hospital_name last_updated_on version hospital_location hospital_address license_number | IN "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." JOHNSON MEMORIAL HOSPITAL FRANKLIN 3/2/24 2.0.0 JOHNSON MEMORIAL HOSPITAL FRANKLIN 1125 WEST JEFFERSON STREET FRANKLIN IN 46131 IN TRUE description code|1 code|1|type code|2 code|2|type code|3 code|3|type code|4 code|4|type setting drug_unit_of_measurement drug_type_of_measurement standard_charge|gross standard_charge|discounted_cash payer_name plan_name modifiers standard_charge|negotiated_dollar standard_charge|negotiated_percentage standard_charge|negotiated_algorithm estimated_amount standard_charge|min standard_charge|max standard_charge|methodology additional_generic_notes Application of blood vessel compression device 10111749_1 CDM 0430 RC 97016 HCPCS inpatient 206 133.9 AETNA AETNA 162.74 79 999999999 124.73 199.82 percent of total billed charges Application of blood vessel compression device 10111749_1 CDM 0430 RC 97016 HCPCS inpatient 206 133.9 SELF PAY DISCOUNT SELF PAY DISCOUNT 133.9 65 999999999 124.73 199.82 percent of total billed charges Application of blood vessel compression device 10111749_1 CDM 0430 RC 97016 HCPCS inpatient 206 133.9 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 199.82 97 999999999 124.73 199.82 percent of total billed charges Application of blood vessel compression device 10111749_1 CDM 0430 RC 97016 HCPCS inpatient 206 133.9 ENCORE - ALL PLANS ENCORE - ALL PLANS 142.14 69 999999999 124.73 199.82 percent of total billed charges Application of blood vessel compression device 10111749_1 CDM 0430 RC 97016 HCPCS inpatient 206 133.9 HUMANA - ALL PLANS HUMANA - ALL PLANS 160.68 78 999999999 124.73 199.82 percent of total billed charges Application of blood vessel compression device 10111749_1 CDM 0430 RC 97016 HCPCS inpatient 206 133.9 UMR - ALL PLANS UMR - ALL PLANS 144.2 70 999999999 124.73 199.82 percent of total billed charges Application of blood vessel compression device 10111749_1 CDM 0430 RC 97016 HCPCS inpatient 206 133.9 SIHO - ALL PLANS SIHO - ALL PLANS 185.4 90 999999999 124.73 199.82 percent of total billed charges Application of blood vessel compression device 10111749_1 CDM 0430 RC 97016 HCPCS inpatient 206 133.9 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 124.73 60.55 999999999 124.73 199.82 percent of total billed charges Application of blood vessel compression device 10111749_1 CDM 0430 RC 97016 HCPCS inpatient 206 133.9 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 124.73 199.82 Application of blood vessel compression device 10111749_1 CDM 0430 RC 97016 HCPCS inpatient 206 133.9 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 124.73 199.82 Application of blood vessel compression device 10111749_1 CDM 0430 RC 97016 HCPCS inpatient 206 133.9 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 124.73 199.82 Application of blood vessel compression device 10111749_1 CDM 0430 RC 97016 HCPCS inpatient 206 133.9 ANTHEM HMO ANTHEM HMO 999999999 124.73 199.82 Application of blood vessel compression device 10111749_1 CDM 0430 RC 97016 HCPCS inpatient 206 133.9 CIGNA - ALL PLANS CIGNA - ALL PLANS 139.26 67.6 999999999 124.73 199.82 percent of total billed charges Application of blood vessel compression device 10111749_1 CDM 0430 RC 97016 HCPCS inpatient 206 133.9 UHC - ALL PLANS UHC - ALL PLANS 999999999 124.73 199.82 Hepatitis B core antibody measurement 1013359_1 CDM 0301 RC 86704 HCPCS inpatient 76 49.4 AETNA AETNA 60.04 79 999999999 46.02 73.72 percent of total billed charges Hepatitis B core antibody measurement 1013359_1 CDM 0301 RC 86704 HCPCS inpatient 76 49.4 SELF PAY DISCOUNT SELF PAY DISCOUNT 49.4 65 999999999 46.02 73.72 percent of total billed charges Hepatitis B core antibody measurement 1013359_1 CDM 0301 RC 86704 HCPCS inpatient 76 49.4 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 73.72 97 999999999 46.02 73.72 percent of total billed charges Hepatitis B core antibody measurement 1013359_1 CDM 0301 RC 86704 HCPCS inpatient 76 49.4 ENCORE - ALL PLANS ENCORE - ALL PLANS 52.44 69 999999999 46.02 73.72 percent of total billed charges Hepatitis B core antibody measurement 1013359_1 CDM 0301 RC 86704 HCPCS inpatient 76 49.4 HUMANA - ALL PLANS HUMANA - ALL PLANS 59.28 78 999999999 46.02 73.72 percent of total billed charges Hepatitis B core antibody measurement 1013359_1 CDM 0301 RC 86704 HCPCS inpatient 76 49.4 UMR - ALL PLANS UMR - ALL PLANS 53.2 70 999999999 46.02 73.72 percent of total billed charges Hepatitis B core antibody measurement 1013359_1 CDM 0301 RC 86704 HCPCS inpatient 76 49.4 SIHO - ALL PLANS SIHO - ALL PLANS 68.4 90 999999999 46.02 73.72 percent of total billed charges Hepatitis B core antibody measurement 1013359_1 CDM 0301 RC 86704 HCPCS inpatient 76 49.4 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 46.02 60.55 999999999 46.02 73.72 percent of total billed charges Hepatitis B core antibody measurement 1013359_1 CDM 0301 RC 86704 HCPCS inpatient 76 49.4 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 46.02 73.72 Hepatitis B core antibody measurement 1013359_1 CDM 0301 RC 86704 HCPCS inpatient 76 49.4 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 46.02 73.72 Hepatitis B core antibody measurement 1013359_1 CDM 0301 RC 86704 HCPCS inpatient 76 49.4 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 46.02 73.72 Hepatitis B core antibody measurement 1013359_1 CDM 0301 RC 86704 HCPCS inpatient 76 49.4 ANTHEM HMO ANTHEM HMO 999999999 46.02 73.72 Hepatitis B core antibody measurement 1013359_1 CDM 0301 RC 86704 HCPCS inpatient 76 49.4 CIGNA - ALL PLANS CIGNA - ALL PLANS 51.38 67.6 999999999 46.02 73.72 percent of total billed charges Hepatitis B core antibody measurement 1013359_1 CDM 0301 RC 86704 HCPCS inpatient 76 49.4 UHC - ALL PLANS UHC - ALL PLANS 999999999 46.02 73.72 Measurement of Hepatitis A antibody (IgM) 10234947_1 CDM 0301 RC 86709 HCPCS inpatient 206 133.9 AETNA AETNA 162.74 79 999999999 124.73 199.82 percent of total billed charges Measurement of Hepatitis A antibody (IgM) 10234947_1 CDM 0301 RC 86709 HCPCS inpatient 206 133.9 SELF PAY DISCOUNT SELF PAY DISCOUNT 133.9 65 999999999 124.73 199.82 percent of total billed charges Measurement of Hepatitis A antibody (IgM) 10234947_1 CDM 0301 RC 86709 HCPCS inpatient 206 133.9 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 199.82 97 999999999 124.73 199.82 percent of total billed charges Measurement of Hepatitis A antibody (IgM) 10234947_1 CDM 0301 RC 86709 HCPCS inpatient 206 133.9 ENCORE - ALL PLANS ENCORE - ALL PLANS 142.14 69 999999999 124.73 199.82 percent of total billed charges Measurement of Hepatitis A antibody (IgM) 10234947_1 CDM 0301 RC 86709 HCPCS inpatient 206 133.9 HUMANA - ALL PLANS HUMANA - ALL PLANS 160.68 78 999999999 124.73 199.82 percent of total billed charges Measurement of Hepatitis A antibody (IgM) 10234947_1 CDM 0301 RC 86709 HCPCS inpatient 206 133.9 UMR - ALL PLANS UMR - ALL PLANS 144.2 70 999999999 124.73 199.82 percent of total billed charges Measurement of Hepatitis A antibody (IgM) 10234947_1 CDM 0301 RC 86709 HCPCS inpatient 206 133.9 SIHO - ALL PLANS SIHO - ALL PLANS 185.4 90 999999999 124.73 199.82 percent of total billed charges Measurement of Hepatitis A antibody (IgM) 10234947_1 CDM 0301 RC 86709 HCPCS inpatient 206 133.9 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 124.73 60.55 999999999 124.73 199.82 percent of total billed charges Measurement of Hepatitis A antibody (IgM) 10234947_1 CDM 0301 RC 86709 HCPCS inpatient 206 133.9 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 124.73 199.82 Measurement of Hepatitis A antibody (IgM) 10234947_1 CDM 0301 RC 86709 HCPCS inpatient 206 133.9 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 124.73 199.82 Measurement of Hepatitis A antibody (IgM) 10234947_1 CDM 0301 RC 86709 HCPCS inpatient 206 133.9 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 124.73 199.82 Measurement of Hepatitis A antibody (IgM) 10234947_1 CDM 0301 RC 86709 HCPCS inpatient 206 133.9 ANTHEM HMO ANTHEM HMO 999999999 124.73 199.82 Measurement of Hepatitis A antibody (IgM) 10234947_1 CDM 0301 RC 86709 HCPCS inpatient 206 133.9 CIGNA - ALL PLANS CIGNA - ALL PLANS 139.26 67.6 999999999 124.73 199.82 percent of total billed charges Measurement of Hepatitis A antibody (IgM) 10234947_1 CDM 0301 RC 86709 HCPCS inpatient 206 133.9 UHC - ALL PLANS UHC - ALL PLANS 999999999 124.73 199.82 "Blood test, clotting time" 1048599_1 CDM 0305 RC 85610 HCPCS inpatient 112 72.8 AETNA AETNA 88.48 79 999999999 67.82 108.64 percent of total billed charges "Blood test, clotting time" 1048599_1 CDM 0305 RC 85610 HCPCS inpatient 112 72.8 SELF PAY DISCOUNT SELF PAY DISCOUNT 72.8 65 999999999 67.82 108.64 percent of total billed charges "Blood test, clotting time" 1048599_1 CDM 0305 RC 85610 HCPCS inpatient 112 72.8 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 108.64 97 999999999 67.82 108.64 percent of total billed charges "Blood test, clotting time" 1048599_1 CDM 0305 RC 85610 HCPCS inpatient 112 72.8 ENCORE - ALL PLANS ENCORE - ALL PLANS 77.28 69 999999999 67.82 108.64 percent of total billed charges "Blood test, clotting time" 1048599_1 CDM 0305 RC 85610 HCPCS inpatient 112 72.8 HUMANA - ALL PLANS HUMANA - ALL PLANS 87.36 78 999999999 67.82 108.64 percent of total billed charges "Blood test, clotting time" 1048599_1 CDM 0305 RC 85610 HCPCS inpatient 112 72.8 UMR - ALL PLANS UMR - ALL PLANS 78.4 70 999999999 67.82 108.64 percent of total billed charges "Blood test, clotting time" 1048599_1 CDM 0305 RC 85610 HCPCS inpatient 112 72.8 SIHO - ALL PLANS SIHO - ALL PLANS 100.8 90 999999999 67.82 108.64 percent of total billed charges "Blood test, clotting time" 1048599_1 CDM 0305 RC 85610 HCPCS inpatient 112 72.8 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 67.82 60.55 999999999 67.82 108.64 percent of total billed charges "Blood test, clotting time" 1048599_1 CDM 0305 RC 85610 HCPCS inpatient 112 72.8 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 67.82 108.64 "Blood test, clotting time" 1048599_1 CDM 0305 RC 85610 HCPCS inpatient 112 72.8 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 67.82 108.64 "Blood test, clotting time" 1048599_1 CDM 0305 RC 85610 HCPCS inpatient 112 72.8 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 67.82 108.64 "Blood test, clotting time" 1048599_1 CDM 0305 RC 85610 HCPCS inpatient 112 72.8 ANTHEM HMO ANTHEM HMO 999999999 67.82 108.64 "Blood test, clotting time" 1048599_1 CDM 0305 RC 85610 HCPCS inpatient 112 72.8 CIGNA - ALL PLANS CIGNA - ALL PLANS 75.71 67.6 999999999 67.82 108.64 percent of total billed charges "Blood test, clotting time" 1048599_1 CDM 0305 RC 85610 HCPCS inpatient 112 72.8 UHC - ALL PLANS UHC - ALL PLANS 999999999 67.82 108.64 "Evaluation for work hardening or conditioning, initial 2 hours" 1066686_1 CDM 0420 RC 97545 HCPCS inpatient 588 382.2 AETNA AETNA 464.52 79 999999999 356.03 570.36 percent of total billed charges "Evaluation for work hardening or conditioning, initial 2 hours" 1066686_1 CDM 0420 RC 97545 HCPCS inpatient 588 382.2 SELF PAY DISCOUNT SELF PAY DISCOUNT 382.2 65 999999999 356.03 570.36 percent of total billed charges "Evaluation for work hardening or conditioning, initial 2 hours" 1066686_1 CDM 0420 RC 97545 HCPCS inpatient 588 382.2 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 570.36 97 999999999 356.03 570.36 percent of total billed charges "Evaluation for work hardening or conditioning, initial 2 hours" 1066686_1 CDM 0420 RC 97545 HCPCS inpatient 588 382.2 ENCORE - ALL PLANS ENCORE - ALL PLANS 405.72 69 999999999 356.03 570.36 percent of total billed charges "Evaluation for work hardening or conditioning, initial 2 hours" 1066686_1 CDM 0420 RC 97545 HCPCS inpatient 588 382.2 HUMANA - ALL PLANS HUMANA - ALL PLANS 458.64 78 999999999 356.03 570.36 percent of total billed charges "Evaluation for work hardening or conditioning, initial 2 hours" 1066686_1 CDM 0420 RC 97545 HCPCS inpatient 588 382.2 UMR - ALL PLANS UMR - ALL PLANS 411.6 70 999999999 356.03 570.36 percent of total billed charges "Evaluation for work hardening or conditioning, initial 2 hours" 1066686_1 CDM 0420 RC 97545 HCPCS inpatient 588 382.2 SIHO - ALL PLANS SIHO - ALL PLANS 529.2 90 999999999 356.03 570.36 percent of total billed charges "Evaluation for work hardening or conditioning, initial 2 hours" 1066686_1 CDM 0420 RC 97545 HCPCS inpatient 588 382.2 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 356.03 60.55 999999999 356.03 570.36 percent of total billed charges "Evaluation for work hardening or conditioning, initial 2 hours" 1066686_1 CDM 0420 RC 97545 HCPCS inpatient 588 382.2 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 356.03 570.36 "Evaluation for work hardening or conditioning, initial 2 hours" 1066686_1 CDM 0420 RC 97545 HCPCS inpatient 588 382.2 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 356.03 570.36 "Evaluation for work hardening or conditioning, initial 2 hours" 1066686_1 CDM 0420 RC 97545 HCPCS inpatient 588 382.2 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 356.03 570.36 "Evaluation for work hardening or conditioning, initial 2 hours" 1066686_1 CDM 0420 RC 97545 HCPCS inpatient 588 382.2 ANTHEM HMO ANTHEM HMO 999999999 356.03 570.36 "Evaluation for work hardening or conditioning, initial 2 hours" 1066686_1 CDM 0420 RC 97545 HCPCS inpatient 588 382.2 CIGNA - ALL PLANS CIGNA - ALL PLANS 397.49 67.6 999999999 356.03 570.36 percent of total billed charges "Evaluation for work hardening or conditioning, initial 2 hours" 1066686_1 CDM 0420 RC 97545 HCPCS inpatient 588 382.2 UHC - ALL PLANS UHC - ALL PLANS 999999999 356.03 570.36 "Evaluation for work hardening or conditioning, each additional hour" 1066687_1 CDM 0420 RC 97546 HCPCS inpatient 301 195.65 AETNA AETNA 237.79 79 999999999 182.26 291.97 percent of total billed charges "Evaluation for work hardening or conditioning, each additional hour" 1066687_1 CDM 0420 RC 97546 HCPCS inpatient 301 195.65 SELF PAY DISCOUNT SELF PAY DISCOUNT 195.65 65 999999999 182.26 291.97 percent of total billed charges "Evaluation for work hardening or conditioning, each additional hour" 1066687_1 CDM 0420 RC 97546 HCPCS inpatient 301 195.65 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 291.97 97 999999999 182.26 291.97 percent of total billed charges "Evaluation for work hardening or conditioning, each additional hour" 1066687_1 CDM 0420 RC 97546 HCPCS inpatient 301 195.65 ENCORE - ALL PLANS ENCORE - ALL PLANS 207.69 69 999999999 182.26 291.97 percent of total billed charges "Evaluation for work hardening or conditioning, each additional hour" 1066687_1 CDM 0420 RC 97546 HCPCS inpatient 301 195.65 HUMANA - ALL PLANS HUMANA - ALL PLANS 234.78 78 999999999 182.26 291.97 percent of total billed charges "Evaluation for work hardening or conditioning, each additional hour" 1066687_1 CDM 0420 RC 97546 HCPCS inpatient 301 195.65 UMR - ALL PLANS UMR - ALL PLANS 210.7 70 999999999 182.26 291.97 percent of total billed charges "Evaluation for work hardening or conditioning, each additional hour" 1066687_1 CDM 0420 RC 97546 HCPCS inpatient 301 195.65 SIHO - ALL PLANS SIHO - ALL PLANS 270.9 90 999999999 182.26 291.97 percent of total billed charges "Evaluation for work hardening or conditioning, each additional hour" 1066687_1 CDM 0420 RC 97546 HCPCS inpatient 301 195.65 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 182.26 60.55 999999999 182.26 291.97 percent of total billed charges "Evaluation for work hardening or conditioning, each additional hour" 1066687_1 CDM 0420 RC 97546 HCPCS inpatient 301 195.65 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 182.26 291.97 "Evaluation for work hardening or conditioning, each additional hour" 1066687_1 CDM 0420 RC 97546 HCPCS inpatient 301 195.65 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 182.26 291.97 "Evaluation for work hardening or conditioning, each additional hour" 1066687_1 CDM 0420 RC 97546 HCPCS inpatient 301 195.65 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 182.26 291.97 "Evaluation for work hardening or conditioning, each additional hour" 1066687_1 CDM 0420 RC 97546 HCPCS inpatient 301 195.65 ANTHEM HMO ANTHEM HMO 999999999 182.26 291.97 "Evaluation for work hardening or conditioning, each additional hour" 1066687_1 CDM 0420 RC 97546 HCPCS inpatient 301 195.65 CIGNA - ALL PLANS CIGNA - ALL PLANS 203.48 67.6 999999999 182.26 291.97 percent of total billed charges "Evaluation for work hardening or conditioning, each additional hour" 1066687_1 CDM 0420 RC 97546 HCPCS inpatient 301 195.65 UHC - ALL PLANS UHC - ALL PLANS 999999999 182.26 291.97 "X-ray of knee, 3 views" 1066969_1 CDM 0320 RC 73562 HCPCS inpatient 489 317.85 AETNA AETNA 386.31 79 999999999 296.09 474.33 percent of total billed charges "X-ray of knee, 3 views" 1066969_1 CDM 0320 RC 73562 HCPCS inpatient 489 317.85 SELF PAY DISCOUNT SELF PAY DISCOUNT 317.85 65 999999999 296.09 474.33 percent of total billed charges "X-ray of knee, 3 views" 1066969_1 CDM 0320 RC 73562 HCPCS inpatient 489 317.85 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 474.33 97 999999999 296.09 474.33 percent of total billed charges "X-ray of knee, 3 views" 1066969_1 CDM 0320 RC 73562 HCPCS inpatient 489 317.85 ENCORE - ALL PLANS ENCORE - ALL PLANS 337.41 69 999999999 296.09 474.33 percent of total billed charges "X-ray of knee, 3 views" 1066969_1 CDM 0320 RC 73562 HCPCS inpatient 489 317.85 HUMANA - ALL PLANS HUMANA - ALL PLANS 381.42 78 999999999 296.09 474.33 percent of total billed charges "X-ray of knee, 3 views" 1066969_1 CDM 0320 RC 73562 HCPCS inpatient 489 317.85 UMR - ALL PLANS UMR - ALL PLANS 342.3 70 999999999 296.09 474.33 percent of total billed charges "X-ray of knee, 3 views" 1066969_1 CDM 0320 RC 73562 HCPCS inpatient 489 317.85 SIHO - ALL PLANS SIHO - ALL PLANS 440.1 90 999999999 296.09 474.33 percent of total billed charges "X-ray of knee, 3 views" 1066969_1 CDM 0320 RC 73562 HCPCS inpatient 489 317.85 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 296.09 60.55 999999999 296.09 474.33 percent of total billed charges "X-ray of knee, 3 views" 1066969_1 CDM 0320 RC 73562 HCPCS inpatient 489 317.85 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 296.09 474.33 "X-ray of knee, 3 views" 1066969_1 CDM 0320 RC 73562 HCPCS inpatient 489 317.85 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 296.09 474.33 "X-ray of knee, 3 views" 1066969_1 CDM 0320 RC 73562 HCPCS inpatient 489 317.85 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 296.09 474.33 "X-ray of knee, 3 views" 1066969_1 CDM 0320 RC 73562 HCPCS inpatient 489 317.85 ANTHEM HMO ANTHEM HMO 999999999 296.09 474.33 "X-ray of knee, 3 views" 1066969_1 CDM 0320 RC 73562 HCPCS inpatient 489 317.85 CIGNA - ALL PLANS CIGNA - ALL PLANS 330.56 67.6 999999999 296.09 474.33 percent of total billed charges "X-ray of knee, 3 views" 1066969_1 CDM 0320 RC 73562 HCPCS inpatient 489 317.85 UHC - ALL PLANS UHC - ALL PLANS 999999999 296.09 474.33 "INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED, 10 MG" 1074599_1 CDM 0510 RC J3301 HCPCS inpatient 12.5 8.13 AETNA AETNA 9.88 79 999999999 7.57 12.13 percent of total billed charges "INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED, 10 MG" 1074599_1 CDM 0510 RC J3301 HCPCS inpatient 12.5 8.13 SELF PAY DISCOUNT SELF PAY DISCOUNT 8.13 65 999999999 7.57 12.13 percent of total billed charges "INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED, 10 MG" 1074599_1 CDM 0510 RC J3301 HCPCS inpatient 12.5 8.13 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 12.13 97 999999999 7.57 12.13 percent of total billed charges "INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED, 10 MG" 1074599_1 CDM 0510 RC J3301 HCPCS inpatient 12.5 8.13 ENCORE - ALL PLANS ENCORE - ALL PLANS 8.63 69 999999999 7.57 12.13 percent of total billed charges "INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED, 10 MG" 1074599_1 CDM 0510 RC J3301 HCPCS inpatient 12.5 8.13 HUMANA - ALL PLANS HUMANA - ALL PLANS 9.75 78 999999999 7.57 12.13 percent of total billed charges "INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED, 10 MG" 1074599_1 CDM 0510 RC J3301 HCPCS inpatient 12.5 8.13 UMR - ALL PLANS UMR - ALL PLANS 8.75 70 999999999 7.57 12.13 percent of total billed charges "INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED, 10 MG" 1074599_1 CDM 0510 RC J3301 HCPCS inpatient 12.5 8.13 SIHO - ALL PLANS SIHO - ALL PLANS 11.25 90 999999999 7.57 12.13 percent of total billed charges "INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED, 10 MG" 1074599_1 CDM 0510 RC J3301 HCPCS inpatient 12.5 8.13 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 7.57 60.55 999999999 7.57 12.13 percent of total billed charges "INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED, 10 MG" 1074599_1 CDM 0510 RC J3301 HCPCS inpatient 12.5 8.13 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 7.57 12.13 "INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED, 10 MG" 1074599_1 CDM 0510 RC J3301 HCPCS inpatient 12.5 8.13 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 7.57 12.13 "INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED, 10 MG" 1074599_1 CDM 0510 RC J3301 HCPCS inpatient 12.5 8.13 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 7.57 12.13 "INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED, 10 MG" 1074599_1 CDM 0510 RC J3301 HCPCS inpatient 12.5 8.13 ANTHEM HMO ANTHEM HMO 999999999 7.57 12.13 "INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED, 10 MG" 1074599_1 CDM 0510 RC J3301 HCPCS inpatient 12.5 8.13 CIGNA - ALL PLANS CIGNA - ALL PLANS 8.45 67.6 999999999 7.57 12.13 percent of total billed charges "INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED, 10 MG" 1074599_1 CDM 0510 RC J3301 HCPCS inpatient 12.5 8.13 UHC - ALL PLANS UHC - ALL PLANS 999999999 7.57 12.13 Application of mechanical traction 10802053_1 CDM 0430 RC 97012 HCPCS inpatient 213 138.45 AETNA AETNA 168.27 79 999999999 128.97 206.61 percent of total billed charges Application of mechanical traction 10802053_1 CDM 0430 RC 97012 HCPCS inpatient 213 138.45 SELF PAY DISCOUNT SELF PAY DISCOUNT 138.45 65 999999999 128.97 206.61 percent of total billed charges Application of mechanical traction 10802053_1 CDM 0430 RC 97012 HCPCS inpatient 213 138.45 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 206.61 97 999999999 128.97 206.61 percent of total billed charges Application of mechanical traction 10802053_1 CDM 0430 RC 97012 HCPCS inpatient 213 138.45 ENCORE - ALL PLANS ENCORE - ALL PLANS 146.97 69 999999999 128.97 206.61 percent of total billed charges Application of mechanical traction 10802053_1 CDM 0430 RC 97012 HCPCS inpatient 213 138.45 HUMANA - ALL PLANS HUMANA - ALL PLANS 166.14 78 999999999 128.97 206.61 percent of total billed charges Application of mechanical traction 10802053_1 CDM 0430 RC 97012 HCPCS inpatient 213 138.45 UMR - ALL PLANS UMR - ALL PLANS 149.1 70 999999999 128.97 206.61 percent of total billed charges Application of mechanical traction 10802053_1 CDM 0430 RC 97012 HCPCS inpatient 213 138.45 SIHO - ALL PLANS SIHO - ALL PLANS 191.7 90 999999999 128.97 206.61 percent of total billed charges Application of mechanical traction 10802053_1 CDM 0430 RC 97012 HCPCS inpatient 213 138.45 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 128.97 60.55 999999999 128.97 206.61 percent of total billed charges Application of mechanical traction 10802053_1 CDM 0430 RC 97012 HCPCS inpatient 213 138.45 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 128.97 206.61 Application of mechanical traction 10802053_1 CDM 0430 RC 97012 HCPCS inpatient 213 138.45 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 128.97 206.61 Application of mechanical traction 10802053_1 CDM 0430 RC 97012 HCPCS inpatient 213 138.45 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 128.97 206.61 Application of mechanical traction 