247.5,
HYPROCURE TARSI IMPLANT #10,3006043,CDM,270,RC,,,Outpatient,,,7110,5332.5,,5545.8,78,,4436.64,percent of total billed charges,78% of total billed charges,4479.3,63,,3583.44,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2701.8,38,,2161.44,percent of total billed charges,38% of total billed charges,2701.8,38,,2161.44,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,6399,90,,5119.2,percent of total billed charges,90% of total billed charges,2488.5,35,,1990.8,percent of total billed charges,35% of total billed charges,4783.25,67.275,,3826.6,percent of total billed charges,67.275% of total billed charges,5688,80,,4550.4,percent of total billed charges,80% of total billed charges,2728.82,38.38,,2183.056,percent of total billed charges,38.38% of total billed charges,5688,80,,4550.4,percent of total billed charges,80% of total billed charges,4389.71,61.74,,3511.768,percent of total billed charges,61.74% of total billed charges,7252.2,102,,5801.76,percent of total billed charges,102% of total billed charges,2701.8,38,,2161.44,percent of total billed charges,38% of total billed charges,2488.5,7252.2,
HYPROCURE TARSI IMPLANT #8,3006046,CDM,270,RC,,,Outpatient,,,7110,5332.5,,5545.8,78,,4436.64,percent of total billed charges,78% of total billed charges,4479.3,63,,3583.44,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2701.8,38,,2161.44,percent of total billed charges,38% of total billed charges,2701.8,38,,2161.44,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,6399,90,,5119.2,percent of total billed charges,90% of total billed charges,2488.5,35,,1990.8,percent of total billed charges,35% of total billed charges,4783.25,67.275,,3826.6,percent of total billed charges,67.275% of total billed charges,5688,80,,4550.4,percent of total billed charges,80% of total billed charges,2728.82,38.38,,2183.056,percent of total billed charges,38.38% of total billed charges,5688,80,,4550.4,percent of total billed charges,80% of total billed charges,4389.71,61.74,,3511.768,percent of total billed charges,61.74% of total billed charges,7252.2,102,,5801.76,percent of total billed charges,102% of total billed charges,2701.8,38,,2161.44,percent of total billed charges,38% of total billed charges,2488.5,7252.2,
REPAIR UM BIL HERNIA,449587,CDM,360,RC,49587,HCPCS,Outpatient,,,7250,5437.5,,5655,78,,4524,percent of total billed charges,78% of total billed charges,4567.5,63,,3654,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2755,38,,2204,percent of total billed charges,38% of total billed charges,2755,38,,2204,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,6525,90,,5220,percent of total billed charges,90% of total billed charges,2537.5,35,,2030,percent of total billed charges,35% of total billed charges,4877.44,67.275,,3901.952,percent of total billed charges,67.275% of total billed charges,5800,80,,4640,percent of total billed charges,80% of total billed charges,2782.55,38.38,,2226.04,percent of total billed charges,38.38% of total billed charges,5800,80,,4640,percent of total billed charges,80% of total billed charges,4476.15,61.74,,3580.92,percent of total billed charges,61.74% of total billed charges,7395,102,,5916,percent of total billed charges,102% of total billed charges,2755,38,,2204,percent of total billed charges,38% of total billed charges,2537.5,7395,
HEMI GREAT TOE IMPLANT,3003105,CDM,270,RC,,,Outpatient,,,7425,5568.75,,5791.5,78,,4633.2,percent of total billed charges,78% of total billed charges,4677.75,63,,3742.2,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2821.5,38,,2257.2,percent of total billed charges,38% of total billed charges,2821.5,38,,2257.2,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,6682.5,90,,5346,percent of total billed charges,90% of total billed charges,2598.75,35,,2079,percent of total billed charges,35% of total billed charges,4930,67.275,,3944,percent of total billed charges,67.275% of total billed charges,5940,80,,4752,percent of total billed charges,80% of total billed charges,2849.72,38.38,,2279.776,percent of total billed charges,38.38% of total billed charges,5940,80,,4752,percent of total billed charges,80% of total billed charges,4584.2,61.74,,3667.36,percent of total billed charges,61.74% of total billed charges,7573.5,102,,6058.8,percent of total billed charges,102% of total billed charges,2821.5,38,,2257.2,percent of total billed charges,38% of total billed charges,2598.75,7573.5,
"Under Repair, Revision, and/or Reconstruction Procedures on the Foot and Toes",4228296,CDM,360,RC,28296,HCPCS,Outpatient,,,7775,5831.25,,6064.5,78,,4851.6,percent of total billed charges,78% of total billed charges,4898.25,63,,3918.6,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2954.5,38,,2363.6,percent of total billed charges,38% of total billed charges,2954.5,38,,2363.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,6997.5,90,,5598,percent of total billed charges,90% of total billed charges,2721.25,35,,2177,percent of total billed charges,35% of total billed charges,5230.63,67.275,,4184.504,percent of total billed charges,67.275% of total billed charges,6220,80,,4976,percent of total billed charges,80% of total billed charges,2984.05,38.38,,2387.24,percent of total billed charges,38.38% of total billed charges,6220,80,,4976,percent of total billed charges,80% of total billed charges,4800.29,61.74,,3840.232,percent of total billed charges,61.74% of total billed charges,7930.5,102,,6344.4,percent of total billed charges,102% of total billed charges,2954.5,38,,2363.6,percent of total billed charges,38% of total billed charges,2721.25,7930.5,
HEMI GREAT TOE IMPLANT,3003103,CDM,270,RC,,,Outpatient,,,7875,5906.25,,6142.5,78,,4914,percent of total billed charges,78% of total billed charges,4961.25,63,,3969,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,2992.5,38,,2394,percent of total billed charges,38% of total billed charges,2992.5,38,,2394,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,7087.5,90,,5670,percent of total billed charges,90% of total billed charges,2756.25,35,,2205,percent of total billed charges,35% of total billed charges,4930,67.275,,3944,percent of total billed charges,67.275% of total billed charges,6300,80,,5040,percent of total billed charges,80% of total billed charges,3022.43,38.38,,2417.944,percent of total billed charges,38.38% of total billed charges,6300,80,,5040,percent of total billed charges,80% of total billed charges,4862.03,61.74,,3889.624,percent of total billed charges,61.74% of total billed charges,8032.5,102,,6426,percent of total billed charges,102% of total billed charges,2992.5,38,,2394,percent of total billed charges,38% of total billed charges,2756.25,8032.5,
ENCOMPASS 12MM HA COATED IMPLANT,3003107,CDM,270,RC,,,Outpatient,,,10150,7612.5,,7917,78,,6333.6,percent of total billed charges,78% of total billed charges,6394.5,63,,5115.6,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,3857,38,,3085.6,percent of total billed charges,38% of total billed charges,3857,38,,3085.6,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,9135,90,,7308,percent of total billed charges,90% of total billed charges,3552.5,35,,2842,percent of total billed charges,35% of total billed charges,4930,67.275,,3944,percent of total billed charges,67.275% of total billed charges,8120,80,,6496,percent of total billed charges,80% of total billed charges,3895.57,38.38,,3116.456,percent of total billed charges,38.38% of total billed charges,8120,80,,6496,percent of total billed charges,80% of total billed charges,6266.61,61.74,,5013.288,percent of total billed charges,61.74% of total billed charges,10353,102,,8282.4,percent of total billed charges,102% of total billed charges,3857,38,,3085.6,percent of total billed charges,38% of total billed charges,3552.5,10353,
BONE GROWTH STIMULATOR,3007007,CDM,270,RC,,,Outpatient,,,22175,16631.25,,17296.5,78,,13837.2,percent of total billed charges,78% of total billed charges,13970.25,63,,11176.2,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,8426.5,38,,6741.2,percent of total billed charges,38% of total billed charges,8426.5,38,,6741.2,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,19957.5,90,,15966,percent of total billed charges,90% of total billed charges,7761.25,35,,6209,percent of total billed charges,35% of total billed charges,4930,67.275,,3944,percent of total billed charges,67.275% of total billed charges,17740,80,,14192,percent of total billed charges,80% of total billed charges,8510.77,38.38,,6808.616,percent of total billed charges,38.38% of total billed charges,17740,80,,14192,percent of total billed charges,80% of total billed charges,13690.85,61.74,,10952.68,percent of total billed charges,61.74% of total billed charges,22618.5,102,,18094.8,percent of total billed charges,102% of total billed charges,8426.5,38,,6741.2,percent of total billed charges,38% of total billed charges,4930,22618.5,
RECONSTRUCTIVE TISSUE MATRIX 20X20 FIRM,3006052,CDM,270,RC,,,Outpatient,,,64300,48225,,50154,78,,40123.2,percent of total billed charges,78% of total billed charges,40509,63,,32407.2,percent of total billed charges,63% of total billed charges,,,,,Other,Not Separately reimbursable,24434,38,,19547.2,percent of total billed charges,38% of total billed charges,24434,38,,19547.2,percent of total billed charges,38% of total billed charges,,,,,Other,Not Separately reimbursable,57870,90,,46296,percent of total billed charges,90% of total billed charges,22505,35,,18004,percent of total billed charges,35% of total billed charges,4930,67.275,,3944,percent of total billed charges,67.275% of total billed charges,51440,80,,41152,percent of total billed charges,80% of total billed charges,24678.34,38.38,,19742.672,percent of total billed charges,38.38% of total billed charges,51440,80,,41152,percent of total billed charges,80% of total billed charges,39698.82,61.74,,31759.056,percent of total billed charges,61.74% of total billed charges,65586,102,,52468.8,percent of total billed charges,102% of total billed charges,24434,38,,19547.2,percent of total billed charges,38% of total billed charges,4930,65586,
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC,1,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,77084.48,100,CUSTOM-DRG,61667.584,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,80938.7,105,CUSTOM-DRG,64750.96,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,78626.04,102,CUSTOM-DRG,62900.832,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,80938.7,
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC,2,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,51904.35,100,CUSTOM-DRG,41523.48,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,54499.56,105,CUSTOM-DRG,43599.648,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,52942.35,102,CUSTOM-DRG,42353.88,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,54499.56,
"ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES",3,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,76535.77,100,CUSTOM-DRG,61228.616,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,80362.55,105,CUSTOM-DRG,64290.04,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,78066.36,102,CUSTOM-DRG,62453.088,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,80362.55,
"TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES",4,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,55132.32,100,CUSTOM-DRG,44105.856,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,57888.93,105,CUSTOM-DRG,46311.144,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,56234.88,102,CUSTOM-DRG,44987.904,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,57888.93,
LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT,5,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,114766.84,100,CUSTOM-DRG,91813.472,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,120505.17,105,CUSTOM-DRG,96404.136,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,117061.99,102,CUSTOM-DRG,93649.592,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,120505.17,
LIVER TRANSPLANT WITHOUT MCC,6,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,52291.96,100,CUSTOM-DRG,41833.568,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,54906.55,105,CUSTOM-DRG,43925.24,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,53337.71,102,CUSTOM-DRG,42670.168,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,54906.55,
LUNG TRANSPLANT,7,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,37328.39,100,CUSTOM-DRG,29862.712,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,39194.8,105,CUSTOM-DRG,31355.84,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,38074.89,102,CUSTOM-DRG,30459.912,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,39194.8,
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT,8,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,33141.29,100,CUSTOM-DRG,26513.032,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,34798.35,105,CUSTOM-DRG,27838.68,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,33804.06,102,CUSTOM-DRG,27043.248,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,34798.35,
PANCREAS TRANSPLANT,10,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,18350.03,100,CUSTOM-DRG,14680.024,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,19267.53,105,CUSTOM-DRG,15414.024,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,18717,102,CUSTOM-DRG,14973.6,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,19267.53,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC",11,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,16241.91,100,CUSTOM-DRG,12993.528,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,17054,105,CUSTOM-DRG,13643.2,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,16566.72,102,CUSTOM-DRG,13253.376,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,17054,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC",12,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,15734.31,100,CUSTOM-DRG,12587.448,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,16521.02,105,CUSTOM-DRG,13216.816,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,16048.97,102,CUSTOM-DRG,12839.176,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,16521.02,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC",13,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7952.94,100,CUSTOM-DRG,6362.352,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,8350.58,105,CUSTOM-DRG,6680.464,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,8111.98,102,CUSTOM-DRG,6489.584,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,8350.58,
ALLOGENEIC BONE MARROW TRANSPLANT,14,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,92721.61,100,CUSTOM-DRG,74177.288,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,97357.68,105,CUSTOM-DRG,77886.144,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,94575.89,102,CUSTOM-DRG,75660.712,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,97357.68,
AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC,16,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,26530.23,100,CUSTOM-DRG,21224.184,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,27856.74,105,CUSTOM-DRG,22285.392,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,27060.79,102,CUSTOM-DRG,21648.632,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,27856.74,
AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC,17,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,12077.61,100,CUSTOM-DRG,9662.088,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,12681.49,105,CUSTOM-DRG,10145.192,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,12319.14,102,CUSTOM-DRG,9855.312,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,12681.49,
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES,18,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS,19,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,1200,2552.31,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC,20,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,37061.13,100,CUSTOM-DRG,29648.904,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,38914.19,105,CUSTOM-DRG,31131.352,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,37802.29,102,CUSTOM-DRG,30241.832,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,38914.19,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC,21,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,23181.9,100,CUSTOM-DRG,18545.52,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,24340.99,105,CUSTOM-DRG,19472.792,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,23645.5,102,CUSTOM-DRG,18916.4,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,24340.99,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC,22,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,15912.23,100,CUSTOM-DRG,12729.784,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,16707.84,105,CUSTOM-DRG,13366.272,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,16230.45,102,CUSTOM-DRG,12984.36,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,16707.84,
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,23,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,21924.5,100,CUSTOM-DRG,17539.6,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,23020.72,105,CUSTOM-DRG,18416.576,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,22362.95,102,CUSTOM-DRG,17890.36,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,23020.72,
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC,24,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,12015.94,100,CUSTOM-DRG,9612.752,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,12616.73,105,CUSTOM-DRG,10093.384,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,12256.24,102,CUSTOM-DRG,9804.992,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,12616.73,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC,25,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,18863.98,100,CUSTOM-DRG,15091.184,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,19807.18,105,CUSTOM-DRG,15845.744,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,19241.23,102,CUSTOM-DRG,15392.984,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,19807.18,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC,26,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,12755.28,100,CUSTOM-DRG,10204.224,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,13393.04,105,CUSTOM-DRG,10714.432,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,13010.36,102,CUSTOM-DRG,10408.288,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,13393.04,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC,27,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,9938.84,100,CUSTOM-DRG,7951.072,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,10435.78,105,CUSTOM-DRG,8348.624,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,10137.6,102,CUSTOM-DRG,8110.08,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,10435.78,
SPINAL PROCEDURES WITH MCC,28,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,18753.34,100,CUSTOM-DRG,15002.672,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,19691,105,CUSTOM-DRG,15752.8,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,19128.38,102,CUSTOM-DRG,15302.704,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,19691,
SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS,29,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,11700.09,100,CUSTOM-DRG,9360.072,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,12285.1,105,CUSTOM-DRG,9828.08,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,11934.08,102,CUSTOM-DRG,9547.264,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,12285.1,
SPINAL PROCEDURES WITHOUT CC/MCC,30,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7821.74,100,CUSTOM-DRG,6257.392,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,8212.83,105,CUSTOM-DRG,6570.264,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,7978.16,102,CUSTOM-DRG,6382.528,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,8212.83,
VENTRICULAR SHUNT PROCEDURES WITH MCC,31,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,9425.64,100,CUSTOM-DRG,7540.512,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,9896.92,105,CUSTOM-DRG,7917.536,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,9614.13,102,CUSTOM-DRG,7691.304,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,9896.92,
VENTRICULAR SHUNT PROCEDURES WITH CC,32,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6036.94,100,CUSTOM-DRG,4829.552,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6338.78,105,CUSTOM-DRG,5071.024,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6157.67,102,CUSTOM-DRG,4926.136,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,6338.78,
VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC,33,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4967.18,100,CUSTOM-DRG,3973.744,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5215.53,105,CUSTOM-DRG,4172.424,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5066.51,102,CUSTOM-DRG,4053.208,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5215.53,
CAROTID ARTERY STENT PROCEDURES WITH MCC,34,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,16382.07,100,CUSTOM-DRG,13105.656,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,17201.18,105,CUSTOM-DRG,13760.944,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,16709.69,102,CUSTOM-DRG,13367.752,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,17201.18,
CAROTID ARTERY STENT PROCEDURES WITH CC,35,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7563.46,100,CUSTOM-DRG,6050.768,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7941.63,105,CUSTOM-DRG,6353.304,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,7714.72,102,CUSTOM-DRG,6171.776,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,7941.63,
CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC,36,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4892.79,100,CUSTOM-DRG,3914.232,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5137.43,105,CUSTOM-DRG,4109.944,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4990.64,102,CUSTOM-DRG,3992.512,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5137.43,
EXTRACRANIAL PROCEDURES WITH MCC,37,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,10053.59,100,CUSTOM-DRG,8042.872,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,10556.27,105,CUSTOM-DRG,8445.016,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,10254.64,102,CUSTOM-DRG,8203.712,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,10556.27,
EXTRACRANIAL PROCEDURES WITH CC,38,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6834.59,100,CUSTOM-DRG,5467.672,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7176.31,105,CUSTOM-DRG,5741.048,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6971.27,102,CUSTOM-DRG,5577.016,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,7176.31,
EXTRACRANIAL PROCEDURES WITHOUT CC/MCC,39,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4276.8,100,CUSTOM-DRG,3421.44,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4490.64,105,CUSTOM-DRG,3592.512,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4362.33,102,CUSTOM-DRG,3489.864,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4490.64,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC",40,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,11080.74,100,CUSTOM-DRG,8864.592,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,11634.77,105,CUSTOM-DRG,9307.816,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,11302.33,102,CUSTOM-DRG,9041.864,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,11634.77,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR",41,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,10796.66,100,CUSTOM-DRG,8637.328,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,11336.5,105,CUSTOM-DRG,9069.2,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,11012.58,102,CUSTOM-DRG,8810.064,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,11336.5,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC",42,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5404.13,100,CUSTOM-DRG,4323.304,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5674.33,105,CUSTOM-DRG,4539.464,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5512.2,102,CUSTOM-DRG,4409.76,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5674.33,
SPINAL DISORDERS AND INJURIES WITH CC/MCC,52,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,29296.21,100,CUSTOM-DRG,23436.968,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,30761.01,105,CUSTOM-DRG,24608.808,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,29882.08,102,CUSTOM-DRG,23905.664,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,30761.01,
SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC,53,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3039.59,100,CUSTOM-DRG,2431.672,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3191.57,105,CUSTOM-DRG,2553.256,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3100.37,102,CUSTOM-DRG,2480.296,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3191.57,
NERVOUS SYSTEM NEOPLASMS WITH MCC,54,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6372.22,100,CUSTOM-DRG,5097.776,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6690.83,105,CUSTOM-DRG,5352.664,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6499.65,102,CUSTOM-DRG,5199.72,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,6690.83,
NERVOUS SYSTEM NEOPLASMS WITHOUT MCC,55,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5078.56,100,CUSTOM-DRG,4062.848,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5332.49,105,CUSTOM-DRG,4265.992,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5180.13,102,CUSTOM-DRG,4144.104,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5332.49,
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC,56,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,10918.89,100,CUSTOM-DRG,8735.112,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,11464.83,105,CUSTOM-DRG,9171.864,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,11137.25,102,CUSTOM-DRG,8909.8,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,11464.83,
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC,57,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5970.78,100,CUSTOM-DRG,4776.624,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6269.32,105,CUSTOM-DRG,5015.456,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6090.18,102,CUSTOM-DRG,4872.144,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,6269.32,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC,58,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4897.65,100,CUSTOM-DRG,3918.12,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5142.53,105,CUSTOM-DRG,4114.024,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4995.6,102,CUSTOM-DRG,3996.48,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5142.53,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC,59,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4886.81,100,CUSTOM-DRG,3909.448,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5131.15,105,CUSTOM-DRG,4104.92,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4984.54,102,CUSTOM-DRG,3987.632,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5131.15,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC,60,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3175.27,100,CUSTOM-DRG,2540.216,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3334.03,105,CUSTOM-DRG,2667.224,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3238.77,102,CUSTOM-DRG,2591.016,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3334.03,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC",61,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,8653.03,100,CUSTOM-DRG,6922.424,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,9085.68,105,CUSTOM-DRG,7268.544,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,8826.08,102,CUSTOM-DRG,7060.864,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,9085.68,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC",62,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6319.52,100,CUSTOM-DRG,5055.616,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6635.49,105,CUSTOM-DRG,5308.392,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6445.9,102,CUSTOM-DRG,5156.72,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,6635.49,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC",63,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5567.84,100,CUSTOM-DRG,4454.272,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5846.23,105,CUSTOM-DRG,4676.984,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5679.19,102,CUSTOM-DRG,4543.352,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5846.23,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC,64,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,10039.01,100,CUSTOM-DRG,8031.208,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,10540.96,105,CUSTOM-DRG,8432.768,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,10239.77,102,CUSTOM-DRG,8191.816,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,10540.96,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS,65,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5426.18,100,CUSTOM-DRG,4340.944,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5697.49,105,CUSTOM-DRG,4557.992,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5534.69,102,CUSTOM-DRG,4427.752,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5697.49,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC,66,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3065.75,100,CUSTOM-DRG,2452.6,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3219.04,105,CUSTOM-DRG,2575.232,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3127.06,102,CUSTOM-DRG,2501.648,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3219.04,
NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC,67,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4228.21,100,CUSTOM-DRG,3382.568,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4439.62,105,CUSTOM-DRG,3551.696,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4312.77,102,CUSTOM-DRG,3450.216,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4439.62,
NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC,68,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2959.6,100,CUSTOM-DRG,2367.68,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3107.58,105,CUSTOM-DRG,2486.064,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3018.79,102,CUSTOM-DRG,2415.032,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3107.58,
TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,69,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2840.36,100,CUSTOM-DRG,2272.288,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2982.38,105,CUSTOM-DRG,2385.904,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2897.16,102,CUSTOM-DRG,2317.728,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2982.38,
NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC,70,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7080.16,100,CUSTOM-DRG,5664.128,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7434.17,105,CUSTOM-DRG,5947.336,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,7221.75,102,CUSTOM-DRG,5777.4,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,7434.17,
NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC,71,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4508.55,100,CUSTOM-DRG,3606.84,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4733.97,105,CUSTOM-DRG,3787.176,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4598.71,102,CUSTOM-DRG,3678.968,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4733.97,
NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC,72,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2543.58,100,CUSTOM-DRG,2034.864,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2670.76,105,CUSTOM-DRG,2136.608,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2594.45,102,CUSTOM-DRG,2075.56,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2670.76,
CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC,73,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5585.04,100,CUSTOM-DRG,4468.032,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5864.29,105,CUSTOM-DRG,4691.432,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5696.73,102,CUSTOM-DRG,4557.384,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5864.29,
CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC,74,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3545.69,100,CUSTOM-DRG,2836.552,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3722.97,105,CUSTOM-DRG,2978.376,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3616.59,102,CUSTOM-DRG,2893.272,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3722.97,
VIRAL MENINGITIS WITH CC/MCC,75,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3462.71,100,CUSTOM-DRG,2770.168,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3635.84,105,CUSTOM-DRG,2908.672,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3531.96,102,CUSTOM-DRG,2825.568,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3635.84,
VIRAL MENINGITIS WITHOUT CC/MCC,76,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2066.26,100,CUSTOM-DRG,1653.008,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2169.57,105,CUSTOM-DRG,1735.656,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2107.58,102,CUSTOM-DRG,1686.064,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
HYPERTENSIVE ENCEPHALOPATHY WITH MCC,77,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4070.85,100,CUSTOM-DRG,3256.68,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4274.39,105,CUSTOM-DRG,3419.512,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4152.26,102,CUSTOM-DRG,3321.808,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4274.39,
HYPERTENSIVE ENCEPHALOPATHY WITH CC,78,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3715.01,100,CUSTOM-DRG,2972.008,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3900.76,105,CUSTOM-DRG,3120.608,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3789.3,102,CUSTOM-DRG,3031.44,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3900.76,
HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC,79,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2489.38,100,CUSTOM-DRG,1991.504,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2613.85,105,CUSTOM-DRG,2091.08,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2539.16,102,CUSTOM-DRG,2031.328,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2613.85,
NONTRAUMATIC STUPOR AND COMA WITH MCC,80,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2942.03,100,CUSTOM-DRG,2353.624,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3089.13,105,CUSTOM-DRG,2471.304,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3000.87,102,CUSTOM-DRG,2400.696,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3089.13,
NONTRAUMATIC STUPOR AND COMA WITHOUT MCC,81,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,1964.97,100,CUSTOM-DRG,1571.976,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2063.21,105,CUSTOM-DRG,1650.568,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2004.26,102,CUSTOM-DRG,1603.408,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC,82,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6689.93,100,CUSTOM-DRG,5351.944,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7024.43,105,CUSTOM-DRG,5619.544,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6823.72,102,CUSTOM-DRG,5458.976,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,7024.43,
TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC,83,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4452.85,100,CUSTOM-DRG,3562.28,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4675.5,105,CUSTOM-DRG,3740.4,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4541.9,102,CUSTOM-DRG,3633.52,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4675.5,
TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC,84,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3284.79,100,CUSTOM-DRG,2627.832,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3449.03,105,CUSTOM-DRG,2759.224,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3350.48,102,CUSTOM-DRG,2680.384,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3449.03,
TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC,85,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5802.58,100,CUSTOM-DRG,4642.064,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6092.7,105,CUSTOM-DRG,4874.16,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5918.62,102,CUSTOM-DRG,4734.896,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,6092.7,
TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC,86,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3237.69,100,CUSTOM-DRG,2590.152,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3399.58,105,CUSTOM-DRG,2719.664,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3302.44,102,CUSTOM-DRG,2641.952,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3399.58,
TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC,87,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2503.96,100,CUSTOM-DRG,2003.168,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2629.16,105,CUSTOM-DRG,2103.328,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2554.03,102,CUSTOM-DRG,2043.224,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2629.16,
CONCUSSION WITH MCC,88,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5012.78,100,CUSTOM-DRG,4010.224,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5263.42,105,CUSTOM-DRG,4210.736,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5113.02,102,CUSTOM-DRG,4090.416,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5263.42,
CONCUSSION WITH CC,89,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4016.65,100,CUSTOM-DRG,3213.32,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4217.48,105,CUSTOM-DRG,3373.984,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4096.98,102,CUSTOM-DRG,3277.584,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4217.48,
CONCUSSION WITHOUT CC/MCC,90,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2393.32,100,CUSTOM-DRG,1914.656,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2512.99,105,CUSTOM-DRG,2010.392,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2441.18,102,CUSTOM-DRG,1952.944,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC,91,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,8615.65,100,CUSTOM-DRG,6892.52,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,9046.43,105,CUSTOM-DRG,7237.144,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,8787.95,102,CUSTOM-DRG,7030.36,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,9046.43,
OTHER DISORDERS OF NERVOUS SYSTEM WITH CC,92,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4288.02,100,CUSTOM-DRG,3430.416,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4502.42,105,CUSTOM-DRG,3601.936,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4373.77,102,CUSTOM-DRG,3499.016,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4502.42,
OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC,93,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3137.14,100,CUSTOM-DRG,2509.712,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3294,105,CUSTOM-DRG,2635.2,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3199.88,102,CUSTOM-DRG,2559.904,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3294,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC,94,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,17201.4,100,CUSTOM-DRG,13761.12,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,18061.47,105,CUSTOM-DRG,14449.176,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,17545.4,102,CUSTOM-DRG,14036.32,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,18061.47,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC,95,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,13765.61,100,CUSTOM-DRG,11012.488,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,14453.89,105,CUSTOM-DRG,11563.112,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,14040.9,102,CUSTOM-DRG,11232.72,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,14453.89,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC,96,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7322,100,CUSTOM-DRG,5857.6,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7688.09,105,CUSTOM-DRG,6150.472,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,7468.42,102,CUSTOM-DRG,5974.736,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,7688.09,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC,97,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,13083.46,100,CUSTOM-DRG,10466.768,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,13737.63,105,CUSTOM-DRG,10990.104,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,13345.1,102,CUSTOM-DRG,10676.08,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,13737.63,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC,98,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7566.08,100,CUSTOM-DRG,6052.864,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7944.38,105,CUSTOM-DRG,6355.504,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,7717.38,102,CUSTOM-DRG,6173.904,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,7944.38,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC,99,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3682.49,100,CUSTOM-DRG,2945.992,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3866.61,105,CUSTOM-DRG,3093.288,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3756.13,102,CUSTOM-DRG,3004.904,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3866.61,
SEIZURES WITH MCC,100,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6347.55,100,CUSTOM-DRG,5078.04,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6664.93,105,CUSTOM-DRG,5331.944,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6474.49,102,CUSTOM-DRG,5179.592,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,6664.93,
SEIZURES WITHOUT MCC,101,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2862.04,100,CUSTOM-DRG,2289.632,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3005.14,105,CUSTOM-DRG,2404.112,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2919.28,102,CUSTOM-DRG,2335.424,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3005.14,
HEADACHES WITH MCC,102,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3421.59,100,CUSTOM-DRG,2737.272,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3592.67,105,CUSTOM-DRG,2874.136,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3490.02,102,CUSTOM-DRG,2792.016,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3592.67,
HEADACHES WITHOUT MCC,103,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2635.53,100,CUSTOM-DRG,2108.424,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2767.31,105,CUSTOM-DRG,2213.848,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2688.24,102,CUSTOM-DRG,2150.592,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2767.31,
ORBITAL PROCEDURES WITH CC/MCC,113,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6773.66,100,CUSTOM-DRG,5418.928,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7112.34,105,CUSTOM-DRG,5689.872,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6909.12,102,CUSTOM-DRG,5527.296,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,7112.34,
ORBITAL PROCEDURES WITHOUT CC/MCC,114,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4359.41,100,CUSTOM-DRG,3487.528,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4577.38,105,CUSTOM-DRG,3661.904,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4446.59,102,CUSTOM-DRG,3557.272,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4577.38,
EXTRAOCULAR PROCEDURES EXCEPT ORBIT,115,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4700.67,100,CUSTOM-DRG,3760.536,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4935.7,105,CUSTOM-DRG,3948.56,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4794.68,102,CUSTOM-DRG,3835.744,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4935.7,
INTRAOCULAR PROCEDURES WITH CC/MCC,116,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4801.59,100,CUSTOM-DRG,3841.272,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5041.67,105,CUSTOM-DRG,4033.336,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4897.61,102,CUSTOM-DRG,3918.088,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5041.67,
INTRAOCULAR PROCEDURES WITHOUT CC/MCC,117,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3518.4,100,CUSTOM-DRG,2814.72,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3694.32,105,CUSTOM-DRG,2955.456,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3588.76,102,CUSTOM-DRG,2871.008,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,3694.32,
ACUTE MAJOR EYE INFECTIONS WITH CC/MCC,121,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2342.11,100,CUSTOM-DRG,1873.688,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2459.22,105,CUSTOM-DRG,1967.376,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2388.95,102,CUSTOM-DRG,1911.16,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC,122,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,1996.74,100,CUSTOM-DRG,1597.392,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2096.57,105,CUSTOM-DRG,1677.256,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2036.67,102,CUSTOM-DRG,1629.336,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
NEUROLOGICAL EYE DISORDERS,123,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3099.77,100,CUSTOM-DRG,2479.816,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3254.75,105,CUSTOM-DRG,2603.8,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3161.76,102,CUSTOM-DRG,2529.408,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3254.75,
OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT,124,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3235.82,100,CUSTOM-DRG,2588.656,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3397.61,105,CUSTOM-DRG,2718.088,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3300.53,102,CUSTOM-DRG,2640.424,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3397.61,
OTHER DISORDERS OF THE EYE WITHOUT MCC,125,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2017.67,100,CUSTOM-DRG,1614.136,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2118.55,105,CUSTOM-DRG,1694.84,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2058.02,102,CUSTOM-DRG,1646.416,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
SINUS AND MASTOID PROCEDURES WITH CC/MCC,135,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7596.73,100,CUSTOM-DRG,6077.384,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7976.56,105,CUSTOM-DRG,6381.248,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,7748.65,102,CUSTOM-DRG,6198.92,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,7976.56,
SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC,136,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3871.25,100,CUSTOM-DRG,3097,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4064.81,105,CUSTOM-DRG,3251.848,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3948.67,102,CUSTOM-DRG,3158.936,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4064.81,
MOUTH PROCEDURES WITH CC/MCC,137,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3459.34,100,CUSTOM-DRG,2767.472,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3632.31,105,CUSTOM-DRG,2905.848,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3528.52,102,CUSTOM-DRG,2822.816,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,3632.31,
MOUTH PROCEDURES WITHOUT CC/MCC,138,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2557.41,100,CUSTOM-DRG,2045.928,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2685.28,105,CUSTOM-DRG,2148.224,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2608.55,102,CUSTOM-DRG,2086.84,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,2685.28,
SALIVARY GLAND PROCEDURES,139,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3846.58,100,CUSTOM-DRG,3077.264,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4038.91,105,CUSTOM-DRG,3231.128,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3923.51,102,CUSTOM-DRG,3138.808,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4038.91,
MAJOR HEAD AND NECK PROCEDURES WITH MCC,140,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2472.56,100,CUSTOM-DRG,1978.048,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2596.19,105,CUSTOM-DRG,2076.952,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2522.01,102,CUSTOM-DRG,2017.608,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,2596.19,
MAJOR HEAD AND NECK PROCEDURES WITH CC,141,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2076.35,100,CUSTOM-DRG,1661.08,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2180.17,105,CUSTOM-DRG,1744.136,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2117.88,102,CUSTOM-DRG,1694.304,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,2552.31,
MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,142,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4967.55,100,CUSTOM-DRG,3974.04,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5215.93,105,CUSTOM-DRG,4172.744,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5066.89,102,CUSTOM-DRG,4053.512,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5215.93,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC",143,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,8448.95,100,CUSTOM-DRG,6759.16,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,8871.39,105,CUSTOM-DRG,7097.112,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,8617.91,102,CUSTOM-DRG,6894.328,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,8871.39,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",144,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2374.63,100,CUSTOM-DRG,1899.704,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2493.36,105,CUSTOM-DRG,1994.688,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2422.12,102,CUSTOM-DRG,1937.696,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,2552.31,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",145,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2621.7,100,CUSTOM-DRG,2097.36,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2752.78,105,CUSTOM-DRG,2202.224,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2674.13,102,CUSTOM-DRG,2139.304,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,2752.78,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC",146,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5037.82,100,CUSTOM-DRG,4030.256,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5289.71,105,CUSTOM-DRG,4231.768,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5138.57,102,CUSTOM-DRG,4110.856,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5289.71,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC",147,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3763.97,100,CUSTOM-DRG,3011.176,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3952.17,105,CUSTOM-DRG,3161.736,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3839.25,102,CUSTOM-DRG,3071.4,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3952.17,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC",148,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2848.21,100,CUSTOM-DRG,2278.568,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2990.62,105,CUSTOM-DRG,2392.496,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2905.17,102,CUSTOM-DRG,2324.136,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2990.62,
DYSEQUILIBRIUM,149,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2511.06,100,CUSTOM-DRG,2008.848,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2636.61,105,CUSTOM-DRG,2109.288,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2561.28,102,CUSTOM-DRG,2049.024,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2636.61,
EPISTAXIS WITH MCC,150,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3115.84,100,CUSTOM-DRG,2492.672,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3271.63,105,CUSTOM-DRG,2617.304,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3178.15,102,CUSTOM-DRG,2542.52,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3271.63,
EPISTAXIS WITHOUT MCC,151,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,1907.4,100,CUSTOM-DRG,1525.92,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2002.77,105,CUSTOM-DRG,1602.216,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,1945.55,102,CUSTOM-DRG,1556.44,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
OTITIS MEDIA AND URI WITH MCC,152,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2823.17,100,CUSTOM-DRG,2258.536,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2964.33,105,CUSTOM-DRG,2371.464,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2879.63,102,CUSTOM-DRG,2303.704,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2964.33,
OTITIS MEDIA AND URI WITHOUT MCC,153,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2407.15,100,CUSTOM-DRG,1925.72,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2527.51,105,CUSTOM-DRG,2022.008,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2455.29,102,CUSTOM-DRG,1964.232,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC",154,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4024.13,100,CUSTOM-DRG,3219.304,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4225.33,105,CUSTOM-DRG,3380.264,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4104.6,102,CUSTOM-DRG,3283.68,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4225.33,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC",155,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2545.45,100,CUSTOM-DRG,2036.36,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2672.72,105,CUSTOM-DRG,2138.176,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2596.35,102,CUSTOM-DRG,2077.08,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2672.72,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC",156,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2018.42,100,CUSTOM-DRG,1614.736,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2119.34,105,CUSTOM-DRG,1695.472,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2058.78,102,CUSTOM-DRG,1647.024,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
DENTAL AND ORAL DISEASES WITH MCC,157,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3906.01,100,CUSTOM-DRG,3124.808,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4101.31,105,CUSTOM-DRG,3281.048,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3984.13,102,CUSTOM-DRG,3187.304,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4101.31,
DENTAL AND ORAL DISEASES WITH CC,158,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3457.47,100,CUSTOM-DRG,2765.976,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3630.35,105,CUSTOM-DRG,2904.28,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3526.62,102,CUSTOM-DRG,2821.296,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3630.35,
DENTAL AND ORAL DISEASES WITHOUT CC/MCC,159,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2699.82,100,CUSTOM-DRG,2159.856,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2834.81,105,CUSTOM-DRG,2267.848,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2753.81,102,CUSTOM-DRG,2203.048,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2834.81,
MAJOR CHEST PROCEDURES WITH MCC,163,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,21275.24,100,CUSTOM-DRG,17020.192,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,22339,105,CUSTOM-DRG,17871.2,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,21700.71,102,CUSTOM-DRG,17360.568,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,22339,
MAJOR CHEST PROCEDURES WITH CC,164,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,9867.44,100,CUSTOM-DRG,7893.952,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,10360.82,105,CUSTOM-DRG,8288.656,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,10064.78,102,CUSTOM-DRG,8051.824,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,10360.82,
MAJOR CHEST PROCEDURES WITHOUT CC/MCC,165,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6730.67,100,CUSTOM-DRG,5384.536,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7067.21,105,CUSTOM-DRG,5653.768,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6865.28,102,CUSTOM-DRG,5492.224,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,7067.21,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC,166,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,15620.31,100,CUSTOM-DRG,12496.248,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,16401.32,105,CUSTOM-DRG,13121.056,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,15932.69,102,CUSTOM-DRG,12746.152,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,16401.32,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC,167,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7210.61,100,CUSTOM-DRG,5768.488,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7571.14,105,CUSTOM-DRG,6056.912,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,7354.81,102,CUSTOM-DRG,5883.848,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,7571.14,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,168,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4988.11,100,CUSTOM-DRG,3990.488,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5237.51,105,CUSTOM-DRG,4190.008,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5087.86,102,CUSTOM-DRG,4070.288,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5237.51,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM,173,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4396.04,100,CUSTOM-DRG,3516.832,Case rate,100% of GA Medicaid ,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4615.84,105,CUSTOM-DRG,3692.672,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1849,100,,,per diem,Pays based on per day rate,4483.95,102,CUSTOM-DRG,3587.16,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1262.8,4615.84,
PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE,175,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5920.69,100,CUSTOM-DRG,4736.552,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6216.72,105,CUSTOM-DRG,4973.376,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1849,100,,,per diem,Pays based on per day rate,6039.1,102,CUSTOM-DRG,4831.28,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,6216.72,
PULMONARY EMBOLISM WITHOUT MCC,176,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3618.57,100,CUSTOM-DRG,2894.856,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3799.5,105,CUSTOM-DRG,3039.6,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1849,100,,,per diem,Pays based on per day rate,3690.94,102,CUSTOM-DRG,2952.752,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3799.5,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,177,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7155.29,100,CUSTOM-DRG,5724.232,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7513.05,105,CUSTOM-DRG,6010.44,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1849,100,,,per diem,Pays based on per day rate,7298.38,102,CUSTOM-DRG,5838.704,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,7513.05,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC,178,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5511.03,100,CUSTOM-DRG,4408.824,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5786.58,105,CUSTOM-DRG,4629.264,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1849,100,,,per diem,Pays based on per day rate,5621.24,102,CUSTOM-DRG,4496.992,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5786.58,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC,179,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2718.51,100,CUSTOM-DRG,2174.808,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2854.43,105,CUSTOM-DRG,2283.544,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1849,100,,,per diem,Pays based on per day rate,2772.87,102,CUSTOM-DRG,2218.296,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2854.43,
RESPIRATORY NEOPLASMS WITH MCC,180,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6662.65,100,CUSTOM-DRG,5330.12,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6995.78,105,CUSTOM-DRG,5596.624,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1849,100,,,per diem,Pays based on per day rate,6795.89,102,CUSTOM-DRG,5436.712,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,6995.78,
RESPIRATORY NEOPLASMS WITH CC,181,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4964.19,100,CUSTOM-DRG,3971.352,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5212.39,105,CUSTOM-DRG,4169.912,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1849,100,,,per diem,Pays based on per day rate,5063.46,102,CUSTOM-DRG,4050.768,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5212.39,
RESPIRATORY NEOPLASMS WITHOUT CC/MCC,182,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2831.76,100,CUSTOM-DRG,2265.408,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2973.35,105,CUSTOM-DRG,2378.68,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1849,100,,,per diem,Pays based on per day rate,2888.4,102,CUSTOM-DRG,2310.72,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2973.35,
MAJOR CHEST TRAUMA WITH MCC,183,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4907,100,CUSTOM-DRG,3925.6,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5152.35,105,CUSTOM-DRG,4121.88,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1849,100,,,per diem,Pays based on per day rate,5005.13,102,CUSTOM-DRG,4004.104,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5152.35,
MAJOR CHEST TRAUMA WITH CC,184,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3117.71,100,CUSTOM-DRG,2494.168,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3273.59,105,CUSTOM-DRG,2618.872,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1849,100,,,per diem,Pays based on per day rate,3180.06,102,CUSTOM-DRG,2544.048,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3273.59,
MAJOR CHEST TRAUMA WITHOUT CC/MCC,185,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,1927.59,100,CUSTOM-DRG,1542.072,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2023.97,105,CUSTOM-DRG,1619.176,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1849,100,,,per diem,Pays based on per day rate,1966.14,102,CUSTOM-DRG,1572.912,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
PLEURAL EFFUSION WITH MCC,186,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6088.89,100,CUSTOM-DRG,4871.112,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6393.34,105,CUSTOM-DRG,5114.672,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1849,100,,,per diem,Pays based on per day rate,6210.66,102,CUSTOM-DRG,4968.528,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,6393.34,
PLEURAL EFFUSION WITH CC,187,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4338.1,100,CUSTOM-DRG,3470.48,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4555.01,105,CUSTOM-DRG,3644.008,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1849,100,,,per diem,Pays based on per day rate,4424.86,102,CUSTOM-DRG,3539.888,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4555.01,
PLEURAL EFFUSION WITHOUT CC/MCC,188,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2420.61,100,CUSTOM-DRG,1936.488,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2541.64,105,CUSTOM-DRG,2033.312,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1849,100,,,per diem,Pays based on per day rate,2469.01,102,CUSTOM-DRG,1975.208,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
PULMONARY EDEMA AND RESPIRATORY FAILURE,189,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5243.77,100,CUSTOM-DRG,4195.016,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5505.96,105,CUSTOM-DRG,4404.768,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5348.64,102,CUSTOM-DRG,4278.912,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5505.96,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,190,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4186.72,100,CUSTOM-DRG,3349.376,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4396.06,105,CUSTOM-DRG,3516.848,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4270.45,102,CUSTOM-DRG,3416.36,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4396.06,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,191,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3351.69,100,CUSTOM-DRG,2681.352,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3519.28,105,CUSTOM-DRG,2815.424,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3418.72,102,CUSTOM-DRG,2734.976,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3519.28,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC,192,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2629.18,100,CUSTOM-DRG,2103.344,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2760.63,105,CUSTOM-DRG,2208.504,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2681.75,102,CUSTOM-DRG,2145.4,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2760.63,
SIMPLE PNEUMONIA AND PLEURISY WITH MCC,193,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5022.87,100,CUSTOM-DRG,4018.296,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5274.01,105,CUSTOM-DRG,4219.208,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5123.32,102,CUSTOM-DRG,4098.656,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5274.01,
SIMPLE PNEUMONIA AND PLEURISY WITH CC,194,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3476.54,100,CUSTOM-DRG,2781.232,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3650.36,105,CUSTOM-DRG,2920.288,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3546.06,102,CUSTOM-DRG,2836.848,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3650.36,
SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC,195,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2620.95,100,CUSTOM-DRG,2096.76,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2752,105,CUSTOM-DRG,2201.6,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2673.37,102,CUSTOM-DRG,2138.696,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2752,
INTERSTITIAL LUNG DISEASE WITH MCC,196,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4858.41,100,CUSTOM-DRG,3886.728,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5101.33,105,CUSTOM-DRG,4081.064,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4955.57,102,CUSTOM-DRG,3964.456,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5101.33,
INTERSTITIAL LUNG DISEASE WITH CC,197,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3820.42,100,CUSTOM-DRG,3056.336,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4011.44,105,CUSTOM-DRG,3209.152,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3896.82,102,CUSTOM-DRG,3117.456,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4011.44,
INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC,198,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2535.36,100,CUSTOM-DRG,2028.288,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2662.12,105,CUSTOM-DRG,2129.696,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2586.06,102,CUSTOM-DRG,2068.848,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2662.12,
PNEUMOTHORAX WITH MCC,199,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5659.79,100,CUSTOM-DRG,4527.832,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5942.78,105,CUSTOM-DRG,4754.224,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5772.98,102,CUSTOM-DRG,4618.384,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5942.78,
PNEUMOTHORAX WITH CC,200,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2849.33,100,CUSTOM-DRG,2279.464,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2991.8,105,CUSTOM-DRG,2393.44,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2906.31,102,CUSTOM-DRG,2325.048,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2991.8,
PNEUMOTHORAX WITHOUT CC/MCC,201,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2304.36,100,CUSTOM-DRG,1843.488,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2419.58,105,CUSTOM-DRG,1935.664,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2350.44,102,CUSTOM-DRG,1880.352,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
BRONCHITIS AND ASTHMA WITH CC/MCC,202,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3233.21,100,CUSTOM-DRG,2586.568,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3394.87,105,CUSTOM-DRG,2715.896,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3297.86,102,CUSTOM-DRG,2638.288,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3394.87,
BRONCHITIS AND ASTHMA WITHOUT CC/MCC,203,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2317.82,100,CUSTOM-DRG,1854.256,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2433.71,105,CUSTOM-DRG,1946.968,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2364.17,102,CUSTOM-DRG,1891.336,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
RESPIRATORY SIGNS AND SYMPTOMS,204,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2979.41,100,CUSTOM-DRG,2383.528,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3128.38,105,CUSTOM-DRG,2502.704,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3038.99,102,CUSTOM-DRG,2431.192,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3128.38,
OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC,205,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4377.72,100,CUSTOM-DRG,3502.176,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4596.61,105,CUSTOM-DRG,3677.288,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4465.27,102,CUSTOM-DRG,3572.216,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4596.61,
OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC,206,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2569,100,CUSTOM-DRG,2055.2,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2697.45,105,CUSTOM-DRG,2157.96,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2620.37,102,CUSTOM-DRG,2096.296,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2697.45,
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,207,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,26113.84,100,CUSTOM-DRG,20891.072,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,27419.52,105,CUSTOM-DRG,21935.616,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,26636.07,102,CUSTOM-DRG,21308.856,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,27419.52,
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,208,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7947.71,100,CUSTOM-DRG,6358.168,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,8345.09,105,CUSTOM-DRG,6676.072,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,8106.65,102,CUSTOM-DRG,6485.32,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,8345.09,
CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES,212,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2043.83,100,CUSTOM-DRG,1635.064,Case rate,100% of GA Medicaid ,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2146.03,105,CUSTOM-DRG,1716.824,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1849,100,,,per diem,Pays based on per day rate,2084.71,102,CUSTOM-DRG,1667.768,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1262.8,2552.31,
OTHER HEART ASSIST SYSTEM IMPLANT,215,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,47967.69,100,CUSTOM-DRG,38374.152,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,50366.07,105,CUSTOM-DRG,40292.856,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,48926.96,102,CUSTOM-DRG,39141.568,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,50366.07,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,216,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,40136.6,100,CUSTOM-DRG,32109.28,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,42143.43,105,CUSTOM-DRG,33714.744,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,40939.27,102,CUSTOM-DRG,32751.416,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,42143.43,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC,217,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,23504.84,100,CUSTOM-DRG,18803.872,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,24680.08,105,CUSTOM-DRG,19744.064,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,23974.9,102,CUSTOM-DRG,19179.92,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,24680.08,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC,218,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,18750.35,100,CUSTOM-DRG,15000.28,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,19687.87,105,CUSTOM-DRG,15750.296,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,19125.33,102,CUSTOM-DRG,15300.264,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,19687.87,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC,219,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,25976.28,100,CUSTOM-DRG,20781.024,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,27275.1,105,CUSTOM-DRG,21820.08,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,26495.77,102,CUSTOM-DRG,21196.616,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,27275.1,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC,220,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,20763.16,100,CUSTOM-DRG,16610.528,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,21801.32,105,CUSTOM-DRG,17441.056,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,21178.39,102,CUSTOM-DRG,16942.712,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,21801.32,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC,221,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,20361.72,100,CUSTOM-DRG,16289.376,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,21379.8,105,CUSTOM-DRG,17103.84,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,20768.92,102,CUSTOM-DRG,16615.136,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,21379.8,
OTHER CARDIOTHORACIC PROCEDURES WITH MCC,228,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,21333.18,100,CUSTOM-DRG,17066.544,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,22399.83,105,CUSTOM-DRG,17919.864,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,21759.8,102,CUSTOM-DRG,17407.84,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,22399.83,
OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC,229,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,13649.73,100,CUSTOM-DRG,10919.784,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,14332.22,105,CUSTOM-DRG,11465.776,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,13922.71,102,CUSTOM-DRG,11138.168,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,14332.22,
CORONARY BYPASS WITH PTCA WITH MCC,231,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,24600.02,100,CUSTOM-DRG,19680.016,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,25830.02,105,CUSTOM-DRG,20664.016,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,25091.98,102,CUSTOM-DRG,20073.584,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,25830.02,
CORONARY BYPASS WITH PTCA WITHOUT MCC,232,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,20802.41,100,CUSTOM-DRG,16641.928,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,21842.53,105,CUSTOM-DRG,17474.024,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,21218.42,102,CUSTOM-DRG,16974.736,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,21842.53,
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC,233,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,24335.01,100,CUSTOM-DRG,19468.008,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,25551.76,105,CUSTOM-DRG,20441.408,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,24821.67,102,CUSTOM-DRG,19857.336,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,25551.76,
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC,234,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,16910.6,100,CUSTOM-DRG,13528.48,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,17756.13,105,CUSTOM-DRG,14204.904,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,17248.78,102,CUSTOM-DRG,13799.024,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,17756.13,
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC,235,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,20071.67,100,CUSTOM-DRG,16057.336,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,21075.25,105,CUSTOM-DRG,16860.2,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,20473.07,102,CUSTOM-DRG,16378.456,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,21075.25,
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,236,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,14538.21,100,CUSTOM-DRG,11630.568,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,15265.12,105,CUSTOM-DRG,12212.096,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,14828.95,102,CUSTOM-DRG,11863.16,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,15265.12,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC,239,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,20707.84,100,CUSTOM-DRG,16566.272,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,21743.23,105,CUSTOM-DRG,17394.584,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,21121.96,102,CUSTOM-DRG,16897.568,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,21743.23,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC,240,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,10044.62,100,CUSTOM-DRG,8035.696,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,10546.85,105,CUSTOM-DRG,8437.48,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,10245.49,102,CUSTOM-DRG,8196.392,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,10546.85,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC,241,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4228.58,100,CUSTOM-DRG,3382.864,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4440.01,105,CUSTOM-DRG,3552.008,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4313.15,102,CUSTOM-DRG,3450.52,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4440.01,
PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC,242,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,15900.27,100,CUSTOM-DRG,12720.216,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,16695.28,105,CUSTOM-DRG,13356.224,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,16218.25,102,CUSTOM-DRG,12974.6,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,16695.28,
PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC,243,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,10206.09,100,CUSTOM-DRG,8164.872,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,10716.39,105,CUSTOM-DRG,8573.112,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,10410.2,102,CUSTOM-DRG,8328.16,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,10716.39,
PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC,244,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7909.21,100,CUSTOM-DRG,6327.368,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,8304.67,105,CUSTOM-DRG,6643.736,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,8067.38,102,CUSTOM-DRG,6453.904,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,8304.67,
AICD GENERATOR PROCEDURES,245,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,18516.36,100,CUSTOM-DRG,14813.088,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,19442.18,105,CUSTOM-DRG,15553.744,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,18886.66,102,CUSTOM-DRG,15109.328,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,19442.18,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC,250,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,9114.28,100,CUSTOM-DRG,7291.424,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,9569.99,105,CUSTOM-DRG,7655.992,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,9296.55,102,CUSTOM-DRG,7437.24,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,9569.99,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC,251,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5576.44,100,CUSTOM-DRG,4461.152,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5855.26,105,CUSTOM-DRG,4684.208,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5687.96,102,CUSTOM-DRG,4550.368,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5855.26,
OTHER VASCULAR PROCEDURES WITH MCC,252,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,12707.06,100,CUSTOM-DRG,10165.648,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,13342.41,105,CUSTOM-DRG,10673.928,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,12961.18,102,CUSTOM-DRG,10368.944,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,13342.41,
OTHER VASCULAR PROCEDURES WITH CC,253,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,10753.68,100,CUSTOM-DRG,8602.944,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,11291.36,105,CUSTOM-DRG,9033.088,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,10968.74,102,CUSTOM-DRG,8774.992,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,11291.36,
OTHER VASCULAR PROCEDURES WITHOUT CC/MCC,254,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7070.07,100,CUSTOM-DRG,5656.056,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7423.57,105,CUSTOM-DRG,5938.856,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,7211.46,102,CUSTOM-DRG,5769.168,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,7423.57,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC,255,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5646.71,100,CUSTOM-DRG,4517.368,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5929.04,105,CUSTOM-DRG,4743.232,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5759.63,102,CUSTOM-DRG,4607.704,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5929.04,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC,256,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5517.76,100,CUSTOM-DRG,4414.208,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5793.64,105,CUSTOM-DRG,4634.912,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5628.1,102,CUSTOM-DRG,4502.48,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5793.64,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC,257,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2820.18,100,CUSTOM-DRG,2256.144,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2961.19,105,CUSTOM-DRG,2368.952,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2876.58,102,CUSTOM-DRG,2301.264,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,2961.19,
CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC,258,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7961.54,100,CUSTOM-DRG,6369.232,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,8359.61,105,CUSTOM-DRG,6687.688,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,8120.75,102,CUSTOM-DRG,6496.6,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,8359.61,
CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC,259,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5570.83,100,CUSTOM-DRG,4456.664,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5849.37,105,CUSTOM-DRG,4679.496,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5682.24,102,CUSTOM-DRG,4545.792,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5849.37,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC,260,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,10650.89,100,CUSTOM-DRG,8520.712,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,11183.43,105,CUSTOM-DRG,8946.744,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,10863.89,102,CUSTOM-DRG,8691.112,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,11183.43,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC,261,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5534.95,100,CUSTOM-DRG,4427.96,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5811.7,105,CUSTOM-DRG,4649.36,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5645.64,102,CUSTOM-DRG,4516.512,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5811.7,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC,262,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5041.18,100,CUSTOM-DRG,4032.944,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5293.24,105,CUSTOM-DRG,4234.592,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5142,102,CUSTOM-DRG,4113.6,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5293.24,
VEIN LIGATION AND STRIPPING,263,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,9833.06,100,CUSTOM-DRG,7866.448,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,10324.71,105,CUSTOM-DRG,8259.768,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,10029.7,102,CUSTOM-DRG,8023.76,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,10324.71,
OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,264,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,10242.72,100,CUSTOM-DRG,8194.176,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,10754.86,105,CUSTOM-DRG,8603.888,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,10447.56,102,CUSTOM-DRG,8358.048,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,10754.86,
AICD LEAD PROCEDURES,265,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,9353.5,100,CUSTOM-DRG,7482.8,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,9821.17,105,CUSTOM-DRG,7856.936,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,9540.55,102,CUSTOM-DRG,7632.44,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,9821.17,
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC,266,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,18017.74,100,CUSTOM-DRG,14414.192,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,18918.62,105,CUSTOM-DRG,15134.896,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,18378.06,102,CUSTOM-DRG,14702.448,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,18918.62,
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC,267,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2057.29,100,CUSTOM-DRG,1645.832,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2160.15,105,CUSTOM-DRG,1728.12,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2098.43,102,CUSTOM-DRG,1678.744,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,2552.31,
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC,268,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,9935.1,100,CUSTOM-DRG,7948.08,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,10431.85,105,CUSTOM-DRG,8345.48,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,10133.78,102,CUSTOM-DRG,8107.024,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,10431.85,
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC,269,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,1675.29,100,CUSTOM-DRG,1340.232,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1759.05,105,CUSTOM-DRG,1407.24,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,1708.79,102,CUSTOM-DRG,1367.032,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,2552.31,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC,270,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,1068.64,100,CUSTOM-DRG,854.912,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1122.07,105,CUSTOM-DRG,897.656,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,1090.01,102,CUSTOM-DRG,872.008,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1068.64,2552.31,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC,271,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2007.58,100,CUSTOM-DRG,1606.064,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2107.96,105,CUSTOM-DRG,1686.368,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2047.73,102,CUSTOM-DRG,1638.184,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,2552.31,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC,272,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,1200,2552.31,
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC,273,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,14559.52,100,CUSTOM-DRG,11647.616,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,15287.49,105,CUSTOM-DRG,12229.992,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,14850.68,102,CUSTOM-DRG,11880.544,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,15287.49,
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC,274,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7736.89,100,CUSTOM-DRG,6189.512,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,8123.74,105,CUSTOM-DRG,6498.992,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,7891.62,102,CUSTOM-DRG,6313.296,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,8123.74,
CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC,275,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,18711.1,100,CUSTOM-DRG,14968.88,Case rate,100% of GA Medicaid ,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,19646.66,105,CUSTOM-DRG,15717.328,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1849,100,,,per diem,Pays based on per day rate,19085.29,102,CUSTOM-DRG,15268.232,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1262.8,19646.66,
CARDIAC DEFIBRILLATOR IMPLANT WITH MCC,276,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,13372.02,100,CUSTOM-DRG,10697.616,Case rate,100% of GA Medicaid ,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,14040.61,105,CUSTOM-DRG,11232.488,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1849,100,,,per diem,Pays based on per day rate,13639.43,102,CUSTOM-DRG,10911.544,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1262.8,14040.61,
CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC,277,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,20184.55,100,CUSTOM-DRG,16147.64,Case rate,100% of GA Medicaid ,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21193.77,105,CUSTOM-DRG,16955.016,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1849,100,,,per diem,Pays based on per day rate,20588.21,102,CUSTOM-DRG,16470.568,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1262.8,21193.77,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC,278,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,13330.15,100,CUSTOM-DRG,10664.12,Case rate,100% of GA Medicaid ,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,13996.66,105,CUSTOM-DRG,11197.328,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1849,100,,,per diem,Pays based on per day rate,13596.73,102,CUSTOM-DRG,10877.384,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1262.8,13996.66,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC,279,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,8399.23,100,CUSTOM-DRG,6719.384,Case rate,100% of GA Medicaid ,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8819.19,105,CUSTOM-DRG,7055.352,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1849,100,,,per diem,Pays based on per day rate,8567.2,102,CUSTOM-DRG,6853.76,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1262.8,8819.19,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC",280,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6219.34,100,CUSTOM-DRG,4975.472,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6530.31,105,CUSTOM-DRG,5224.248,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6343.72,102,CUSTOM-DRG,5074.976,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,6530.31,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC",281,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3679.87,100,CUSTOM-DRG,2943.896,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3863.87,105,CUSTOM-DRG,3091.096,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3753.47,102,CUSTOM-DRG,3002.776,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3863.87,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC",282,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3679.87,100,CUSTOM-DRG,2943.896,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3863.87,105,CUSTOM-DRG,3091.096,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3753.47,102,CUSTOM-DRG,3002.776,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3863.87,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC",283,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4654.69,100,CUSTOM-DRG,3723.752,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4887.43,105,CUSTOM-DRG,3909.944,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4747.78,102,CUSTOM-DRG,3798.224,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4887.43,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC",284,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2211.29,100,CUSTOM-DRG,1769.032,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2321.85,105,CUSTOM-DRG,1857.48,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2255.51,102,CUSTOM-DRG,1804.408,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC",285,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2151.86,100,CUSTOM-DRG,1721.488,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2259.45,105,CUSTOM-DRG,1807.56,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2194.89,102,CUSTOM-DRG,1755.912,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC",286,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,9632.34,100,CUSTOM-DRG,7705.872,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,10113.95,105,CUSTOM-DRG,8091.16,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,9824.97,102,CUSTOM-DRG,7859.976,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,10113.95,
"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC",287,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4981.75,100,CUSTOM-DRG,3985.4,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5230.84,105,CUSTOM-DRG,4184.672,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5081.38,102,CUSTOM-DRG,4065.104,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5230.84,
ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC,288,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7834.45,100,CUSTOM-DRG,6267.56,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,8226.17,105,CUSTOM-DRG,6580.936,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,7991.13,102,CUSTOM-DRG,6392.904,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,8226.17,
ACUTE AND SUBACUTE ENDOCARDITIS WITH CC,289,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5014.65,100,CUSTOM-DRG,4011.72,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5265.38,105,CUSTOM-DRG,4212.304,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5114.93,102,CUSTOM-DRG,4091.944,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5265.38,
ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC,290,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4588.54,100,CUSTOM-DRG,3670.832,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4817.96,105,CUSTOM-DRG,3854.368,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4680.3,102,CUSTOM-DRG,3744.24,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4817.96,
HEART FAILURE AND SHOCK WITH MCC,291,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5169.02,100,CUSTOM-DRG,4135.216,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5427.47,105,CUSTOM-DRG,4341.976,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5272.39,102,CUSTOM-DRG,4217.912,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5427.47,
HEART FAILURE AND SHOCK WITH CC,292,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3334.87,100,CUSTOM-DRG,2667.896,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3501.62,105,CUSTOM-DRG,2801.296,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3401.57,102,CUSTOM-DRG,2721.256,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3501.62,
HEART FAILURE AND SHOCK WITHOUT CC/MCC,293,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2314.83,100,CUSTOM-DRG,1851.864,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2430.57,105,CUSTOM-DRG,1944.456,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2361.12,102,CUSTOM-DRG,1888.896,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC,294,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2924.09,100,CUSTOM-DRG,2339.272,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3070.29,105,CUSTOM-DRG,2456.232,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2982.57,102,CUSTOM-DRG,2386.056,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3070.29,
DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC,295,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2924.09,100,CUSTOM-DRG,2339.272,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3070.29,105,CUSTOM-DRG,2456.232,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2982.57,102,CUSTOM-DRG,2386.056,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3070.29,
"CARDIAC ARREST, UNEXPLAINED WITH MCC",296,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6426.04,100,CUSTOM-DRG,5140.832,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6747.34,105,CUSTOM-DRG,5397.872,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6554.55,102,CUSTOM-DRG,5243.64,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,6747.34,
"CARDIAC ARREST, UNEXPLAINED WITH CC",297,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,1809.1,100,CUSTOM-DRG,1447.28,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1899.55,105,CUSTOM-DRG,1519.64,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,1845.28,102,CUSTOM-DRG,1476.224,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
"CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC",298,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,1809.1,100,CUSTOM-DRG,1447.28,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1899.55,105,CUSTOM-DRG,1519.64,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,1845.28,102,CUSTOM-DRG,1476.224,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
PERIPHERAL VASCULAR DISORDERS WITH MCC,299,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4686.47,100,CUSTOM-DRG,3749.176,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4920.79,105,CUSTOM-DRG,3936.632,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4780.19,102,CUSTOM-DRG,3824.152,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4920.79,
PERIPHERAL VASCULAR DISORDERS WITH CC,300,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3861.16,100,CUSTOM-DRG,3088.928,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4054.22,105,CUSTOM-DRG,3243.376,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3938.37,102,CUSTOM-DRG,3150.696,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4054.22,
PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC,301,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2218.76,100,CUSTOM-DRG,1775.008,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2329.7,105,CUSTOM-DRG,1863.76,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2263.14,102,CUSTOM-DRG,1810.512,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
ATHEROSCLEROSIS WITH MCC,302,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2775.32,100,CUSTOM-DRG,2220.256,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2914.09,105,CUSTOM-DRG,2331.272,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2830.83,102,CUSTOM-DRG,2264.664,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2914.09,
ATHEROSCLEROSIS WITHOUT MCC,303,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2665.06,100,CUSTOM-DRG,2132.048,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2798.31,105,CUSTOM-DRG,2238.648,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2718.36,102,CUSTOM-DRG,2174.688,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2798.31,
HYPERTENSION WITH MCC,304,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3302.73,100,CUSTOM-DRG,2642.184,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3467.86,105,CUSTOM-DRG,2774.288,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3368.78,102,CUSTOM-DRG,2695.024,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3467.86,
HYPERTENSION WITHOUT MCC,305,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2702.81,100,CUSTOM-DRG,2162.248,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2837.95,105,CUSTOM-DRG,2270.36,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2756.86,102,CUSTOM-DRG,2205.488,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2837.95,
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC,306,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3356.55,100,CUSTOM-DRG,2685.24,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3524.38,105,CUSTOM-DRG,2819.504,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3423.68,102,CUSTOM-DRG,2738.944,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3524.38,
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC,307,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2607.12,100,CUSTOM-DRG,2085.696,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2737.48,105,CUSTOM-DRG,2189.984,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2659.26,102,CUSTOM-DRG,2127.408,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2737.48,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC,308,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5034.83,100,CUSTOM-DRG,4027.864,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5286.57,105,CUSTOM-DRG,4229.256,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5135.52,102,CUSTOM-DRG,4108.416,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5286.57,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC,309,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3221.99,100,CUSTOM-DRG,2577.592,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3383.09,105,CUSTOM-DRG,2706.472,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3286.43,102,CUSTOM-DRG,2629.144,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3383.09,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC,310,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2179.52,100,CUSTOM-DRG,1743.616,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2288.49,105,CUSTOM-DRG,1830.792,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2223.1,102,CUSTOM-DRG,1778.48,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
ANGINA PECTORIS,311,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2731.97,100,CUSTOM-DRG,2185.576,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2868.56,105,CUSTOM-DRG,2294.848,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2786.6,102,CUSTOM-DRG,2229.28,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2868.56,
SYNCOPE AND COLLAPSE,312,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2852.7,100,CUSTOM-DRG,2282.16,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2995.33,105,CUSTOM-DRG,2396.264,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2909.75,102,CUSTOM-DRG,2327.8,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2995.33,
CHEST PAIN,313,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2794.76,100,CUSTOM-DRG,2235.808,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2934.5,105,CUSTOM-DRG,2347.6,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2850.65,102,CUSTOM-DRG,2280.52,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2934.5,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC,314,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,8716.57,100,CUSTOM-DRG,6973.256,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,9152.4,105,CUSTOM-DRG,7321.92,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,8890.89,102,CUSTOM-DRG,7112.712,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,9152.4,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC,315,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4286.52,100,CUSTOM-DRG,3429.216,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4500.85,105,CUSTOM-DRG,3600.68,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4372.24,102,CUSTOM-DRG,3497.792,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4500.85,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC,316,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3284.04,100,CUSTOM-DRG,2627.232,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3448.24,105,CUSTOM-DRG,2758.592,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3349.72,102,CUSTOM-DRG,2679.776,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3448.24,
OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC,319,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,1200,2552.31,
OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC,320,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,1200,2552.31,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES,321,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2552.31,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1849,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,1262.8,2552.31,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC,322,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2552.31,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1849,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,1262.8,2552.31,
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC,323,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2552.31,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1849,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,1262.8,2552.31,
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC,324,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2552.31,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1849,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,1262.8,2552.31,
CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE,325,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2552.31,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1849,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,1262.8,2552.31,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC",326,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,17477.63,100,CUSTOM-DRG,13982.104,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,18351.5,105,CUSTOM-DRG,14681.2,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,17827.15,102,CUSTOM-DRG,14261.72,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,18351.5,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC",327,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,8742.74,100,CUSTOM-DRG,6994.192,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,9179.87,105,CUSTOM-DRG,7343.896,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,8917.58,102,CUSTOM-DRG,7134.064,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,9179.87,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC",328,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5315.91,100,CUSTOM-DRG,4252.728,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5581.71,105,CUSTOM-DRG,4465.368,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5422.22,102,CUSTOM-DRG,4337.776,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5581.71,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,329,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,18224.81,100,CUSTOM-DRG,14579.848,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,19136.05,105,CUSTOM-DRG,15308.84,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,18589.28,102,CUSTOM-DRG,14871.424,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,19136.05,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,330,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,9443.95,100,CUSTOM-DRG,7555.16,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,9916.15,105,CUSTOM-DRG,7932.92,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,9632.81,102,CUSTOM-DRG,7706.248,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,9916.15,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,331,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6301.57,100,CUSTOM-DRG,5041.256,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6616.65,105,CUSTOM-DRG,5293.32,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6427.59,102,CUSTOM-DRG,5142.072,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,6616.65,
RECTAL RESECTION WITH MCC,332,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,13373.51,100,CUSTOM-DRG,10698.808,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,14042.18,105,CUSTOM-DRG,11233.744,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,13640.96,102,CUSTOM-DRG,10912.768,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,14042.18,
RECTAL RESECTION WITH CC,333,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7359.75,100,CUSTOM-DRG,5887.8,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7727.73,105,CUSTOM-DRG,6182.184,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,7506.93,102,CUSTOM-DRG,6005.544,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,7727.73,
RECTAL RESECTION WITHOUT CC/MCC,334,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5700.16,100,CUSTOM-DRG,4560.128,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5985.17,105,CUSTOM-DRG,4788.136,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5814.15,102,CUSTOM-DRG,4651.32,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5985.17,
PERITONEAL ADHESIOLYSIS WITH MCC,335,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,18121.28,100,CUSTOM-DRG,14497.024,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,19027.34,105,CUSTOM-DRG,15221.872,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,18483.67,102,CUSTOM-DRG,14786.936,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,19027.34,
PERITONEAL ADHESIOLYSIS WITH CC,336,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,9208.84,100,CUSTOM-DRG,7367.072,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,9669.28,105,CUSTOM-DRG,7735.424,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,9393,102,CUSTOM-DRG,7514.4,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,9669.28,
PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC,337,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5630.26,100,CUSTOM-DRG,4504.208,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5911.78,105,CUSTOM-DRG,4729.424,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5742.86,102,CUSTOM-DRG,4594.288,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5911.78,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,344,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,9640.56,100,CUSTOM-DRG,7712.448,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,10122.59,105,CUSTOM-DRG,8098.072,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,9833.35,102,CUSTOM-DRG,7866.68,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,10122.59,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,345,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5070.34,100,CUSTOM-DRG,4056.272,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5323.86,105,CUSTOM-DRG,4259.088,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5171.74,102,CUSTOM-DRG,4137.392,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5323.86,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,346,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3613.34,100,CUSTOM-DRG,2890.672,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3794.01,105,CUSTOM-DRG,3035.208,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3685.6,102,CUSTOM-DRG,2948.48,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,3794.01,
ANAL AND STOMAL PROCEDURES WITH MCC,347,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4471.92,100,CUSTOM-DRG,3577.536,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4695.51,105,CUSTOM-DRG,3756.408,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4561.35,102,CUSTOM-DRG,3649.08,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4695.51,
ANAL AND STOMAL PROCEDURES WITH CC,348,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4219.61,100,CUSTOM-DRG,3375.688,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4430.59,105,CUSTOM-DRG,3544.472,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4304,102,CUSTOM-DRG,3443.2,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4430.59,
ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC,349,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2898.67,100,CUSTOM-DRG,2318.936,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3043.6,105,CUSTOM-DRG,2434.88,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2956.64,102,CUSTOM-DRG,2365.312,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,3043.6,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC,350,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7542.15,100,CUSTOM-DRG,6033.72,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7919.26,105,CUSTOM-DRG,6335.408,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,7692.98,102,CUSTOM-DRG,6154.384,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,7919.26,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC,351,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4786.27,100,CUSTOM-DRG,3829.016,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5025.58,105,CUSTOM-DRG,4020.464,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4881.98,102,CUSTOM-DRG,3905.584,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5025.58,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC,352,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2977.54,100,CUSTOM-DRG,2382.032,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3126.42,105,CUSTOM-DRG,2501.136,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3037.09,102,CUSTOM-DRG,2429.672,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,3126.42,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC,353,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,8343.17,100,CUSTOM-DRG,6674.536,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,8760.32,105,CUSTOM-DRG,7008.256,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,8510.02,102,CUSTOM-DRG,6808.016,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,8760.32,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC,354,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5976.76,100,CUSTOM-DRG,4781.408,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6275.6,105,CUSTOM-DRG,5020.48,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6096.28,102,CUSTOM-DRG,4877.024,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,6275.6,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC,355,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4222.98,100,CUSTOM-DRG,3378.384,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4434.13,105,CUSTOM-DRG,3547.304,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4307.43,102,CUSTOM-DRG,3445.944,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4434.13,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC,356,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,13253.9,100,CUSTOM-DRG,10603.12,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,13916.59,105,CUSTOM-DRG,11133.272,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,13518.96,102,CUSTOM-DRG,10815.168,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,13916.59,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC,357,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6126.64,100,CUSTOM-DRG,4901.312,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6432.98,105,CUSTOM-DRG,5146.384,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6249.17,102,CUSTOM-DRG,4999.336,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,6432.98,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,358,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5601.48,100,CUSTOM-DRG,4481.184,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5881.56,105,CUSTOM-DRG,4705.248,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5713.5,102,CUSTOM-DRG,4570.8,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5881.56,
MAJOR ESOPHAGEAL DISORDERS WITH MCC,368,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5298.35,100,CUSTOM-DRG,4238.68,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5563.26,105,CUSTOM-DRG,4450.608,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5404.3,102,CUSTOM-DRG,4323.44,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5563.26,
MAJOR ESOPHAGEAL DISORDERS WITH CC,369,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4310.82,100,CUSTOM-DRG,3448.656,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4526.36,105,CUSTOM-DRG,3621.088,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4397.03,102,CUSTOM-DRG,3517.624,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4526.36,
MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC,370,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2174.66,100,CUSTOM-DRG,1739.728,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2283.39,105,CUSTOM-DRG,1826.712,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2218.15,102,CUSTOM-DRG,1774.52,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC,371,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6415.95,100,CUSTOM-DRG,5132.76,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6736.75,105,CUSTOM-DRG,5389.4,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6544.26,102,CUSTOM-DRG,5235.408,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,6736.75,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC,372,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3762.11,100,CUSTOM-DRG,3009.688,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3950.21,105,CUSTOM-DRG,3160.168,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3837.34,102,CUSTOM-DRG,3069.872,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3950.21,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC,373,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2951.75,100,CUSTOM-DRG,2361.4,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3099.34,105,CUSTOM-DRG,2479.472,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3010.78,102,CUSTOM-DRG,2408.624,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3099.34,
DIGESTIVE MALIGNANCY WITH MCC,374,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6282.14,100,CUSTOM-DRG,5025.712,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6596.24,105,CUSTOM-DRG,5276.992,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6407.77,102,CUSTOM-DRG,5126.216,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,6596.24,
DIGESTIVE MALIGNANCY WITH CC,375,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4837.47,100,CUSTOM-DRG,3869.976,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5079.35,105,CUSTOM-DRG,4063.48,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4934.22,102,CUSTOM-DRG,3947.376,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5079.35,
DIGESTIVE MALIGNANCY WITHOUT CC/MCC,376,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3011.93,100,CUSTOM-DRG,2409.544,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3162.52,105,CUSTOM-DRG,2530.016,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3072.16,102,CUSTOM-DRG,2457.728,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3162.52,
GASTROINTESTINAL HEMORRHAGE WITH MCC,377,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6078.05,100,CUSTOM-DRG,4862.44,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6381.95,105,CUSTOM-DRG,5105.56,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6199.6,102,CUSTOM-DRG,4959.68,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,6381.95,
GASTROINTESTINAL HEMORRHAGE WITH CC,378,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3686.98,100,CUSTOM-DRG,2949.584,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3871.32,105,CUSTOM-DRG,3097.056,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3760.71,102,CUSTOM-DRG,3008.568,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3871.32,
GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC,379,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2964.46,100,CUSTOM-DRG,2371.568,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3112.68,105,CUSTOM-DRG,2490.144,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3023.74,102,CUSTOM-DRG,2418.992,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3112.68,
COMPLICATED PEPTIC ULCER WITH MCC,380,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4753.37,100,CUSTOM-DRG,3802.696,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4991.04,105,CUSTOM-DRG,3992.832,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4848.43,102,CUSTOM-DRG,3878.744,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4991.04,
COMPLICATED PEPTIC ULCER WITH CC,381,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3631.66,100,CUSTOM-DRG,2905.328,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3813.24,105,CUSTOM-DRG,3050.592,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3704.28,102,CUSTOM-DRG,2963.424,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3813.24,
COMPLICATED PEPTIC ULCER WITHOUT CC/MCC,382,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2722.99,100,CUSTOM-DRG,2178.392,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2859.14,105,CUSTOM-DRG,2287.312,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2777.45,102,CUSTOM-DRG,2221.96,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2859.14,
UNCOMPLICATED PEPTIC ULCER WITH MCC,383,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4161.68,100,CUSTOM-DRG,3329.344,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4369.76,105,CUSTOM-DRG,3495.808,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4244.9,102,CUSTOM-DRG,3395.92,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4369.76,
UNCOMPLICATED PEPTIC ULCER WITHOUT MCC,384,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2985.39,100,CUSTOM-DRG,2388.312,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3134.66,105,CUSTOM-DRG,2507.728,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3045.09,102,CUSTOM-DRG,2436.072,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3134.66,
INFLAMMATORY BOWEL DISEASE WITH MCC,385,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4194.94,100,CUSTOM-DRG,3355.952,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4404.69,105,CUSTOM-DRG,3523.752,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4278.84,102,CUSTOM-DRG,3423.072,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4404.69,
INFLAMMATORY BOWEL DISEASE WITH CC,386,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3925.45,100,CUSTOM-DRG,3140.36,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4121.72,105,CUSTOM-DRG,3297.376,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4003.95,102,CUSTOM-DRG,3203.16,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4121.72,
INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC,387,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3166.67,100,CUSTOM-DRG,2533.336,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3325.01,105,CUSTOM-DRG,2660.008,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3230,102,CUSTOM-DRG,2584,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3325.01,
GASTROINTESTINAL OBSTRUCTION WITH MCC,388,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4610.96,100,CUSTOM-DRG,3688.768,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4841.51,105,CUSTOM-DRG,3873.208,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4703.17,102,CUSTOM-DRG,3762.536,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4841.51,
GASTROINTESTINAL OBSTRUCTION WITH CC,389,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3138.64,100,CUSTOM-DRG,2510.912,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3295.57,105,CUSTOM-DRG,2636.456,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3201.41,102,CUSTOM-DRG,2561.128,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3295.57,
GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC,390,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2198.95,100,CUSTOM-DRG,1759.16,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2308.9,105,CUSTOM-DRG,1847.12,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2242.93,102,CUSTOM-DRG,1794.344,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC",391,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4127.29,100,CUSTOM-DRG,3301.832,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4333.65,105,CUSTOM-DRG,3466.92,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4209.83,102,CUSTOM-DRG,3367.864,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4333.65,
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC",392,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2783.55,100,CUSTOM-DRG,2226.84,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2922.72,105,CUSTOM-DRG,2338.176,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2839.21,102,CUSTOM-DRG,2271.368,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2922.72,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC,393,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4688.71,100,CUSTOM-DRG,3750.968,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4923.14,105,CUSTOM-DRG,3938.512,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4782.48,102,CUSTOM-DRG,3825.984,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4923.14,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,394,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3710.15,100,CUSTOM-DRG,2968.12,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3895.66,105,CUSTOM-DRG,3116.528,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3784.35,102,CUSTOM-DRG,3027.48,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3895.66,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,395,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2510.69,100,CUSTOM-DRG,2008.552,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2636.22,105,CUSTOM-DRG,2108.976,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2560.9,102,CUSTOM-DRG,2048.72,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2636.22,
APPENDIX PROCEDURES WITH MCC,397,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2552.31,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1849,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,1262.8,2552.31,
APPENDIX PROCEDURES WITH CC,398,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2552.31,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1849,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,1262.8,2552.31,
APPENDIX PROCEDURES WITHOUT CC/MCC,399,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2552.31,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1849,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,1262.8,2552.31,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC",405,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,14572.6,100,CUSTOM-DRG,11658.08,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,15301.23,105,CUSTOM-DRG,12240.984,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,14864.03,102,CUSTOM-DRG,11891.224,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,15301.23,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC",406,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,10463.63,100,CUSTOM-DRG,8370.904,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,10986.81,105,CUSTOM-DRG,8789.448,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,10672.88,102,CUSTOM-DRG,8538.304,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,10986.81,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC",407,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7698.02,100,CUSTOM-DRG,6158.416,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,8082.92,105,CUSTOM-DRG,6466.336,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,7851.97,102,CUSTOM-DRG,6281.576,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,8082.92,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC,408,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,11536,100,CUSTOM-DRG,9228.8,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,12112.8,105,CUSTOM-DRG,9690.24,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,11766.7,102,CUSTOM-DRG,9413.36,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,12112.8,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC,409,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7442.35,100,CUSTOM-DRG,5953.88,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7814.47,105,CUSTOM-DRG,6251.576,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,7591.19,102,CUSTOM-DRG,6072.952,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,7814.47,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC,410,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5246.02,100,CUSTOM-DRG,4196.816,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5508.32,105,CUSTOM-DRG,4406.656,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5350.93,102,CUSTOM-DRG,4280.744,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5508.32,
CHOLECYSTECTOMY WITH C.D.E. WITH MCC,411,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,13878.49,100,CUSTOM-DRG,11102.792,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,14572.41,105,CUSTOM-DRG,11657.928,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,14156.04,102,CUSTOM-DRG,11324.832,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,14572.41,
CHOLECYSTECTOMY WITH C.D.E. WITH CC,412,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7088.38,100,CUSTOM-DRG,5670.704,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7442.8,105,CUSTOM-DRG,5954.24,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,7230.14,102,CUSTOM-DRG,5784.112,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,7442.8,
CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC,413,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5232.93,100,CUSTOM-DRG,4186.344,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5494.58,105,CUSTOM-DRG,4395.664,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5337.58,102,CUSTOM-DRG,4270.064,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5494.58,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC,414,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,13626.56,100,CUSTOM-DRG,10901.248,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,14307.89,105,CUSTOM-DRG,11446.312,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,13899.07,102,CUSTOM-DRG,11119.256,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,14307.89,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC,415,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6591.25,100,CUSTOM-DRG,5273,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6920.82,105,CUSTOM-DRG,5536.656,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6723.07,102,CUSTOM-DRG,5378.456,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,6920.82,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC,416,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3508.31,100,CUSTOM-DRG,2806.648,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3683.72,105,CUSTOM-DRG,2946.976,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3578.47,102,CUSTOM-DRG,2862.776,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,3683.72,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC,417,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,8334.94,100,CUSTOM-DRG,6667.952,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,8751.69,105,CUSTOM-DRG,7001.352,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,8501.63,102,CUSTOM-DRG,6801.304,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,8751.69,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC,418,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5654.19,100,CUSTOM-DRG,4523.352,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5936.89,105,CUSTOM-DRG,4749.512,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5767.26,102,CUSTOM-DRG,4613.808,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5936.89,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC,419,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4442.39,100,CUSTOM-DRG,3553.912,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4664.51,105,CUSTOM-DRG,3731.608,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4531.23,102,CUSTOM-DRG,3624.984,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4664.51,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC,420,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,12763.13,100,CUSTOM-DRG,10210.504,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,13401.28,105,CUSTOM-DRG,10721.024,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,13018.37,102,CUSTOM-DRG,10414.696,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,13401.28,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC,421,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5090.15,100,CUSTOM-DRG,4072.12,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5344.66,105,CUSTOM-DRG,4275.728,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5191.94,102,CUSTOM-DRG,4153.552,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5344.66,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC,422,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4513.41,100,CUSTOM-DRG,3610.728,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4739.08,105,CUSTOM-DRG,3791.264,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4603.67,102,CUSTOM-DRG,3682.936,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4739.08,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC,423,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,12043.6,100,CUSTOM-DRG,9634.88,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,12645.78,105,CUSTOM-DRG,10116.624,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,12284.45,102,CUSTOM-DRG,9827.56,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,12645.78,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC,424,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6858.13,100,CUSTOM-DRG,5486.504,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7201.04,105,CUSTOM-DRG,5760.832,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6995.29,102,CUSTOM-DRG,5596.232,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,7201.04,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC,425,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6740.39,100,CUSTOM-DRG,5392.312,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7077.41,105,CUSTOM-DRG,5661.928,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6875.19,102,CUSTOM-DRG,5500.152,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,7077.41,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC,432,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7003.53,100,CUSTOM-DRG,5602.824,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7353.71,105,CUSTOM-DRG,5882.968,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,7143.59,102,CUSTOM-DRG,5714.872,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,7353.71,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC,433,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3524.38,100,CUSTOM-DRG,2819.504,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3700.6,105,CUSTOM-DRG,2960.48,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3594.86,102,CUSTOM-DRG,2875.888,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3700.6,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC,434,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2452,100,CUSTOM-DRG,1961.6,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2574.6,105,CUSTOM-DRG,2059.68,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2501.04,102,CUSTOM-DRG,2000.832,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2574.6,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC,435,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5347.31,100,CUSTOM-DRG,4277.848,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5614.68,105,CUSTOM-DRG,4491.744,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5454.25,102,CUSTOM-DRG,4363.4,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5614.68,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC,436,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3937.04,100,CUSTOM-DRG,3149.632,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4133.89,105,CUSTOM-DRG,3307.112,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4015.77,102,CUSTOM-DRG,3212.616,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4133.89,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC,437,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3092.29,100,CUSTOM-DRG,2473.832,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3246.9,105,CUSTOM-DRG,2597.52,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3154.13,102,CUSTOM-DRG,2523.304,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3246.9,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC,438,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6614.43,100,CUSTOM-DRG,5291.544,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6945.15,105,CUSTOM-DRG,5556.12,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6746.71,102,CUSTOM-DRG,5397.368,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,6945.15,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,439,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3358.8,100,CUSTOM-DRG,2687.04,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3526.74,105,CUSTOM-DRG,2821.392,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3425.97,102,CUSTOM-DRG,2740.776,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3526.74,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC,440,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2459.48,100,CUSTOM-DRG,1967.584,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2582.45,105,CUSTOM-DRG,2065.96,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2508.66,102,CUSTOM-DRG,2006.928,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2582.45,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC",441,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6794.59,100,CUSTOM-DRG,5435.672,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7134.32,105,CUSTOM-DRG,5707.456,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6930.47,102,CUSTOM-DRG,5544.376,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,7134.32,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC",442,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4093.65,100,CUSTOM-DRG,3274.92,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4298.33,105,CUSTOM-DRG,3438.664,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4175.52,102,CUSTOM-DRG,3340.416,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4298.33,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC",443,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2546.57,100,CUSTOM-DRG,2037.256,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2673.9,105,CUSTOM-DRG,2139.12,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2597.5,102,CUSTOM-DRG,2078,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2673.9,
DISORDERS OF THE BILIARY TRACT WITH MCC,444,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5711.75,100,CUSTOM-DRG,4569.4,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5997.33,105,CUSTOM-DRG,4797.864,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5825.97,102,CUSTOM-DRG,4660.776,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5997.33,
DISORDERS OF THE BILIARY TRACT WITH CC,445,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4149.34,100,CUSTOM-DRG,3319.472,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4356.81,105,CUSTOM-DRG,3485.448,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4232.32,102,CUSTOM-DRG,3385.856,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4356.81,
DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC,446,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2633.29,100,CUSTOM-DRG,2106.632,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2764.95,105,CUSTOM-DRG,2211.96,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2685.95,102,CUSTOM-DRG,2148.76,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2764.95,
COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC,453,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,34126.58,100,CUSTOM-DRG,27301.264,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,35832.9,105,CUSTOM-DRG,28666.32,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,34809.05,102,CUSTOM-DRG,27847.24,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,35832.9,
COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC,454,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,19934.11,100,CUSTOM-DRG,15947.288,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,20930.82,105,CUSTOM-DRG,16744.656,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,20332.76,102,CUSTOM-DRG,16266.208,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,20930.82,
COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC,455,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,18347.79,100,CUSTOM-DRG,14678.232,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,19265.17,105,CUSTOM-DRG,15412.136,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,18714.71,102,CUSTOM-DRG,14971.768,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,19265.17,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC",456,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,41889.64,100,CUSTOM-DRG,33511.712,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,43984.11,105,CUSTOM-DRG,35187.288,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,42727.36,102,CUSTOM-DRG,34181.888,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,43984.11,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC",457,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,29387.78,100,CUSTOM-DRG,23510.224,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,30857.17,105,CUSTOM-DRG,24685.736,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,29975.49,102,CUSTOM-DRG,23980.392,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,30857.17,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC",458,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,28200.66,100,CUSTOM-DRG,22560.528,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,29610.68,105,CUSTOM-DRG,23688.544,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,28764.62,102,CUSTOM-DRG,23011.696,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,29610.68,
SPINAL FUSION EXCEPT CERVICAL WITH MCC,459,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,33635.06,100,CUSTOM-DRG,26908.048,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,35316.81,105,CUSTOM-DRG,28253.448,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,34307.7,102,CUSTOM-DRG,27446.16,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,35316.81,
SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,460,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,15021.14,100,CUSTOM-DRG,12016.912,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,15772.19,105,CUSTOM-DRG,12617.752,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,15321.53,102,CUSTOM-DRG,12257.224,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,15772.19,
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC,461,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,14931.8,100,CUSTOM-DRG,11945.44,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,15678.39,105,CUSTOM-DRG,12542.712,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,15230.41,102,CUSTOM-DRG,12184.328,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,15678.39,
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC,462,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,14931.8,100,CUSTOM-DRG,11945.44,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,15678.39,105,CUSTOM-DRG,12542.712,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,15230.41,102,CUSTOM-DRG,12184.328,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,15678.39,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC,463,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,21592.21,100,CUSTOM-DRG,17273.768,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,22671.81,105,CUSTOM-DRG,18137.448,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,22024.02,102,CUSTOM-DRG,17619.216,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,22671.81,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC,464,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,11254.55,100,CUSTOM-DRG,9003.64,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,11817.27,105,CUSTOM-DRG,9453.816,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,11479.62,102,CUSTOM-DRG,9183.696,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,11817.27,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,465,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5484.86,100,CUSTOM-DRG,4387.888,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5759.1,105,CUSTOM-DRG,4607.28,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5594.55,102,CUSTOM-DRG,4475.64,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5759.1,
REVISION OF HIP OR KNEE REPLACEMENT WITH MCC,466,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,12138.16,100,CUSTOM-DRG,9710.528,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,12745.07,105,CUSTOM-DRG,10196.056,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,12380.91,102,CUSTOM-DRG,9904.728,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,12745.07,
REVISION OF HIP OR KNEE REPLACEMENT WITH CC,467,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,11003.74,100,CUSTOM-DRG,8802.992,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,11553.92,105,CUSTOM-DRG,9243.136,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,11223.8,102,CUSTOM-DRG,8979.04,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,11553.92,
REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC,468,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,8832.82,100,CUSTOM-DRG,7066.256,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,9274.46,105,CUSTOM-DRG,7419.568,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,9009.46,102,CUSTOM-DRG,7207.568,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,9274.46,
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT,469,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,10764.89,100,CUSTOM-DRG,8611.912,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,11303.14,105,CUSTOM-DRG,9042.512,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,10980.17,102,CUSTOM-DRG,8784.136,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,11303.14,
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,470,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,8103.95,100,CUSTOM-DRG,6483.16,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,8509.14,105,CUSTOM-DRG,6807.312,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,8266.01,102,CUSTOM-DRG,6612.808,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,8509.14,
CERVICAL SPINAL FUSION WITH MCC,471,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,12637.54,100,CUSTOM-DRG,10110.032,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,13269.41,105,CUSTOM-DRG,10615.528,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,12890.27,102,CUSTOM-DRG,10312.216,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,13269.41,
CERVICAL SPINAL FUSION WITH CC,472,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,9762.41,100,CUSTOM-DRG,7809.928,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,10250.53,105,CUSTOM-DRG,8200.424,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,9957.64,102,CUSTOM-DRG,7966.112,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,10250.53,
CERVICAL SPINAL FUSION WITHOUT CC/MCC,473,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7570.19,100,CUSTOM-DRG,6056.152,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7948.69,105,CUSTOM-DRG,6358.952,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,7721.58,102,CUSTOM-DRG,6177.264,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,7948.69,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC,474,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,13063.27,100,CUSTOM-DRG,10450.616,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,13716.43,105,CUSTOM-DRG,10973.144,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,13324.52,102,CUSTOM-DRG,10659.616,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,13716.43,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC,475,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,8271.4,100,CUSTOM-DRG,6617.12,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,8684.97,105,CUSTOM-DRG,6947.976,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,8436.81,102,CUSTOM-DRG,6749.448,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,8684.97,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,476,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3585.31,100,CUSTOM-DRG,2868.248,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3764.57,105,CUSTOM-DRG,3011.656,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3657.01,102,CUSTOM-DRG,2925.608,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,3764.57,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,477,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,10515.95,100,CUSTOM-DRG,8412.76,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,11041.75,105,CUSTOM-DRG,8833.4,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,10726.26,102,CUSTOM-DRG,8581.008,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,11041.75,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,478,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,8414.18,100,CUSTOM-DRG,6731.344,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,8834.89,105,CUSTOM-DRG,7067.912,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,8582.45,102,CUSTOM-DRG,6865.96,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,8834.89,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,479,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6323.63,100,CUSTOM-DRG,5058.904,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6639.81,105,CUSTOM-DRG,5311.848,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6450.09,102,CUSTOM-DRG,5160.072,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,6639.81,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC,480,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,14381.97,100,CUSTOM-DRG,11505.576,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,15101.07,105,CUSTOM-DRG,12080.856,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,14669.59,102,CUSTOM-DRG,11735.672,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,15101.07,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,481,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,8745.73,100,CUSTOM-DRG,6996.584,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,9183.01,105,CUSTOM-DRG,7346.408,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,8920.63,102,CUSTOM-DRG,7136.504,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,9183.01,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC,482,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6198.41,100,CUSTOM-DRG,4958.728,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6508.33,105,CUSTOM-DRG,5206.664,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6322.37,102,CUSTOM-DRG,5057.896,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,6508.33,
MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES,483,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,8631.72,100,CUSTOM-DRG,6905.376,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,9063.31,105,CUSTOM-DRG,7250.648,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,8804.34,102,CUSTOM-DRG,7043.472,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,9063.31,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC,485,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7603.83,100,CUSTOM-DRG,6083.064,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7984.02,105,CUSTOM-DRG,6387.216,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,7755.89,102,CUSTOM-DRG,6204.712,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,7984.02,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC,486,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7053.25,100,CUSTOM-DRG,5642.6,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7405.91,105,CUSTOM-DRG,5924.728,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,7194.3,102,CUSTOM-DRG,5755.44,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,7405.91,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,487,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3869.38,100,CUSTOM-DRG,3095.504,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4062.85,105,CUSTOM-DRG,3250.28,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3946.76,102,CUSTOM-DRG,3157.408,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4062.85,
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC,488,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5648.95,100,CUSTOM-DRG,4519.16,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5931.4,105,CUSTOM-DRG,4745.12,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5761.92,102,CUSTOM-DRG,4609.536,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5931.4,
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,489,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5045.67,100,CUSTOM-DRG,4036.536,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5297.95,105,CUSTOM-DRG,4238.36,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5146.57,102,CUSTOM-DRG,4117.256,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5297.95,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC",492,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,11875.77,100,CUSTOM-DRG,9500.616,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,12469.56,105,CUSTOM-DRG,9975.648,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,12113.27,102,CUSTOM-DRG,9690.616,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,12469.56,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC",493,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,8000.78,100,CUSTOM-DRG,6400.624,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,8400.82,105,CUSTOM-DRG,6720.656,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,8160.78,102,CUSTOM-DRG,6528.624,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,8400.82,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC",494,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5856.4,100,CUSTOM-DRG,4685.12,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6149.22,105,CUSTOM-DRG,4919.376,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5973.52,102,CUSTOM-DRG,4778.816,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,6149.22,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC,495,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,9587.86,100,CUSTOM-DRG,7670.288,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,10067.25,105,CUSTOM-DRG,8053.8,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,9779.6,102,CUSTOM-DRG,7823.68,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,10067.25,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC,496,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5376.47,100,CUSTOM-DRG,4301.176,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5645.29,105,CUSTOM-DRG,4516.232,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5483.99,102,CUSTOM-DRG,4387.192,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5645.29,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC,497,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4280.54,100,CUSTOM-DRG,3424.432,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4494.57,105,CUSTOM-DRG,3595.656,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4366.14,102,CUSTOM-DRG,3492.912,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4494.57,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC,498,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6952.7,100,CUSTOM-DRG,5562.16,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7300.33,105,CUSTOM-DRG,5840.264,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,7091.74,102,CUSTOM-DRG,5673.392,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,7300.33,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC,499,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3730.71,100,CUSTOM-DRG,2984.568,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3917.24,105,CUSTOM-DRG,3133.792,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3805.32,102,CUSTOM-DRG,3044.256,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,3917.24,
SOFT TISSUE PROCEDURES WITH MCC,500,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,8670.6,100,CUSTOM-DRG,6936.48,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,9104.13,105,CUSTOM-DRG,7283.304,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,8844,102,CUSTOM-DRG,7075.2,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,9104.13,
SOFT TISSUE PROCEDURES WITH CC,501,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6634.24,100,CUSTOM-DRG,5307.392,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6965.95,105,CUSTOM-DRG,5572.76,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6766.91,102,CUSTOM-DRG,5413.528,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,6965.95,
SOFT TISSUE PROCEDURES WITHOUT CC/MCC,502,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4931.67,100,CUSTOM-DRG,3945.336,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5178.25,105,CUSTOM-DRG,4142.6,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5030.29,102,CUSTOM-DRG,4024.232,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5178.25,
FOOT PROCEDURES WITH MCC,503,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6435.01,100,CUSTOM-DRG,5148.008,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6756.76,105,CUSTOM-DRG,5405.408,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6563.7,102,CUSTOM-DRG,5250.96,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,6756.76,
FOOT PROCEDURES WITH CC,504,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5606.72,100,CUSTOM-DRG,4485.376,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5887.05,105,CUSTOM-DRG,4709.64,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5718.84,102,CUSTOM-DRG,4575.072,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5887.05,
FOOT PROCEDURES WITHOUT CC/MCC,505,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5407.49,100,CUSTOM-DRG,4325.992,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5677.86,105,CUSTOM-DRG,4542.288,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5515.63,102,CUSTOM-DRG,4412.504,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5677.86,
MAJOR THUMB OR JOINT PROCEDURES,506,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3940.03,100,CUSTOM-DRG,3152.024,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4137.03,105,CUSTOM-DRG,3309.624,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4018.82,102,CUSTOM-DRG,3215.056,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4137.03,
MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC,507,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5593.26,100,CUSTOM-DRG,4474.608,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5872.92,105,CUSTOM-DRG,4698.336,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5705.11,102,CUSTOM-DRG,4564.088,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5872.92,
MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC,508,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4714.5,100,CUSTOM-DRG,3771.6,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4950.22,105,CUSTOM-DRG,3960.176,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4808.78,102,CUSTOM-DRG,3847.024,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4950.22,
ARTHROSCOPY,509,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7704.75,100,CUSTOM-DRG,6163.8,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,8089.98,105,CUSTOM-DRG,6471.984,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,7858.83,102,CUSTOM-DRG,6287.064,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,8089.98,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC",510,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7982.09,100,CUSTOM-DRG,6385.672,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,8381.2,105,CUSTOM-DRG,6704.96,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,8141.72,102,CUSTOM-DRG,6513.376,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,8381.2,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC",511,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5862.38,100,CUSTOM-DRG,4689.904,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6155.5,105,CUSTOM-DRG,4924.4,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5979.62,102,CUSTOM-DRG,4783.696,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,6155.5,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC",512,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3862.28,100,CUSTOM-DRG,3089.824,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4055.39,105,CUSTOM-DRG,3244.312,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3939.52,102,CUSTOM-DRG,3151.616,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4055.39,
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC",513,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4952.22,100,CUSTOM-DRG,3961.776,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5199.84,105,CUSTOM-DRG,4159.872,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5051.26,102,CUSTOM-DRG,4041.008,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5199.84,
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC",514,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4068.98,100,CUSTOM-DRG,3255.184,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4272.43,105,CUSTOM-DRG,3417.944,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4150.35,102,CUSTOM-DRG,3320.28,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4272.43,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC,515,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,13615.72,100,CUSTOM-DRG,10892.576,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,14296.5,105,CUSTOM-DRG,11437.2,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,13888.01,102,CUSTOM-DRG,11110.408,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,14296.5,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC,516,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,8133.47,100,CUSTOM-DRG,6506.776,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,8540.15,105,CUSTOM-DRG,6832.12,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,8296.13,102,CUSTOM-DRG,6636.904,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,8540.15,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC,517,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7505.52,100,CUSTOM-DRG,6004.416,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7880.8,105,CUSTOM-DRG,6304.64,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,7655.62,102,CUSTOM-DRG,6124.496,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,7880.8,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR,518,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,8823.47,100,CUSTOM-DRG,7058.776,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,9264.65,105,CUSTOM-DRG,7411.72,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,8999.93,102,CUSTOM-DRG,7199.944,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,9264.65,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC,519,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7484.22,100,CUSTOM-DRG,5987.376,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7858.43,105,CUSTOM-DRG,6286.744,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,7633.89,102,CUSTOM-DRG,6107.112,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,7858.43,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC,520,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4073.47,100,CUSTOM-DRG,3258.776,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4277.14,105,CUSTOM-DRG,3421.712,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4154.93,102,CUSTOM-DRG,3323.944,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4277.14,
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,521,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,1200,2552.31,
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,522,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,1200,2552.31,
FRACTURES OF FEMUR WITH MCC,533,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3399.91,100,CUSTOM-DRG,2719.928,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3569.91,105,CUSTOM-DRG,2855.928,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3467.9,102,CUSTOM-DRG,2774.32,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3569.91,
FRACTURES OF FEMUR WITHOUT MCC,534,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,1792.28,100,CUSTOM-DRG,1433.824,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1881.89,105,CUSTOM-DRG,1505.512,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,1828.12,102,CUSTOM-DRG,1462.496,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
FRACTURES OF HIP AND PELVIS WITH MCC,535,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3189.47,100,CUSTOM-DRG,2551.576,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3348.95,105,CUSTOM-DRG,2679.16,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3253.26,102,CUSTOM-DRG,2602.608,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3348.95,
FRACTURES OF HIP AND PELVIS WITHOUT MCC,536,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2721.5,100,CUSTOM-DRG,2177.2,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2857.57,105,CUSTOM-DRG,2286.056,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2775.92,102,CUSTOM-DRG,2220.736,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2857.57,
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC",537,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2561.52,100,CUSTOM-DRG,2049.216,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2689.6,105,CUSTOM-DRG,2151.68,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2612.75,102,CUSTOM-DRG,2090.2,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2689.6,
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC",538,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,1924.97,100,CUSTOM-DRG,1539.976,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2021.22,105,CUSTOM-DRG,1616.976,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,1963.47,102,CUSTOM-DRG,1570.776,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
OSTEOMYELITIS WITH MCC,539,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6722.45,100,CUSTOM-DRG,5377.96,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7058.57,105,CUSTOM-DRG,5646.856,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6856.89,102,CUSTOM-DRG,5485.512,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,7058.57,
OSTEOMYELITIS WITH CC,540,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4851.68,100,CUSTOM-DRG,3881.344,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5094.26,105,CUSTOM-DRG,4075.408,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4948.7,102,CUSTOM-DRG,3958.96,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5094.26,
OSTEOMYELITIS WITHOUT CC/MCC,541,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2717.76,100,CUSTOM-DRG,2174.208,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2853.65,105,CUSTOM-DRG,2282.92,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2772.11,102,CUSTOM-DRG,2217.688,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2853.65,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC,542,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5495.7,100,CUSTOM-DRG,4396.56,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5770.49,105,CUSTOM-DRG,4616.392,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5605.61,102,CUSTOM-DRG,4484.488,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5770.49,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC,543,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5359.65,100,CUSTOM-DRG,4287.72,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5627.63,105,CUSTOM-DRG,4502.104,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5466.83,102,CUSTOM-DRG,4373.464,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5627.63,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC,544,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2358.56,100,CUSTOM-DRG,1886.848,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2476.49,105,CUSTOM-DRG,1981.192,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2405.73,102,CUSTOM-DRG,1924.584,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
CONNECTIVE TISSUE DISORDERS WITH MCC,545,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,8488.57,100,CUSTOM-DRG,6790.856,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,8912.99,105,CUSTOM-DRG,7130.392,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,8658.32,102,CUSTOM-DRG,6926.656,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,8912.99,
CONNECTIVE TISSUE DISORDERS WITH CC,546,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4443.13,100,CUSTOM-DRG,3554.504,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4665.29,105,CUSTOM-DRG,3732.232,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4531.99,102,CUSTOM-DRG,3625.592,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4665.29,
CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,547,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2998.47,100,CUSTOM-DRG,2398.776,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3148.39,105,CUSTOM-DRG,2518.712,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3058.44,102,CUSTOM-DRG,2446.752,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3148.39,
SEPTIC ARTHRITIS WITH MCC,548,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5010.53,100,CUSTOM-DRG,4008.424,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5261.06,105,CUSTOM-DRG,4208.848,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5110.74,102,CUSTOM-DRG,4088.592,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5261.06,
SEPTIC ARTHRITIS WITH CC,549,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5010.53,100,CUSTOM-DRG,4008.424,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5261.06,105,CUSTOM-DRG,4208.848,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5110.74,102,CUSTOM-DRG,4088.592,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5261.06,
SEPTIC ARTHRITIS WITHOUT CC/MCC,550,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2827.65,100,CUSTOM-DRG,2262.12,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2969.04,105,CUSTOM-DRG,2375.232,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2884.2,102,CUSTOM-DRG,2307.36,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2969.04,
MEDICAL BACK PROBLEMS WITH MCC,551,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4145.61,100,CUSTOM-DRG,3316.488,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4352.88,105,CUSTOM-DRG,3482.304,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4228.51,102,CUSTOM-DRG,3382.808,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4352.88,
MEDICAL BACK PROBLEMS WITHOUT MCC,552,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3370.76,100,CUSTOM-DRG,2696.608,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3539.29,105,CUSTOM-DRG,2831.432,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3438.17,102,CUSTOM-DRG,2750.536,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3539.29,
BONE DISEASES AND ARTHROPATHIES WITH MCC,553,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3181.25,100,CUSTOM-DRG,2545,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3340.31,105,CUSTOM-DRG,2672.248,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3244.87,102,CUSTOM-DRG,2595.896,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3340.31,
BONE DISEASES AND ARTHROPATHIES WITHOUT MCC,554,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2978.29,100,CUSTOM-DRG,2382.632,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3127.2,105,CUSTOM-DRG,2501.76,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3037.85,102,CUSTOM-DRG,2430.28,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3127.2,
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,555,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4272.32,100,CUSTOM-DRG,3417.856,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4485.93,105,CUSTOM-DRG,3588.744,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4357.76,102,CUSTOM-DRG,3486.208,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4485.93,
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC,556,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2828.03,100,CUSTOM-DRG,2262.424,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2969.43,105,CUSTOM-DRG,2375.544,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2884.58,102,CUSTOM-DRG,2307.664,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2969.43,
"TENDONITIS, MYOSITIS AND BURSITIS WITH MCC",557,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3707.53,100,CUSTOM-DRG,2966.024,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3892.91,105,CUSTOM-DRG,3114.328,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3781.68,102,CUSTOM-DRG,3025.344,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3892.91,
"TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC",558,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2913.25,100,CUSTOM-DRG,2330.6,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3058.91,105,CUSTOM-DRG,2447.128,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2971.51,102,CUSTOM-DRG,2377.208,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3058.91,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC",559,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,10825.82,100,CUSTOM-DRG,8660.656,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,11367.11,105,CUSTOM-DRG,9093.688,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,11042.32,102,CUSTOM-DRG,8833.856,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,11367.11,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC",560,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7576.17,100,CUSTOM-DRG,6060.936,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7954.97,105,CUSTOM-DRG,6363.976,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,7727.68,102,CUSTOM-DRG,6182.144,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,7954.97,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC",561,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5602.6,100,CUSTOM-DRG,4482.08,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5882.73,105,CUSTOM-DRG,4706.184,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5714.65,102,CUSTOM-DRG,4571.72,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5882.73,
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC",562,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3617.83,100,CUSTOM-DRG,2894.264,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3798.72,105,CUSTOM-DRG,3038.976,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3690.18,102,CUSTOM-DRG,2952.144,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3798.72,
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC",563,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3201.43,100,CUSTOM-DRG,2561.144,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3361.51,105,CUSTOM-DRG,2689.208,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3265.46,102,CUSTOM-DRG,2612.368,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3361.51,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC,564,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4239.05,100,CUSTOM-DRG,3391.24,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4451,105,CUSTOM-DRG,3560.8,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4323.82,102,CUSTOM-DRG,3459.056,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4451,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC,565,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4239.05,100,CUSTOM-DRG,3391.24,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4451,105,CUSTOM-DRG,3560.8,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4323.82,102,CUSTOM-DRG,3459.056,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4451,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC,566,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2170.17,100,CUSTOM-DRG,1736.136,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2278.68,105,CUSTOM-DRG,1822.944,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2213.57,102,CUSTOM-DRG,1770.856,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
SKIN DEBRIDEMENT WITH MCC,570,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6128.89,100,CUSTOM-DRG,4903.112,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6435.33,105,CUSTOM-DRG,5148.264,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6251.45,102,CUSTOM-DRG,5001.16,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,6435.33,
SKIN DEBRIDEMENT WITH CC,571,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4554.52,100,CUSTOM-DRG,3643.616,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4782.25,105,CUSTOM-DRG,3825.8,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4645.6,102,CUSTOM-DRG,3716.48,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4782.25,