10802053_1 CDM 0430 RC 97012 HCPCS inpatient 213 138.45 ANTHEM HMO ANTHEM HMO 999999999 128.97 206.61 Application of mechanical traction 10802053_1 CDM 0430 RC 97012 HCPCS inpatient 213 138.45 UHC - ALL PLANS UHC - ALL PLANS 999999999 128.97 206.61 Application of mechanical traction 10802053_1 CDM 0430 RC 97012 HCPCS inpatient 213 138.45 CIGNA - ALL PLANS CIGNA - ALL PLANS 143.99 67.6 999999999 128.97 206.61 percent of total billed charges Therapy procedure in a group setting 10815062_1 CDM 0430 RC 97150 HCPCS inpatient 109 70.85 AETNA AETNA 86.11 79 999999999 66 105.73 percent of total billed charges Therapy procedure in a group setting 10815062_1 CDM 0430 RC 97150 HCPCS inpatient 109 70.85 SELF PAY DISCOUNT SELF PAY DISCOUNT 70.85 65 999999999 66 105.73 percent of total billed charges Therapy procedure in a group setting 10815062_1 CDM 0430 RC 97150 HCPCS inpatient 109 70.85 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 105.73 97 999999999 66 105.73 percent of total billed charges Therapy procedure in a group setting 10815062_1 CDM 0430 RC 97150 HCPCS inpatient 109 70.85 ENCORE - ALL PLANS ENCORE - ALL PLANS 75.21 69 999999999 66 105.73 percent of total billed charges Therapy procedure in a group setting 10815062_1 CDM 0430 RC 97150 HCPCS inpatient 109 70.85 HUMANA - ALL PLANS HUMANA - ALL PLANS 85.02 78 999999999 66 105.73 percent of total billed charges Therapy procedure in a group setting 10815062_1 CDM 0430 RC 97150 HCPCS inpatient 109 70.85 UMR - ALL PLANS UMR - ALL PLANS 76.3 70 999999999 66 105.73 percent of total billed charges Therapy procedure in a group setting 10815062_1 CDM 0430 RC 97150 HCPCS inpatient 109 70.85 SIHO - ALL PLANS SIHO - ALL PLANS 98.1 90 999999999 66 105.73 percent of total billed charges Therapy procedure in a group setting 10815062_1 CDM 0430 RC 97150 HCPCS inpatient 109 70.85 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 66 60.55 999999999 66 105.73 percent of total billed charges Therapy procedure in a group setting 10815062_1 CDM 0430 RC 97150 HCPCS inpatient 109 70.85 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 66 105.73 Therapy procedure in a group setting 10815062_1 CDM 0430 RC 97150 HCPCS inpatient 109 70.85 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 66 105.73 Therapy procedure in a group setting 10815062_1 CDM 0430 RC 97150 HCPCS inpatient 109 70.85 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 66 105.73 Therapy procedure in a group setting 10815062_1 CDM 0430 RC 97150 HCPCS inpatient 109 70.85 ANTHEM HMO ANTHEM HMO 999999999 66 105.73 Therapy procedure in a group setting 10815062_1 CDM 0430 RC 97150 HCPCS inpatient 109 70.85 UHC - ALL PLANS UHC - ALL PLANS 999999999 66 105.73 Therapy procedure in a group setting 10815062_1 CDM 0430 RC 97150 HCPCS inpatient 109 70.85 CIGNA - ALL PLANS CIGNA - ALL PLANS 73.68 67.6 999999999 66 105.73 percent of total billed charges Fluoroscopic guidance for insertion or removal of central vein access device 10826863_1 CDM 0320 RC 77001 HCPCS inpatient 386 250.9 AETNA AETNA 304.94 79 999999999 233.72 374.42 percent of total billed charges Fluoroscopic guidance for insertion or removal of central vein access device 10826863_1 CDM 0320 RC 77001 HCPCS inpatient 386 250.9 SELF PAY DISCOUNT SELF PAY DISCOUNT 250.9 65 999999999 233.72 374.42 percent of total billed charges Fluoroscopic guidance for insertion or removal of central vein access device 10826863_1 CDM 0320 RC 77001 HCPCS inpatient 386 250.9 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 374.42 97 999999999 233.72 374.42 percent of total billed charges Fluoroscopic guidance for insertion or removal of central vein access device 10826863_1 CDM 0320 RC 77001 HCPCS inpatient 386 250.9 ENCORE - ALL PLANS ENCORE - ALL PLANS 266.34 69 999999999 233.72 374.42 percent of total billed charges Fluoroscopic guidance for insertion or removal of central vein access device 10826863_1 CDM 0320 RC 77001 HCPCS inpatient 386 250.9 HUMANA - ALL PLANS HUMANA - ALL PLANS 301.08 78 999999999 233.72 374.42 percent of total billed charges Fluoroscopic guidance for insertion or removal of central vein access device 10826863_1 CDM 0320 RC 77001 HCPCS inpatient 386 250.9 UMR - ALL PLANS UMR - ALL PLANS 270.2 70 999999999 233.72 374.42 percent of total billed charges Fluoroscopic guidance for insertion or removal of central vein access device 10826863_1 CDM 0320 RC 77001 HCPCS inpatient 386 250.9 SIHO - ALL PLANS SIHO - ALL PLANS 347.4 90 999999999 233.72 374.42 percent of total billed charges Fluoroscopic guidance for insertion or removal of central vein access device 10826863_1 CDM 0320 RC 77001 HCPCS inpatient 386 250.9 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 233.72 60.55 999999999 233.72 374.42 percent of total billed charges Fluoroscopic guidance for insertion or removal of central vein access device 10826863_1 CDM 0320 RC 77001 HCPCS inpatient 386 250.9 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 233.72 374.42 Fluoroscopic guidance for insertion or removal of central vein access device 10826863_1 CDM 0320 RC 77001 HCPCS inpatient 386 250.9 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 233.72 374.42 Fluoroscopic guidance for insertion or removal of central vein access device 10826863_1 CDM 0320 RC 77001 HCPCS inpatient 386 250.9 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 233.72 374.42 Fluoroscopic guidance for insertion or removal of central vein access device 10826863_1 CDM 0320 RC 77001 HCPCS inpatient 386 250.9 ANTHEM HMO ANTHEM HMO 999999999 233.72 374.42 Fluoroscopic guidance for insertion or removal of central vein access device 10826863_1 CDM 0320 RC 77001 HCPCS inpatient 386 250.9 UHC - ALL PLANS UHC - ALL PLANS 999999999 233.72 374.42 Fluoroscopic guidance for insertion or removal of central vein access device 10826863_1 CDM 0320 RC 77001 HCPCS inpatient 386 250.9 CIGNA - ALL PLANS CIGNA - ALL PLANS 260.94 67.6 999999999 233.72 374.42 percent of total billed charges Blood typing for red blood cell antigens 10958951_1 CDM 0300 RC 86905 HCPCS inpatient 319 207.35 AETNA AETNA 252.01 79 999999999 193.15 309.43 percent of total billed charges Blood typing for red blood cell antigens 10958951_1 CDM 0300 RC 86905 HCPCS inpatient 319 207.35 SELF PAY DISCOUNT SELF PAY DISCOUNT 207.35 65 999999999 193.15 309.43 percent of total billed charges Blood typing for red blood cell antigens 10958951_1 CDM 0300 RC 86905 HCPCS inpatient 319 207.35 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 309.43 97 999999999 193.15 309.43 percent of total billed charges Blood typing for red blood cell antigens 10958951_1 CDM 0300 RC 86905 HCPCS inpatient 319 207.35 ENCORE - ALL PLANS ENCORE - ALL PLANS 220.11 69 999999999 193.15 309.43 percent of total billed charges Blood typing for red blood cell antigens 10958951_1 CDM 0300 RC 86905 HCPCS inpatient 319 207.35 HUMANA - ALL PLANS HUMANA - ALL PLANS 248.82 78 999999999 193.15 309.43 percent of total billed charges Blood typing for red blood cell antigens 10958951_1 CDM 0300 RC 86905 HCPCS inpatient 319 207.35 UMR - ALL PLANS UMR - ALL PLANS 223.3 70 999999999 193.15 309.43 percent of total billed charges Blood typing for red blood cell antigens 10958951_1 CDM 0300 RC 86905 HCPCS inpatient 319 207.35 SIHO - ALL PLANS SIHO - ALL PLANS 287.1 90 999999999 193.15 309.43 percent of total billed charges Blood typing for red blood cell antigens 10958951_1 CDM 0300 RC 86905 HCPCS inpatient 319 207.35 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 193.15 60.55 999999999 193.15 309.43 percent of total billed charges Blood typing for red blood cell antigens 10958951_1 CDM 0300 RC 86905 HCPCS inpatient 319 207.35 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 193.15 309.43 Blood typing for red blood cell antigens 10958951_1 CDM 0300 RC 86905 HCPCS inpatient 319 207.35 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 193.15 309.43 Blood typing for red blood cell antigens 10958951_1 CDM 0300 RC 86905 HCPCS inpatient 319 207.35 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 193.15 309.43 Blood typing for red blood cell antigens 10958951_1 CDM 0300 RC 86905 HCPCS inpatient 319 207.35 ANTHEM HMO ANTHEM HMO 999999999 193.15 309.43 Blood typing for red blood cell antigens 10958951_1 CDM 0300 RC 86905 HCPCS inpatient 319 207.35 UHC - ALL PLANS UHC - ALL PLANS 999999999 193.15 309.43 Blood typing for red blood cell antigens 10958951_1 CDM 0300 RC 86905 HCPCS inpatient 319 207.35 CIGNA - ALL PLANS CIGNA - ALL PLANS 215.64 67.6 999999999 193.15 309.43 percent of total billed charges "Imaging guidance for procedure, 60 minutes or less" 10989063_1 CDM 0320 RC 76000 HCPCS inpatient 1172 761.8 AETNA AETNA 925.88 79 999999999 709.65 1136.84 percent of total billed charges "Imaging guidance for procedure, 60 minutes or less" 10989063_1 CDM 0320 RC 76000 HCPCS inpatient 1172 761.8 SELF PAY DISCOUNT SELF PAY DISCOUNT 761.8 65 999999999 709.65 1136.84 percent of total billed charges "Imaging guidance for procedure, 60 minutes or less" 10989063_1 CDM 0320 RC 76000 HCPCS inpatient 1172 761.8 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 1136.84 97 999999999 709.65 1136.84 percent of total billed charges "Imaging guidance for procedure, 60 minutes or less" 10989063_1 CDM 0320 RC 76000 HCPCS inpatient 1172 761.8 ENCORE - ALL PLANS ENCORE - ALL PLANS 808.68 69 999999999 709.65 1136.84 percent of total billed charges "Imaging guidance for procedure, 60 minutes or less" 10989063_1 CDM 0320 RC 76000 HCPCS inpatient 1172 761.8 HUMANA - ALL PLANS HUMANA - ALL PLANS 914.16 78 999999999 709.65 1136.84 percent of total billed charges "Imaging guidance for procedure, 60 minutes or less" 10989063_1 CDM 0320 RC 76000 HCPCS inpatient 1172 761.8 UMR - ALL PLANS UMR - ALL PLANS 820.4 70 999999999 709.65 1136.84 percent of total billed charges "Imaging guidance for procedure, 60 minutes or less" 10989063_1 CDM 0320 RC 76000 HCPCS inpatient 1172 761.8 SIHO - ALL PLANS SIHO - ALL PLANS 1054.8 90 999999999 709.65 1136.84 percent of total billed charges "Imaging guidance for procedure, 60 minutes or less" 10989063_1 CDM 0320 RC 76000 HCPCS inpatient 1172 761.8 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 709.65 60.55 999999999 709.65 1136.84 percent of total billed charges "Imaging guidance for procedure, 60 minutes or less" 10989063_1 CDM 0320 RC 76000 HCPCS inpatient 1172 761.8 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 709.65 1136.84 "Imaging guidance for procedure, 60 minutes or less" 10989063_1 CDM 0320 RC 76000 HCPCS inpatient 1172 761.8 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 709.65 1136.84 "Imaging guidance for procedure, 60 minutes or less" 10989063_1 CDM 0320 RC 76000 HCPCS inpatient 1172 761.8 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 709.65 1136.84 "Imaging guidance for procedure, 60 minutes or less" 10989063_1 CDM 0320 RC 76000 HCPCS inpatient 1172 761.8 ANTHEM HMO ANTHEM HMO 999999999 709.65 1136.84 "Imaging guidance for procedure, 60 minutes or less" 10989063_1 CDM 0320 RC 76000 HCPCS inpatient 1172 761.8 UHC - ALL PLANS UHC - ALL PLANS 999999999 709.65 1136.84 "Imaging guidance for procedure, 60 minutes or less" 10989063_1 CDM 0320 RC 76000 HCPCS inpatient 1172 761.8 CIGNA - ALL PLANS CIGNA - ALL PLANS 792.27 67.6 999999999 709.65 1136.84 percent of total billed charges "Ultrasound scan of uterus, ovaries, tubes, cervix and pelvic area through vagina" 10989305_1 CDM 0402 RC 76830 HCPCS inpatient 550 357.5 AETNA AETNA 434.5 79 999999999 333.03 533.5 percent of total billed charges "Ultrasound scan of uterus, ovaries, tubes, cervix and pelvic area through vagina" 10989305_1 CDM 0402 RC 76830 HCPCS inpatient 550 357.5 SELF PAY DISCOUNT SELF PAY DISCOUNT 357.5 65 999999999 333.03 533.5 percent of total billed charges "Ultrasound scan of uterus, ovaries, tubes, cervix and pelvic area through vagina" 10989305_1 CDM 0402 RC 76830 HCPCS inpatient 550 357.5 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 533.5 97 999999999 333.03 533.5 percent of total billed charges "Ultrasound scan of uterus, ovaries, tubes, cervix and pelvic area through vagina" 10989305_1 CDM 0402 RC 76830 HCPCS inpatient 550 357.5 ENCORE - ALL PLANS ENCORE - ALL PLANS 379.5 69 999999999 333.03 533.5 percent of total billed charges "Ultrasound scan of uterus, ovaries, tubes, cervix and pelvic area through vagina" 10989305_1 CDM 0402 RC 76830 HCPCS inpatient 550 357.5 HUMANA - ALL PLANS HUMANA - ALL PLANS 429 78 999999999 333.03 533.5 percent of total billed charges "Ultrasound scan of uterus, ovaries, tubes, cervix and pelvic area through vagina" 10989305_1 CDM 0402 RC 76830 HCPCS inpatient 550 357.5 UMR - ALL PLANS UMR - ALL PLANS 385 70 999999999 333.03 533.5 percent of total billed charges "Ultrasound scan of uterus, ovaries, tubes, cervix and pelvic area through vagina" 10989305_1 CDM 0402 RC 76830 HCPCS inpatient 550 357.5 SIHO - ALL PLANS SIHO - ALL PLANS 495 90 999999999 333.03 533.5 percent of total billed charges "Ultrasound scan of uterus, ovaries, tubes, cervix and pelvic area through vagina" 10989305_1 CDM 0402 RC 76830 HCPCS inpatient 550 357.5 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 333.03 60.55 999999999 333.03 533.5 percent of total billed charges "Ultrasound scan of uterus, ovaries, tubes, cervix and pelvic area through vagina" 10989305_1 CDM 0402 RC 76830 HCPCS inpatient 550 357.5 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 333.03 533.5 "Ultrasound scan of uterus, ovaries, tubes, cervix and pelvic area through vagina" 10989305_1 CDM 0402 RC 76830 HCPCS inpatient 550 357.5 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 333.03 533.5 "Ultrasound scan of uterus, ovaries, tubes, cervix and pelvic area through vagina" 10989305_1 CDM 0402 RC 76830 HCPCS inpatient 550 357.5 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 333.03 533.5 "Ultrasound scan of uterus, ovaries, tubes, cervix and pelvic area through vagina" 10989305_1 CDM 0402 RC 76830 HCPCS inpatient 550 357.5 ANTHEM HMO ANTHEM HMO 999999999 333.03 533.5 "Ultrasound scan of uterus, ovaries, tubes, cervix and pelvic area through vagina" 10989305_1 CDM 0402 RC 76830 HCPCS inpatient 550 357.5 UHC - ALL PLANS UHC - ALL PLANS 999999999 333.03 533.5 "Ultrasound scan of uterus, ovaries, tubes, cervix and pelvic area through vagina" 10989305_1 CDM 0402 RC 76830 HCPCS inpatient 550 357.5 CIGNA - ALL PLANS CIGNA - ALL PLANS 371.8 67.6 999999999 333.03 533.5 percent of total billed charges Nuclear medicine study of liver and bile duct system with use of drugs 10989351_1 CDM 0341 RC 78227 HCPCS inpatient 2534 1647.1 AETNA AETNA 2001.86 79 999999999 1534.34 2457.98 percent of total billed charges Nuclear medicine study of liver and bile duct system with use of drugs 10989351_1 CDM 0341 RC 78227 HCPCS inpatient 2534 1647.1 SELF PAY DISCOUNT SELF PAY DISCOUNT 1647.1 65 999999999 1534.34 2457.98 percent of total billed charges Nuclear medicine study of liver and bile duct system with use of drugs 10989351_1 CDM 0341 RC 78227 HCPCS inpatient 2534 1647.1 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 2457.98 97 999999999 1534.34 2457.98 percent of total billed charges Nuclear medicine study of liver and bile duct system with use of drugs 10989351_1 CDM 0341 RC 78227 HCPCS inpatient 2534 1647.1 ENCORE - ALL PLANS ENCORE - ALL PLANS 1748.46 69 999999999 1534.34 2457.98 percent of total billed charges Nuclear medicine study of liver and bile duct system with use of drugs 10989351_1 CDM 0341 RC 78227 HCPCS inpatient 2534 1647.1 HUMANA - ALL PLANS HUMANA - ALL PLANS 1976.52 78 999999999 1534.34 2457.98 percent of total billed charges Nuclear medicine study of liver and bile duct system with use of drugs 10989351_1 CDM 0341 RC 78227 HCPCS inpatient 2534 1647.1 UMR - ALL PLANS UMR - ALL PLANS 1773.8 70 999999999 1534.34 2457.98 percent of total billed charges Nuclear medicine study of liver and bile duct system with use of drugs 10989351_1 CDM 0341 RC 78227 HCPCS inpatient 2534 1647.1 SIHO - ALL PLANS SIHO - ALL PLANS 2280.6 90 999999999 1534.34 2457.98 percent of total billed charges Nuclear medicine study of liver and bile duct system with use of drugs 10989351_1 CDM 0341 RC 78227 HCPCS inpatient 2534 1647.1 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1534.34 60.55 999999999 1534.34 2457.98 percent of total billed charges Nuclear medicine study of liver and bile duct system with use of drugs 10989351_1 CDM 0341 RC 78227 HCPCS inpatient 2534 1647.1 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1534.34 2457.98 Nuclear medicine study of liver and bile duct system with use of drugs 10989351_1 CDM 0341 RC 78227 HCPCS inpatient 2534 1647.1 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1534.34 2457.98 Nuclear medicine study of liver and bile duct system with use of drugs 10989351_1 CDM 0341 RC 78227 HCPCS inpatient 2534 1647.1 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1534.34 2457.98 Nuclear medicine study of liver and bile duct system with use of drugs 10989351_1 CDM 0341 RC 78227 HCPCS inpatient 2534 1647.1 ANTHEM HMO ANTHEM HMO 999999999 1534.34 2457.98 Nuclear medicine study of liver and bile duct system with use of drugs 10989351_1 CDM 0341 RC 78227 HCPCS inpatient 2534 1647.1 UHC - ALL PLANS UHC - ALL PLANS 999999999 1534.34 2457.98 Nuclear medicine study of liver and bile duct system with use of drugs 10989351_1 CDM 0341 RC 78227 HCPCS inpatient 2534 1647.1 CIGNA - ALL PLANS CIGNA - ALL PLANS 1712.98 67.6 999999999 1534.34 2457.98 percent of total billed charges Ultrasonic guidance for needle placement 10989387_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 AETNA AETNA 692.83 79 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 10989387_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 SELF PAY DISCOUNT SELF PAY DISCOUNT 570.05 65 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 10989387_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 850.69 97 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 10989387_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 ENCORE - ALL PLANS ENCORE - ALL PLANS 605.13 69 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 10989387_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 HUMANA - ALL PLANS HUMANA - ALL PLANS 684.06 78 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 10989387_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 UMR - ALL PLANS UMR - ALL PLANS 613.9 70 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 10989387_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 SIHO - ALL PLANS SIHO - ALL PLANS 789.3 90 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 10989387_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 531.02 60.55 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 10989387_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 531.02 850.69 Ultrasonic guidance for needle placement 10989387_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 531.02 850.69 Ultrasonic guidance for needle placement 10989387_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 531.02 850.69 Ultrasonic guidance for needle placement 10989387_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 ANTHEM HMO ANTHEM HMO 999999999 531.02 850.69 Ultrasonic guidance for needle placement 10989387_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 UHC - ALL PLANS UHC - ALL PLANS 999999999 531.02 850.69 Ultrasonic guidance for needle placement 10989387_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 CIGNA - ALL PLANS CIGNA - ALL PLANS 592.85 67.6 999999999 531.02 850.69 percent of total billed charges CT scan of chest before and after contrast 1102623_1 CDM 0352 RC 71270 HCPCS inpatient 489 317.85 AETNA AETNA 386.31 79 999999999 296.09 474.33 percent of total billed charges CT scan of chest before and after contrast 1102623_1 CDM 0352 RC 71270 HCPCS inpatient 489 317.85 SELF PAY DISCOUNT SELF PAY DISCOUNT 317.85 65 999999999 296.09 474.33 percent of total billed charges CT scan of chest before and after contrast 1102623_1 CDM 0352 RC 71270 HCPCS inpatient 489 317.85 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 474.33 97 999999999 296.09 474.33 percent of total billed charges CT scan of chest before and after contrast 1102623_1 CDM 0352 RC 71270 HCPCS inpatient 489 317.85 ENCORE - ALL PLANS ENCORE - ALL PLANS 337.41 69 999999999 296.09 474.33 percent of total billed charges CT scan of chest before and after contrast 1102623_1 CDM 0352 RC 71270 HCPCS inpatient 489 317.85 HUMANA - ALL PLANS HUMANA - ALL PLANS 381.42 78 999999999 296.09 474.33 percent of total billed charges CT scan of chest before and after contrast 1102623_1 CDM 0352 RC 71270 HCPCS inpatient 489 317.85 UMR - ALL PLANS UMR - ALL PLANS 342.3 70 999999999 296.09 474.33 percent of total billed charges CT scan of chest before and after contrast 1102623_1 CDM 0352 RC 71270 HCPCS inpatient 489 317.85 SIHO - ALL PLANS SIHO - ALL PLANS 440.1 90 999999999 296.09 474.33 percent of total billed charges CT scan of chest before and after contrast 1102623_1 CDM 0352 RC 71270 HCPCS inpatient 489 317.85 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 296.09 60.55 999999999 296.09 474.33 percent of total billed charges CT scan of chest before and after contrast 1102623_1 CDM 0352 RC 71270 HCPCS inpatient 489 317.85 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 296.09 474.33 CT scan of chest before and after contrast 1102623_1 CDM 0352 RC 71270 HCPCS inpatient 489 317.85 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 296.09 474.33 CT scan of chest before and after contrast 1102623_1 CDM 0352 RC 71270 HCPCS inpatient 489 317.85 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 296.09 474.33 CT scan of chest before and after contrast 1102623_1 CDM 0352 RC 71270 HCPCS inpatient 489 317.85 ANTHEM HMO ANTHEM HMO 999999999 296.09 474.33 CT scan of chest before and after contrast 1102623_1 CDM 0352 RC 71270 HCPCS inpatient 489 317.85 UHC - ALL PLANS UHC - ALL PLANS 999999999 296.09 474.33 CT scan of chest before and after contrast 1102623_1 CDM 0352 RC 71270 HCPCS inpatient 489 317.85 CIGNA - ALL PLANS CIGNA - ALL PLANS 330.56 67.6 999999999 296.09 474.33 percent of total billed charges ROOM & BOARD - PRIVATE (ONE BED) - OBSTETRICS (OB) 11040767_1 CDM 0112 RC inpatient 1618 1051.7 AETNA AETNA 1278.22 79 999999999 979.7 1569.46 percent of total billed charges ROOM & BOARD - PRIVATE (ONE BED) - OBSTETRICS (OB) 11040767_1 CDM 0112 RC inpatient 1618 1051.7 SELF PAY DISCOUNT SELF PAY DISCOUNT 1051.7 65 999999999 979.7 1569.46 percent of total billed charges ROOM & BOARD - PRIVATE (ONE BED) - OBSTETRICS (OB) 11040767_1 CDM 0112 RC inpatient 1618 1051.7 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 1569.46 97 999999999 979.7 1569.46 percent of total billed charges ROOM & BOARD - PRIVATE (ONE BED) - OBSTETRICS (OB) 11040767_1 CDM 0112 RC inpatient 1618 1051.7 ENCORE - ALL PLANS ENCORE - ALL PLANS 1116.42 69 999999999 979.7 1569.46 percent of total billed charges ROOM & BOARD - PRIVATE (ONE BED) - OBSTETRICS (OB) 11040767_1 CDM 0112 RC inpatient 1618 1051.7 HUMANA - ALL PLANS HUMANA - ALL PLANS 1262.04 78 999999999 979.7 1569.46 percent of total billed charges ROOM & BOARD - PRIVATE (ONE BED) - OBSTETRICS (OB) 11040767_1 CDM 0112 RC inpatient 1618 1051.7 UMR - ALL PLANS UMR - ALL PLANS 1132.6 70 999999999 979.7 1569.46 percent of total billed charges ROOM & BOARD - PRIVATE (ONE BED) - OBSTETRICS (OB) 11040767_1 CDM 0112 RC inpatient 1618 1051.7 SIHO - ALL PLANS SIHO - ALL PLANS 1456.2 90 999999999 979.7 1569.46 percent of total billed charges ROOM & BOARD - PRIVATE (ONE BED) - OBSTETRICS (OB) 11040767_1 CDM 0112 RC inpatient 1618 1051.7 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 979.7 60.55 999999999 979.7 1569.46 percent of total billed charges ROOM & BOARD - PRIVATE (ONE BED) - OBSTETRICS (OB) 11040767_1 CDM 0112 RC inpatient 1618 1051.7 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 