SKIN DEBRIDEMENT WITHOUT CC/MCC,572,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3396.17,100,CUSTOM-DRG,2716.936,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3565.98,105,CUSTOM-DRG,2852.784,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3464.09,102,CUSTOM-DRG,2771.272,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,3565.98,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC,573,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,10361.96,100,CUSTOM-DRG,8289.568,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,10880.05,105,CUSTOM-DRG,8704.04,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,10569.18,102,CUSTOM-DRG,8455.344,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,10880.05,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC,574,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,8160.76,100,CUSTOM-DRG,6528.608,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,8568.8,105,CUSTOM-DRG,6855.04,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,8323.96,102,CUSTOM-DRG,6659.168,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,8568.8,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,575,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5360.39,100,CUSTOM-DRG,4288.312,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5628.41,105,CUSTOM-DRG,4502.728,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5467.59,102,CUSTOM-DRG,4374.072,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5628.41,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC,576,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,19069.56,100,CUSTOM-DRG,15255.648,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,20023.03,105,CUSTOM-DRG,16018.424,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,19450.92,102,CUSTOM-DRG,15560.736,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,20023.03,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC,577,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,8497.91,100,CUSTOM-DRG,6798.328,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,8922.81,105,CUSTOM-DRG,7138.248,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,8667.86,102,CUSTOM-DRG,6934.288,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,8922.81,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,578,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5604.1,100,CUSTOM-DRG,4483.28,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5884.3,105,CUSTOM-DRG,4707.44,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5716.17,102,CUSTOM-DRG,4572.936,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5884.3,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC",579,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,11457.14,100,CUSTOM-DRG,9165.712,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,12029.99,105,CUSTOM-DRG,9623.992,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,11686.26,102,CUSTOM-DRG,9349.008,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,12029.99,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC",580,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5154.44,100,CUSTOM-DRG,4123.552,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5412.16,105,CUSTOM-DRG,4329.728,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5257.52,102,CUSTOM-DRG,4206.016,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5412.16,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC",581,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3676.14,100,CUSTOM-DRG,2940.912,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3859.94,105,CUSTOM-DRG,3087.952,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3749.65,102,CUSTOM-DRG,2999.72,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,3859.94,
MASTECTOMY FOR MALIGNANCY WITH CC/MCC,582,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5744.64,100,CUSTOM-DRG,4595.712,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6031.87,105,CUSTOM-DRG,4825.496,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5859.52,102,CUSTOM-DRG,4687.616,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,6031.87,
MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC,583,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5387.68,100,CUSTOM-DRG,4310.144,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5657.06,105,CUSTOM-DRG,4525.648,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5495.42,102,CUSTOM-DRG,4396.336,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5657.06,
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC",584,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6396.51,100,CUSTOM-DRG,5117.208,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6716.34,105,CUSTOM-DRG,5373.072,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6524.43,102,CUSTOM-DRG,5219.544,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,6716.34,
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC",585,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5736.42,100,CUSTOM-DRG,4589.136,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6023.24,105,CUSTOM-DRG,4818.592,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5851.14,102,CUSTOM-DRG,4680.912,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,6023.24,
SKIN ULCERS WITH MCC,592,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5393.66,100,CUSTOM-DRG,4314.928,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5663.34,105,CUSTOM-DRG,4530.672,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5501.52,102,CUSTOM-DRG,4401.216,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5663.34,
SKIN ULCERS WITH CC,593,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3792.01,100,CUSTOM-DRG,3033.608,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3981.61,105,CUSTOM-DRG,3185.288,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3867.84,102,CUSTOM-DRG,3094.272,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3981.61,
SKIN ULCERS WITHOUT CC/MCC,594,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,1880.12,100,CUSTOM-DRG,1504.096,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1974.12,105,CUSTOM-DRG,1579.296,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,1917.72,102,CUSTOM-DRG,1534.176,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
MAJOR SKIN DISORDERS WITH MCC,595,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5562.24,100,CUSTOM-DRG,4449.792,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5840.35,105,CUSTOM-DRG,4672.28,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5673.47,102,CUSTOM-DRG,4538.776,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5840.35,
MAJOR SKIN DISORDERS WITHOUT MCC,596,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3356.55,100,CUSTOM-DRG,2685.24,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3524.38,105,CUSTOM-DRG,2819.504,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3423.68,102,CUSTOM-DRG,2738.944,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3524.38,
MALIGNANT BREAST DISORDERS WITH MCC,597,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4591.53,100,CUSTOM-DRG,3673.224,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4821.1,105,CUSTOM-DRG,3856.88,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4683.35,102,CUSTOM-DRG,3746.68,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4821.1,
MALIGNANT BREAST DISORDERS WITH CC,598,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3473.92,100,CUSTOM-DRG,2779.136,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3647.62,105,CUSTOM-DRG,2918.096,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3543.39,102,CUSTOM-DRG,2834.712,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3647.62,
MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,599,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3473.92,100,CUSTOM-DRG,2779.136,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3647.62,105,CUSTOM-DRG,2918.096,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3543.39,102,CUSTOM-DRG,2834.712,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3647.62,
NON-MALIGNANT BREAST DISORDERS WITH CC/MCC,600,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3437.66,100,CUSTOM-DRG,2750.128,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3609.55,105,CUSTOM-DRG,2887.64,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3506.41,102,CUSTOM-DRG,2805.128,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3609.55,
NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,601,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2570.12,100,CUSTOM-DRG,2056.096,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2698.62,105,CUSTOM-DRG,2158.896,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2621.52,102,CUSTOM-DRG,2097.216,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2698.62,
CELLULITIS WITH MCC,602,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5104.73,100,CUSTOM-DRG,4083.784,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5359.96,105,CUSTOM-DRG,4287.968,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5206.81,102,CUSTOM-DRG,4165.448,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5359.96,
CELLULITIS WITHOUT MCC,603,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3302.36,100,CUSTOM-DRG,2641.888,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3467.47,105,CUSTOM-DRG,2773.976,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3368.4,102,CUSTOM-DRG,2694.72,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3467.47,
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC",604,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3633.9,100,CUSTOM-DRG,2907.12,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3815.59,105,CUSTOM-DRG,3052.472,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3706.57,102,CUSTOM-DRG,2965.256,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3815.59,
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC",605,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2607.12,100,CUSTOM-DRG,2085.696,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2737.48,105,CUSTOM-DRG,2189.984,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2659.26,102,CUSTOM-DRG,2127.408,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2737.48,
MINOR SKIN DISORDERS WITH MCC,606,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3418.23,100,CUSTOM-DRG,2734.584,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3589.14,105,CUSTOM-DRG,2871.312,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3486.59,102,CUSTOM-DRG,2789.272,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3589.14,
MINOR SKIN DISORDERS WITHOUT MCC,607,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2590.68,100,CUSTOM-DRG,2072.544,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2720.21,105,CUSTOM-DRG,2176.168,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2642.49,102,CUSTOM-DRG,2113.992,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2720.21,
ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC,614,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,9741.85,100,CUSTOM-DRG,7793.48,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,10228.95,105,CUSTOM-DRG,8183.16,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,9936.68,102,CUSTOM-DRG,7949.344,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,10228.95,
ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC,615,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4792.25,100,CUSTOM-DRG,3833.8,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5031.86,105,CUSTOM-DRG,4025.488,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4888.08,102,CUSTOM-DRG,3910.464,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5031.86,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",616,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,12130.31,100,CUSTOM-DRG,9704.248,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,12736.83,105,CUSTOM-DRG,10189.464,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,12372.9,102,CUSTOM-DRG,9898.32,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,12736.83,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",617,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7013.63,100,CUSTOM-DRG,5610.904,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7364.31,105,CUSTOM-DRG,5891.448,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,7153.89,102,CUSTOM-DRG,5723.112,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,7364.31,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",618,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4958.95,100,CUSTOM-DRG,3967.16,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5206.9,105,CUSTOM-DRG,4165.52,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5058.12,102,CUSTOM-DRG,4046.496,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5206.9,
O.R. PROCEDURES FOR OBESITY WITH MCC,619,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,10263.65,100,CUSTOM-DRG,8210.92,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,10776.83,105,CUSTOM-DRG,8621.464,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,10468.91,102,CUSTOM-DRG,8375.128,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,10776.83,
O.R. PROCEDURES FOR OBESITY WITH CC,620,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6600.22,100,CUSTOM-DRG,5280.176,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6930.24,105,CUSTOM-DRG,5544.192,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6732.22,102,CUSTOM-DRG,5385.776,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,6930.24,
O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC,621,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5309.56,100,CUSTOM-DRG,4247.648,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5575.04,105,CUSTOM-DRG,4460.032,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5415.74,102,CUSTOM-DRG,4332.592,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5575.04,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",622,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,12372.52,100,CUSTOM-DRG,9898.016,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,12991.15,105,CUSTOM-DRG,10392.92,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,12619.95,102,CUSTOM-DRG,10095.96,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,12991.15,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",623,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6759.08,100,CUSTOM-DRG,5407.264,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7097.04,105,CUSTOM-DRG,5677.632,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6894.25,102,CUSTOM-DRG,5515.4,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,7097.04,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",624,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2711.78,100,CUSTOM-DRG,2169.424,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2847.37,105,CUSTOM-DRG,2277.896,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2766.01,102,CUSTOM-DRG,2212.808,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,2847.37,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC",625,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7036.43,100,CUSTOM-DRG,5629.144,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7388.25,105,CUSTOM-DRG,5910.6,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,7177.14,102,CUSTOM-DRG,5741.712,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,7388.25,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC",626,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5947.98,100,CUSTOM-DRG,4758.384,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6245.38,105,CUSTOM-DRG,4996.304,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6066.93,102,CUSTOM-DRG,4853.544,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,6245.38,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC",627,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4332.12,100,CUSTOM-DRG,3465.696,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4548.73,105,CUSTOM-DRG,3638.984,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4418.76,102,CUSTOM-DRG,3535.008,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4548.73,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC",628,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,9036.16,100,CUSTOM-DRG,7228.928,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,9487.96,105,CUSTOM-DRG,7590.368,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,9216.86,102,CUSTOM-DRG,7373.488,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,9487.96,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC",629,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,9036.16,100,CUSTOM-DRG,7228.928,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,9487.96,105,CUSTOM-DRG,7590.368,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,9216.86,102,CUSTOM-DRG,7373.488,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,9487.96,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC",630,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4479.39,100,CUSTOM-DRG,3583.512,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4703.36,105,CUSTOM-DRG,3762.688,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4568.97,102,CUSTOM-DRG,3655.176,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4703.36,
DIABETES WITH MCC,637,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5048.66,100,CUSTOM-DRG,4038.928,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5301.09,105,CUSTOM-DRG,4240.872,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5149.62,102,CUSTOM-DRG,4119.696,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5301.09,
DIABETES WITH CC,638,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2946.52,100,CUSTOM-DRG,2357.216,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3093.84,105,CUSTOM-DRG,2475.072,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3005.44,102,CUSTOM-DRG,2404.352,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3093.84,
DIABETES WITHOUT CC/MCC,639,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2052.06,100,CUSTOM-DRG,1641.648,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2154.66,105,CUSTOM-DRG,1723.728,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2093.1,102,CUSTOM-DRG,1674.48,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC",640,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3625.3,100,CUSTOM-DRG,2900.24,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3806.57,105,CUSTOM-DRG,3045.256,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3697.8,102,CUSTOM-DRG,2958.24,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3806.57,
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC",641,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2776.45,100,CUSTOM-DRG,2221.16,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2915.27,105,CUSTOM-DRG,2332.216,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2831.97,102,CUSTOM-DRG,2265.576,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2915.27,
INBORN AND OTHER DISORDERS OF METABOLISM,642,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3436.17,100,CUSTOM-DRG,2748.936,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3607.98,105,CUSTOM-DRG,2886.384,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3504.89,102,CUSTOM-DRG,2803.912,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3607.98,
ENDOCRINE DISORDERS WITH MCC,643,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6370.72,100,CUSTOM-DRG,5096.576,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6689.26,105,CUSTOM-DRG,5351.408,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6498.13,102,CUSTOM-DRG,5198.504,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,6689.26,
ENDOCRINE DISORDERS WITH CC,644,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3379.35,100,CUSTOM-DRG,2703.48,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3548.32,105,CUSTOM-DRG,2838.656,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3446.94,102,CUSTOM-DRG,2757.552,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3548.32,
ENDOCRINE DISORDERS WITHOUT CC/MCC,645,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2598.15,100,CUSTOM-DRG,2078.52,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2728.06,105,CUSTOM-DRG,2182.448,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2650.11,102,CUSTOM-DRG,2120.088,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2728.06,
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,650,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5444.12,100,CUSTOM-DRG,4355.296,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5716.33,105,CUSTOM-DRG,4573.064,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5552.99,102,CUSTOM-DRG,4442.392,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5716.33,
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,651,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,32137.69,100,CUSTOM-DRG,25710.152,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,33744.57,105,CUSTOM-DRG,26995.656,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,32780.39,102,CUSTOM-DRG,26224.312,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,33744.57,
KIDNEY TRANSPLANT,652,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,51633.36,100,CUSTOM-DRG,41306.688,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,54215.02,105,CUSTOM-DRG,43372.016,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,52665.94,102,CUSTOM-DRG,42132.752,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,54215.02,
MAJOR BLADDER PROCEDURES WITH MCC,653,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,17864.12,100,CUSTOM-DRG,14291.296,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,18757.32,105,CUSTOM-DRG,15005.856,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,18221.37,102,CUSTOM-DRG,14577.096,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,18757.32,
MAJOR BLADDER PROCEDURES WITH CC,654,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,8183.19,100,CUSTOM-DRG,6546.552,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,8592.35,105,CUSTOM-DRG,6873.88,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,8346.84,102,CUSTOM-DRG,6677.472,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,8592.35,
MAJOR BLADDER PROCEDURES WITHOUT CC/MCC,655,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6744.13,100,CUSTOM-DRG,5395.304,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7081.34,105,CUSTOM-DRG,5665.072,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6879,102,CUSTOM-DRG,5503.2,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,7081.34,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC,656,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,10173.2,100,CUSTOM-DRG,8138.56,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,10681.86,105,CUSTOM-DRG,8545.488,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,10376.64,102,CUSTOM-DRG,8301.312,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,10681.86,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC,657,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,8888.51,100,CUSTOM-DRG,7110.808,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,9332.94,105,CUSTOM-DRG,7466.352,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,9066.27,102,CUSTOM-DRG,7253.016,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,9332.94,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC,658,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6645.45,100,CUSTOM-DRG,5316.36,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6977.72,105,CUSTOM-DRG,5582.176,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6778.35,102,CUSTOM-DRG,5422.68,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,6977.72,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC,659,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,9396.11,100,CUSTOM-DRG,7516.888,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,9865.91,105,CUSTOM-DRG,7892.728,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,9584.01,102,CUSTOM-DRG,7667.208,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,9865.91,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC,660,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5133.51,100,CUSTOM-DRG,4106.808,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5390.18,105,CUSTOM-DRG,4312.144,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5236.17,102,CUSTOM-DRG,4188.936,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5390.18,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC,661,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4554.15,100,CUSTOM-DRG,3643.32,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4781.85,105,CUSTOM-DRG,3825.48,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4645.22,102,CUSTOM-DRG,3716.176,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4781.85,
MINOR BLADDER PROCEDURES WITH MCC,662,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,12815.46,100,CUSTOM-DRG,10252.368,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,13456.23,105,CUSTOM-DRG,10764.984,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,13071.74,102,CUSTOM-DRG,10457.392,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,13456.23,
MINOR BLADDER PROCEDURES WITH CC,663,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4946.62,100,CUSTOM-DRG,3957.296,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5193.95,105,CUSTOM-DRG,4155.16,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5045.54,102,CUSTOM-DRG,4036.432,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5193.95,
MINOR BLADDER PROCEDURES WITHOUT CC/MCC,664,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3804.72,100,CUSTOM-DRG,3043.776,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3994.95,105,CUSTOM-DRG,3195.96,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3880.8,102,CUSTOM-DRG,3104.64,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,3994.95,
PROSTATECTOMY WITH MCC,665,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,9725.03,100,CUSTOM-DRG,7780.024,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,10211.28,105,CUSTOM-DRG,8169.024,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,9919.52,102,CUSTOM-DRG,7935.616,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,10211.28,
PROSTATECTOMY WITH CC,666,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6332.22,100,CUSTOM-DRG,5065.776,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6648.83,105,CUSTOM-DRG,5319.064,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6458.86,102,CUSTOM-DRG,5167.088,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,6648.83,
PROSTATECTOMY WITHOUT CC/MCC,667,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3720.24,100,CUSTOM-DRG,2976.192,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3906.25,105,CUSTOM-DRG,3125,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3794.64,102,CUSTOM-DRG,3035.712,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,3906.25,
TRANSURETHRAL PROCEDURES WITH MCC,668,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,9308.64,100,CUSTOM-DRG,7446.912,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,9774.07,105,CUSTOM-DRG,7819.256,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,9494.8,102,CUSTOM-DRG,7595.84,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,9774.07,
TRANSURETHRAL PROCEDURES WITH CC,669,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4279.04,100,CUSTOM-DRG,3423.232,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4493,105,CUSTOM-DRG,3594.4,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4364.62,102,CUSTOM-DRG,3491.696,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4493,
TRANSURETHRAL PROCEDURES WITHOUT CC/MCC,670,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2882.97,100,CUSTOM-DRG,2306.376,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3027.12,105,CUSTOM-DRG,2421.696,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2940.63,102,CUSTOM-DRG,2352.504,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,3027.12,
URETHRAL PROCEDURES WITH CC/MCC,671,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5140.24,100,CUSTOM-DRG,4112.192,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5397.25,105,CUSTOM-DRG,4317.8,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5243.03,102,CUSTOM-DRG,4194.424,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5397.25,
URETHRAL PROCEDURES WITHOUT CC/MCC,672,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4479.02,100,CUSTOM-DRG,3583.216,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4702.97,105,CUSTOM-DRG,3762.376,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4568.59,102,CUSTOM-DRG,3654.872,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4702.97,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC,673,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,9928.74,100,CUSTOM-DRG,7942.992,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,10425.18,105,CUSTOM-DRG,8340.144,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,10127.3,102,CUSTOM-DRG,8101.84,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,10425.18,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC,674,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,9566.55,100,CUSTOM-DRG,7653.24,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,10044.88,105,CUSTOM-DRG,8035.904,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,9757.87,102,CUSTOM-DRG,7806.296,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,10044.88,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC,675,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4887.56,100,CUSTOM-DRG,3910.048,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5131.94,105,CUSTOM-DRG,4105.552,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4985.3,102,CUSTOM-DRG,3988.24,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5131.94,
RENAL FAILURE WITH MCC,682,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4952.6,100,CUSTOM-DRG,3962.08,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5200.23,105,CUSTOM-DRG,4160.184,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5051.64,102,CUSTOM-DRG,4041.312,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5200.23,
RENAL FAILURE WITH CC,683,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3492.61,100,CUSTOM-DRG,2794.088,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3667.24,105,CUSTOM-DRG,2933.792,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3562.46,102,CUSTOM-DRG,2849.968,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3667.24,
RENAL FAILURE WITHOUT CC/MCC,684,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2165.31,100,CUSTOM-DRG,1732.248,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2273.58,105,CUSTOM-DRG,1818.864,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2208.62,102,CUSTOM-DRG,1766.896,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC,686,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3882.84,100,CUSTOM-DRG,3106.272,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4076.98,105,CUSTOM-DRG,3261.584,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3960.49,102,CUSTOM-DRG,3168.392,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4076.98,
KIDNEY AND URINARY TRACT NEOPLASMS WITH CC,687,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3020.15,100,CUSTOM-DRG,2416.12,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3171.16,105,CUSTOM-DRG,2536.928,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3080.55,102,CUSTOM-DRG,2464.44,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3171.16,
KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC,688,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,1965.34,100,CUSTOM-DRG,1572.272,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2063.61,105,CUSTOM-DRG,1650.888,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2004.64,102,CUSTOM-DRG,1603.712,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
KIDNEY AND URINARY TRACT INFECTIONS WITH MCC,689,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4119.07,100,CUSTOM-DRG,3295.256,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4325.02,105,CUSTOM-DRG,3460.016,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4201.44,102,CUSTOM-DRG,3361.152,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4325.02,
KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,690,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2918.11,100,CUSTOM-DRG,2334.488,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3064.01,105,CUSTOM-DRG,2451.208,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2976.47,102,CUSTOM-DRG,2381.176,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3064.01,
URINARY STONES WITH MCC,693,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3573.72,100,CUSTOM-DRG,2858.976,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3752.41,105,CUSTOM-DRG,3001.928,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3645.19,102,CUSTOM-DRG,2916.152,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3752.41,
URINARY STONES WITHOUT MCC,694,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2742.06,100,CUSTOM-DRG,2193.648,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2879.16,105,CUSTOM-DRG,2303.328,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2796.89,102,CUSTOM-DRG,2237.512,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2879.16,
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC,695,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3605.49,100,CUSTOM-DRG,2884.392,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3785.77,105,CUSTOM-DRG,3028.616,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3677.6,102,CUSTOM-DRG,2942.08,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3785.77,
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC,696,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,1942.54,100,CUSTOM-DRG,1554.032,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2039.67,105,CUSTOM-DRG,1631.736,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,1981.39,102,CUSTOM-DRG,1585.112,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
URETHRAL STRICTURE,697,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2274.08,100,CUSTOM-DRG,1819.264,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2387.79,105,CUSTOM-DRG,1910.232,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2319.56,102,CUSTOM-DRG,1855.648,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC,698,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5171.26,100,CUSTOM-DRG,4137.008,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5429.82,105,CUSTOM-DRG,4343.856,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5274.68,102,CUSTOM-DRG,4219.744,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5429.82,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC,699,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3678.38,100,CUSTOM-DRG,2942.704,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3862.3,105,CUSTOM-DRG,3089.84,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3751.94,102,CUSTOM-DRG,3001.552,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3862.3,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC,700,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2602.26,100,CUSTOM-DRG,2081.808,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2732.38,105,CUSTOM-DRG,2185.904,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2654.3,102,CUSTOM-DRG,2123.44,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2732.38,
MAJOR MALE PELVIC PROCEDURES WITH CC/MCC,707,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7098.1,100,CUSTOM-DRG,5678.48,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7453.01,105,CUSTOM-DRG,5962.408,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,7240.05,102,CUSTOM-DRG,5792.04,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,7453.01,
MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC,708,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4308.2,100,CUSTOM-DRG,3446.56,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4523.61,105,CUSTOM-DRG,3618.888,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4394.36,102,CUSTOM-DRG,3515.488,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4523.61,
PENIS PROCEDURES WITH CC/MCC,709,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5639.98,100,CUSTOM-DRG,4511.984,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5921.98,105,CUSTOM-DRG,4737.584,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5752.77,102,CUSTOM-DRG,4602.216,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5921.98,