979.7 1569.46 ROOM & BOARD - PRIVATE (ONE BED) - OBSTETRICS (OB) 11040767_1 CDM 0112 RC inpatient 1618 1051.7 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 979.7 1569.46 ROOM & BOARD - PRIVATE (ONE BED) - OBSTETRICS (OB) 11040767_1 CDM 0112 RC inpatient 1618 1051.7 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 979.7 1569.46 ROOM & BOARD - PRIVATE (ONE BED) - OBSTETRICS (OB) 11040767_1 CDM 0112 RC inpatient 1618 1051.7 ANTHEM HMO ANTHEM HMO 999999999 979.7 1569.46 ROOM & BOARD - PRIVATE (ONE BED) - OBSTETRICS (OB) 11040767_1 CDM 0112 RC inpatient 1618 1051.7 UHC - ALL PLANS UHC - ALL PLANS 999999999 979.7 1569.46 ROOM & BOARD - PRIVATE (ONE BED) - OBSTETRICS (OB) 11040767_1 CDM 0112 RC inpatient 1618 1051.7 CIGNA - ALL PLANS CIGNA - ALL PLANS 1093.77 67.6 999999999 979.7 1569.46 percent of total billed charges "Red blood count automated, with additional calculations" 11040896_1 CDM 0305 RC 85046 HCPCS inpatient 142 92.3 AETNA AETNA 112.18 79 999999999 85.98 137.74 percent of total billed charges "Red blood count automated, with additional calculations" 11040896_1 CDM 0305 RC 85046 HCPCS inpatient 142 92.3 SELF PAY DISCOUNT SELF PAY DISCOUNT 92.3 65 999999999 85.98 137.74 percent of total billed charges "Red blood count automated, with additional calculations" 11040896_1 CDM 0305 RC 85046 HCPCS inpatient 142 92.3 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 137.74 97 999999999 85.98 137.74 percent of total billed charges "Red blood count automated, with additional calculations" 11040896_1 CDM 0305 RC 85046 HCPCS inpatient 142 92.3 ENCORE - ALL PLANS ENCORE - ALL PLANS 97.98 69 999999999 85.98 137.74 percent of total billed charges "Red blood count automated, with additional calculations" 11040896_1 CDM 0305 RC 85046 HCPCS inpatient 142 92.3 HUMANA - ALL PLANS HUMANA - ALL PLANS 110.76 78 999999999 85.98 137.74 percent of total billed charges "Red blood count automated, with additional calculations" 11040896_1 CDM 0305 RC 85046 HCPCS inpatient 142 92.3 UMR - ALL PLANS UMR - ALL PLANS 99.4 70 999999999 85.98 137.74 percent of total billed charges "Red blood count automated, with additional calculations" 11040896_1 CDM 0305 RC 85046 HCPCS inpatient 142 92.3 SIHO - ALL PLANS SIHO - ALL PLANS 127.8 90 999999999 85.98 137.74 percent of total billed charges "Red blood count automated, with additional calculations" 11040896_1 CDM 0305 RC 85046 HCPCS inpatient 142 92.3 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 85.98 60.55 999999999 85.98 137.74 percent of total billed charges "Red blood count automated, with additional calculations" 11040896_1 CDM 0305 RC 85046 HCPCS inpatient 142 92.3 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 85.98 137.74 "Red blood count automated, with additional calculations" 11040896_1 CDM 0305 RC 85046 HCPCS inpatient 142 92.3 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 85.98 137.74 "Red blood count automated, with additional calculations" 11040896_1 CDM 0305 RC 85046 HCPCS inpatient 142 92.3 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 85.98 137.74 "Red blood count automated, with additional calculations" 11040896_1 CDM 0305 RC 85046 HCPCS inpatient 142 92.3 ANTHEM HMO ANTHEM HMO 999999999 85.98 137.74 "Red blood count automated, with additional calculations" 11040896_1 CDM 0305 RC 85046 HCPCS inpatient 142 92.3 UHC - ALL PLANS UHC - ALL PLANS 999999999 85.98 137.74 "Red blood count automated, with additional calculations" 11040896_1 CDM 0305 RC 85046 HCPCS inpatient 142 92.3 CIGNA - ALL PLANS CIGNA - ALL PLANS 95.99 67.6 999999999 85.98 137.74 percent of total billed charges Application of lower and upper arm splint 11109095_1 CDM 0430 RC 29105 HCPCS inpatient 490 318.5 AETNA AETNA 387.1 79 999999999 296.7 475.3 percent of total billed charges Application of lower and upper arm splint 11109095_1 CDM 0430 RC 29105 HCPCS inpatient 490 318.5 SELF PAY DISCOUNT SELF PAY DISCOUNT 318.5 65 999999999 296.7 475.3 percent of total billed charges Application of lower and upper arm splint 11109095_1 CDM 0430 RC 29105 HCPCS inpatient 490 318.5 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 475.3 97 999999999 296.7 475.3 percent of total billed charges Application of lower and upper arm splint 11109095_1 CDM 0430 RC 29105 HCPCS inpatient 490 318.5 ENCORE - ALL PLANS ENCORE - ALL PLANS 338.1 69 999999999 296.7 475.3 percent of total billed charges Application of lower and upper arm splint 11109095_1 CDM 0430 RC 29105 HCPCS inpatient 490 318.5 HUMANA - ALL PLANS HUMANA - ALL PLANS 382.2 78 999999999 296.7 475.3 percent of total billed charges Application of lower and upper arm splint 11109095_1 CDM 0430 RC 29105 HCPCS inpatient 490 318.5 UMR - ALL PLANS UMR - ALL PLANS 343 70 999999999 296.7 475.3 percent of total billed charges Application of lower and upper arm splint 11109095_1 CDM 0430 RC 29105 HCPCS inpatient 490 318.5 SIHO - ALL PLANS SIHO - ALL PLANS 441 90 999999999 296.7 475.3 percent of total billed charges Application of lower and upper arm splint 11109095_1 CDM 0430 RC 29105 HCPCS inpatient 490 318.5 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 296.7 60.55 999999999 296.7 475.3 percent of total billed charges Application of lower and upper arm splint 11109095_1 CDM 0430 RC 29105 HCPCS inpatient 490 318.5 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 296.7 475.3 Application of lower and upper arm splint 11109095_1 CDM 0430 RC 29105 HCPCS inpatient 490 318.5 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 296.7 475.3 Application of lower and upper arm splint 11109095_1 CDM 0430 RC 29105 HCPCS inpatient 490 318.5 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 296.7 475.3 Application of lower and upper arm splint 11109095_1 CDM 0430 RC 29105 HCPCS inpatient 490 318.5 ANTHEM HMO ANTHEM HMO 999999999 296.7 475.3 Application of lower and upper arm splint 11109095_1 CDM 0430 RC 29105 HCPCS inpatient 490 318.5 UHC - ALL PLANS UHC - ALL PLANS 999999999 296.7 475.3 Application of lower and upper arm splint 11109095_1 CDM 0430 RC 29105 HCPCS inpatient 490 318.5 CIGNA - ALL PLANS CIGNA - ALL PLANS 331.24 67.6 999999999 296.7 475.3 percent of total billed charges Application of nonmoveable finger splint 11109098_1 CDM 0430 RC 29130 HCPCS inpatient 404 262.6 AETNA AETNA 319.16 79 999999999 244.62 391.88 percent of total billed charges Application of nonmoveable finger splint 11109098_1 CDM 0430 RC 29130 HCPCS inpatient 404 262.6 SELF PAY DISCOUNT SELF PAY DISCOUNT 262.6 65 999999999 244.62 391.88 percent of total billed charges Application of nonmoveable finger splint 11109098_1 CDM 0430 RC 29130 HCPCS inpatient 404 262.6 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 391.88 97 999999999 244.62 391.88 percent of total billed charges Application of nonmoveable finger splint 11109098_1 CDM 0430 RC 29130 HCPCS inpatient 404 262.6 ENCORE - ALL PLANS ENCORE - ALL PLANS 278.76 69 999999999 244.62 391.88 percent of total billed charges Application of nonmoveable finger splint 11109098_1 CDM 0430 RC 29130 HCPCS inpatient 404 262.6 HUMANA - ALL PLANS HUMANA - ALL PLANS 315.12 78 999999999 244.62 391.88 percent of total billed charges Application of nonmoveable finger splint 11109098_1 CDM 0430 RC 29130 HCPCS inpatient 404 262.6 UMR - ALL PLANS UMR - ALL PLANS 282.8 70 999999999 244.62 391.88 percent of total billed charges Application of nonmoveable finger splint 11109098_1 CDM 0430 RC 29130 HCPCS inpatient 404 262.6 SIHO - ALL PLANS SIHO - ALL PLANS 363.6 90 999999999 244.62 391.88 percent of total billed charges Application of nonmoveable finger splint 11109098_1 CDM 0430 RC 29130 HCPCS inpatient 404 262.6 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 244.62 60.55 999999999 244.62 391.88 percent of total billed charges Application of nonmoveable finger splint 11109098_1 CDM 0430 RC 29130 HCPCS inpatient 404 262.6 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 244.62 391.88 Application of nonmoveable finger splint 11109098_1 CDM 0430 RC 29130 HCPCS inpatient 404 262.6 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 244.62 391.88 Application of nonmoveable finger splint 11109098_1 CDM 0430 RC 29130 HCPCS inpatient 404 262.6 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 244.62 391.88 Application of nonmoveable finger splint 11109098_1 CDM 0430 RC 29130 HCPCS inpatient 404 262.6 ANTHEM HMO ANTHEM HMO 999999999 244.62 391.88 Application of nonmoveable finger splint 11109098_1 CDM 0430 RC 29130 HCPCS inpatient 404 262.6 UHC - ALL PLANS UHC - ALL PLANS 999999999 244.62 391.88 Application of nonmoveable finger splint 11109098_1 CDM 0430 RC 29130 HCPCS inpatient 404 262.6 CIGNA - ALL PLANS CIGNA - ALL PLANS 273.1 67.6 999999999 244.62 391.88 percent of total billed charges Evaluation of swallowing function image 11109125_1 CDM 0444 RC 92611 HCPCS inpatient 673 437.45 AETNA AETNA 531.67 79 999999999 407.5 652.81 percent of total billed charges Evaluation of swallowing function image 11109125_1 CDM 0444 RC 92611 HCPCS inpatient 673 437.45 SELF PAY DISCOUNT SELF PAY DISCOUNT 437.45 65 999999999 407.5 652.81 percent of total billed charges Evaluation of swallowing function image 11109125_1 CDM 0444 RC 92611 HCPCS inpatient 673 437.45 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 652.81 97 999999999 407.5 652.81 percent of total billed charges Evaluation of swallowing function image 11109125_1 CDM 0444 RC 92611 HCPCS inpatient 673 437.45 ENCORE - ALL PLANS ENCORE - ALL PLANS 464.37 69 999999999 407.5 652.81 percent of total billed charges Evaluation of swallowing function image 11109125_1 CDM 0444 RC 92611 HCPCS inpatient 673 437.45 HUMANA - ALL PLANS HUMANA - ALL PLANS 524.94 78 999999999 407.5 652.81 percent of total billed charges Evaluation of swallowing function image 11109125_1 CDM 0444 RC 92611 HCPCS inpatient 673 437.45 UMR - ALL PLANS UMR - ALL PLANS 471.1 70 999999999 407.5 652.81 percent of total billed charges Evaluation of swallowing function image 11109125_1 CDM 0444 RC 92611 HCPCS inpatient 673 437.45 SIHO - ALL PLANS SIHO - ALL PLANS 605.7 90 999999999 407.5 652.81 percent of total billed charges Evaluation of swallowing function image 11109125_1 CDM 0444 RC 92611 HCPCS inpatient 673 437.45 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 407.5 60.55 999999999 407.5 652.81 percent of total billed charges Evaluation of swallowing function image 11109125_1 CDM 0444 RC 92611 HCPCS inpatient 673 437.45 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 407.5 652.81 Evaluation of swallowing function image 11109125_1 CDM 0444 RC 92611 HCPCS inpatient 673 437.45 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 407.5 652.81 Evaluation of swallowing function image 11109125_1 CDM 0444 RC 92611 HCPCS inpatient 673 437.45 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 407.5 652.81 Evaluation of swallowing function image 11109125_1 CDM 0444 RC 92611 HCPCS inpatient 673 437.45 ANTHEM HMO ANTHEM HMO 999999999 407.5 652.81 Evaluation of swallowing function image 11109125_1 CDM 0444 RC 92611 HCPCS inpatient 673 437.45 UHC - ALL PLANS UHC - ALL PLANS 999999999 407.5 652.81 Evaluation of swallowing function image 11109125_1 CDM 0444 RC 92611 HCPCS inpatient 673 437.45 CIGNA - ALL PLANS CIGNA - ALL PLANS 454.95 67.6 999999999 407.5 652.81 percent of total billed charges Evaluation of use of breathing device 11201889_1 CDM 0460 RC 94664 HCPCS inpatient 175 113.75 AETNA AETNA 138.25 79 999999999 105.96 169.75 percent of total billed charges Evaluation of use of breathing device 11201889_1 CDM 0460 RC 94664 HCPCS inpatient 175 113.75 SELF PAY DISCOUNT SELF PAY DISCOUNT 113.75 65 999999999 105.96 169.75 percent of total billed charges Evaluation of use of breathing device 11201889_1 CDM 0460 RC 94664 HCPCS inpatient 175 113.75 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 169.75 97 999999999 105.96 169.75 percent of total billed charges Evaluation of use of breathing device 11201889_1 CDM 0460 RC 94664 HCPCS inpatient 175 113.75 ENCORE - ALL PLANS ENCORE - ALL PLANS 120.75 69 999999999 105.96 169.75 percent of total billed charges Evaluation of use of breathing device 11201889_1 CDM 0460 RC 94664 HCPCS inpatient 175 113.75 HUMANA - ALL PLANS HUMANA - ALL PLANS 136.5 78 999999999 105.96 169.75 percent of total billed charges Evaluation of use of breathing device 11201889_1 CDM 0460 RC 94664 HCPCS inpatient 175 113.75 UMR - ALL PLANS UMR - ALL PLANS 122.5 70 999999999 105.96 169.75 percent of total billed charges Evaluation of use of breathing device 11201889_1 CDM 0460 RC 94664 HCPCS inpatient 175 113.75 SIHO - ALL PLANS SIHO - ALL PLANS 157.5 90 999999999 105.96 169.75 percent of total billed charges Evaluation of use of breathing device 11201889_1 CDM 0460 RC 94664 HCPCS inpatient 175 113.75 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 105.96 60.55 999999999 105.96 169.75 percent of total billed charges Evaluation of use of breathing device 11201889_1 CDM 0460 RC 94664 HCPCS inpatient 175 113.75 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 105.96 169.75 Evaluation of use of breathing device 11201889_1 CDM 0460 RC 94664 HCPCS inpatient 175 113.75 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 105.96 169.75 Evaluation of use of breathing device 11201889_1 CDM 0460 RC 94664 HCPCS inpatient 175 113.75 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 105.96 169.75 Evaluation of use of breathing device 11201889_1 CDM 0460 RC 94664 HCPCS inpatient 175 113.75 ANTHEM HMO ANTHEM HMO 999999999 105.96 169.75 Evaluation of use of breathing device 11201889_1 CDM 0460 RC 94664 HCPCS inpatient 175 113.75 UHC - ALL PLANS UHC - ALL PLANS 999999999 105.96 169.75 Evaluation of use of breathing device 11201889_1 CDM 0460 RC 94664 HCPCS inpatient 175 113.75 CIGNA - ALL PLANS CIGNA - ALL PLANS 118.3 67.6 999999999 105.96 169.75 percent of total billed charges RT Continuous Neb Subsequent Charge 11201890_1 CDM 0460 RC inpatient 266 172.9 AETNA AETNA 210.14 79 999999999 161.06 258.02 percent of total billed charges RT Continuous Neb Subsequent Charge 11201890_1 CDM 0460 RC inpatient 266 172.9 SELF PAY DISCOUNT SELF PAY DISCOUNT 172.9 65 999999999 161.06 258.02 percent of total billed charges RT Continuous Neb Subsequent Charge 11201890_1 CDM 0460 RC inpatient 266 172.9 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 258.02 97 999999999 161.06 258.02 percent of total billed charges RT Continuous Neb Subsequent Charge 11201890_1 CDM 0460 RC inpatient 266 172.9 ENCORE - ALL PLANS ENCORE - ALL PLANS 183.54 69 999999999 161.06 258.02 percent of total billed charges RT Continuous Neb Subsequent Charge 11201890_1 CDM 0460 RC inpatient 266 172.9 HUMANA - ALL PLANS HUMANA - ALL PLANS 207.48 78 999999999 161.06 258.02 percent of total billed charges RT Continuous Neb Subsequent Charge 11201890_1 CDM 0460 RC inpatient 266 172.9 UMR - ALL PLANS UMR - ALL PLANS 186.2 70 999999999 161.06 258.02 percent of total billed charges RT Continuous Neb Subsequent Charge 11201890_1 CDM 0460 RC inpatient 266 172.9 SIHO - ALL PLANS SIHO - ALL PLANS 239.4 90 999999999 161.06 258.02 percent of total billed charges RT Continuous Neb Subsequent Charge 11201890_1 CDM 0460 RC inpatient 266 172.9 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 161.06 60.55 999999999 161.06 258.02 percent of total billed charges RT Continuous Neb Subsequent Charge 11201890_1 CDM 0460 RC inpatient 266 172.9 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 161.06 258.02 RT Continuous Neb Subsequent Charge 11201890_1 CDM 0460 RC inpatient 266 172.9 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 161.06 258.02 RT Continuous Neb Subsequent Charge 11201890_1 CDM 0460 RC inpatient 266 172.9 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 161.06 258.02 RT Continuous Neb Subsequent Charge 11201890_1 CDM 0460 RC inpatient 266 172.9 ANTHEM HMO ANTHEM HMO 999999999 161.06 258.02 RT Continuous Neb Subsequent Charge 11201890_1 CDM 0460 RC inpatient 266 172.9 UHC - ALL PLANS UHC - ALL PLANS 999999999 161.06 258.02 RT Continuous Neb Subsequent Charge 11201890_1 CDM 0460 RC inpatient 266 172.9 CIGNA - ALL PLANS CIGNA - ALL PLANS 179.82 67.6 999999999 161.06 258.02 percent of total billed charges Test to measure expiratory airflow and volume changes before and after medication administration 11201894_1 CDM 0410 RC 94060 HCPCS inpatient 441 286.65 AETNA AETNA 348.39 79 999999999 267.03 427.77 percent of total billed charges Test to measure expiratory airflow and volume changes before and after medication administration 11201894_1 CDM 0410 RC 94060 HCPCS inpatient 441 286.65 SELF PAY DISCOUNT SELF PAY DISCOUNT 286.65 65 999999999 267.03 427.77 percent of total billed charges Test to measure expiratory airflow and volume changes before and after medication administration 11201894_1 CDM 0410 RC 94060 HCPCS inpatient 441 286.65 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 427.77 97 999999999 267.03 427.77 percent of total billed charges Test to measure expiratory airflow and volume changes before and after medication administration 11201894_1 CDM 0410 RC 94060 HCPCS inpatient 441 286.65 ENCORE - ALL PLANS ENCORE - ALL PLANS 304.29 69 999999999 267.03 427.77 percent of total billed charges Test to measure expiratory airflow and volume changes before and after medication administration 11201894_1 CDM 0410 RC 94060 HCPCS inpatient 441 286.65 HUMANA - ALL PLANS HUMANA - ALL PLANS 343.98 78 999999999 267.03 427.77 percent of total billed charges Test to measure expiratory airflow and volume changes before and after medication administration 11201894_1 CDM 0410 RC 94060 HCPCS inpatient 441 286.65 UMR - ALL PLANS UMR - ALL PLANS 308.7 70 999999999 267.03 427.77 percent of total billed charges Test to measure expiratory airflow and volume changes before and after medication administration 11201894_1 CDM 0410 RC 94060 HCPCS inpatient 441 286.65 SIHO - ALL PLANS SIHO - ALL PLANS 396.9 90 999999999 267.03 427.77 percent of total billed charges Test to measure expiratory airflow and volume changes before and after medication administration 11201894_1 CDM 0410 RC 94060 HCPCS inpatient 441 286.65 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 267.03 60.55 999999999 267.03 427.77 percent of total billed charges Test to measure expiratory airflow and volume changes before and after medication administration 11201894_1 CDM 0410 RC 94060 HCPCS inpatient 441 286.65 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 267.03 427.77 Test to measure expiratory airflow and volume changes before and after medication administration 11201894_1 CDM 0410 RC 94060 HCPCS inpatient 441 286.65 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 267.03 427.77 Test to measure expiratory airflow and volume changes before and after medication administration 11201894_1 CDM 0410 RC 94060 HCPCS inpatient 441 286.65 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 267.03 427.77 Test to measure expiratory airflow and volume changes before and after medication administration 11201894_1 CDM 0410 RC 94060 HCPCS inpatient 441 286.65 ANTHEM HMO ANTHEM HMO 999999999 267.03 427.77 Test to measure expiratory airflow and volume changes before and after medication administration 11201894_1 CDM 0410 RC 94060 HCPCS inpatient 441 286.65 UHC - ALL PLANS UHC - ALL PLANS 999999999 267.03 427.77 Test to measure expiratory airflow and volume changes before and after medication administration 11201894_1 CDM 0410 RC 94060 HCPCS inpatient 441 286.65 CIGNA - ALL PLANS CIGNA - ALL PLANS 298.12 67.6 999999999 267.03 427.77 percent of total billed charges "X-ray of elbow, minimum of 3 views" 11287199_1 CDM 0320 RC 73080 HCPCS inpatient 430 279.5 AETNA AETNA 339.7 79 999999999 260.37 417.1 percent of total billed charges "X-ray of elbow, minimum of 3 views" 11287199_1 CDM 0320 RC 73080 HCPCS inpatient 430 279.5 SELF PAY DISCOUNT SELF PAY DISCOUNT 279.5 65 999999999 260.37 417.1 percent of total billed charges "X-ray of elbow, minimum of 3 views" 11287199_1 CDM 0320 RC 73080 HCPCS inpatient 430 279.5 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 417.1 97 999999999 260.37 417.1 percent of total billed charges "X-ray of elbow, minimum of 3 views" 11287199_1 CDM 0320 RC 73080 HCPCS inpatient 430 279.5 ENCORE - ALL PLANS ENCORE - ALL PLANS 296.7 69 999999999 260.37 417.1 percent of total billed charges "X-ray of elbow, minimum of 3 views" 11287199_1 CDM 0320 RC 73080 HCPCS inpatient 430 279.5 HUMANA - ALL PLANS HUMANA - ALL PLANS 335.4 78 999999999 260.37 417.1 percent of total billed charges "X-ray of elbow, minimum of 3 views" 11287199_1 CDM 0320 RC 73080 HCPCS inpatient 430 279.5 UMR - ALL PLANS UMR - ALL PLANS 301 70 999999999 260.37 417.1 percent of total billed charges "X-ray of elbow, minimum of 3 views" 11287199_1 CDM 0320 RC 73080 HCPCS inpatient 430 279.5 SIHO - ALL PLANS SIHO - ALL PLANS 387 90 999999999 260.37 417.1 percent of total billed charges "X-ray of elbow, minimum of 3 views" 11287199_1 CDM 0320 RC 73080 HCPCS inpatient 430 279.5 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 260.37 60.55 999999999 260.37 417.1 percent of total billed charges "X-ray of elbow, minimum of 3 views" 11287199_1 CDM 0320 RC 73080 HCPCS inpatient 430 279.5 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 260.37 417.1 "X-ray of elbow, minimum of 3 views" 11287199_1 CDM 0320 RC 73080 HCPCS inpatient 430 279.5 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 260.37 417.1 "X-ray of elbow, minimum of 3 views" 11287199_1 CDM 0320 RC 73080 HCPCS inpatient 430 279.5 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 260.37 417.1 "X-ray of elbow, minimum of 3 views" 11287199_1 CDM 0320 RC 73080 HCPCS inpatient 430 279.5 ANTHEM HMO ANTHEM HMO 999999999 260.37 417.1 "X-ray of elbow, minimum of 3 views" 11287199_1 CDM 0320 RC 73080 HCPCS inpatient 430 279.5 UHC - ALL PLANS UHC - ALL PLANS 999999999 260.37 417.1 "X-ray of elbow, minimum of 3 views" 11287199_1 CDM 0320 RC 73080 HCPCS inpatient 430 279.5 CIGNA - ALL PLANS CIGNA - ALL PLANS 290.68 67.6 999999999 260.37 417.1 percent of total billed charges "X-ray of elbow, minimum of 3 views" 11287202_1 CDM 0320 RC 73080 HCPCS inpatient 428 278.2 AETNA AETNA 338.12 79 999999999 259.15 415.16 percent of total billed charges "X-ray of elbow, minimum of 3 views" 11287202_1 CDM 0320 RC 73080 HCPCS inpatient 428 278.2 SELF PAY DISCOUNT SELF PAY DISCOUNT 278.2 65 999999999 259.15 415.16 percent of total billed charges "X-ray of elbow, minimum of 3 views" 11287202_1 CDM 0320 RC 73080 HCPCS inpatient 428 278.2 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 415.16 97 999999999 259.15 415.16 percent of total billed charges "X-ray of elbow, minimum of 3 views" 11287202_1 CDM 0320 RC 73080 HCPCS inpatient 428 278.2 ENCORE - ALL PLANS ENCORE - ALL PLANS 295.32 69 999999999 259.15 415.16 percent of total billed charges "X-ray of elbow, minimum of 3 views" 11287202_1 CDM 0320 RC 73080 HCPCS inpatient 428 278.2 HUMANA - ALL PLANS HUMANA - ALL PLANS 333.84 78 999999999 259.15 415.16 percent of total billed charges "X-ray of elbow, minimum of 3 views" 11287202_1 CDM 0320 RC 73080 HCPCS inpatient 428 278.2 UMR - ALL PLANS UMR - ALL PLANS 299.6 70 999999999 259.15 415.16 percent of total billed charges "X-ray of elbow, minimum of 3 views" 11287202_1 CDM 0320 RC 73080 HCPCS inpatient 428 278.2 SIHO - ALL PLANS SIHO - ALL PLANS 385.2 90 999999999 259.15 415.16 percent of total billed charges "X-ray of elbow, minimum of 3 views" 11287202_1 CDM 0320 RC 73080 HCPCS inpatient 428 278.2 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 259.15 60.55 999999999 259.15 415.16 percent of total billed charges "X-ray of elbow, minimum of 3 views" 11287202_1 CDM 0320 RC 73080 HCPCS inpatient 428 278.2 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 259.15 415.16 "X-ray of elbow, minimum of 3 views" 11287202_1 CDM 0320 RC 73080 HCPCS inpatient 428 278.2 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 259.15 415.16 "X-ray of elbow, minimum of 3 views" 11287202_1 CDM 0320 RC 73080 HCPCS inpatient 428 278.2 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 259.15 415.16 "X-ray of elbow, minimum of 3 views" 11287202_1 CDM 0320 RC 73080 HCPCS inpatient 428 278.2 ANTHEM HMO ANTHEM HMO 999999999 259.15 415.16 "X-ray of elbow, minimum of 3 views" 11287202_1 CDM 0320 RC 73080 HCPCS inpatient 428 278.2 UHC - ALL PLANS UHC - ALL PLANS 999999999 259.15 415.16 "X-ray of elbow, minimum of 3 views" 11287202_1 CDM 0320 RC 73080 HCPCS inpatient 428 278.2 CIGNA - ALL PLANS CIGNA - ALL PLANS 289.33 67.6 999999999 259.15 415.16 percent of total billed charges "Stool analysis for blood, by fecal hemoglobin determination by immunoassay" 11397016_1 CDM 0301 RC 82274 HCPCS inpatient 81 52.65 AETNA AETNA 63.99 79 999999999 49.05 78.57 percent of total billed charges "Stool analysis for blood, by fecal hemoglobin determination by immunoassay" 11397016_1 CDM 0301 RC 82274 HCPCS inpatient 81 52.65 SELF PAY DISCOUNT SELF PAY DISCOUNT 52.65 65 999999999 49.05 78.57 percent of total billed charges "Stool analysis for blood, by fecal hemoglobin determination by immunoassay" 11397016_1 CDM 0301 RC 82274 HCPCS inpatient 81 52.65 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 78.57 97 999999999 49.05 78.57 percent of total billed charges "Stool analysis for blood, by fecal hemoglobin determination by immunoassay" 11397016_1 CDM 0301 RC 82274 HCPCS inpatient 81 52.65 ENCORE - ALL PLANS ENCORE - ALL PLANS 55.89 69 999999999 49.05 78.57 percent of total billed charges "Stool analysis for blood, by fecal hemoglobin determination by immunoassay" 11397016_1 CDM 0301 RC 82274 HCPCS inpatient 81 52.65 HUMANA - ALL PLANS HUMANA - ALL PLANS 63.18 78 999999999 49.05 78.57 percent of total billed charges "Stool analysis for blood, by fecal hemoglobin determination by immunoassay" 11397016_1 CDM 0301 RC 82274 HCPCS inpatient 81 52.65 UMR - ALL PLANS UMR - ALL PLANS 56.7 70 999999999 49.05 78.57 percent of total billed charges "Stool analysis for blood, by fecal hemoglobin determination by immunoassay" 11397016_1 CDM 0301 RC 82274 HCPCS inpatient 81 52.65 SIHO - ALL PLANS SIHO - ALL PLANS 72.9 90 999999999 49.05 78.57 percent of total billed charges "Stool analysis for blood, by fecal hemoglobin determination by immunoassay" 11397016_1 CDM 0301 RC 82274 HCPCS inpatient 81 52.65 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 49.05 60.55 999999999 49.05 78.57 percent of total billed charges "Stool analysis for blood, by fecal hemoglobin determination by immunoassay" 11397016_1 CDM 0301 RC 82274 HCPCS inpatient 81 52.65 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 49.05 78.57 "Stool analysis for blood, by fecal hemoglobin determination by immunoassay" 11397016_1 CDM 0301 RC 82274 HCPCS inpatient 81 52.65 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 49.05 78.57 "Stool analysis for blood, by fecal hemoglobin determination by immunoassay" 11397016_1 CDM 0301 RC 82274 HCPCS inpatient 81 52.65 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 49.05 78.57 "Stool analysis for blood, by fecal hemoglobin determination by immunoassay" 11397016_1 CDM 0301 RC 82274 HCPCS inpatient 81 52.65 ANTHEM HMO ANTHEM HMO 999999999 49.05 78.57 "Stool analysis for blood, by fecal hemoglobin determination by immunoassay" 11397016_1 CDM 0301 RC 82274 HCPCS inpatient 81 52.65 UHC - ALL PLANS UHC - ALL PLANS 999999999 49.05 78.57 "Stool analysis for blood, by fecal hemoglobin determination by immunoassay" 11397016_1 CDM 0301 RC 82274 HCPCS inpatient 81 52.65 CIGNA - ALL PLANS CIGNA - ALL PLANS 54.76 67.6 999999999 49.05 78.57 percent of total billed charges Radioactive drug therapy by mouth 11408816_1 CDM 0342 RC 79005 HCPCS inpatient 2243 1457.95 AETNA AETNA 1771.97 79 999999999 1358.14 2175.71 percent of total billed charges Radioactive drug therapy by mouth 11408816_1 CDM 0342 RC 79005 HCPCS inpatient 2243 1457.95 SELF PAY DISCOUNT SELF PAY DISCOUNT 1457.95 65 999999999 1358.14 2175.71 percent of total billed charges Radioactive drug therapy by mouth 11408816_1 CDM 0342 RC 79005 HCPCS inpatient 2243 1457.95 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 2175.71 97 999999999 1358.14 2175.71 percent of total billed charges Radioactive drug therapy by mouth 11408816_1 CDM 0342 RC 79005 HCPCS inpatient 2243 1457.95 ENCORE - ALL PLANS ENCORE - ALL PLANS 1547.67 69 999999999 1358.14 2175.71 percent of total billed charges Radioactive drug therapy by mouth 11408816_1 CDM 0342 RC 79005 HCPCS inpatient 2243 1457.95 HUMANA - ALL PLANS HUMANA - ALL PLANS 1749.54 78 999999999 1358.14 2175.71 percent of total billed charges Radioactive drug therapy by mouth 11408816_1 CDM 0342 RC 79005 HCPCS inpatient 2243 1457.95 UMR - ALL PLANS UMR - ALL PLANS 1570.1 70 999999999 1358.14 2175.71 percent of total billed charges Radioactive drug therapy by mouth 11408816_1 CDM 0342 RC 79005 HCPCS inpatient 2243 1457.95 SIHO - ALL PLANS SIHO - ALL PLANS 2018.7 90 999999999 1358.14 2175.71 percent of total billed charges Radioactive drug therapy by mouth 11408816_1 CDM 0342 RC 79005 HCPCS inpatient 2243 1457.95 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1358.14 60.55 999999999 1358.14 2175.71 percent of total billed charges Radioactive drug therapy by mouth 11408816_1 CDM 0342 RC 79005 HCPCS inpatient 2243 1457.95 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1358.14 2175.71 Radioactive drug therapy by mouth 11408816_1 CDM 0342 RC 79005 HCPCS inpatient 2243 1457.95 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1358.14 2175.71 Radioactive drug therapy by mouth 11408816_1 CDM 0342 RC 79005 HCPCS inpatient 2243 1457.95 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1358.14 2175.71 Radioactive drug therapy by mouth 11408816_1 CDM 0342 RC 79005 HCPCS inpatient 2243 1457.95 ANTHEM HMO ANTHEM HMO 999999999 1358.14 2175.71 Radioactive drug therapy by mouth 11408816_1 CDM 0342 RC 79005 HCPCS inpatient 2243 1457.95 UHC - ALL PLANS UHC - ALL PLANS 999999999 1358.14 2175.71 Radioactive drug therapy by mouth 11408816_1 CDM 0342 RC 79005 HCPCS inpatient 2243 1457.95 CIGNA - ALL PLANS CIGNA - ALL PLANS 1516.27 67.6 999999999 1358.14 2175.71 percent of total billed charges "Calcium level, total" 11444643_1 CDM 0300 RC 82310 HCPCS inpatient 164 106.6 AETNA AETNA 129.56 79 999999999 99.3 159.08 percent of total billed charges "Calcium level, total" 11444643_1 CDM 0300 RC 82310 HCPCS inpatient 164 106.6 SELF PAY DISCOUNT SELF PAY DISCOUNT 106.6 65 999999999 99.3 159.08 percent of total billed charges "Calcium level, total" 11444643_1 CDM 0300 RC 82310 HCPCS inpatient 164 106.6 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 159.08 97 999999999 99.3 159.08 percent of total billed charges "Calcium level, total" 11444643_1 CDM 0300 RC 82310 HCPCS inpatient 164 106.6 ENCORE - ALL PLANS ENCORE - ALL PLANS 113.16 69 999999999 99.3 159.08 percent of total billed charges "Calcium level, total" 11444643_1 CDM 0300 RC 82310 HCPCS inpatient 164 106.6 HUMANA - ALL PLANS HUMANA - ALL PLANS 127.92 78 999999999 99.3 159.08 percent of total billed charges "Calcium level, total" 11444643_1 CDM 0300 RC 82310 HCPCS inpatient 164 106.6 UMR - ALL PLANS UMR - ALL PLANS 114.8 70 999999999 99.3 159.08 percent of total billed charges "Calcium level, total" 11444643_1 CDM 0300 RC 82310 HCPCS inpatient 164 106.6 SIHO - ALL PLANS SIHO - ALL PLANS 147.6 90 999999999 99.3 159.08 percent of total billed charges "Calcium level, total" 11444643_1 CDM 0300 RC 82310 HCPCS inpatient 164 106.6 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 99.3 60.55 999999999 99.3 159.08 percent of total billed charges "Calcium level, total" 11444643_1 CDM 0300 RC 82310 HCPCS inpatient 164 106.6 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 99.3 159.08 "Calcium level, total" 11444643_1 CDM 0300 RC 82310 HCPCS inpatient 164 106.6 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 99.3 159.08 "Calcium level, total" 11444643_1 CDM 0300 RC 82310 HCPCS inpatient 164 106.6 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 99.3 159.08 "Calcium level, total" 11444643_1 CDM 0300 RC 82310 HCPCS inpatient 164 106.6 ANTHEM HMO ANTHEM HMO 999999999 99.3 159.08 "Calcium level, total" 11444643_1 CDM 0300 RC 82310 HCPCS inpatient 164 106.6 UHC - ALL PLANS UHC - ALL PLANS 999999999 99.3 159.08 "Calcium level, total" 11444643_1 CDM 0300 RC 82310 HCPCS inpatient 164 106.6 CIGNA - ALL PLANS CIGNA - ALL PLANS 110.86 67.6 999999999 99.3 159.08 percent of total billed charges "Creatine kinase (cardiac enzyme) level, total" 11473584_1 CDM 0301 RC 82550 HCPCS inpatient 80 52 AETNA AETNA 63.2 79 999999999 48.44 77.6 percent of total billed charges "Creatine kinase (cardiac enzyme) level, total" 11473584_1 CDM 0301 RC 82550 HCPCS inpatient 80 52 SELF PAY DISCOUNT SELF PAY DISCOUNT 52 65 999999999 48.44 77.6 percent of total billed charges "Creatine kinase (cardiac enzyme) level, total" 11473584_1 CDM 0301 RC 82550 HCPCS inpatient 80 52 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 77.6 97 999999999 48.44 77.6 percent of total billed charges "Creatine kinase (cardiac enzyme) level, total" 11473584_1 CDM 0301 RC 82550 HCPCS inpatient 80 52 ENCORE - ALL PLANS ENCORE - ALL PLANS 55.2 69 999999999 48.44 77.6 percent of total billed charges "Creatine kinase (cardiac enzyme) level, total" 11473584_1 CDM 0301 RC 82550 HCPCS inpatient 80 52 HUMANA - ALL PLANS HUMANA - ALL PLANS 62.4 78 999999999 48.44 77.6 percent of total billed charges "Creatine kinase (cardiac enzyme) level, total" 11473584_1 CDM 0301 RC 82550 HCPCS inpatient 80 52 UMR - ALL PLANS UMR - ALL PLANS 56 70 999999999 48.44 77.6 percent of total billed charges "Creatine kinase (cardiac enzyme) level, total" 11473584_1 CDM 0301 RC 82550 HCPCS inpatient 80 52 SIHO - ALL PLANS SIHO - ALL PLANS 72 90 999999999 48.44 77.6 percent of total billed charges "Creatine kinase (cardiac enzyme) level, total" 11473584_1 CDM 0301 RC 82550 HCPCS inpatient 80 52 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 48.44 60.55 999999999 48.44 77.6 percent of total billed charges "Creatine kinase (cardiac enzyme) level, total" 11473584_1 CDM 0301 RC 82550 HCPCS inpatient 80 52 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 48.44 77.6 "Creatine kinase (cardiac enzyme) level, total" 11473584_1 CDM 0301 RC 82550 HCPCS inpatient 80 52 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 48.44 77.6 "Creatine kinase (cardiac enzyme) level, total" 11473584_1 CDM 0301 RC 82550 HCPCS inpatient 80 52 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 48.44 77.6 "Creatine kinase (cardiac enzyme) level, total" 11473584_1 CDM 0301 RC 82550 HCPCS inpatient 80 52 ANTHEM HMO ANTHEM HMO 999999999 48.44 77.6 "Creatine kinase (cardiac enzyme) level, total" 11473584_1 CDM 0301 RC 82550 HCPCS inpatient 80 52 UHC - ALL PLANS UHC - ALL PLANS 999999999 48.44 77.6 "Creatine kinase (cardiac enzyme) level, total" 11473584_1 CDM 0301 RC 82550 HCPCS inpatient 80 52 CIGNA - ALL PLANS CIGNA - ALL PLANS 54.08 67.6 999999999 48.44 77.6 percent of total billed charges Hepatitis B core antibody measurement 11542345_1 CDM 0301 RC 86704 HCPCS inpatient 76 49.4 AETNA AETNA 60.04 79 999999999 46.02 73.72 percent of total billed charges Hepatitis B core antibody measurement 11542345_1 CDM 0301 RC 86704 HCPCS inpatient 76 49.4 SELF PAY DISCOUNT SELF PAY DISCOUNT 49.4 65 999999999 46.02 73.72 percent of total billed charges Hepatitis B core antibody measurement 11542345_1 CDM 0301 RC 86704 HCPCS inpatient 76 49.4 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 73.72 97 999999999 46.02 73.72 percent of total billed charges Hepatitis B core antibody measurement 11542345_1 CDM 0301 RC 86704 HCPCS inpatient 76 49.4 ENCORE - ALL PLANS ENCORE - ALL PLANS 52.44 69 999999999 46.02 73.72 percent of total billed charges Hepatitis B core antibody measurement 11542345_1 CDM 0301 RC 86704 HCPCS inpatient 76 49.4 HUMANA - ALL PLANS HUMANA - ALL PLANS 59.28 78 999999999 46.02 73.72 percent of total billed charges Hepatitis B core antibody measurement 11542345_1 CDM 0301 RC 86704 HCPCS inpatient 76 49.4 UMR - ALL PLANS UMR - ALL PLANS 53.2 70 999999999 46.02 73.72 percent of total billed charges Hepatitis B core antibody measurement 11542345_1 CDM 0301 RC 86704 HCPCS inpatient 76 49.4 SIHO - ALL PLANS SIHO - ALL PLANS 68.4 90 999999999 46.02 73.72 percent of total billed charges Hepatitis B core antibody measurement 11542345_1 CDM 0301 RC 86704 HCPCS inpatient 76 49.4 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 46.02 60.55 999999999 46.02 73.72 percent of total billed charges Hepatitis B core antibody measurement 11542345_1 CDM 0301 RC 86704 HCPCS inpatient 76 49.4 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 46.02 73.72 Hepatitis B core antibody measurement 11542345_1 CDM 0301 RC 86704 HCPCS inpatient 76 49.4 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 46.02 73.72 Hepatitis B core antibody measurement 11542345_1 CDM 0301 RC 86704 HCPCS inpatient 76 49.4 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 46.02 73.72 Hepatitis B core antibody measurement 11542345_1 CDM 0301 RC 86704 HCPCS inpatient 76 49.4 ANTHEM HMO ANTHEM HMO 999999999 46.02 73.72 Hepatitis B core antibody measurement 11542345_1 CDM 0301 RC 86704 HCPCS inpatient 76 49.4 UHC - ALL PLANS UHC - ALL PLANS 999999999 46.02 73.72 Hepatitis B core antibody measurement 11542345_1 CDM 0301 RC 86704 HCPCS inpatient 76 49.4 CIGNA - ALL PLANS CIGNA - ALL PLANS 51.38 67.6 999999999 46.02 73.72 percent of total billed charges Application of nonmoveable forearm to hand splint 12061393_1 CDM 0430 RC 29125 HCPCS inpatient 404 262.6 AETNA AETNA 319.16 79 999999999 244.62 391.88 percent of total billed charges Application of nonmoveable forearm to hand splint 12061393_1 CDM 0430 RC 29125 HCPCS inpatient 404 262.6 SELF PAY DISCOUNT SELF PAY DISCOUNT 262.6 65 999999999 244.62 391.88 percent of total billed charges Application of nonmoveable forearm to hand splint 12061393_1 CDM 0430 RC 29125 HCPCS inpatient 404 262.6 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 391.88 97 999999999 244.62 391.88 percent of total billed charges Application of nonmoveable forearm to hand splint 12061393_1 CDM 0430 RC 29125 HCPCS inpatient 404 262.6 ENCORE - ALL PLANS ENCORE - ALL PLANS 278.76 69 999999999 244.62 391.88 percent of total billed charges Application of nonmoveable forearm to hand splint 12061393_1 CDM 0430 RC 29125 HCPCS inpatient 404 262.6 HUMANA - ALL PLANS HUMANA - ALL PLANS 315.12 78 999999999 244.62 391.88 percent of total billed charges Application of nonmoveable forearm to hand splint 12061393_1 CDM 0430 RC 29125 HCPCS inpatient 404 262.6 UMR - ALL PLANS UMR - ALL PLANS 282.8 70 999999999 244.62 391.88 percent of total billed charges Application of nonmoveable forearm to hand splint 12061393_1 CDM 0430 RC 29125 HCPCS inpatient 404 262.6 SIHO - ALL PLANS SIHO - ALL PLANS 363.6 90 999999999 244.62 391.88 percent of total billed charges Application of nonmoveable forearm to hand splint 12061393_1 CDM 0430 RC 29125 HCPCS inpatient 404 262.6 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 244.62 60.55 999999999 244.62 391.88 percent of total billed charges Application of nonmoveable forearm to hand splint 12061393_1 CDM 0430 RC 29125 HCPCS inpatient 404 262.6 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 244.62 391.88 Application of nonmoveable forearm to hand splint 12061393_1 CDM 0430 RC 29125 HCPCS inpatient 404 262.6 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 244.62 391.88 Application of nonmoveable forearm to hand splint 12061393_1 CDM 0430 RC 29125 HCPCS inpatient 404 262.6 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 244.62 391.88 Application of nonmoveable forearm to hand splint 12061393_1 CDM 0430 RC 29125 HCPCS inpatient 404 262.6 ANTHEM HMO ANTHEM HMO 999999999 244.62 391.88 Application of nonmoveable forearm to hand splint 12061393_1 CDM 0430 RC 29125 HCPCS inpatient 404 262.6 UHC - ALL PLANS UHC - ALL PLANS 999999999 244.62 391.88 Application of nonmoveable forearm to hand splint 12061393_1 CDM 0430 RC 29125 HCPCS inpatient 404 262.6 CIGNA - ALL PLANS CIGNA - ALL PLANS 273.1 67.6 999999999 244.62 391.88 percent of total billed charges Application of moveable or hinged forearm to hand splint 12061394_1 CDM 0430 RC 29126 HCPCS inpatient 336 218.4 AETNA AETNA 265.44 79 999999999 203.45 325.92 percent of total billed charges Application of moveable or hinged forearm to hand splint 12061394_1 CDM 0430 RC 29126 HCPCS inpatient 336 218.4 SELF PAY DISCOUNT SELF PAY DISCOUNT 218.4 65 999999999 203.45 325.92 percent of total billed charges Application of moveable or hinged forearm to hand splint 12061394_1 CDM 0430 RC 29126 HCPCS inpatient 336 218.4 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 325.92 97 999999999 203.45 325.92 percent of total billed charges Application of moveable or hinged forearm to hand splint 12061394_1 CDM 0430 RC 29126 HCPCS inpatient 336 218.4 ENCORE - ALL PLANS ENCORE - ALL PLANS 231.84 69 999999999 203.45 325.92 percent of total billed charges Application of moveable or hinged forearm to hand splint 12061394_1 CDM 0430 RC 29126 HCPCS inpatient 336 218.4 HUMANA - ALL PLANS HUMANA - ALL PLANS 262.08 78 999999999 203.45 325.92 percent of total billed charges Application of moveable or hinged forearm to hand splint 12061394_1 CDM 0430 RC 29126 HCPCS inpatient 336 218.4 UMR - ALL PLANS UMR - ALL PLANS 235.2 70 999999999 203.45 325.92 percent of total billed charges Application of moveable or hinged forearm to hand splint 12061394_1 CDM 0430 RC 29126 HCPCS inpatient 336 218.4 SIHO - ALL PLANS SIHO - ALL PLANS 302.4 90 999999999 203.45 325.92 percent of total billed charges Application of moveable or hinged forearm to hand splint 12061394_1 CDM 0430 RC 29126 HCPCS inpatient 336 218.4 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 203.45 60.55 999999999 203.45 325.92 percent of total billed charges Application of moveable or hinged forearm to hand splint 12061394_1 CDM 0430 RC 29126 HCPCS inpatient 336 218.4 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 203.45 325.92 Application of moveable or hinged forearm to hand splint 12061394_1 CDM 0430 RC 29126 HCPCS inpatient 336 218.4 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 203.45 325.92 Application of moveable or hinged forearm to hand splint 12061394_1 CDM 0430 RC 29126 HCPCS inpatient 336 218.4 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 203.45 325.92 Application of moveable or hinged forearm to hand splint 12061394_1 CDM 0430 RC 29126 HCPCS inpatient 336 218.4 ANTHEM HMO ANTHEM HMO 999999999 203.45 325.92 Application of moveable or hinged forearm to hand splint 12061394_1 CDM 0430 RC 29126 HCPCS inpatient 336 218.4 UHC - ALL PLANS UHC - ALL PLANS 999999999 203.45 325.92 Application of moveable or hinged forearm to hand splint 12061394_1 CDM 0430 RC 29126 HCPCS inpatient 336 218.4 CIGNA - ALL PLANS CIGNA - ALL PLANS 227.14 67.6 999999999 203.45 325.92 percent of total billed charges Creatinine level to test for kidney function or muscle injury 12166925_1 CDM 0301 RC 82570 HCPCS inpatient 195 126.75 AETNA AETNA 154.05 79 999999999 118.07 189.15 percent of total billed charges Creatinine level to test for kidney function or muscle injury 12166925_1 CDM 0301 RC 82570 HCPCS inpatient 195 126.75 SELF PAY DISCOUNT SELF PAY DISCOUNT 126.75 65 999999999 118.07 189.15 percent of total billed charges Creatinine level to test for kidney function or muscle injury 12166925_1 CDM 0301 RC 82570 HCPCS inpatient 195 126.75 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 189.15 97 999999999 118.07 189.15 percent of total billed charges Creatinine level to test for kidney function or muscle injury 12166925_1 CDM 0301 RC 82570 HCPCS inpatient 195 126.75 ENCORE - ALL PLANS ENCORE - ALL PLANS 134.55 69 999999999 118.07 189.15 percent of total billed charges Creatinine level to test for kidney function or muscle injury 12166925_1 CDM 0301 RC 82570 HCPCS inpatient 195 126.75 HUMANA - ALL PLANS HUMANA - ALL PLANS 152.1 78 999999999 118.07 189.15 percent of total billed charges Creatinine level to test for kidney function or muscle injury 12166925_1 CDM 0301 RC 82570 HCPCS inpatient 195 126.75 UMR - ALL PLANS UMR - ALL PLANS 136.5 70 999999999 118.07 189.15 percent of total billed charges Creatinine level to test for kidney function or muscle injury 12166925_1 CDM 0301 RC 82570 HCPCS inpatient 195 126.75 SIHO - ALL PLANS SIHO - ALL PLANS 175.5 90 999999999 118.07 189.15 percent of total billed charges Creatinine level to test for kidney function or muscle injury 12166925_1 CDM 0301 RC 82570 HCPCS inpatient 195 126.75 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 118.07 60.55 999999999 118.07 189.15 percent of total billed charges Creatinine level to test for kidney function or muscle injury 12166925_1 CDM 0301 RC 82570 HCPCS inpatient 195 126.75 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 118.07 189.15 Creatinine level to test for kidney function or muscle injury 12166925_1 CDM 0301 RC 82570 HCPCS inpatient 195 126.75 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 118.07 189.15 Creatinine level to test for kidney function or muscle injury 12166925_1 CDM 0301 RC 82570 HCPCS inpatient 195 126.75 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 118.07 189.15 Creatinine level to test for kidney function or muscle injury 12166925_1 CDM 0301 RC 82570 HCPCS inpatient 195 126.75 ANTHEM HMO ANTHEM HMO 999999999 118.07 189.15 Creatinine level to test for kidney function or muscle injury 12166925_1 CDM 0301 RC 82570 HCPCS inpatient 195 126.75 UHC - ALL PLANS UHC - ALL PLANS 999999999 118.07 189.15 Creatinine level to test for kidney function or muscle injury 12166925_1 CDM 0301 RC 82570 HCPCS inpatient 195 126.75 CIGNA - ALL PLANS CIGNA - ALL PLANS 131.82 67.6 999999999 118.07 189.15 percent of total billed charges Urine microalbumin (protein) level 12182921_1 CDM 0301 RC 82043 HCPCS inpatient 92 59.8 AETNA AETNA 72.68 79 999999999 55.71 89.24 percent of total billed charges Urine microalbumin (protein) level 12182921_1 CDM 0301 RC 82043 HCPCS inpatient 92 59.8 SELF PAY DISCOUNT SELF PAY DISCOUNT 59.8 65 999999999 55.71 89.24 percent of total billed charges Urine microalbumin (protein) level 12182921_1 CDM 0301 RC 82043 HCPCS inpatient 92 59.8 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 89.24 97 999999999 55.71 89.24 percent of total billed charges Urine microalbumin (protein) level 12182921_1 CDM 0301 RC 82043 HCPCS inpatient 92 59.8 ENCORE - ALL PLANS ENCORE - ALL PLANS 63.48 69 999999999 55.71 89.24 percent of total billed charges Urine microalbumin (protein) level 12182921_1 CDM 0301 RC 82043 HCPCS inpatient 92 59.8 HUMANA - ALL PLANS HUMANA - ALL PLANS 71.76 78 999999999 55.71 89.24 percent of total billed charges Urine microalbumin (protein) level 12182921_1 CDM 0301 RC 82043 HCPCS inpatient 92 59.8 UMR - ALL PLANS UMR - ALL PLANS 64.4 70 999999999 55.71 89.24 percent of total billed charges Urine microalbumin (protein) level 12182921_1 CDM 0301 RC 82043 HCPCS inpatient 92 59.8 SIHO - ALL PLANS SIHO - ALL PLANS 82.8 90 999999999 55.71 89.24 percent of total billed charges Urine microalbumin (protein) level 12182921_1 CDM 0301 RC 82043 HCPCS inpatient 92 59.8 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 55.71 60.55 999999999 55.71 89.24 percent of total billed charges Urine microalbumin (protein) level 12182921_1 CDM 0301 RC 82043 HCPCS inpatient 92 59.8 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 55.71 89.24 Urine microalbumin (protein) level 12182921_1 CDM 0301 RC 82043 HCPCS inpatient 92 59.8 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 55.71 89.24 Urine microalbumin (protein) level 12182921_1 CDM 0301 RC 82043 HCPCS inpatient 92 59.8 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 55.71 89.24 Urine microalbumin (protein) level 12182921_1 