PENIS PROCEDURES WITHOUT CC/MCC,710,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3597.64,100,CUSTOM-DRG,2878.112,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3777.52,105,CUSTOM-DRG,3022.016,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3669.59,102,CUSTOM-DRG,2935.672,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,3777.52,
TESTES PROCEDURES WITH CC/MCC,711,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6962.04,100,CUSTOM-DRG,5569.632,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7310.15,105,CUSTOM-DRG,5848.12,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,7101.27,102,CUSTOM-DRG,5681.016,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,7310.15,
TESTES PROCEDURES WITHOUT CC/MCC,712,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4048.8,100,CUSTOM-DRG,3239.04,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4251.24,105,CUSTOM-DRG,3400.992,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4129.76,102,CUSTOM-DRG,3303.808,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4251.24,
TRANSURETHRAL PROSTATECTOMY WITH CC/MCC,713,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5040.81,100,CUSTOM-DRG,4032.648,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5292.85,105,CUSTOM-DRG,4234.28,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5141.62,102,CUSTOM-DRG,4113.296,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5292.85,
TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC,714,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2949.51,100,CUSTOM-DRG,2359.608,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3096.98,105,CUSTOM-DRG,2477.584,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3008.49,102,CUSTOM-DRG,2406.792,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,3096.98,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC,715,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,9152.78,100,CUSTOM-DRG,7322.224,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,9610.41,105,CUSTOM-DRG,7688.328,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,9335.82,102,CUSTOM-DRG,7468.656,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,9610.41,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC,716,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,8283.36,100,CUSTOM-DRG,6626.688,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,8697.53,105,CUSTOM-DRG,6958.024,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,8449.01,102,CUSTOM-DRG,6759.208,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,8697.53,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC,717,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5661.29,100,CUSTOM-DRG,4529.032,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5944.35,105,CUSTOM-DRG,4755.48,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5774.5,102,CUSTOM-DRG,4619.6,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5944.35,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC,718,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5243.77,100,CUSTOM-DRG,4195.016,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5505.96,105,CUSTOM-DRG,4404.768,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5348.64,102,CUSTOM-DRG,4278.912,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5505.96,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC",722,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7306.3,100,CUSTOM-DRG,5845.04,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7671.61,105,CUSTOM-DRG,6137.288,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,7452.41,102,CUSTOM-DRG,5961.928,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,7671.61,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC",723,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3053.04,100,CUSTOM-DRG,2442.432,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3205.69,105,CUSTOM-DRG,2564.552,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3114.1,102,CUSTOM-DRG,2491.28,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3205.69,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",724,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3053.04,100,CUSTOM-DRG,2442.432,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3205.69,105,CUSTOM-DRG,2564.552,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3114.1,102,CUSTOM-DRG,2491.28,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3205.69,
BENIGN PROSTATIC HYPERTROPHY WITH MCC,725,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2970.81,100,CUSTOM-DRG,2376.648,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3119.35,105,CUSTOM-DRG,2495.48,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3030.22,102,CUSTOM-DRG,2424.176,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3119.35,
BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC,726,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2132.05,100,CUSTOM-DRG,1705.64,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2238.65,105,CUSTOM-DRG,1790.92,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2174.68,102,CUSTOM-DRG,1739.744,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC,727,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3460.84,100,CUSTOM-DRG,2768.672,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3633.88,105,CUSTOM-DRG,2907.104,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3530.05,102,CUSTOM-DRG,2824.04,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3633.88,
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC,728,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3110.61,100,CUSTOM-DRG,2488.488,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3266.14,105,CUSTOM-DRG,2612.912,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3172.81,102,CUSTOM-DRG,2538.248,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3266.14,
OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC,729,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3232.08,100,CUSTOM-DRG,2585.664,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3393.69,105,CUSTOM-DRG,2714.952,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3296.72,102,CUSTOM-DRG,2637.376,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3393.69,
OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,730,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2024.02,100,CUSTOM-DRG,1619.216,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2125.23,105,CUSTOM-DRG,1700.184,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2064.5,102,CUSTOM-DRG,1651.6,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC",734,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7119.78,100,CUSTOM-DRG,5695.824,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7475.77,105,CUSTOM-DRG,5980.616,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,7262.16,102,CUSTOM-DRG,5809.728,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,7475.77,
"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC",735,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4712.63,100,CUSTOM-DRG,3770.104,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4948.26,105,CUSTOM-DRG,3958.608,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4806.88,102,CUSTOM-DRG,3845.504,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4948.26,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC,736,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,10649.77,100,CUSTOM-DRG,8519.816,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,11182.26,105,CUSTOM-DRG,8945.808,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,10862.75,102,CUSTOM-DRG,8690.2,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,11182.26,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC,737,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5967.04,100,CUSTOM-DRG,4773.632,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6265.39,105,CUSTOM-DRG,5012.312,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6086.37,102,CUSTOM-DRG,4869.096,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,6265.39,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC,738,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4491.73,100,CUSTOM-DRG,3593.384,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4716.31,105,CUSTOM-DRG,3773.048,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4581.55,102,CUSTOM-DRG,3665.24,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4716.31,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC,739,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,9580.38,100,CUSTOM-DRG,7664.304,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,10059.4,105,CUSTOM-DRG,8047.52,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,9771.97,102,CUSTOM-DRG,7817.576,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,10059.4,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC,740,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6710.49,100,CUSTOM-DRG,5368.392,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7046.01,105,CUSTOM-DRG,5636.808,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6844.69,102,CUSTOM-DRG,5475.752,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,7046.01,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC,741,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3641.37,100,CUSTOM-DRG,2913.096,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3823.44,105,CUSTOM-DRG,3058.752,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3714.2,102,CUSTOM-DRG,2971.36,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,3823.44,
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC,742,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4390.06,100,CUSTOM-DRG,3512.048,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4609.56,105,CUSTOM-DRG,3687.648,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4477.85,102,CUSTOM-DRG,3582.28,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4609.56,
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,743,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3315.06,100,CUSTOM-DRG,2652.048,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3480.82,105,CUSTOM-DRG,2784.656,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3381.36,102,CUSTOM-DRG,2705.088,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,3480.82,
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC",744,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4458.46,100,CUSTOM-DRG,3566.768,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4681.38,105,CUSTOM-DRG,3745.104,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4547.62,102,CUSTOM-DRG,3638.096,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4681.38,
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC",745,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2860.55,100,CUSTOM-DRG,2288.44,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3003.57,105,CUSTOM-DRG,2402.856,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2917.75,102,CUSTOM-DRG,2334.2,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,3003.57,
"VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC",746,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4267.83,100,CUSTOM-DRG,3414.264,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4481.22,105,CUSTOM-DRG,3584.976,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4353.18,102,CUSTOM-DRG,3482.544,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4481.22,
"VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC",747,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3161.44,100,CUSTOM-DRG,2529.152,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3319.51,105,CUSTOM-DRG,2655.608,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3224.66,102,CUSTOM-DRG,2579.728,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,3319.51,
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,748,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3427.95,100,CUSTOM-DRG,2742.36,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3599.34,105,CUSTOM-DRG,2879.472,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3496.5,102,CUSTOM-DRG,2797.2,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,3599.34,
OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC,749,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7427.78,100,CUSTOM-DRG,5942.224,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7799.16,105,CUSTOM-DRG,6239.328,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,7576.32,102,CUSTOM-DRG,6061.056,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,7799.16,
OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,750,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4020.39,100,CUSTOM-DRG,3216.312,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4221.41,105,CUSTOM-DRG,3377.128,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4100.79,102,CUSTOM-DRG,3280.632,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4221.41,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC",754,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4801.22,100,CUSTOM-DRG,3840.976,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5041.28,105,CUSTOM-DRG,4033.024,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4897.23,102,CUSTOM-DRG,3917.784,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5041.28,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC",755,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4334.74,100,CUSTOM-DRG,3467.792,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4551.47,105,CUSTOM-DRG,3641.176,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4421.43,102,CUSTOM-DRG,3537.144,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4551.47,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",756,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2672.53,100,CUSTOM-DRG,2138.024,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2806.16,105,CUSTOM-DRG,2244.928,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2725.98,102,CUSTOM-DRG,2180.784,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2806.16,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC",757,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3729.96,100,CUSTOM-DRG,2983.968,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3916.46,105,CUSTOM-DRG,3133.168,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3804.55,102,CUSTOM-DRG,3043.64,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3916.46,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC",758,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3014.17,100,CUSTOM-DRG,2411.336,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3164.88,105,CUSTOM-DRG,2531.904,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3074.45,102,CUSTOM-DRG,2459.56,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3164.88,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",759,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2293.52,100,CUSTOM-DRG,1834.816,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2408.2,105,CUSTOM-DRG,1926.56,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2339.39,102,CUSTOM-DRG,1871.512,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC,760,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2751.78,100,CUSTOM-DRG,2201.424,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2889.36,105,CUSTOM-DRG,2311.488,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2806.81,102,CUSTOM-DRG,2245.448,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2889.36,
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC,761,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2143.26,100,CUSTOM-DRG,1714.608,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2250.42,105,CUSTOM-DRG,1800.336,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2186.12,102,CUSTOM-DRG,1748.896,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C,768,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3055.66,100,CUSTOM-DRG,2444.528,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3208.44,105,CUSTOM-DRG,2566.752,Case rate,105% of GA Medicaid ,2939.4,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3116.77,102,CUSTOM-DRG,2493.416,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,3208.44,
POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES,769,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4859.53,100,CUSTOM-DRG,3887.624,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5102.5,105,CUSTOM-DRG,4082,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4956.71,102,CUSTOM-DRG,3965.368,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5102.5,
"ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY",770,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2421.73,100,CUSTOM-DRG,1937.384,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2542.81,105,CUSTOM-DRG,2034.248,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2470.16,102,CUSTOM-DRG,1976.128,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,2552.31,
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,776,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2424.34,100,CUSTOM-DRG,1939.472,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2545.56,105,CUSTOM-DRG,2036.448,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2472.83,102,CUSTOM-DRG,1978.264,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
ABORTION WITHOUT D&C,779,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2007.2,100,CUSTOM-DRG,1605.76,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2107.56,105,CUSTOM-DRG,1686.048,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2047.34,102,CUSTOM-DRG,1637.872,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
CESAREAN SECTION WITH STERILIZATION WITH MCC,783,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4542.61,100,,,per diem,Pays based on per day rate,1500,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,1200,4542.61,
CESAREAN SECTION WITH STERILIZATION WITH CC,784,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4542.61,100,,,per diem,Pays based on per day rate,1500,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,1200,4542.61,
CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC,785,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4542.61,100,,,per diem,Pays based on per day rate,1500,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,1200,4542.61,
CESAREAN SECTION WITHOUT STERILIZATION WITH MCC,786,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4542.61,100,,,per diem,Pays based on per day rate,1500,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,1200,4542.61,
CESAREAN SECTION WITHOUT STERILIZATION WITH CC,787,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2667.67,100,CUSTOM-DRG,2134.136,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2801.06,105,CUSTOM-DRG,2240.848,Case rate,105% of GA Medicaid ,4542.61,100,,,per diem,Pays based on per day rate,1500,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2721.02,102,CUSTOM-DRG,2176.816,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4542.61,
CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC,788,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2898.3,100,CUSTOM-DRG,2318.64,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3043.21,105,CUSTOM-DRG,2434.568,Case rate,105% of GA Medicaid ,4542.61,100,,,per diem,Pays based on per day rate,1500,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2956.26,102,CUSTOM-DRG,2365.008,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4542.61,
"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",789,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7476.37,100,CUSTOM-DRG,5981.096,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7850.18,105,CUSTOM-DRG,6280.144,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,7625.88,102,CUSTOM-DRG,6100.704,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,7850.18,
"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",790,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2666.93,100,CUSTOM-DRG,2133.544,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2800.27,105,CUSTOM-DRG,2240.216,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2720.26,102,CUSTOM-DRG,2176.208,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2800.27,
PREMATURITY WITH MAJOR PROBLEMS,791,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,1403.17,100,CUSTOM-DRG,1122.536,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1473.33,105,CUSTOM-DRG,1178.664,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,1431.24,102,CUSTOM-DRG,1144.992,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
PREMATURITY WITHOUT MAJOR PROBLEMS,792,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,1058.17,100,CUSTOM-DRG,846.536,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1111.08,105,CUSTOM-DRG,888.864,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,1079.34,102,CUSTOM-DRG,863.472,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
FULL TERM NEONATE WITH MAJOR PROBLEMS,793,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6534.44,100,CUSTOM-DRG,5227.552,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6861.16,105,CUSTOM-DRG,5488.928,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6665.12,102,CUSTOM-DRG,5332.096,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,6861.16,
NEONATE WITH OTHER SIGNIFICANT PROBLEMS,794,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,15979.51,100,CUSTOM-DRG,12783.608,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,16778.48,105,CUSTOM-DRG,13422.784,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,16299.08,102,CUSTOM-DRG,13039.264,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,16778.48,
NORMAL NEWBORN,795,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,815.96,100,CUSTOM-DRG,652.768,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,856.76,105,CUSTOM-DRG,685.408,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,832.28,102,CUSTOM-DRG,665.824,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC,796,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3935.91,100,CUSTOM-DRG,3148.728,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4132.71,105,CUSTOM-DRG,3306.168,Case rate,105% of GA Medicaid ,2939.4,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4014.63,102,CUSTOM-DRG,3211.704,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4132.71,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC,797,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3935.91,100,CUSTOM-DRG,3148.728,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4132.71,105,CUSTOM-DRG,3306.168,Case rate,105% of GA Medicaid ,2939.4,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4014.63,102,CUSTOM-DRG,3211.704,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4132.71,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC,798,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2939.4,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,1200,2939.4,
SPLENIC PROCEDURES WITH MCC,799,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,10712.94,100,CUSTOM-DRG,8570.352,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,11248.58,105,CUSTOM-DRG,8998.864,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,10927.18,102,CUSTOM-DRG,8741.744,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,11248.58,
SPLENIC PROCEDURES WITH CC,800,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7992.19,100,CUSTOM-DRG,6393.752,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,8391.79,105,CUSTOM-DRG,6713.432,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,8152.02,102,CUSTOM-DRG,6521.616,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,8391.79,
SPLENIC PROCEDURES WITHOUT CC/MCC,801,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5252.37,100,CUSTOM-DRG,4201.896,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5514.99,105,CUSTOM-DRG,4411.992,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5357.41,102,CUSTOM-DRG,4285.928,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5514.99,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC,802,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,10336.54,100,CUSTOM-DRG,8269.232,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,10853.37,105,CUSTOM-DRG,8682.696,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,10543.25,102,CUSTOM-DRG,8434.6,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,10853.37,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC,803,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4985.49,100,CUSTOM-DRG,3988.392,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5234.76,105,CUSTOM-DRG,4187.808,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5085.19,102,CUSTOM-DRG,4068.152,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5234.76,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC,804,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4102.99,100,CUSTOM-DRG,3282.392,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4308.14,105,CUSTOM-DRG,3446.512,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4185.05,102,CUSTOM-DRG,3348.04,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4308.14,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC,805,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2939.4,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,800,2939.4,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,806,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2939.4,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,800,2939.4,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,807,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2939.4,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,800,2939.4,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC,808,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,10724.15,100,CUSTOM-DRG,8579.32,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,11260.36,105,CUSTOM-DRG,9008.288,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,10938.62,102,CUSTOM-DRG,8750.896,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,11260.36,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC,809,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5074.08,100,CUSTOM-DRG,4059.264,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5327.78,105,CUSTOM-DRG,4262.224,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5175.55,102,CUSTOM-DRG,4140.44,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5327.78,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC,810,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2583.57,100,CUSTOM-DRG,2066.856,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2712.75,105,CUSTOM-DRG,2170.2,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2635.24,102,CUSTOM-DRG,2108.192,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2712.75,
RED BLOOD CELL DISORDERS WITH MCC,811,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5601.11,100,CUSTOM-DRG,4480.888,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5881.16,105,CUSTOM-DRG,4704.928,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5713.12,102,CUSTOM-DRG,4570.496,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5881.16,
RED BLOOD CELL DISORDERS WITHOUT MCC,812,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3173.03,100,CUSTOM-DRG,2538.424,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3331.68,105,CUSTOM-DRG,2665.344,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3236.48,102,CUSTOM-DRG,2589.184,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3331.68,
COAGULATION DISORDERS,813,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4563.12,100,CUSTOM-DRG,3650.496,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4791.27,105,CUSTOM-DRG,3833.016,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4654.37,102,CUSTOM-DRG,3723.496,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4791.27,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC,814,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4203.54,100,CUSTOM-DRG,3362.832,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4413.72,105,CUSTOM-DRG,3530.976,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4287.6,102,CUSTOM-DRG,3430.08,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4413.72,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC,815,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3296.75,100,CUSTOM-DRG,2637.4,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3461.59,105,CUSTOM-DRG,2769.272,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3362.68,102,CUSTOM-DRG,2690.144,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3461.59,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC,816,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2167.18,100,CUSTOM-DRG,1733.744,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2275.54,105,CUSTOM-DRG,1820.432,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2210.52,102,CUSTOM-DRG,1768.416,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC,817,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,1200,2552.31,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC,818,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,1200,2552.31,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC,819,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,1200,2552.31,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC,820,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,17623.03,100,CUSTOM-DRG,14098.424,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,18504.18,105,CUSTOM-DRG,14803.344,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,17975.46,102,CUSTOM-DRG,14380.368,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,18504.18,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC,821,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7442.35,100,CUSTOM-DRG,5953.88,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7814.47,105,CUSTOM-DRG,6251.576,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,7591.19,102,CUSTOM-DRG,6072.952,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,7814.47,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,822,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4214.75,100,CUSTOM-DRG,3371.8,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4425.49,105,CUSTOM-DRG,3540.392,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4299.04,102,CUSTOM-DRG,3439.232,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4425.49,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC,823,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,13912.13,100,CUSTOM-DRG,11129.704,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,14607.73,105,CUSTOM-DRG,11686.184,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,14190.35,102,CUSTOM-DRG,11352.28,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,14607.73,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC,824,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7503.65,100,CUSTOM-DRG,6002.92,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7878.84,105,CUSTOM-DRG,6303.072,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,7653.71,102,CUSTOM-DRG,6122.968,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,7878.84,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC,825,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4917.46,100,CUSTOM-DRG,3933.968,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5163.34,105,CUSTOM-DRG,4130.672,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5015.8,102,CUSTOM-DRG,4012.64,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5163.34,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC,826,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,14734.07,100,CUSTOM-DRG,11787.256,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,15470.77,105,CUSTOM-DRG,12376.616,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,15028.73,102,CUSTOM-DRG,12022.984,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,15470.77,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC,827,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6559.86,100,CUSTOM-DRG,5247.888,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6887.85,105,CUSTOM-DRG,5510.28,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6691.04,102,CUSTOM-DRG,5352.832,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,6887.85,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,828,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4727.58,100,CUSTOM-DRG,3782.064,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4963.96,105,CUSTOM-DRG,3971.168,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4822.13,102,CUSTOM-DRG,3857.704,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4963.96,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC,829,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,8612.66,100,CUSTOM-DRG,6890.128,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,9043.29,105,CUSTOM-DRG,7234.632,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,8784.9,102,CUSTOM-DRG,7027.92,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,9043.29,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC,830,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3571.48,100,CUSTOM-DRG,2857.184,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3750.05,105,CUSTOM-DRG,3000.04,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3642.9,102,CUSTOM-DRG,2914.32,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,3750.05,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC,831,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC,832,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC,833,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC,834,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,30811.14,100,CUSTOM-DRG,24648.912,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,32351.69,105,CUSTOM-DRG,25881.352,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,31427.31,102,CUSTOM-DRG,25141.848,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,32351.69,
ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC,835,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,8842.91,100,CUSTOM-DRG,7074.328,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,9285.06,105,CUSTOM-DRG,7428.048,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,9019.75,102,CUSTOM-DRG,7215.8,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,9285.06,
ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CC/MCC,836,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3580.07,100,CUSTOM-DRG,2864.056,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3759.08,105,CUSTOM-DRG,3007.264,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3651.67,102,CUSTOM-DRG,2921.336,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3759.08,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC,837,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,17482.86,100,CUSTOM-DRG,13986.288,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,18357,105,CUSTOM-DRG,14685.6,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,17832.49,102,CUSTOM-DRG,14265.992,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,18357,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT,838,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5523.74,100,CUSTOM-DRG,4418.992,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5799.92,105,CUSTOM-DRG,4639.936,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5634.2,102,CUSTOM-DRG,4507.36,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5799.92,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,839,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3754.26,100,CUSTOM-DRG,3003.408,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3941.97,105,CUSTOM-DRG,3153.576,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3829.34,102,CUSTOM-DRG,3063.472,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3941.97,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC,840,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,15550.04,100,CUSTOM-DRG,12440.032,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,16327.54,105,CUSTOM-DRG,13062.032,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,15861.01,102,CUSTOM-DRG,12688.808,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,16327.54,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC,841,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5312.55,100,CUSTOM-DRG,4250.04,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5578.18,105,CUSTOM-DRG,4462.544,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5418.79,102,CUSTOM-DRG,4335.032,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5578.18,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC,842,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4252.88,100,CUSTOM-DRG,3402.304,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4465.52,105,CUSTOM-DRG,3572.416,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4337.93,102,CUSTOM-DRG,3470.344,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4465.52,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC,843,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4739.92,100,CUSTOM-DRG,3791.936,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4976.91,105,CUSTOM-DRG,3981.528,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4834.71,102,CUSTOM-DRG,3867.768,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4976.91,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC,844,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3204.8,100,CUSTOM-DRG,2563.84,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3365.04,105,CUSTOM-DRG,2692.032,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3268.89,102,CUSTOM-DRG,2615.112,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3365.04,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC,845,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2698.7,100,CUSTOM-DRG,2158.96,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2833.63,105,CUSTOM-DRG,2266.904,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2752.67,102,CUSTOM-DRG,2202.136,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2833.63,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC,846,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,8201.5,100,CUSTOM-DRG,6561.2,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,8611.58,105,CUSTOM-DRG,6889.264,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,8365.52,102,CUSTOM-DRG,6692.416,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,8611.58,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC,847,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4607.6,100,CUSTOM-DRG,3686.08,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4837.98,105,CUSTOM-DRG,3870.384,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4699.74,102,CUSTOM-DRG,3759.792,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4837.98,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,848,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2303.24,100,CUSTOM-DRG,1842.592,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2418.4,105,CUSTOM-DRG,1934.72,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2349.3,102,CUSTOM-DRG,1879.44,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
RADIOTHERAPY,849,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3230.22,100,CUSTOM-DRG,2584.176,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3391.73,105,CUSTOM-DRG,2713.384,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3294.81,102,CUSTOM-DRG,2635.848,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3391.73,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,853,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,20934.35,100,CUSTOM-DRG,16747.48,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,21981.07,105,CUSTOM-DRG,17584.856,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,21353,102,CUSTOM-DRG,17082.4,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,21981.07,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,854,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,8657.89,100,CUSTOM-DRG,6926.312,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,9090.78,105,CUSTOM-DRG,7272.624,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,8831.03,102,CUSTOM-DRG,7064.824,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,9090.78,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC,855,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5462.06,100,CUSTOM-DRG,4369.648,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5735.16,105,CUSTOM-DRG,4588.128,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5571.29,102,CUSTOM-DRG,4457.032,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5735.16,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC,856,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,14995.72,100,CUSTOM-DRG,11996.576,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,15745.5,105,CUSTOM-DRG,12596.4,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,15295.61,102,CUSTOM-DRG,12236.488,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,15745.5,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC,857,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6672.74,100,CUSTOM-DRG,5338.192,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7006.37,105,CUSTOM-DRG,5605.096,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6806.18,102,CUSTOM-DRG,5444.944,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,7006.37,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC,858,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5846.31,100,CUSTOM-DRG,4677.048,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6138.62,105,CUSTOM-DRG,4910.896,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5963.23,102,CUSTOM-DRG,4770.584,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,6138.62,
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC,862,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5870.6,100,CUSTOM-DRG,4696.48,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6164.13,105,CUSTOM-DRG,4931.304,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5988.01,102,CUSTOM-DRG,4790.408,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,6164.13,
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC,863,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3220.87,100,CUSTOM-DRG,2576.696,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3381.91,105,CUSTOM-DRG,2705.528,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3285.28,102,CUSTOM-DRG,2628.224,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3381.91,
FEVER AND INFLAMMATORY CONDITIONS,864,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3019.03,100,CUSTOM-DRG,2415.224,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3169.98,105,CUSTOM-DRG,2535.984,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3079.4,102,CUSTOM-DRG,2463.52,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3169.98,
VIRAL ILLNESS WITH MCC,865,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2932.69,100,CUSTOM-DRG,2346.152,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3079.32,105,CUSTOM-DRG,2463.456,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2991.33,102,CUSTOM-DRG,2393.064,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3079.32,
VIRAL ILLNESS WITHOUT MCC,866,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2687.49,100,CUSTOM-DRG,2149.992,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2821.86,105,CUSTOM-DRG,2257.488,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2741.23,102,CUSTOM-DRG,2192.984,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2821.86,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC,867,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6618.17,100,CUSTOM-DRG,5294.536,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6949.07,105,CUSTOM-DRG,5559.256,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6750.52,102,CUSTOM-DRG,5400.416,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,6949.07,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC,868,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2899.79,100,CUSTOM-DRG,2319.832,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3044.78,105,CUSTOM-DRG,2435.824,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2957.78,102,CUSTOM-DRG,2366.224,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3044.78,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC,869,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2899.79,100,CUSTOM-DRG,2319.832,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3044.78,105,CUSTOM-DRG,2435.824,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2957.78,102,CUSTOM-DRG,2366.224,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3044.78,
SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,870,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,22345.38,100,CUSTOM-DRG,17876.304,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,23462.64,105,CUSTOM-DRG,18770.112,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,22792.25,102,CUSTOM-DRG,18233.8,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,23462.64,
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,7,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,37328.39,100,CUSTOM-DRG,29862.712,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,39194.8,105,CUSTOM-DRG,31355.84,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,38074.89,102,CUSTOM-DRG,30459.912,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,39194.8,
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,872,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3720.62,100,CUSTOM-DRG,2976.496,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3906.65,105,CUSTOM-DRG,3125.32,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3795.02,102,CUSTOM-DRG,3036.016,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3906.65,
O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS,876,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,7322,100,CUSTOM-DRG,5857.6,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7688.09,105,CUSTOM-DRG,6150.472,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,7468.42,102,CUSTOM-DRG,5974.736,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,7688.09,
ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,880,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2312.96,100,CUSTOM-DRG,1850.368,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2428.6,105,CUSTOM-DRG,1942.88,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2359.21,102,CUSTOM-DRG,1887.368,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
DEPRESSIVE NEUROSES,881,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,1995.24,100,CUSTOM-DRG,1596.192,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2095,105,CUSTOM-DRG,1676,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2035.14,102,CUSTOM-DRG,1628.112,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
NEUROSES EXCEPT DEPRESSIVE,882,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2055.42,100,CUSTOM-DRG,1644.336,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2158.19,105,CUSTOM-DRG,1726.552,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2096.53,102,CUSTOM-DRG,1677.224,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
DISORDERS OF PERSONALITY AND IMPULSE CONTROL,883,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2947.26,100,CUSTOM-DRG,2357.808,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3094.63,105,CUSTOM-DRG,2475.704,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3006.2,102,CUSTOM-DRG,2404.96,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3094.63,
ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY,884,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4189.34,100,CUSTOM-DRG,3351.472,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4398.8,105,CUSTOM-DRG,3519.04,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4273.12,102,CUSTOM-DRG,3418.496,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4398.8,
PSYCHOSES,885,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2699.82,100,CUSTOM-DRG,2159.856,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2834.81,105,CUSTOM-DRG,2267.848,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2753.81,102,CUSTOM-DRG,2203.048,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2834.81,
BEHAVIORAL AND DEVELOPMENTAL DISORDERS,886,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2136.91,100,CUSTOM-DRG,1709.528,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2243.75,105,CUSTOM-DRG,1795,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2179.64,102,CUSTOM-DRG,1743.712,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
OTHER MENTAL DISORDER DIAGNOSES,887,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2224.37,100,CUSTOM-DRG,1779.496,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2335.59,105,CUSTOM-DRG,1868.472,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2268.85,102,CUSTOM-DRG,1815.08,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA",894,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2158.96,100,CUSTOM-DRG,1727.168,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2266.91,105,CUSTOM-DRG,1813.528,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2202.13,102,CUSTOM-DRG,1761.704,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY",895,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,1652.11,100,CUSTOM-DRG,1321.688,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1734.72,105,CUSTOM-DRG,1387.776,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,1685.15,102,CUSTOM-DRG,1348.12,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC",896,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5225.08,100,CUSTOM-DRG,4180.064,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5486.34,105,CUSTOM-DRG,4389.072,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5329.58,102,CUSTOM-DRG,4263.664,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5486.34,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC",897,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
WOUND DEBRIDEMENTS FOR INJURIES WITH MCC,901,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,11483.3,100,CUSTOM-DRG,9186.64,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,12057.46,105,CUSTOM-DRG,9645.968,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,11712.95,102,CUSTOM-DRG,9370.36,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,12057.46,
WOUND DEBRIDEMENTS FOR INJURIES WITH CC,902,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5155.56,100,CUSTOM-DRG,4124.448,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5413.34,105,CUSTOM-DRG,4330.672,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5258.66,102,CUSTOM-DRG,4206.928,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5413.34,
WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC,903,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3741.17,100,CUSTOM-DRG,2992.936,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3928.23,105,CUSTOM-DRG,3142.584,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3815.99,102,CUSTOM-DRG,3052.792,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,3928.23,
SKIN GRAFTS FOR INJURIES WITH CC/MCC,904,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,9843.9,100,CUSTOM-DRG,7875.12,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,10336.09,105,CUSTOM-DRG,8268.872,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,10040.76,102,CUSTOM-DRG,8032.608,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,10336.09,
SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC,905,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5171.26,100,CUSTOM-DRG,4137.008,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5429.82,105,CUSTOM-DRG,4343.856,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5274.68,102,CUSTOM-DRG,4219.744,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5429.82,
HAND PROCEDURES FOR INJURIES,906,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3933.3,100,CUSTOM-DRG,3146.64,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4129.96,105,CUSTOM-DRG,3303.968,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4011.96,102,CUSTOM-DRG,3209.568,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4129.96,
OTHER O.R. PROCEDURES FOR INJURIES WITH MCC,907,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,16261.72,100,CUSTOM-DRG,13009.376,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,17074.8,105,CUSTOM-DRG,13659.84,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,16586.92,102,CUSTOM-DRG,13269.536,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,17074.8,
OTHER O.R. PROCEDURES FOR INJURIES WITH CC,908,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6547.15,100,CUSTOM-DRG,5237.72,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6874.5,105,CUSTOM-DRG,5499.6,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6678.08,102,CUSTOM-DRG,5342.464,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,6874.5,
OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC,909,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4583.3,100,CUSTOM-DRG,3666.64,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4812.47,105,CUSTOM-DRG,3849.976,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4674.96,102,CUSTOM-DRG,3739.968,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4812.47,
TRAUMATIC INJURY WITH MCC,913,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4239.8,100,CUSTOM-DRG,3391.84,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4451.79,105,CUSTOM-DRG,3561.432,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4324.59,102,CUSTOM-DRG,3459.672,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4451.79,
TRAUMATIC INJURY WITHOUT MCC,914,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2581.33,100,CUSTOM-DRG,2065.064,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2710.4,105,CUSTOM-DRG,2168.32,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2632.95,102,CUSTOM-DRG,2106.36,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2710.4,
ALLERGIC REACTIONS WITH MCC,915,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5980.5,100,CUSTOM-DRG,4784.4,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6279.52,105,CUSTOM-DRG,5023.616,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6100.1,102,CUSTOM-DRG,4880.08,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,6279.52,
ALLERGIC REACTIONS WITHOUT MCC,916,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2312.58,100,CUSTOM-DRG,1850.064,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2428.21,105,CUSTOM-DRG,1942.568,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2358.83,102,CUSTOM-DRG,1887.064,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC,917,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4717.12,100,CUSTOM-DRG,3773.696,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4952.97,105,CUSTOM-DRG,3962.376,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4811.45,102,CUSTOM-DRG,3849.16,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4952.97,
POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC,918,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2459.48,100,CUSTOM-DRG,1967.584,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2582.45,105,CUSTOM-DRG,2065.96,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2508.66,102,CUSTOM-DRG,2006.928,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2582.45,
COMPLICATIONS OF TREATMENT WITH MCC,919,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4447.62,100,CUSTOM-DRG,3558.096,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4670,105,CUSTOM-DRG,3736,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4536.57,102,CUSTOM-DRG,3629.256,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4670,
COMPLICATIONS OF TREATMENT WITH CC,920,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4104.86,100,CUSTOM-DRG,3283.888,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4310.11,105,CUSTOM-DRG,3448.088,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4186.95,102,CUSTOM-DRG,3349.56,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4310.11,
COMPLICATIONS OF TREATMENT WITHOUT CC/MCC,921,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2831.02,100,CUSTOM-DRG,2264.816,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2972.57,105,CUSTOM-DRG,2378.056,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2887.63,102,CUSTOM-DRG,2310.104,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2972.57,
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC",922,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5009.04,100,CUSTOM-DRG,4007.232,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5259.49,105,CUSTOM-DRG,4207.592,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5109.21,102,CUSTOM-DRG,4087.368,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5259.49,
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC",923,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2940.54,100,CUSTOM-DRG,2352.432,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3087.56,105,CUSTOM-DRG,2470.048,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2999.34,102,CUSTOM-DRG,2399.472,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3087.56,
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT,927,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,50683.96,100,CUSTOM-DRG,40547.168,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,53218.15,105,CUSTOM-DRG,42574.52,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,51697.55,102,CUSTOM-DRG,41358.04,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,53218.15,
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC,928,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,8360.36,100,CUSTOM-DRG,6688.288,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,8778.38,105,CUSTOM-DRG,7022.704,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,8527.55,102,CUSTOM-DRG,6822.04,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,8778.38,
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC,929,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3997.96,100,CUSTOM-DRG,3198.368,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4197.86,105,CUSTOM-DRG,3358.288,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4077.91,102,CUSTOM-DRG,3262.328,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,4197.86,
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT,933,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,13698.33,100,CUSTOM-DRG,10958.664,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,14383.24,105,CUSTOM-DRG,11506.592,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,13972.27,102,CUSTOM-DRG,11177.816,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,14383.24,
FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY,934,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3593.9,100,CUSTOM-DRG,2875.12,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3773.6,105,CUSTOM-DRG,3018.88,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3665.78,102,CUSTOM-DRG,2932.624,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3773.6,
NON-EXTENSIVE BURNS,935,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3231.34,100,CUSTOM-DRG,2585.072,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3392.9,105,CUSTOM-DRG,2714.32,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3295.96,102,CUSTOM-DRG,2636.768,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3392.9,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC,939,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,9929.12,100,CUSTOM-DRG,7943.296,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,10425.57,105,CUSTOM-DRG,8340.456,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,10127.68,102,CUSTOM-DRG,8102.144,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,10425.57,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC,940,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6558.74,100,CUSTOM-DRG,5246.992,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6886.67,105,CUSTOM-DRG,5509.336,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6689.9,102,CUSTOM-DRG,5351.92,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,6886.67,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC,941,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4960.82,100,CUSTOM-DRG,3968.656,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5208.86,105,CUSTOM-DRG,4167.088,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5060.03,102,CUSTOM-DRG,4048.024,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5208.86,
REHABILITATION WITH CC/MCC,945,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,13283.06,100,CUSTOM-DRG,10626.448,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,13947.21,105,CUSTOM-DRG,11157.768,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,13548.69,102,CUSTOM-DRG,10838.952,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,13947.21,
REHABILITATION WITHOUT CC/MCC,946,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3023.51,100,CUSTOM-DRG,2418.808,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3174.69,105,CUSTOM-DRG,2539.752,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3083.98,102,CUSTOM-DRG,2467.184,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3174.69,
SIGNS AND SYMPTOMS WITH MCC,947,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5710.25,100,CUSTOM-DRG,4568.2,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5995.76,105,CUSTOM-DRG,4796.608,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5824.45,102,CUSTOM-DRG,4659.56,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,5995.76,
SIGNS AND SYMPTOMS WITHOUT MCC,948,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3075.1,100,CUSTOM-DRG,2460.08,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3228.85,105,CUSTOM-DRG,2583.08,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3136.59,102,CUSTOM-DRG,2509.272,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3228.85,
AFTERCARE WITH CC/MCC,949,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,8230.28,100,CUSTOM-DRG,6584.224,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,8641.8,105,CUSTOM-DRG,6913.44,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,8394.88,102,CUSTOM-DRG,6715.904,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,8641.8,
AFTERCARE WITHOUT CC/MCC,950,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,2874.38,100,CUSTOM-DRG,2299.504,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3018.09,105,CUSTOM-DRG,2414.472,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,2931.86,102,CUSTOM-DRG,2345.488,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3018.09,
OTHER FACTORS INFLUENCING HEALTH STATUS,951,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,1907.03,100,CUSTOM-DRG,1525.624,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,2002.38,105,CUSTOM-DRG,1601.904,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,1945.17,102,CUSTOM-DRG,1556.136,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,955,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,22223.9,100,CUSTOM-DRG,17779.12,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,23335.09,105,CUSTOM-DRG,18668.072,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,22668.34,102,CUSTOM-DRG,18134.672,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,23335.09,
"LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA",956,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,20880.9,100,CUSTOM-DRG,16704.72,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,21924.94,105,CUSTOM-DRG,17539.952,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,21298.49,102,CUSTOM-DRG,17038.792,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,21924.94,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC,957,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,31661.12,100,CUSTOM-DRG,25328.896,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,33244.17,105,CUSTOM-DRG,26595.336,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,32294.29,102,CUSTOM-DRG,25835.432,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,33244.17,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC,958,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,13045.33,100,CUSTOM-DRG,10436.264,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,13697.6,105,CUSTOM-DRG,10958.08,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,13306.22,102,CUSTOM-DRG,10644.976,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,13697.6,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,959,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,8035.17,100,CUSTOM-DRG,6428.136,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,8436.93,105,CUSTOM-DRG,6749.544,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,8195.86,102,CUSTOM-DRG,6556.688,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,8436.93,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC,963,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,12149,100,CUSTOM-DRG,9719.2,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,12756.45,105,CUSTOM-DRG,10205.16,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,12391.96,102,CUSTOM-DRG,9913.568,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,12756.45,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC,964,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6804.31,100,CUSTOM-DRG,5443.448,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,7144.52,105,CUSTOM-DRG,5715.616,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6940.38,102,CUSTOM-DRG,5552.304,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,7144.52,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,965,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3378.98,100,CUSTOM-DRG,2703.184,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3547.93,105,CUSTOM-DRG,2838.344,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3446.55,102,CUSTOM-DRG,2757.24,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3547.93,
HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC,969,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,16084.54,100,CUSTOM-DRG,12867.632,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,16888.77,105,CUSTOM-DRG,13511.016,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,16406.21,102,CUSTOM-DRG,13124.968,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,16888.77,
HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC,970,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,10811.24,100,CUSTOM-DRG,8648.992,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,11351.8,105,CUSTOM-DRG,9081.44,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,11027.45,102,CUSTOM-DRG,8821.96,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,11351.8,
HIV WITH MAJOR RELATED CONDITION WITH MCC,974,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,10541,100,CUSTOM-DRG,8432.8,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,11068.05,105,CUSTOM-DRG,8854.44,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,10751.8,102,CUSTOM-DRG,8601.44,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,11068.05,
HIV WITH MAJOR RELATED CONDITION WITH CC,975,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4452.85,100,CUSTOM-DRG,3562.28,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4675.5,105,CUSTOM-DRG,3740.4,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4541.9,102,CUSTOM-DRG,3633.52,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4675.5,
HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC,976,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3275.82,100,CUSTOM-DRG,2620.656,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3439.61,105,CUSTOM-DRG,2751.688,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3341.33,102,CUSTOM-DRG,2673.064,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,3439.61,
HIV WITH OR WITHOUT OTHER RELATED CONDITION,977,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,4535.46,100,CUSTOM-DRG,3628.368,Case rate,100% of GA Medicaid ,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,4762.23,105,CUSTOM-DRG,3809.784,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,4626.16,102,CUSTOM-DRG,3700.928,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,800,4762.23,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,981,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,18963.03,100,CUSTOM-DRG,15170.424,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,19911.18,105,CUSTOM-DRG,15928.944,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,19342.26,102,CUSTOM-DRG,15473.808,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,19911.18,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,982,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,8592.1,100,CUSTOM-DRG,6873.68,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,9021.71,105,CUSTOM-DRG,7217.368,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,8763.93,102,CUSTOM-DRG,7011.144,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,9021.71,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,983,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,5212.38,100,CUSTOM-DRG,4169.904,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,5472.99,105,CUSTOM-DRG,4378.392,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,5316.61,102,CUSTOM-DRG,4253.288,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,5472.99,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,987,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,14885.83,100,CUSTOM-DRG,11908.664,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,15630.12,105,CUSTOM-DRG,12504.096,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,15183.52,102,CUSTOM-DRG,12146.816,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,15630.12,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,988,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,6503.79,100,CUSTOM-DRG,5203.032,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,6828.98,105,CUSTOM-DRG,5463.184,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,6633.85,102,CUSTOM-DRG,5307.08,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,6828.98,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,989,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,3641.37,100,CUSTOM-DRG,2913.096,Case rate,100% of GA Medicaid ,1390.5,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1463.63,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,3823.44,105,CUSTOM-DRG,3058.752,Case rate,105% of GA Medicaid ,2552.31,100,,,per diem,Pays based on per day rate,1300,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1200,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,3714.2,102,CUSTOM-DRG,2971.36,Case rate,102% of GA Medicaid ,1262.8,100,,,per diem,Pays based on per day rate,1200,3823.44,
PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS,998,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,
UNGROUPABLE,999,MS-DRG,100,RC,,,Inpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,984.68,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,1036.18,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2552.31,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1262.8,100,,,per diem,Pays based on per day rate,800,100,,,per diem,Pays based on per day rate,1849,100,,,per diem,Pays based on per day rate,,,,,Other,Not Separately reimbursable,1262.8,100,,,per diem,Pays based on per day rate,800,2552.31,