CDM 0301 RC 82043 HCPCS inpatient 92 59.8 ANTHEM HMO ANTHEM HMO 999999999 55.71 89.24 Urine microalbumin (protein) level 12182921_1 CDM 0301 RC 82043 HCPCS inpatient 92 59.8 UHC - ALL PLANS UHC - ALL PLANS 999999999 55.71 89.24 Urine microalbumin (protein) level 12182921_1 CDM 0301 RC 82043 HCPCS inpatient 92 59.8 CIGNA - ALL PLANS CIGNA - ALL PLANS 62.19 67.6 999999999 55.71 89.24 percent of total billed charges Evaluation of use of breathing device 12436883_1 CDM 0410 RC 94664 HCPCS inpatient 239 155.35 AETNA AETNA 188.81 79 999999999 144.71 231.83 percent of total billed charges Evaluation of use of breathing device 12436883_1 CDM 0410 RC 94664 HCPCS inpatient 239 155.35 SELF PAY DISCOUNT SELF PAY DISCOUNT 155.35 65 999999999 144.71 231.83 percent of total billed charges Evaluation of use of breathing device 12436883_1 CDM 0410 RC 94664 HCPCS inpatient 239 155.35 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 231.83 97 999999999 144.71 231.83 percent of total billed charges Evaluation of use of breathing device 12436883_1 CDM 0410 RC 94664 HCPCS inpatient 239 155.35 ENCORE - ALL PLANS ENCORE - ALL PLANS 164.91 69 999999999 144.71 231.83 percent of total billed charges Evaluation of use of breathing device 12436883_1 CDM 0410 RC 94664 HCPCS inpatient 239 155.35 HUMANA - ALL PLANS HUMANA - ALL PLANS 186.42 78 999999999 144.71 231.83 percent of total billed charges Evaluation of use of breathing device 12436883_1 CDM 0410 RC 94664 HCPCS inpatient 239 155.35 UMR - ALL PLANS UMR - ALL PLANS 167.3 70 999999999 144.71 231.83 percent of total billed charges Evaluation of use of breathing device 12436883_1 CDM 0410 RC 94664 HCPCS inpatient 239 155.35 SIHO - ALL PLANS SIHO - ALL PLANS 215.1 90 999999999 144.71 231.83 percent of total billed charges Evaluation of use of breathing device 12436883_1 CDM 0410 RC 94664 HCPCS inpatient 239 155.35 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 144.71 60.55 999999999 144.71 231.83 percent of total billed charges Evaluation of use of breathing device 12436883_1 CDM 0410 RC 94664 HCPCS inpatient 239 155.35 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 144.71 231.83 Evaluation of use of breathing device 12436883_1 CDM 0410 RC 94664 HCPCS inpatient 239 155.35 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 144.71 231.83 Evaluation of use of breathing device 12436883_1 CDM 0410 RC 94664 HCPCS inpatient 239 155.35 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 144.71 231.83 Evaluation of use of breathing device 12436883_1 CDM 0410 RC 94664 HCPCS inpatient 239 155.35 ANTHEM HMO ANTHEM HMO 999999999 144.71 231.83 Evaluation of use of breathing device 12436883_1 CDM 0410 RC 94664 HCPCS inpatient 239 155.35 UHC - ALL PLANS UHC - ALL PLANS 999999999 144.71 231.83 Evaluation of use of breathing device 12436883_1 CDM 0410 RC 94664 HCPCS inpatient 239 155.35 CIGNA - ALL PLANS CIGNA - ALL PLANS 161.56 67.6 999999999 144.71 231.83 percent of total billed charges Inhalation treatment for airway obstruction or sputum production 12436884_1 CDM 0410 RC 94640 HCPCS inpatient 231 150.15 AETNA AETNA 182.49 79 999999999 139.87 224.07 percent of total billed charges Inhalation treatment for airway obstruction or sputum production 12436884_1 CDM 0410 RC 94640 HCPCS inpatient 231 150.15 SELF PAY DISCOUNT SELF PAY DISCOUNT 150.15 65 999999999 139.87 224.07 percent of total billed charges Inhalation treatment for airway obstruction or sputum production 12436884_1 CDM 0410 RC 94640 HCPCS inpatient 231 150.15 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 224.07 97 999999999 139.87 224.07 percent of total billed charges Inhalation treatment for airway obstruction or sputum production 12436884_1 CDM 0410 RC 94640 HCPCS inpatient 231 150.15 ENCORE - ALL PLANS ENCORE - ALL PLANS 159.39 69 999999999 139.87 224.07 percent of total billed charges Inhalation treatment for airway obstruction or sputum production 12436884_1 CDM 0410 RC 94640 HCPCS inpatient 231 150.15 HUMANA - ALL PLANS HUMANA - ALL PLANS 180.18 78 999999999 139.87 224.07 percent of total billed charges Inhalation treatment for airway obstruction or sputum production 12436884_1 CDM 0410 RC 94640 HCPCS inpatient 231 150.15 UMR - ALL PLANS UMR - ALL PLANS 161.7 70 999999999 139.87 224.07 percent of total billed charges Inhalation treatment for airway obstruction or sputum production 12436884_1 CDM 0410 RC 94640 HCPCS inpatient 231 150.15 SIHO - ALL PLANS SIHO - ALL PLANS 207.9 90 999999999 139.87 224.07 percent of total billed charges Inhalation treatment for airway obstruction or sputum production 12436884_1 CDM 0410 RC 94640 HCPCS inpatient 231 150.15 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 139.87 60.55 999999999 139.87 224.07 percent of total billed charges Inhalation treatment for airway obstruction or sputum production 12436884_1 CDM 0410 RC 94640 HCPCS inpatient 231 150.15 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 139.87 224.07 Inhalation treatment for airway obstruction or sputum production 12436884_1 CDM 0410 RC 94640 HCPCS inpatient 231 150.15 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 139.87 224.07 Inhalation treatment for airway obstruction or sputum production 12436884_1 CDM 0410 RC 94640 HCPCS inpatient 231 150.15 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 139.87 224.07 Inhalation treatment for airway obstruction or sputum production 12436884_1 CDM 0410 RC 94640 HCPCS inpatient 231 150.15 ANTHEM HMO ANTHEM HMO 999999999 139.87 224.07 Inhalation treatment for airway obstruction or sputum production 12436884_1 CDM 0410 RC 94640 HCPCS inpatient 231 150.15 UHC - ALL PLANS UHC - ALL PLANS 999999999 139.87 224.07 Inhalation treatment for airway obstruction or sputum production 12436884_1 CDM 0410 RC 94640 HCPCS inpatient 231 150.15 CIGNA - ALL PLANS CIGNA - ALL PLANS 156.16 67.6 999999999 139.87 224.07 percent of total billed charges Inhalation treatment for airway obstruction or sputum production 12436889_1 CDM 0410 RC 94640 HCPCS inpatient 231 150.15 AETNA AETNA 182.49 79 999999999 139.87 224.07 percent of total billed charges Inhalation treatment for airway obstruction or sputum production 12436889_1 CDM 0410 RC 94640 HCPCS inpatient 231 150.15 SELF PAY DISCOUNT SELF PAY DISCOUNT 150.15 65 999999999 139.87 224.07 percent of total billed charges Inhalation treatment for airway obstruction or sputum production 12436889_1 CDM 0410 RC 94640 HCPCS inpatient 231 150.15 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 224.07 97 999999999 139.87 224.07 percent of total billed charges Inhalation treatment for airway obstruction or sputum production 12436889_1 CDM 0410 RC 94640 HCPCS inpatient 231 150.15 ENCORE - ALL PLANS ENCORE - ALL PLANS 159.39 69 999999999 139.87 224.07 percent of total billed charges Inhalation treatment for airway obstruction or sputum production 12436889_1 CDM 0410 RC 94640 HCPCS inpatient 231 150.15 HUMANA - ALL PLANS HUMANA - ALL PLANS 180.18 78 999999999 139.87 224.07 percent of total billed charges Inhalation treatment for airway obstruction or sputum production 12436889_1 CDM 0410 RC 94640 HCPCS inpatient 231 150.15 UMR - ALL PLANS UMR - ALL PLANS 161.7 70 999999999 139.87 224.07 percent of total billed charges Inhalation treatment for airway obstruction or sputum production 12436889_1 CDM 0410 RC 94640 HCPCS inpatient 231 150.15 SIHO - ALL PLANS SIHO - ALL PLANS 207.9 90 999999999 139.87 224.07 percent of total billed charges Inhalation treatment for airway obstruction or sputum production 12436889_1 CDM 0410 RC 94640 HCPCS inpatient 231 150.15 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 139.87 60.55 999999999 139.87 224.07 percent of total billed charges Inhalation treatment for airway obstruction or sputum production 12436889_1 CDM 0410 RC 94640 HCPCS inpatient 231 150.15 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 139.87 224.07 Inhalation treatment for airway obstruction or sputum production 12436889_1 CDM 0410 RC 94640 HCPCS inpatient 231 150.15 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 139.87 224.07 Inhalation treatment for airway obstruction or sputum production 12436889_1 CDM 0410 RC 94640 HCPCS inpatient 231 150.15 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 139.87 224.07 Inhalation treatment for airway obstruction or sputum production 12436889_1 CDM 0410 RC 94640 HCPCS inpatient 231 150.15 ANTHEM HMO ANTHEM HMO 999999999 139.87 224.07 Inhalation treatment for airway obstruction or sputum production 12436889_1 CDM 0410 RC 94640 HCPCS inpatient 231 150.15 UHC - ALL PLANS UHC - ALL PLANS 999999999 139.87 224.07 Inhalation treatment for airway obstruction or sputum production 12436889_1 CDM 0410 RC 94640 HCPCS inpatient 231 150.15 CIGNA - ALL PLANS CIGNA - ALL PLANS 156.16 67.6 999999999 139.87 224.07 percent of total billed charges Inhalation treatment for airway obstruction or sputum production 12436890_1 CDM 0410 RC 94640 HCPCS inpatient 188 122.2 AETNA AETNA 148.52 79 999999999 113.83 182.36 percent of total billed charges Inhalation treatment for airway obstruction or sputum production 12436890_1 CDM 0410 RC 94640 HCPCS inpatient 188 122.2 SELF PAY DISCOUNT SELF PAY DISCOUNT 122.2 65 999999999 113.83 182.36 percent of total billed charges Inhalation treatment for airway obstruction or sputum production 12436890_1 CDM 0410 RC 94640 HCPCS inpatient 188 122.2 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 182.36 97 999999999 113.83 182.36 percent of total billed charges Inhalation treatment for airway obstruction or sputum production 12436890_1 CDM 0410 RC 94640 HCPCS inpatient 188 122.2 ENCORE - ALL PLANS ENCORE - ALL PLANS 129.72 69 999999999 113.83 182.36 percent of total billed charges Inhalation treatment for airway obstruction or sputum production 12436890_1 CDM 0410 RC 94640 HCPCS inpatient 188 122.2 HUMANA - ALL PLANS HUMANA - ALL PLANS 146.64 78 999999999 113.83 182.36 percent of total billed charges Inhalation treatment for airway obstruction or sputum production 12436890_1 CDM 0410 RC 94640 HCPCS inpatient 188 122.2 UMR - ALL PLANS UMR - ALL PLANS 131.6 70 999999999 113.83 182.36 percent of total billed charges Inhalation treatment for airway obstruction or sputum production 12436890_1 CDM 0410 RC 94640 HCPCS inpatient 188 122.2 SIHO - ALL PLANS SIHO - ALL PLANS 169.2 90 999999999 113.83 182.36 percent of total billed charges Inhalation treatment for airway obstruction or sputum production 12436890_1 CDM 0410 RC 94640 HCPCS inpatient 188 122.2 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 113.83 60.55 999999999 113.83 182.36 percent of total billed charges Inhalation treatment for airway obstruction or sputum production 12436890_1 CDM 0410 RC 94640 HCPCS inpatient 188 122.2 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 113.83 182.36 Inhalation treatment for airway obstruction or sputum production 12436890_1 CDM 0410 RC 94640 HCPCS inpatient 188 122.2 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 113.83 182.36 Inhalation treatment for airway obstruction or sputum production 12436890_1 CDM 0410 RC 94640 HCPCS inpatient 188 122.2 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 113.83 182.36 Inhalation treatment for airway obstruction or sputum production 12436890_1 CDM 0410 RC 94640 HCPCS inpatient 188 122.2 ANTHEM HMO ANTHEM HMO 999999999 113.83 182.36 Inhalation treatment for airway obstruction or sputum production 12436890_1 CDM 0410 RC 94640 HCPCS inpatient 188 122.2 UHC - ALL PLANS UHC - ALL PLANS 999999999 113.83 182.36 Inhalation treatment for airway obstruction or sputum production 12436890_1 CDM 0410 RC 94640 HCPCS inpatient 188 122.2 CIGNA - ALL PLANS CIGNA - ALL PLANS 127.09 67.6 999999999 113.83 182.36 percent of total billed charges Application of mechanical traction 12820907_1 CDM 0430 RC 97012 HCPCS inpatient 213 138.45 AETNA AETNA 168.27 79 999999999 128.97 206.61 percent of total billed charges Application of mechanical traction 12820907_1 CDM 0430 RC 97012 HCPCS inpatient 213 138.45 SELF PAY DISCOUNT SELF PAY DISCOUNT 138.45 65 999999999 128.97 206.61 percent of total billed charges Application of mechanical traction 12820907_1 CDM 0430 RC 97012 HCPCS inpatient 213 138.45 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 206.61 97 999999999 128.97 206.61 percent of total billed charges Application of mechanical traction 12820907_1 CDM 0430 RC 97012 HCPCS inpatient 213 138.45 ENCORE - ALL PLANS ENCORE - ALL PLANS 146.97 69 999999999 128.97 206.61 percent of total billed charges Application of mechanical traction 12820907_1 CDM 0430 RC 97012 HCPCS inpatient 213 138.45 HUMANA - ALL PLANS HUMANA - ALL PLANS 166.14 78 999999999 128.97 206.61 percent of total billed charges Application of mechanical traction 12820907_1 CDM 0430 RC 97012 HCPCS inpatient 213 138.45 UMR - ALL PLANS UMR - ALL PLANS 149.1 70 999999999 128.97 206.61 percent of total billed charges Application of mechanical traction 12820907_1 CDM 0430 RC 97012 HCPCS inpatient 213 138.45 SIHO - ALL PLANS SIHO - ALL PLANS 191.7 90 999999999 128.97 206.61 percent of total billed charges Application of mechanical traction 12820907_1 CDM 0430 RC 97012 HCPCS inpatient 213 138.45 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 128.97 60.55 999999999 128.97 206.61 percent of total billed charges Application of mechanical traction 12820907_1 CDM 0430 RC 97012 HCPCS inpatient 213 138.45 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 128.97 206.61 Application of mechanical traction 12820907_1 CDM 0430 RC 97012 HCPCS inpatient 213 138.45 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 128.97 206.61 Application of mechanical traction 12820907_1 CDM 0430 RC 97012 HCPCS inpatient 213 138.45 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 128.97 206.61 Application of mechanical traction 12820907_1 CDM 0430 RC 97012 HCPCS inpatient 213 138.45 ANTHEM HMO ANTHEM HMO 999999999 128.97 206.61 Application of mechanical traction 12820907_1 CDM 0430 RC 97012 HCPCS inpatient 213 138.45 UHC - ALL PLANS UHC - ALL PLANS 999999999 128.97 206.61 Application of mechanical traction 12820907_1 CDM 0430 RC 97012 HCPCS inpatient 213 138.45 CIGNA - ALL PLANS CIGNA - ALL PLANS 143.99 67.6 999999999 128.97 206.61 percent of total billed charges Test to measure the total volume of air that can be exhaled after inhaling 12969358_1 CDM 0410 RC 94150 HCPCS inpatient 280 182 AETNA AETNA 221.2 79 999999999 169.54 271.6 percent of total billed charges Test to measure the total volume of air that can be exhaled after inhaling 12969358_1 CDM 0410 RC 94150 HCPCS inpatient 280 182 SELF PAY DISCOUNT SELF PAY DISCOUNT 182 65 999999999 169.54 271.6 percent of total billed charges Test to measure the total volume of air that can be exhaled after inhaling 12969358_1 CDM 0410 RC 94150 HCPCS inpatient 280 182 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 271.6 97 999999999 169.54 271.6 percent of total billed charges Test to measure the total volume of air that can be exhaled after inhaling 12969358_1 CDM 0410 RC 94150 HCPCS inpatient 280 182 ENCORE - ALL PLANS ENCORE - ALL PLANS 193.2 69 999999999 169.54 271.6 percent of total billed charges Test to measure the total volume of air that can be exhaled after inhaling 12969358_1 CDM 0410 RC 94150 HCPCS inpatient 280 182 HUMANA - ALL PLANS HUMANA - ALL PLANS 218.4 78 999999999 169.54 271.6 percent of total billed charges Test to measure the total volume of air that can be exhaled after inhaling 12969358_1 CDM 0410 RC 94150 HCPCS inpatient 280 182 UMR - ALL PLANS UMR - ALL PLANS 196 70 999999999 169.54 271.6 percent of total billed charges Test to measure the total volume of air that can be exhaled after inhaling 12969358_1 CDM 0410 RC 94150 HCPCS inpatient 280 182 SIHO - ALL PLANS SIHO - ALL PLANS 252 90 999999999 169.54 271.6 percent of total billed charges Test to measure the total volume of air that can be exhaled after inhaling 12969358_1 CDM 0410 RC 94150 HCPCS inpatient 280 182 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 169.54 60.55 999999999 169.54 271.6 percent of total billed charges Test to measure the total volume of air that can be exhaled after inhaling 12969358_1 CDM 0410 RC 94150 HCPCS inpatient 280 182 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 169.54 271.6 Test to measure the total volume of air that can be exhaled after inhaling 12969358_1 CDM 0410 RC 94150 HCPCS inpatient 280 182 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 169.54 271.6 Test to measure the total volume of air that can be exhaled after inhaling 12969358_1 CDM 0410 RC 94150 HCPCS inpatient 280 182 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 169.54 271.6 Test to measure the total volume of air that can be exhaled after inhaling 12969358_1 CDM 0410 RC 94150 HCPCS inpatient 280 182 ANTHEM HMO ANTHEM HMO 999999999 169.54 271.6 Test to measure the total volume of air that can be exhaled after inhaling 12969358_1 CDM 0410 RC 94150 HCPCS inpatient 280 182 UHC - ALL PLANS UHC - ALL PLANS 999999999 169.54 271.6 Test to measure the total volume of air that can be exhaled after inhaling 12969358_1 CDM 0410 RC 94150 HCPCS inpatient 280 182 CIGNA - ALL PLANS CIGNA - ALL PLANS 189.28 67.6 999999999 169.54 271.6 percent of total billed charges Insertion of needle into vein for collection of blood sample 12994894_1 CDM 0300 RC 36415 HCPCS inpatient 47 30.55 AETNA AETNA 37.13 79 999999999 28.46 45.59 percent of total billed charges Insertion of needle into vein for collection of blood sample 12994894_1 CDM 0300 RC 36415 HCPCS inpatient 47 30.55 SELF PAY DISCOUNT SELF PAY DISCOUNT 30.55 65 999999999 28.46 45.59 percent of total billed charges Insertion of needle into vein for collection of blood sample 12994894_1 CDM 0300 RC 36415 HCPCS inpatient 47 30.55 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 45.59 97 999999999 28.46 45.59 percent of total billed charges Insertion of needle into vein for collection of blood sample 12994894_1 CDM 0300 RC 36415 HCPCS inpatient 47 30.55 ENCORE - ALL PLANS ENCORE - ALL PLANS 32.43 69 999999999 28.46 45.59 percent of total billed charges Insertion of needle into vein for collection of blood sample 12994894_1 CDM 0300 RC 36415 HCPCS inpatient 47 30.55 HUMANA - ALL PLANS HUMANA - ALL PLANS 36.66 78 999999999 28.46 45.59 percent of total billed charges Insertion of needle into vein for collection of blood sample 12994894_1 CDM 0300 RC 36415 HCPCS inpatient 47 30.55 UMR - ALL PLANS UMR - ALL PLANS 32.9 70 999999999 28.46 45.59 percent of total billed charges Insertion of needle into vein for collection of blood sample 12994894_1 CDM 0300 RC 36415 HCPCS inpatient 47 30.55 SIHO - ALL PLANS SIHO - ALL PLANS 42.3 90 999999999 28.46 45.59 percent of total billed charges Insertion of needle into vein for collection of blood sample 12994894_1 CDM 0300 RC 36415 HCPCS inpatient 47 30.55 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 28.46 60.55 999999999 28.46 45.59 percent of total billed charges Insertion of needle into vein for collection of blood sample 12994894_1 CDM 0300 RC 36415 HCPCS inpatient 47 30.55 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 28.46 45.59 Insertion of needle into vein for collection of blood sample 12994894_1 CDM 0300 RC 36415 HCPCS inpatient 47 30.55 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 28.46 45.59 Insertion of needle into vein for collection of blood sample 12994894_1 CDM 0300 RC 36415 HCPCS inpatient 47 30.55 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 28.46 45.59 Insertion of needle into vein for collection of blood sample 12994894_1 CDM 0300 RC 36415 HCPCS inpatient 47 30.55 ANTHEM HMO ANTHEM HMO 999999999 28.46 45.59 Insertion of needle into vein for collection of blood sample 12994894_1 CDM 0300 RC 36415 HCPCS inpatient 47 30.55 UHC - ALL PLANS UHC - ALL PLANS 999999999 28.46 45.59 Insertion of needle into vein for collection of blood sample 12994894_1 CDM 0300 RC 36415 HCPCS inpatient 47 30.55 CIGNA - ALL PLANS CIGNA - ALL PLANS 31.77 67.6 999999999 28.46 45.59 percent of total billed charges "Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation, differential lysis" 12994896_1 CDM 0302 RC 85460 HCPCS inpatient 192 124.8 AETNA AETNA 151.68 79 999999999 116.26 186.24 percent of total billed charges "Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation, differential lysis" 12994896_1 CDM 0302 RC 85460 HCPCS inpatient 192 124.8 SELF PAY DISCOUNT SELF PAY DISCOUNT 124.8 65 999999999 116.26 186.24 percent of total billed charges "Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation, differential lysis" 12994896_1 CDM 0302 RC 85460 HCPCS inpatient 192 124.8 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 186.24 97 999999999 116.26 186.24 percent of total billed charges "Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation, differential lysis" 12994896_1 CDM 0302 RC 85460 HCPCS inpatient 192 124.8 ENCORE - ALL PLANS ENCORE - ALL PLANS 132.48 69 999999999 116.26 186.24 percent of total billed charges "Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation, differential lysis" 12994896_1 CDM 0302 RC 85460 HCPCS inpatient 192 124.8 HUMANA - ALL PLANS HUMANA - ALL PLANS 149.76 78 999999999 116.26 186.24 percent of total billed charges "Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation, differential lysis" 12994896_1 CDM 0302 RC 85460 HCPCS inpatient 192 124.8 UMR - ALL PLANS UMR - ALL PLANS 134.4 70 999999999 116.26 186.24 percent of total billed charges "Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation, differential lysis" 12994896_1 CDM 0302 RC 85460 HCPCS inpatient 192 124.8 SIHO - ALL PLANS SIHO - ALL PLANS 172.8 90 999999999 116.26 186.24 percent of total billed charges "Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation, differential lysis" 12994896_1 CDM 0302 RC 85460 HCPCS inpatient 192 124.8 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 116.26 60.55 999999999 116.26 186.24 percent of total billed charges "Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation, differential lysis" 12994896_1 CDM 0302 RC 85460 HCPCS inpatient 192 124.8 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 116.26 186.24 "Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation, differential lysis" 12994896_1 CDM 0302 RC 85460 HCPCS inpatient 192 124.8 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 116.26 186.24 "Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation, differential lysis" 12994896_1 CDM 0302 RC 85460 HCPCS inpatient 192 124.8 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 116.26 186.24 "Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation, differential lysis" 12994896_1 CDM 0302 RC 85460 HCPCS inpatient 192 124.8 ANTHEM HMO ANTHEM HMO 999999999 116.26 186.24 "Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation, differential lysis" 12994896_1 CDM 0302 RC 85460 HCPCS inpatient 192 124.8 UHC - ALL PLANS UHC - ALL PLANS 999999999 116.26 186.24 "Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation, differential lysis" 12994896_1 CDM 0302 RC 85460 HCPCS inpatient 192 124.8 CIGNA - ALL PLANS CIGNA - ALL PLANS 129.79 67.6 999999999 116.26 186.24 percent of total billed charges CT scan of blood vessels of chest with contrast 1339986_1 CDM 0352 RC 71275 HCPCS inpatient 3248 2111.2 AETNA AETNA 2565.92 79 999999999 1966.66 3150.56 percent of total billed charges CT scan of blood vessels of chest with contrast 1339986_1 CDM 0352 RC 71275 HCPCS inpatient 3248 2111.2 SELF PAY DISCOUNT SELF PAY DISCOUNT 2111.2 65 999999999 1966.66 3150.56 percent of total billed charges CT scan of blood vessels of chest with contrast 1339986_1 CDM 0352 RC 71275 HCPCS inpatient 3248 2111.2 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 3150.56 97 999999999 1966.66 3150.56 percent of total billed charges CT scan of blood vessels of chest with contrast 1339986_1 CDM 0352 RC 71275 HCPCS inpatient 3248 2111.2 ENCORE - ALL PLANS ENCORE - ALL PLANS 2241.12 69 999999999 1966.66 3150.56 percent of total billed charges CT scan of blood vessels of chest with contrast 1339986_1 CDM 0352 RC 71275 HCPCS inpatient 3248 2111.2 HUMANA - ALL PLANS HUMANA - ALL PLANS 2533.44 78 999999999 1966.66 3150.56 percent of total billed charges CT scan of blood vessels of chest with contrast 1339986_1 CDM 0352 RC 71275 HCPCS inpatient 3248 2111.2 UMR - ALL PLANS UMR - ALL PLANS 2273.6 70 999999999 1966.66 3150.56 percent of total billed charges CT scan of blood vessels of chest with contrast 1339986_1 CDM 0352 RC 71275 HCPCS inpatient 3248 2111.2 SIHO - ALL PLANS SIHO - ALL PLANS 2923.2 90 999999999 1966.66 3150.56 percent of total billed charges CT scan of blood vessels of chest with contrast 1339986_1 CDM 0352 RC 71275 HCPCS inpatient 3248 2111.2 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1966.66 60.55 999999999 1966.66 3150.56 percent of total billed charges CT scan of blood vessels of chest with contrast 1339986_1 CDM 0352 RC 71275 HCPCS inpatient 3248 2111.2 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1966.66 3150.56 CT scan of blood vessels of chest with contrast 1339986_1 CDM 0352 RC 71275 HCPCS inpatient 3248 2111.2 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1966.66 3150.56 CT scan of blood vessels of chest with contrast 1339986_1 CDM 0352 RC 71275 HCPCS inpatient 3248 2111.2 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1966.66 3150.56 CT scan of blood vessels of chest with contrast 1339986_1 CDM 0352 RC 71275 HCPCS inpatient 3248 2111.2 ANTHEM HMO ANTHEM HMO 999999999 1966.66 3150.56 CT scan of blood vessels of chest with contrast 1339986_1 CDM 0352 RC 71275 HCPCS inpatient 3248 2111.2 UHC - ALL PLANS UHC - ALL PLANS 999999999 1966.66 3150.56 CT scan of blood vessels of chest with contrast 1339986_1 CDM 0352 RC 71275 HCPCS inpatient 3248 2111.2 CIGNA - ALL PLANS CIGNA - ALL PLANS 2195.65 67.6 999999999 1966.66 3150.56 percent of total billed charges Review by radiologist of CT guidance for needle placement 1339998_1 CDM 0320 RC 77012 HCPCS inpatient 1858 1207.7 AETNA AETNA 1467.82 79 999999999 1125.02 1802.26 percent of total billed charges Review by radiologist of CT guidance for needle placement 1339998_1 CDM 0320 RC 77012 HCPCS inpatient 1858 1207.7 SELF PAY DISCOUNT SELF PAY DISCOUNT 1207.7 65 999999999 1125.02 1802.26 percent of total billed charges Review by radiologist of CT guidance for needle placement 1339998_1 CDM 0320 RC 77012 HCPCS inpatient 1858 1207.7 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 1802.26 97 999999999 1125.02 1802.26 percent of total billed charges Review by radiologist of CT guidance for needle placement 1339998_1 CDM 0320 RC 77012 HCPCS inpatient 1858 1207.7 ENCORE - ALL PLANS ENCORE - ALL PLANS 1282.02 69 999999999 1125.02 1802.26 percent of total billed charges Review by radiologist of CT guidance for needle placement 1339998_1 CDM 0320 RC 77012 HCPCS inpatient 1858 1207.7 HUMANA - ALL PLANS HUMANA - ALL PLANS 1449.24 78 999999999 1125.02 1802.26 percent of total billed charges Review by radiologist of CT guidance for needle placement 1339998_1 CDM 0320 RC 77012 HCPCS inpatient 1858 1207.7 UMR - ALL PLANS UMR - ALL PLANS 1300.6 70 999999999 1125.02 1802.26 percent of total billed charges Review by radiologist of CT guidance for needle placement 1339998_1 CDM 0320 RC 77012 HCPCS inpatient 1858 1207.7 SIHO - ALL PLANS SIHO - ALL PLANS 1672.2 90 999999999 1125.02 1802.26 percent of total billed charges Review by radiologist of CT guidance for needle placement 1339998_1 CDM 0320 RC 77012 HCPCS inpatient 1858 1207.7 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1125.02 60.55 999999999 1125.02 1802.26 percent of total billed charges Review by radiologist of CT guidance for needle placement 1339998_1 CDM 0320 RC 77012 HCPCS inpatient 1858 1207.7 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1125.02 1802.26 Review by radiologist of CT guidance for needle placement 1339998_1 CDM 0320 RC 77012 HCPCS inpatient 1858 1207.7 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1125.02 1802.26 Review by radiologist of CT guidance for needle placement 1339998_1 CDM 0320 RC 77012 HCPCS inpatient 1858 1207.7 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1125.02 1802.26 Review by radiologist of CT guidance for needle placement 1339998_1 CDM 0320 RC 77012 HCPCS inpatient 1858 1207.7 ANTHEM HMO ANTHEM HMO 999999999 1125.02 1802.26 Review by radiologist of CT guidance for needle placement 1339998_1 CDM 0320 RC 77012 HCPCS inpatient 1858 1207.7 UHC - ALL PLANS UHC - ALL PLANS 999999999 1125.02 1802.26 Review by radiologist of CT guidance for needle placement 1339998_1 CDM 0320 RC 77012 HCPCS inpatient 1858 1207.7 CIGNA - ALL PLANS CIGNA - ALL PLANS 1256.01 67.6 999999999 1125.02 1802.26 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340001_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 AETNA AETNA 1334.31 79 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340001_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 SELF PAY DISCOUNT SELF PAY DISCOUNT 1097.85 65 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340001_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 1638.33 97 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340001_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ENCORE - ALL PLANS ENCORE - ALL PLANS 1165.41 69 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340001_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 HUMANA - ALL PLANS HUMANA - ALL PLANS 1317.42 78 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340001_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 UMR - ALL PLANS UMR - ALL PLANS 1182.3 70 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340001_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 SIHO - ALL PLANS SIHO - ALL PLANS 1520.1 90 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340001_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1022.69 60.55 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340001_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340001_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340001_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM HMO ANTHEM HMO 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340001_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340001_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 UHC - ALL PLANS UHC - ALL PLANS 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340001_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 CIGNA - ALL PLANS CIGNA - ALL PLANS 1141.76 67.6 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340004_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 AETNA AETNA 1334.31 79 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340004_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 SELF PAY DISCOUNT SELF PAY DISCOUNT 1097.85 65 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340004_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 1638.33 97 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340004_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ENCORE - ALL PLANS ENCORE - ALL PLANS 1165.41 69 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340004_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 HUMANA - ALL PLANS HUMANA - ALL PLANS 1317.42 78 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340004_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 UMR - ALL PLANS UMR - ALL PLANS 1182.3 70 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340004_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 SIHO - ALL PLANS SIHO - ALL PLANS 1520.1 90 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340004_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1022.69 60.55 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340004_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340004_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340004_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM HMO ANTHEM HMO 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340004_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340004_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 UHC - ALL PLANS UHC - ALL PLANS 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340004_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 CIGNA - ALL PLANS CIGNA - ALL PLANS 1141.76 67.6 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340007_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 AETNA AETNA 1334.31 79 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340007_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 SELF PAY DISCOUNT SELF PAY DISCOUNT 1097.85 65 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340007_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 1638.33 97 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340007_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ENCORE - ALL PLANS ENCORE - ALL PLANS 1165.41 69 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340007_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 HUMANA - ALL PLANS HUMANA - ALL PLANS 1317.42 78 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340007_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 UMR - ALL PLANS UMR - ALL PLANS 1182.3 70 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340007_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 SIHO - ALL PLANS SIHO - ALL PLANS 1520.1 90 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340007_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1022.69 60.55 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340007_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340007_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340007_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM HMO ANTHEM HMO 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340007_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340007_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 UHC - ALL PLANS UHC - ALL PLANS 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340007_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 CIGNA - ALL PLANS CIGNA - ALL PLANS 1141.76 67.6 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340010_1 CDM 0350 RC 77012 HCPCS inpatient 1688 1097.2 AETNA AETNA 1333.52 79 999999999 1022.08 1637.36 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340010_1 CDM 0350 RC 77012 HCPCS inpatient 1688 1097.2 SELF PAY DISCOUNT SELF PAY DISCOUNT 1097.2 65 999999999 1022.08 1637.36 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340010_1 CDM 0350 RC 77012 HCPCS inpatient 1688 1097.2 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 1637.36 97 999999999 1022.08 1637.36 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340010_1 CDM 0350 RC 77012 HCPCS inpatient 1688 1097.2 ENCORE - ALL PLANS ENCORE - ALL PLANS 1164.72 69 999999999 1022.08 1637.36 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340010_1 CDM 0350 RC 77012 HCPCS inpatient 1688 1097.2 HUMANA - ALL PLANS HUMANA - ALL PLANS 1316.64 78 999999999 1022.08 1637.36 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340010_1 CDM 0350 RC 77012 HCPCS inpatient 1688 1097.2 UMR - ALL PLANS UMR - ALL PLANS 1181.6 70 999999999 1022.08 1637.36 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340010_1 CDM 0350 RC 77012 HCPCS inpatient 1688 1097.2 SIHO - ALL PLANS SIHO - ALL PLANS 1519.2 90 999999999 1022.08 1637.36 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340010_1 CDM 0350 RC 77012 HCPCS inpatient 1688 1097.2 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1022.08 60.55 999999999 1022.08 1637.36 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340010_1 CDM 0350 RC 77012 HCPCS inpatient 1688 1097.2 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1022.08 1637.36 Review by radiologist of CT guidance for needle placement 1340010_1 CDM 0350 RC 77012 HCPCS inpatient 1688 1097.2 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1022.08 1637.36 Review by radiologist of CT guidance for needle placement 1340010_1 CDM 0350 RC 77012 HCPCS inpatient 1688 1097.2 ANTHEM HMO ANTHEM HMO 999999999 1022.08 1637.36 Review by radiologist of CT guidance for needle placement 1340010_1 CDM 0350 RC 77012 HCPCS inpatient 1688 1097.2 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1022.08 1637.36 Review by radiologist of CT guidance for needle placement 1340010_1 CDM 0350 RC 77012 HCPCS inpatient 1688 1097.2 UHC - ALL PLANS UHC - ALL PLANS 999999999 1022.08 1637.36 Review by radiologist of CT guidance for needle placement 1340010_1 CDM 0350 RC 77012 HCPCS inpatient 1688 1097.2 CIGNA - ALL PLANS CIGNA - ALL PLANS 1141.09 67.6 999999999 1022.08 1637.36 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340013_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 AETNA AETNA 1334.31 79 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340013_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 SELF PAY DISCOUNT SELF PAY DISCOUNT 1097.85 65 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340013_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 1638.33 97 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340013_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ENCORE - ALL PLANS ENCORE - ALL PLANS 1165.41 69 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340013_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 HUMANA - ALL PLANS HUMANA - ALL PLANS 1317.42 78 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340013_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 UMR - ALL PLANS UMR - ALL PLANS 1182.3 70 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340013_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 SIHO - ALL PLANS SIHO - ALL PLANS 1520.1 90 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340013_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1022.69 60.55 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340013_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340013_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340013_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM HMO ANTHEM HMO 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340013_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340013_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 UHC - ALL PLANS UHC - ALL PLANS 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340013_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 CIGNA - ALL PLANS CIGNA - ALL PLANS 1141.76 67.6 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340015_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 AETNA AETNA 1334.31 79 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340015_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 SELF PAY DISCOUNT SELF PAY DISCOUNT 1097.85 65 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340015_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 1638.33 97 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340015_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ENCORE - ALL PLANS ENCORE - ALL PLANS 1165.41 69 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340015_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 HUMANA - ALL PLANS HUMANA - ALL PLANS 1317.42 78 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340015_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 UMR - ALL PLANS UMR - ALL PLANS 1182.3 70 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340015_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 SIHO - ALL PLANS SIHO - ALL PLANS 1520.1 90 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340015_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1022.69 60.55 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340015_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340015_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340015_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM HMO ANTHEM HMO 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340015_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340015_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 UHC - ALL PLANS UHC - ALL PLANS 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340015_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 CIGNA - ALL PLANS CIGNA - ALL PLANS 1141.76 67.6 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340017_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 AETNA AETNA 1334.31 79 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340017_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 SELF PAY DISCOUNT SELF PAY DISCOUNT 1097.85 65 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340017_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 1638.33 97 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340017_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ENCORE - ALL PLANS ENCORE - ALL PLANS 1165.41 69 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340017_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 HUMANA - ALL PLANS HUMANA - ALL PLANS 1317.42 78 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340017_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 UMR - ALL PLANS UMR - ALL PLANS 1182.3 70 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340017_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 SIHO - ALL PLANS SIHO - ALL PLANS 1520.1 90 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340017_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1022.69 60.55 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340017_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340017_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340017_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM HMO ANTHEM HMO 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340017_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340017_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 UHC - ALL PLANS UHC - ALL PLANS 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340017_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 CIGNA - ALL PLANS CIGNA - ALL PLANS 1141.76 67.6 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340019_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 AETNA AETNA 1334.31 79 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340019_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 SELF PAY DISCOUNT SELF PAY DISCOUNT 1097.85 65 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340019_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 1638.33 97 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340019_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ENCORE - ALL PLANS ENCORE - ALL PLANS 1165.41 69 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340019_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 HUMANA - ALL PLANS HUMANA - ALL PLANS 1317.42 78 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340019_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 UMR - ALL PLANS UMR - ALL PLANS 1182.3 70 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340019_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 SIHO - ALL PLANS SIHO - ALL PLANS 1520.1 90 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340019_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1022.69 60.55 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340019_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340019_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340019_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM HMO ANTHEM HMO 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340019_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340019_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 UHC - ALL PLANS UHC - ALL PLANS 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340019_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 CIGNA - ALL PLANS CIGNA - ALL PLANS 1141.76 67.6 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340027_1 CDM 0350 RC 77012 HCPCS inpatient 1858 1207.7 AETNA AETNA 1467.82 79 999999999 1125.02 1802.26 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340027_1 CDM 0350 RC 77012 HCPCS inpatient 1858 1207.7 SELF PAY DISCOUNT SELF PAY DISCOUNT 1207.7 65 999999999 1125.02 1802.26 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340027_1 CDM 0350 RC 77012 HCPCS inpatient 1858 1207.7 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 1802.26 97 999999999 1125.02 1802.26 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340027_1 CDM 0350 RC 77012 HCPCS inpatient 1858 1207.7 ENCORE - ALL PLANS ENCORE - ALL PLANS 1282.02 69 999999999 1125.02 1802.26 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340027_1 CDM 0350 RC 77012 HCPCS inpatient 1858 1207.7 HUMANA - ALL PLANS HUMANA - ALL PLANS 1449.24 78 999999999 1125.02 1802.26 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340027_1 CDM 0350 RC 77012 HCPCS inpatient 1858 1207.7 UMR - ALL PLANS UMR - ALL PLANS 1300.6 70 999999999 1125.02 1802.26 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340027_1 CDM 0350 RC 77012 HCPCS inpatient 1858 1207.7 SIHO - ALL PLANS SIHO - ALL PLANS 1672.2 90 999999999 1125.02 1802.26 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340027_1 CDM 0350 RC 77012 HCPCS inpatient 1858 1207.7 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1125.02 60.55 999999999 1125.02 1802.26 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340027_1 CDM 0350 RC 77012 HCPCS inpatient 1858 1207.7 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1125.02 1802.26 Review by radiologist of CT guidance for needle placement 1340027_1 CDM 0350 RC 77012 HCPCS inpatient 1858 1207.7 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1125.02 1802.26 Review by radiologist of CT guidance for needle placement 1340027_1 CDM 0350 RC 77012 HCPCS inpatient 1858 1207.7 ANTHEM HMO ANTHEM HMO 999999999 1125.02 1802.26 Review by radiologist of CT guidance for needle placement 1340027_1 CDM 0350 RC 77012 HCPCS inpatient 1858 1207.7 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1125.02 1802.26 Review by radiologist of CT guidance for needle placement 1340027_1 CDM 0350 RC 77012 HCPCS inpatient 1858 1207.7 UHC - ALL PLANS UHC - ALL PLANS 999999999 1125.02 1802.26 Review by radiologist of CT guidance for needle placement 1340027_1 CDM 0350 RC 77012 HCPCS inpatient 1858 1207.7 CIGNA - ALL PLANS CIGNA - ALL PLANS 1256.01 67.6 999999999 1125.02 1802.26 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340029_1 CDM 0320 RC 77012 HCPCS inpatient 1858 1207.7 AETNA AETNA 1467.82 79 999999999 1125.02 1802.26 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340029_1 CDM 0320 RC 77012 HCPCS inpatient 1858 1207.7 SELF PAY DISCOUNT SELF PAY DISCOUNT 1207.7 65 999999999 1125.02 1802.26 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340029_1 CDM 0320 RC 77012 HCPCS inpatient 1858 1207.7 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 1802.26 97 999999999 1125.02 1802.26 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340029_1 CDM 0320 RC 77012 HCPCS inpatient 1858 1207.7 ENCORE - ALL PLANS ENCORE - ALL PLANS 1282.02 69 999999999 1125.02 1802.26 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340029_1 CDM 0320 RC 77012 HCPCS inpatient 1858 1207.7 HUMANA - ALL PLANS HUMANA - ALL PLANS 1449.24 78 999999999 1125.02 1802.26 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340029_1 CDM 0320 RC 77012 HCPCS inpatient 1858 1207.7 UMR - ALL PLANS UMR - ALL PLANS 1300.6 70 999999999 1125.02 1802.26 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340029_1 CDM 0320 RC 77012 HCPCS inpatient 1858 1207.7 SIHO - ALL PLANS SIHO - ALL PLANS 1672.2 90 999999999 1125.02 1802.26 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340029_1 CDM 0320 RC 77012 HCPCS inpatient 1858 1207.7 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1125.02 60.55 999999999 1125.02 1802.26 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340029_1 CDM 0320 RC 77012 HCPCS inpatient 1858 1207.7 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1125.02 1802.26 Review by radiologist of CT guidance for needle placement 1340029_1 CDM 0320 RC 77012 HCPCS inpatient 1858 1207.7 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1125.02 1802.26 Review by radiologist of CT guidance for needle placement 1340029_1 CDM 0320 RC 77012 HCPCS inpatient 1858 1207.7 ANTHEM HMO ANTHEM HMO 999999999 1125.02 1802.26 Review by radiologist of CT guidance for needle placement 1340029_1 CDM 0320 RC 77012 HCPCS inpatient 1858 1207.7 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1125.02 1802.26 Review by radiologist of CT guidance for needle placement 1340029_1 CDM 0320 RC 77012 HCPCS inpatient 1858 1207.7 UHC - ALL PLANS UHC - ALL PLANS 999999999 1125.02 1802.26 Review by radiologist of CT guidance for needle placement 1340029_1 CDM 0320 RC 77012 HCPCS inpatient 1858 1207.7 CIGNA - ALL PLANS CIGNA - ALL PLANS 1256.01 67.6 999999999 1125.02 1802.26 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340031_1 CDM 0320 RC 77012 HCPCS inpatient 1688 1097.2 AETNA AETNA 1333.52 79 999999999 1022.08 1637.36 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340031_1 CDM 0320 RC 77012 HCPCS inpatient 1688 1097.2 SELF PAY DISCOUNT SELF PAY DISCOUNT 1097.2 65 999999999 1022.08 1637.36 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340031_1 CDM 0320 RC 77012 HCPCS inpatient 1688 1097.2 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 1637.36 97 999999999 1022.08 1637.36 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340031_1 CDM 0320 RC 77012 HCPCS inpatient 1688 1097.2 ENCORE - ALL PLANS ENCORE - ALL PLANS 1164.72 69 999999999 1022.08 1637.36 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340031_1 CDM 0320 RC 77012 HCPCS inpatient 1688 1097.2 HUMANA - ALL PLANS HUMANA - ALL PLANS 1316.64 78 999999999 1022.08 1637.36 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340031_1 CDM 0320 RC 77012 HCPCS inpatient 1688 1097.2 UMR - ALL PLANS UMR - ALL PLANS 1181.6 70 999999999 1022.08 1637.36 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340031_1 CDM 0320 RC 77012 HCPCS inpatient 1688 1097.2 SIHO - ALL PLANS SIHO - ALL PLANS 1519.2 90 999999999 1022.08 1637.36 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340031_1 CDM 0320 RC 77012 HCPCS inpatient 1688 1097.2 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1022.08 60.55 999999999 1022.08 1637.36 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340031_1 CDM 0320 RC 77012 HCPCS inpatient 1688 1097.2 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1022.08 1637.36 Review by radiologist of CT guidance for needle placement 1340031_1 CDM 0320 RC 77012 HCPCS inpatient 1688 1097.2 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1022.08 1637.36 Review by radiologist of CT guidance for needle placement 1340031_1 CDM 0320 RC 77012 HCPCS inpatient 1688 1097.2 ANTHEM HMO ANTHEM HMO 999999999 1022.08 1637.36 Review by radiologist of CT guidance for needle placement 1340031_1 CDM 0320 RC 77012 HCPCS inpatient 1688 1097.2 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1022.08 1637.36 Review by radiologist of CT guidance for needle placement 1340031_1 CDM 0320 RC 77012 HCPCS inpatient 1688 1097.2 UHC - ALL PLANS UHC - ALL PLANS 999999999 1022.08 1637.36 Review by radiologist of CT guidance for needle placement 1340031_1 CDM 0320 RC 77012 HCPCS inpatient 1688 1097.2 CIGNA - ALL PLANS CIGNA - ALL PLANS 1141.09 67.6 999999999 1022.08 1637.36 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340036_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 AETNA AETNA 1334.31 79 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340036_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 SELF PAY DISCOUNT SELF PAY DISCOUNT 1097.85 65 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340036_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 1638.33 97 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340036_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ENCORE - ALL PLANS ENCORE - ALL PLANS 1165.41 69 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340036_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 HUMANA - ALL PLANS HUMANA - ALL PLANS 1317.42 78 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340036_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 UMR - ALL PLANS UMR - ALL PLANS 1182.3 70 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340036_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 SIHO - ALL PLANS SIHO - ALL PLANS 1520.1 90 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340036_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1022.69 60.55 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340036_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340036_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340036_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM HMO ANTHEM HMO 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340036_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340036_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 UHC - ALL PLANS UHC - ALL PLANS 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340036_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 CIGNA - ALL PLANS CIGNA - ALL PLANS 1141.76 67.6 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340038_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 AETNA AETNA 1334.31 79 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340038_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 SELF PAY DISCOUNT SELF PAY DISCOUNT 1097.85 65 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340038_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 1638.33 97 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340038_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ENCORE - ALL PLANS ENCORE - ALL PLANS 1165.41 69 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340038_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 HUMANA - ALL PLANS HUMANA - ALL PLANS 1317.42 78 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340038_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 UMR - ALL PLANS UMR - ALL PLANS 1182.3 70 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340038_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 SIHO - ALL PLANS SIHO - ALL PLANS 1520.1 90 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340038_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1022.69 60.55 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1340038_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340038_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340038_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM HMO ANTHEM HMO 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340038_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340038_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 UHC - ALL PLANS UHC - ALL PLANS 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1340038_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 CIGNA - ALL PLANS CIGNA - ALL PLANS 1141.76 67.6 999999999 1022.69 1638.33 percent of total billed charges CT scan of heart with evaluation of blood vessel calcium 1340055_1 CDM 0350 RC 75571 HCPCS inpatient 86 55.9 AETNA AETNA 67.94 79 999999999 52.07 83.42 percent of total billed charges CT scan of heart with evaluation of blood vessel calcium 1340055_1 CDM 0350 RC 75571 HCPCS inpatient 86 55.9 SELF PAY DISCOUNT SELF PAY DISCOUNT 55.9 65 999999999 52.07 83.42 percent of total billed charges CT scan of heart with evaluation of blood vessel calcium 1340055_1 CDM 0350 RC 75571 HCPCS inpatient 86 55.9 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 83.42 97 999999999 52.07 83.42 percent of total billed charges CT scan of heart with evaluation of blood vessel calcium 1340055_1 CDM 0350 RC 75571 HCPCS inpatient 86 55.9 ENCORE - ALL PLANS ENCORE - ALL PLANS 59.34 69 999999999 52.07 83.42 percent of total billed charges CT scan of heart with evaluation of blood vessel calcium 1340055_1 CDM 0350 RC 75571 HCPCS inpatient 86 55.9 HUMANA - ALL PLANS HUMANA - ALL PLANS 67.08 78 999999999 52.07 83.42 percent of total billed charges CT scan of heart with evaluation of blood vessel calcium 1340055_1 CDM 0350 RC 75571 HCPCS inpatient 86 55.9 UMR - ALL PLANS UMR - ALL PLANS 60.2 70 999999999 52.07 83.42 percent of total billed charges CT scan of heart with evaluation of blood vessel calcium 1340055_1 CDM 0350 RC 75571 HCPCS inpatient 86 55.9 SIHO - ALL PLANS SIHO - ALL PLANS 77.4 90 999999999 52.07 83.42 percent of total billed charges CT scan of heart with evaluation of blood vessel calcium 1340055_1 CDM 0350 RC 75571 HCPCS inpatient 86 55.9 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 52.07 60.55 999999999 52.07 83.42 percent of total billed charges CT scan of heart with evaluation of blood vessel calcium 1340055_1 CDM 0350 RC 75571 HCPCS inpatient 86 55.9 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 52.07 83.42 CT scan of heart with evaluation of blood vessel calcium 1340055_1 CDM 0350 RC 75571 HCPCS inpatient 86 55.9 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 52.07 83.42 CT scan of heart with evaluation of blood vessel calcium 1340055_1 CDM 0350 RC 75571 HCPCS inpatient 86 55.9 ANTHEM HMO ANTHEM HMO 999999999 52.07 83.42 CT scan of heart with evaluation of blood vessel calcium 1340055_1 CDM 0350 RC 75571 HCPCS inpatient 86 55.9 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 52.07 83.42 CT scan of heart with evaluation of blood vessel calcium 1340055_1 CDM 0350 RC 75571 HCPCS inpatient 86 55.9 UHC - ALL PLANS UHC - ALL PLANS 999999999 52.07 83.42 CT scan of heart with evaluation of blood vessel calcium 1340055_1 CDM 0350 RC 75571 HCPCS inpatient 86 55.9 CIGNA - ALL PLANS CIGNA - ALL PLANS 58.14 67.6 999999999 52.07 83.42 percent of total billed charges "Placement of locating device in breast using imaging guidance, first growth" 1340093_1 CDM 0361 RC 19281 HCPCS inpatient 695 451.75 AETNA AETNA 549.05 79 999999999 420.82 674.15 percent of total billed charges "Placement of locating device in breast using imaging guidance, first growth" 1340093_1 CDM 0361 RC 19281 HCPCS inpatient 695 451.75 SELF PAY DISCOUNT SELF PAY DISCOUNT 451.75 65 999999999 420.82 674.15 percent of total billed charges "Placement of locating device in breast using imaging guidance, first growth" 1340093_1 CDM 0361 RC 19281 HCPCS inpatient 695 451.75 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 674.15 97 999999999 420.82 674.15 percent of total billed charges "Placement of locating device in breast using imaging guidance, first growth" 1340093_1 CDM 0361 RC 19281 HCPCS inpatient 695 451.75 ENCORE - ALL PLANS ENCORE - ALL PLANS 479.55 69 999999999 420.82 674.15 percent of total billed charges "Placement of locating device in breast using imaging guidance, first growth" 1340093_1 CDM 0361 RC 19281 HCPCS inpatient 695 451.75 HUMANA - ALL PLANS HUMANA - ALL PLANS 542.1 78 999999999 420.82 674.15 percent of total billed charges "Placement of locating device in breast using imaging guidance, first growth" 1340093_1 CDM 0361 RC 19281 HCPCS inpatient 695 451.75 UMR - ALL PLANS UMR - ALL PLANS 486.5 70 999999999 420.82 674.15 percent of total billed charges "Placement of locating device in breast using imaging guidance, first growth" 1340093_1 CDM 0361 RC 19281 HCPCS inpatient 695 451.75 SIHO - ALL PLANS SIHO - ALL PLANS 625.5 90 999999999 420.82 674.15 percent of total billed charges "Placement of locating device in breast using imaging guidance, first growth" 1340093_1 CDM 0361 RC 19281 HCPCS inpatient 695 451.75 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 420.82 60.55 999999999 420.82 674.15 percent of total billed charges "Placement of locating device in breast using imaging guidance, first growth" 1340093_1 CDM 0361 RC 19281 HCPCS inpatient 695 451.75 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 420.82 674.15 "Placement of locating device in breast using imaging guidance, first growth" 1340093_1 CDM 0361 RC 19281 HCPCS inpatient 695 451.75 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 420.82 674.15 "Placement of locating device in breast using imaging guidance, first growth" 1340093_1 CDM 0361 RC 19281 HCPCS inpatient 695 451.75 ANTHEM HMO ANTHEM HMO 999999999 420.82 674.15 "Placement of locating device in breast using imaging guidance, first growth" 1340093_1 CDM 0361 RC 19281 HCPCS inpatient 695 451.75 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 420.82 674.15 "Placement of locating device in breast using imaging guidance, first growth" 1340093_1 CDM 0361 RC 19281 HCPCS inpatient 695 451.75 UHC - ALL PLANS UHC - ALL PLANS 999999999 420.82 674.15 "Placement of locating device in breast using imaging guidance, first growth" 1340093_1 CDM 0361 RC 19281 HCPCS inpatient 695 451.75 CIGNA - ALL PLANS CIGNA - ALL PLANS 469.82 67.6 999999999 420.82 674.15 percent of total billed charges "Placement of locating device in breast using imaging guidance, first growth" 1340095_1 CDM 0361 RC 19281 HCPCS inpatient 877 570.05 AETNA AETNA 692.83 79 999999999 531.02 850.69 percent of total billed charges "Placement of locating device in breast using imaging guidance, first growth" 1340095_1 CDM 0361 RC 19281 HCPCS inpatient 877 570.05 SELF PAY DISCOUNT SELF PAY DISCOUNT 570.05 65 999999999 531.02 850.69 percent of total billed charges "Placement of locating device in breast using imaging guidance, first growth" 1340095_1 CDM 0361 RC 19281 HCPCS inpatient 877 570.05 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 850.69 97 999999999 531.02 850.69 percent of total billed charges "Placement of locating device in breast using imaging guidance, first growth" 1340095_1 CDM 0361 RC 19281 HCPCS inpatient 877 570.05 ENCORE - ALL PLANS ENCORE - ALL PLANS 605.13 69 999999999 531.02 850.69 percent of total billed charges "Placement of locating device in breast using imaging guidance, first growth" 1340095_1 CDM 0361 RC 19281 HCPCS inpatient 877 570.05 HUMANA - ALL PLANS HUMANA - ALL PLANS 684.06 78 999999999 531.02 850.69 percent of total billed charges "Placement of locating device in breast using imaging guidance, first growth" 1340095_1 CDM 0361 RC 19281 HCPCS inpatient 877 570.05 UMR - ALL PLANS UMR - ALL PLANS 613.9 70 999999999 531.02 850.69 percent of total billed charges "Placement of locating device in breast using imaging guidance, first growth" 1340095_1 CDM 0361 RC 19281 HCPCS inpatient 877 570.05 SIHO - ALL PLANS SIHO - ALL PLANS 789.3 90 999999999 531.02 850.69 percent of total billed charges "Placement of locating device in breast using imaging guidance, first growth" 1340095_1 CDM 0361 RC 19281 HCPCS inpatient 877 570.05 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 531.02 60.55 999999999 531.02 850.69 percent of total billed charges "Placement of locating device in breast using imaging guidance, first growth" 1340095_1 CDM 0361 RC 19281 HCPCS inpatient 877 570.05 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 531.02 850.69 "Placement of locating device in breast using imaging guidance, first growth" 1340095_1 CDM 0361 RC 19281 HCPCS inpatient 877 570.05 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 531.02 850.69 "Placement of locating device in breast using imaging guidance, first growth" 1340095_1 CDM 0361 RC 19281 HCPCS inpatient 877 570.05 ANTHEM HMO ANTHEM HMO 999999999 531.02 850.69 "Placement of locating device in breast using imaging guidance, first growth" 1340095_1 CDM 0361 RC 19281 HCPCS inpatient 877 570.05 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 531.02 850.69 "Placement of locating device in breast using imaging guidance, first growth" 1340095_1 CDM 0361 RC 19281 HCPCS inpatient 877 570.05 UHC - ALL PLANS UHC - ALL PLANS 999999999 531.02 850.69 "Placement of locating device in breast using imaging guidance, first growth" 1340095_1 CDM 0361 RC 19281 HCPCS inpatient 877 570.05 CIGNA - ALL PLANS CIGNA - ALL PLANS 592.85 67.6 999999999 531.02 850.69 percent of total billed charges MRI scan of blood vessels of abdomen 1340121_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 AETNA AETNA 2370.79 79 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of abdomen 1340121_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 SELF PAY DISCOUNT SELF PAY DISCOUNT 1950.65 65 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of abdomen 1340121_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 2910.97 97 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of abdomen 1340121_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 ENCORE - ALL PLANS ENCORE - ALL PLANS 2070.69 69 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of abdomen 1340121_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 HUMANA - ALL PLANS HUMANA - ALL PLANS 2340.78 78 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of abdomen 1340121_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 UMR - ALL PLANS UMR - ALL PLANS 2100.7 70 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of abdomen 1340121_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 SIHO - ALL PLANS SIHO - ALL PLANS 2700.9 90 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of abdomen 1340121_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1817.11 60.55 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of abdomen 1340121_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1817.11 2910.97 MRI scan of blood vessels of abdomen 1340121_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1817.11 2910.97 MRI scan of blood vessels of abdomen 1340121_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 ANTHEM HMO ANTHEM HMO 999999999 1817.11 2910.97 MRI scan of blood vessels of abdomen 1340121_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1817.11 2910.97 MRI scan of blood vessels of abdomen 1340121_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 UHC - ALL PLANS UHC - ALL PLANS 999999999 1817.11 2910.97 MRI scan of blood vessels of abdomen 1340121_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 CIGNA - ALL PLANS CIGNA - ALL PLANS 2028.68 67.6 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of abdomen 1340123_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 AETNA AETNA 2370.79 79 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of abdomen 1340123_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 SELF PAY DISCOUNT SELF PAY DISCOUNT 1950.65 65 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of abdomen 1340123_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 2910.97 97 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of abdomen 1340123_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 ENCORE - ALL PLANS ENCORE - ALL PLANS 2070.69 69 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of abdomen 1340123_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 HUMANA - ALL PLANS HUMANA - ALL PLANS 2340.78 78 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of abdomen 1340123_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 UMR - ALL PLANS UMR - ALL PLANS 2100.7 70 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of abdomen 1340123_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 SIHO - ALL PLANS SIHO - ALL PLANS 2700.9 90 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of abdomen 1340123_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1817.11 60.55 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of abdomen 1340123_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1817.11 2910.97 MRI scan of blood vessels of abdomen 1340123_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1817.11 2910.97 MRI scan of blood vessels of abdomen 1340123_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 ANTHEM HMO ANTHEM HMO 999999999 1817.11 2910.97 MRI scan of blood vessels of abdomen 1340123_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1817.11 2910.97 MRI scan of blood vessels of abdomen 1340123_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 UHC - ALL PLANS UHC - ALL PLANS 999999999 1817.11 2910.97 MRI scan of blood vessels of abdomen 1340123_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 CIGNA - ALL PLANS CIGNA - ALL PLANS 2028.68 67.6 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of chest 1340125_1 CDM 0618 RC 71555 HCPCS inpatient 3001 1950.65 AETNA AETNA 2370.79 79 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of chest 1340125_1 CDM 0618 RC 71555 HCPCS inpatient 3001 1950.65 SELF PAY DISCOUNT SELF PAY DISCOUNT 1950.65 65 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of chest 1340125_1 CDM 0618 RC 71555 HCPCS inpatient 3001 1950.65 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 2910.97 97 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of chest 1340125_1 CDM 0618 RC 71555 HCPCS inpatient 3001 1950.65 ENCORE - ALL PLANS ENCORE - ALL PLANS 2070.69 69 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of chest 1340125_1 CDM 0618 RC 71555 HCPCS inpatient 3001 1950.65 HUMANA - ALL PLANS HUMANA - ALL PLANS 2340.78 78 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of chest 1340125_1 CDM 0618 RC 71555 HCPCS inpatient 3001 1950.65 UMR - ALL PLANS UMR - ALL PLANS 2100.7 70 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of chest 1340125_1 CDM 0618 RC 71555 HCPCS inpatient 3001 1950.65 SIHO - ALL PLANS SIHO - ALL PLANS 2700.9 90 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of chest 1340125_1 CDM 0618 RC 71555 HCPCS inpatient 3001 1950.65 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1817.11 60.55 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of chest 1340125_1 CDM 0618 RC 71555 HCPCS inpatient 3001 1950.65 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1817.11 2910.97 MRI scan of blood vessels of chest 1340125_1 CDM 0618 RC 71555 HCPCS inpatient 3001 1950.65 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1817.11 2910.97 MRI scan of blood vessels of chest 1340125_1 CDM 0618 RC 71555 HCPCS inpatient 3001 1950.65 ANTHEM HMO ANTHEM HMO 999999999 1817.11 2910.97 MRI scan of blood vessels of chest 1340125_1 CDM 0618 RC 71555 HCPCS inpatient 3001 1950.65 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1817.11 2910.97 MRI scan of blood vessels of chest 1340125_1 CDM 0618 RC 71555 HCPCS inpatient 3001 1950.65 UHC - ALL PLANS UHC - ALL PLANS 999999999 1817.11 2910.97 MRI scan of blood vessels of chest 1340125_1 CDM 0618 RC 71555 HCPCS inpatient 3001 1950.65 CIGNA - ALL PLANS CIGNA - ALL PLANS 2028.68 67.6 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of leg 1340127_1 CDM 0610 RC 73725 HCPCS inpatient 5972 3881.8 AETNA AETNA 4717.88 79 999999999 3616.05 5792.84 percent of total billed charges MRI scan of blood vessels of leg 1340127_1 CDM 0610 RC 73725 HCPCS inpatient 5972 3881.8 SELF PAY DISCOUNT SELF PAY DISCOUNT 3881.8 65 999999999 3616.05 5792.84 percent of total billed charges MRI scan of blood vessels of leg 1340127_1 CDM 0610 RC 73725 HCPCS inpatient 5972 3881.8 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 5792.84 97 999999999 3616.05 5792.84 percent of total billed charges MRI scan of blood vessels of leg 1340127_1 CDM 0610 RC 73725 HCPCS inpatient 5972 3881.8 ENCORE - ALL PLANS ENCORE - ALL PLANS 4120.68 69 999999999 3616.05 5792.84 percent of total billed charges MRI scan of blood vessels of leg 1340127_1 CDM 0610 RC 73725 HCPCS inpatient 5972 3881.8 HUMANA - ALL PLANS HUMANA - ALL PLANS 4658.16 78 999999999 3616.05 5792.84 percent of total billed charges MRI scan of blood vessels of leg 1340127_1 CDM 0610 RC 73725 HCPCS inpatient 5972 3881.8 UMR - ALL PLANS UMR - ALL PLANS 4180.4 70 999999999 3616.05 5792.84 percent of total billed charges MRI scan of blood vessels of leg 1340127_1 CDM 0610 RC 73725 HCPCS inpatient 5972 3881.8 SIHO - ALL PLANS SIHO - ALL PLANS 5374.8 90 999999999 3616.05 5792.84 percent of total billed charges MRI scan of blood vessels of leg 1340127_1 CDM 0610 RC 73725 HCPCS inpatient 5972 3881.8 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 3616.05 60.55 999999999 3616.05 5792.84 percent of total billed charges MRI scan of blood vessels of leg 1340127_1 CDM 0610 RC 73725 HCPCS inpatient 5972 3881.8 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 3616.05 5792.84 MRI scan of blood vessels of leg 1340127_1 CDM 0610 RC 73725 HCPCS inpatient 5972 3881.8 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 3616.05 5792.84 MRI scan of blood vessels of leg 1340127_1 CDM 0610 RC 73725 HCPCS inpatient 5972 3881.8 ANTHEM HMO ANTHEM HMO 999999999 3616.05 5792.84 MRI scan of blood vessels of leg 1340127_1 CDM 0610 RC 73725 HCPCS inpatient 5972 3881.8 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 3616.05 5792.84 MRI scan of blood vessels of leg 1340127_1 CDM 0610 RC 73725 HCPCS inpatient 5972 3881.8 UHC - ALL PLANS UHC - ALL PLANS 999999999 3616.05 5792.84 MRI scan of blood vessels of leg 1340127_1 CDM 0610 RC 73725 HCPCS inpatient 5972 3881.8 CIGNA - ALL PLANS CIGNA - ALL PLANS 4037.07 67.6 999999999 3616.05 5792.84 percent of total billed charges MRI scan of blood vessels of pelvis 1340131_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 AETNA AETNA 2370.79 79 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of pelvis 1340131_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 SELF PAY DISCOUNT SELF PAY DISCOUNT 1950.65 65 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of pelvis 1340131_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 2910.97 97 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of pelvis 1340131_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 ENCORE - ALL PLANS ENCORE - ALL PLANS 2070.69 69 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of pelvis 1340131_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 HUMANA - ALL PLANS HUMANA - ALL PLANS 2340.78 78 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of pelvis 1340131_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 UMR - ALL PLANS UMR - ALL PLANS 2100.7 70 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of pelvis 1340131_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 SIHO - ALL PLANS SIHO - ALL PLANS 2700.9 90 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of pelvis 1340131_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1817.11 60.55 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of pelvis 1340131_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1817.11 2910.97 MRI scan of blood vessels of pelvis 1340131_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1817.11 2910.97 MRI scan of blood vessels of pelvis 1340131_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 ANTHEM HMO ANTHEM HMO 999999999 1817.11 2910.97 MRI scan of blood vessels of pelvis 1340131_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1817.11 2910.97 MRI scan of blood vessels of pelvis 1340131_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 UHC - ALL PLANS UHC - ALL PLANS 999999999 1817.11 2910.97 MRI scan of blood vessels of pelvis 1340131_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 CIGNA - ALL PLANS CIGNA - ALL PLANS 2028.68 67.6 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of arm 1340136_1 CDM 0618 RC 73225 HCPCS inpatient 2777 1805.05 AETNA AETNA 2193.83 79 999999999 1681.47 2693.69 percent of total billed charges MRI scan of blood vessels of arm 1340136_1 CDM 0618 RC 73225 HCPCS inpatient 2777 1805.05 SELF PAY DISCOUNT SELF PAY DISCOUNT 1805.05 65 999999999 1681.47 2693.69 percent of total billed charges MRI scan of blood vessels of arm 1340136_1 CDM 0618 RC 73225 HCPCS inpatient 2777 1805.05 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 2693.69 97 999999999 1681.47 2693.69 percent of total billed charges MRI scan of blood vessels of arm 1340136_1 CDM 0618 RC 73225 HCPCS inpatient 2777 1805.05 ENCORE - ALL PLANS ENCORE - ALL PLANS 1916.13 69 999999999 1681.47 2693.69 percent of total billed charges MRI scan of blood vessels of arm 1340136_1 CDM 0618 RC 73225 HCPCS inpatient 2777 1805.05 HUMANA - ALL PLANS HUMANA - ALL PLANS 2166.06 78 999999999 1681.47 2693.69 percent of total billed charges MRI scan of blood vessels of arm 1340136_1 CDM 0618 RC 73225 HCPCS inpatient 2777 1805.05 UMR - ALL PLANS UMR - ALL PLANS 1943.9 70 999999999 1681.47 2693.69 percent of total billed charges MRI scan of blood vessels of arm 1340136_1 CDM 0618 RC 73225 HCPCS inpatient 2777 1805.05 SIHO - ALL PLANS SIHO - ALL PLANS 2499.3 90 999999999 1681.47 2693.69 percent of total billed charges MRI scan of blood vessels of arm 1340136_1 CDM 0618 RC 73225 HCPCS inpatient 2777 1805.05 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1681.47 60.55 999999999 1681.47 2693.69 percent of total billed charges MRI scan of blood vessels of arm 1340136_1 CDM 0618 RC 73225 HCPCS inpatient 2777 1805.05 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1681.47 2693.69 MRI scan of blood vessels of arm 1340136_1 CDM 0618 RC 73225 HCPCS inpatient 2777 1805.05 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1681.47 2693.69 MRI scan of blood vessels of arm 1340136_1 CDM 0618 RC 73225 HCPCS inpatient 2777 1805.05 ANTHEM HMO ANTHEM HMO 999999999 1681.47 2693.69 MRI scan of blood vessels of arm 1340136_1 CDM 0618 RC 73225 HCPCS inpatient 2777 1805.05 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1681.47 2693.69 MRI scan of blood vessels of arm 1340136_1 CDM 0618 RC 73225 HCPCS inpatient 2777 1805.05 UHC - ALL PLANS UHC - ALL PLANS 999999999 1681.47 2693.69 MRI scan of blood vessels of arm 1340136_1 CDM 0618 RC 73225 HCPCS inpatient 2777 1805.05 CIGNA - ALL PLANS CIGNA - ALL PLANS 1877.25 67.6 999999999 1681.47 2693.69 percent of total billed charges MRI scan of blood vessels of arm 1340139_1 CDM 0618 RC 73225 HCPCS inpatient 2777 1805.05 AETNA AETNA 2193.83 79 999999999 1681.47 2693.69 percent of total billed charges MRI scan of blood vessels of arm 1340139_1 CDM 0618 RC 73225 HCPCS inpatient 2777 1805.05 SELF PAY DISCOUNT SELF PAY DISCOUNT 1805.05 65 999999999 1681.47 2693.69 percent of total billed charges MRI scan of blood vessels of arm 1340139_1 CDM 0618 RC 73225 HCPCS inpatient 2777 1805.05 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 2693.69 97 999999999 1681.47 2693.69 percent of total billed charges MRI scan of blood vessels of arm 1340139_1 CDM 0618 RC 73225 HCPCS inpatient 2777 1805.05 ENCORE - ALL PLANS ENCORE - ALL PLANS 1916.13 69 999999999 1681.47 2693.69 percent of total billed charges MRI scan of blood vessels of arm 1340139_1 CDM 0618 RC 73225 HCPCS inpatient 2777 1805.05 HUMANA - ALL PLANS HUMANA - ALL PLANS 2166.06 78 999999999 1681.47 2693.69 percent of total billed charges MRI scan of blood vessels of arm 1340139_1 CDM 0618 RC 73225 HCPCS inpatient 2777 1805.05 UMR - ALL PLANS UMR - ALL PLANS 1943.9 70 999999999 1681.47 2693.69 percent of total billed charges MRI scan of blood vessels of arm 1340139_1 CDM 0618 RC 73225 HCPCS inpatient 2777 1805.05 SIHO - ALL PLANS SIHO - ALL PLANS 2499.3 90 999999999 1681.47 2693.69 percent of total billed charges MRI scan of blood vessels of arm 1340139_1 CDM 0618 RC 73225 HCPCS inpatient 2777 1805.05 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1681.47 60.55 999999999 1681.47 2693.69 percent of total billed charges MRI scan of blood vessels of arm 1340139_1 CDM 0618 RC 73225 HCPCS inpatient 2777 1805.05 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1681.47 2693.69 MRI scan of blood vessels of arm 1340139_1 CDM 0618 RC 73225 HCPCS inpatient 2777 1805.05 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1681.47 2693.69 MRI scan of blood vessels of arm 1340139_1 CDM 0618 RC 73225 HCPCS inpatient 2777 1805.05 ANTHEM HMO ANTHEM HMO 999999999 1681.47 2693.69 MRI scan of blood vessels of arm 1340139_1 CDM 0618 RC 73225 HCPCS inpatient 2777 1805.05 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1681.47 2693.69 MRI scan of blood vessels of arm 1340139_1 CDM 0618 RC 73225 HCPCS inpatient 2777 1805.05 UHC - ALL PLANS UHC - ALL PLANS 999999999 1681.47 2693.69 MRI scan of blood vessels of arm 1340139_1 CDM 0618 RC 73225 HCPCS inpatient 2777 1805.05 CIGNA - ALL PLANS CIGNA - ALL PLANS 1877.25 67.6 999999999 1681.47 2693.69 percent of total billed charges MRI scan of brain before and after contrast 1340202_1 CDM 0611 RC 70553 HCPCS inpatient 4567 2968.55 AETNA AETNA 3607.93 79 999999999 2765.32 4429.99 percent of total billed charges MRI scan of brain before and after contrast 1340202_1 CDM 0611 RC 70553 HCPCS inpatient 4567 2968.55 SELF PAY DISCOUNT SELF PAY DISCOUNT 2968.55 65 999999999 2765.32 4429.99 percent of total billed charges MRI scan of brain before and after contrast 1340202_1 CDM 0611 RC 70553 HCPCS inpatient 4567 2968.55 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 4429.99 97 999999999 2765.32 4429.99 percent of total billed charges MRI scan of brain before and after contrast 1340202_1 CDM 0611 RC 70553 HCPCS inpatient 4567 2968.55 ENCORE - ALL PLANS ENCORE - ALL PLANS 3151.23 69 999999999 2765.32 4429.99 percent of total billed charges MRI scan of brain before and after contrast 1340202_1 CDM 0611 RC 70553 HCPCS inpatient 4567 2968.55 HUMANA - ALL PLANS HUMANA - ALL PLANS 3562.26 78 999999999 2765.32 4429.99 percent of total billed charges MRI scan of brain before and after contrast 1340202_1 CDM 0611 RC 70553 HCPCS inpatient 4567 2968.55 UMR - ALL PLANS UMR - ALL PLANS 3196.9 70 999999999 2765.32 4429.99 percent of total billed charges MRI scan of brain before and after contrast 1340202_1 CDM 0611 RC 70553 HCPCS inpatient 4567 2968.55 SIHO - ALL PLANS SIHO - ALL PLANS 4110.3 90 999999999 2765.32 4429.99 percent of total billed charges MRI scan of brain before and after contrast 1340202_1 CDM 0611 RC 70553 HCPCS inpatient 4567 2968.55 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 2765.32 4429.99 MRI scan of brain before and after contrast 1340202_1 CDM 0611 RC 70553 HCPCS inpatient 4567 2968.55 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 2765.32 60.55 999999999 2765.32 4429.99 percent of total billed charges MRI scan of brain before and after contrast 1340202_1 CDM 0611 RC 70553 HCPCS inpatient 4567 2968.55 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 2765.32 4429.99 MRI scan of brain before and after contrast 1340202_1 CDM 0611 RC 70553 HCPCS inpatient 4567 2968.55 ANTHEM HMO ANTHEM HMO 999999999 2765.32 4429.99 MRI scan of brain before and after contrast 1340202_1 CDM 0611 RC 70553 HCPCS inpatient 4567 2968.55 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 2765.32 4429.99 MRI scan of brain before and after contrast 1340202_1 CDM 0611 RC 70553 HCPCS inpatient 4567 2968.55 UHC - ALL PLANS UHC - ALL PLANS 999999999 2765.32 4429.99 MRI scan of brain before and after contrast 1340202_1 CDM 0611 RC 70553 HCPCS inpatient 4567 2968.55 CIGNA - ALL PLANS CIGNA - ALL PLANS 3087.29 67.6 999999999 2765.32 4429.99 percent of total billed charges "MRI scan of bone of eye socket, face, and/or neck without contrast" 1340208_1 CDM 0611 RC 70540 HCPCS inpatient 4781 3107.65 AETNA AETNA 3776.99 79 999999999 2894.9 4637.57 percent of total billed charges "MRI scan of bone of eye socket, face, and/or neck without contrast" 1340208_1 CDM 0611 RC 70540 HCPCS inpatient 4781 3107.65 SELF PAY DISCOUNT SELF PAY DISCOUNT 3107.65 65 999999999 2894.9 4637.57 percent of total billed charges "MRI scan of bone of eye socket, face, and/or neck without contrast" 1340208_1 CDM 0611 RC 70540 HCPCS inpatient 4781 3107.65 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 4637.57 97 999999999 2894.9 4637.57 percent of total billed charges "MRI scan of bone of eye socket, face, and/or neck without contrast" 1340208_1 CDM 0611 RC 70540 HCPCS inpatient 4781 3107.65 ENCORE - ALL PLANS ENCORE - ALL PLANS 3298.89 69 999999999 2894.9 4637.57 percent of total billed charges "MRI scan of bone of eye socket, face, and/or neck without contrast" 1340208_1 CDM 0611 RC 70540 HCPCS inpatient 4781 3107.65 HUMANA - ALL PLANS HUMANA - ALL PLANS 3729.18 78 999999999 2894.9 4637.57 percent of total billed charges "MRI scan of bone of eye socket, face, and/or neck without contrast" 1340208_1 CDM 0611 RC 70540 HCPCS inpatient 4781 3107.65 UMR - ALL PLANS UMR - ALL PLANS 3346.7 70 999999999 2894.9 4637.57 percent of total billed charges "MRI scan of bone of eye socket, face, and/or neck without contrast" 1340208_1 CDM 0611 RC 70540 HCPCS inpatient 4781 3107.65 SIHO - ALL PLANS SIHO - ALL PLANS 4302.9 90 999999999 2894.9 4637.57 percent of total billed charges "MRI scan of bone of eye socket, face, and/or neck without contrast" 1340208_1 CDM 0611 RC 70540 HCPCS inpatient 4781 3107.65 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 2894.9 4637.57 "MRI scan of bone of eye socket, face, and/or neck without contrast" 1340208_1 CDM 0611 RC 70540 HCPCS inpatient 4781 3107.65 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 2894.9 60.55 999999999 2894.9 4637.57 percent of total billed charges "MRI scan of bone of eye socket, face, and/or neck without contrast" 1340208_1 CDM 0611 RC 70540 HCPCS inpatient 4781 3107.65 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 2894.9 4637.57 "MRI scan of bone of eye socket, face, and/or neck without contrast" 1340208_1 CDM 0611 RC 70540 HCPCS inpatient 4781 3107.65 ANTHEM HMO ANTHEM HMO 999999999 2894.9 4637.57 "MRI scan of bone of eye socket, face, and/or neck without contrast" 1340208_1 CDM 0611 RC 70540 HCPCS inpatient 4781 3107.65 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 2894.9 4637.57 "MRI scan of bone of eye socket, face, and/or neck without contrast" 1340208_1 CDM 0611 RC 70540 HCPCS inpatient 4781 3107.65 UHC - ALL PLANS UHC - ALL PLANS 999999999 2894.9 4637.57 "MRI scan of bone of eye socket, face, and/or neck without contrast" 1340208_1 CDM 0611 RC 70540 HCPCS inpatient 4781 3107.65 CIGNA - ALL PLANS CIGNA - ALL PLANS 3231.96 67.6 999999999 2894.9 4637.57 percent of total billed charges RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; WHOLE BODY 1340223_1 CDM 0341 RC 78806 HCPCS inpatient 4067 2643.55 AETNA AETNA 3212.93 79 999999999 2462.57 3944.99 percent of total billed charges RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; WHOLE BODY 1340223_1 CDM 0341 RC 78806 HCPCS inpatient 4067 2643.55 SELF PAY DISCOUNT SELF PAY DISCOUNT 2643.55 65 999999999 2462.57 3944.99 percent of total billed charges RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; WHOLE BODY 1340223_1 CDM 0341 RC 78806 HCPCS inpatient 4067 2643.55 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 3944.99 97 999999999 2462.57 3944.99 percent of total billed charges RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; WHOLE BODY 1340223_1 CDM 0341 RC 78806 HCPCS inpatient 4067 2643.55 ENCORE - ALL PLANS ENCORE - ALL PLANS 2806.23 69 999999999 2462.57 3944.99 percent of total billed charges RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; WHOLE BODY 1340223_1 CDM 0341 RC 78806 HCPCS inpatient 4067 2643.55 HUMANA - ALL PLANS HUMANA - ALL PLANS 3172.26 78 999999999 2462.57 3944.99 percent of total billed charges RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; WHOLE BODY 1340223_1 CDM 0341 RC 78806 HCPCS inpatient 4067 2643.55 UMR - ALL PLANS UMR - ALL PLANS 2846.9 70 999999999 2462.57 3944.99 percent of total billed charges RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; WHOLE BODY 1340223_1 CDM 0341 RC 78806 HCPCS inpatient 4067 2643.55 SIHO - ALL PLANS SIHO - ALL PLANS 3660.3 90 999999999 2462.57 3944.99 percent of total billed charges RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; WHOLE BODY 1340223_1 CDM 0341 RC 78806 HCPCS inpatient 4067 2643.55 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 2462.57 3944.99 RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; WHOLE BODY 1340223_1 CDM 0341 RC 78806 HCPCS inpatient 4067 2643.55 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 2462.57 60.55 999999999 2462.57 3944.99 percent of total billed charges RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; WHOLE BODY 1340223_1 CDM 0341 RC 78806 HCPCS inpatient 4067 2643.55 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 2462.57 3944.99 RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; WHOLE BODY 1340223_1 CDM 0341 RC 78806 HCPCS inpatient 4067 2643.55 ANTHEM HMO ANTHEM HMO 999999999 2462.57 3944.99 RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; WHOLE BODY 1340223_1 CDM 0341 RC 78806 HCPCS inpatient 4067 2643.55 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 2462.57 3944.99 RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; WHOLE BODY 1340223_1 CDM 0341 RC 78806 HCPCS inpatient 4067 2643.55 UHC - ALL PLANS UHC - ALL PLANS 999999999 2462.57 3944.99 RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; WHOLE BODY 1340223_1 CDM 0341 RC 78806 HCPCS inpatient 4067 2643.55 CIGNA - ALL PLANS CIGNA - ALL PLANS 2749.29 67.6 999999999 2462.57 3944.99 percent of total billed charges RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; WHOLE BODY 1340226_1 CDM 0341 RC 78806 HCPCS inpatient 4067 2643.55 AETNA AETNA 3212.93 79 999999999 2462.57 3944.99 percent of total billed charges RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; WHOLE BODY 1340226_1 CDM 0341 RC 78806 HCPCS inpatient 4067 2643.55 SELF PAY DISCOUNT SELF PAY DISCOUNT 2643.55 65 999999999 2462.57 3944.99 percent of total billed charges RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; WHOLE BODY 1340226_1 CDM 0341 RC 78806 HCPCS inpatient 4067 2643.55 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 3944.99 97 999999999 2462.57 3944.99 percent of total billed charges RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; WHOLE BODY 1340226_1 CDM 0341 RC 78806 HCPCS inpatient 4067 2643.55 ENCORE - ALL PLANS ENCORE - ALL PLANS 2806.23 69 999999999 2462.57 3944.99 percent of total billed charges RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; WHOLE BODY 1340226_1 CDM 0341 RC 78806 HCPCS inpatient 4067 2643.55 HUMANA - ALL PLANS HUMANA - ALL PLANS 3172.26 78 999999999 2462.57 3944.99 percent of total billed charges RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; WHOLE BODY 1340226_1 CDM 0341 RC 78806 HCPCS inpatient 4067 2643.55 UMR - ALL PLANS UMR - ALL PLANS 2846.9 70 999999999 2462.57 3944.99 percent of total billed charges RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; WHOLE BODY 1340226_1 CDM 0341 RC 78806 HCPCS inpatient 4067 2643.55 SIHO - ALL PLANS SIHO - ALL PLANS 3660.3 90 999999999 2462.57 3944.99 percent of total billed charges RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; WHOLE BODY 1340226_1 CDM 0341 RC 78806 HCPCS inpatient 4067 2643.55 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 2462.57 3944.99 RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; WHOLE BODY 1340226_1 CDM 0341 RC 78806 HCPCS inpatient 4067 2643.55 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 2462.57 60.55 999999999 2462.57 3944.99 percent of total billed charges RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; WHOLE BODY 1340226_1 CDM 0341 RC 78806 HCPCS inpatient 4067 2643.55 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 2462.57 3944.99 RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; WHOLE BODY 1340226_1 CDM 0341 RC 78806 HCPCS inpatient 4067 2643.55 ANTHEM HMO ANTHEM HMO 999999999 2462.57 3944.99 RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; WHOLE BODY 1340226_1 CDM 0341 RC 78806 HCPCS inpatient 4067 2643.55 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 2462.57 3944.99 RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; WHOLE BODY 1340226_1 CDM 0341 RC 78806 HCPCS inpatient 4067 2643.55 UHC - ALL PLANS UHC - ALL PLANS 999999999 2462.57 3944.99 RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; WHOLE BODY 1340226_1 CDM 0341 RC 78806 HCPCS inpatient 4067 2643.55 CIGNA - ALL PLANS CIGNA - ALL PLANS 2749.29 67.6 999999999 2462.57 3944.99 percent of total billed charges "Nuclear medicine study, SPECT imaging, 1 area or single acquisition, single day imaging" 1340235_1 CDM 0341 RC 78803 HCPCS inpatient 1971 1281.15 AETNA AETNA 1557.09 79 999999999 1193.44 1911.87 percent of total billed charges "Nuclear medicine study, SPECT imaging, 1 area or single acquisition, single day imaging" 1340235_1 CDM 0341 RC 78803 HCPCS inpatient 1971 1281.15 SELF PAY DISCOUNT SELF PAY DISCOUNT 1281.15 65 999999999 1193.44 1911.87 percent of total billed charges "Nuclear medicine study, SPECT imaging, 1 area or single acquisition, single day imaging" 1340235_1 CDM 0341 RC 78803 HCPCS inpatient 1971 1281.15 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 1911.87 97 999999999 1193.44 1911.87 percent of total billed charges "Nuclear medicine study, SPECT imaging, 1 area or single acquisition, single day imaging" 1340235_1 CDM 0341 RC 78803 HCPCS inpatient 1971 1281.15 ENCORE - ALL PLANS ENCORE - ALL PLANS 1359.99 69 999999999 1193.44 1911.87 percent of total billed charges "Nuclear medicine study, SPECT imaging, 1 area or single acquisition, single day imaging" 1340235_1 CDM 0341 RC 78803 HCPCS inpatient 1971 1281.15 HUMANA - ALL PLANS HUMANA - ALL PLANS 1537.38 78 999999999 1193.44 1911.87 percent of total billed charges "Nuclear medicine study, SPECT imaging, 1 area or single acquisition, single day imaging" 1340235_1 CDM 0341 RC 78803 HCPCS inpatient 1971 1281.15 UMR - ALL PLANS UMR - ALL PLANS 1379.7 70 999999999 1193.44 1911.87 percent of total billed charges "Nuclear medicine study, SPECT imaging, 1 area or single acquisition, single day imaging" 1340235_1 CDM 0341 RC 78803 HCPCS inpatient 1971 1281.15 SIHO - ALL PLANS SIHO - ALL PLANS 1773.9 90 999999999 1193.44 1911.87 percent of total billed charges "Nuclear medicine study, SPECT imaging, 1 area or single acquisition, single day imaging" 1340235_1 CDM 0341 RC 78803 HCPCS inpatient 1971 1281.15 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1193.44 1911.87 "Nuclear medicine study, SPECT imaging, 1 area or single acquisition, single day imaging" 1340235_1 CDM 0341 RC 78803 HCPCS inpatient 1971 1281.15 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1193.44 60.55 999999999 1193.44 1911.87 percent of total billed charges "Nuclear medicine study, SPECT imaging, 1 area or single acquisition, single day imaging" 1340235_1 CDM 0341 RC 78803 HCPCS inpatient 1971 1281.15 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1193.44 1911.87 "Nuclear medicine study, SPECT imaging, 1 area or single acquisition, single day imaging" 1340235_1 CDM 0341 RC 78803 HCPCS inpatient 1971 1281.15 ANTHEM HMO ANTHEM HMO 999999999 1193.44 1911.87 "Nuclear medicine study, SPECT imaging, 1 area or single acquisition, single day imaging" 1340235_1 CDM 0341 RC 78803 HCPCS inpatient 1971 1281.15 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1193.44 1911.87 "Nuclear medicine study, SPECT imaging, 1 area or single acquisition, single day imaging" 1340235_1 CDM 0341 RC 78803 HCPCS inpatient 1971 1281.15 UHC - ALL PLANS UHC - ALL PLANS 999999999 1193.44 1911.87 "Nuclear medicine study, SPECT imaging, 1 area or single acquisition, single day imaging" 1340235_1 CDM 0341 RC 78803 HCPCS inpatient 1971 1281.15 CIGNA - ALL PLANS CIGNA - ALL PLANS 1332.4 67.6 999999999 1193.44 1911.87 percent of total billed charges Nuclear medicine study of bone taken at different times 1340238_1 CDM 0341 RC 78315 HCPCS inpatient 4312 2802.8 AETNA AETNA 3406.48 79 999999999 2610.92 4182.64 percent of total billed charges Nuclear medicine study of bone taken at different times 1340238_1 CDM 0341 RC 78315 HCPCS inpatient 4312 2802.8 SELF PAY DISCOUNT SELF PAY DISCOUNT 2802.8 65 999999999 2610.92 4182.64 percent of total billed charges Nuclear medicine study of bone taken at different times 1340238_1 CDM 0341 RC 78315 HCPCS inpatient 4312 2802.8 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 4182.64 97 999999999 2610.92 4182.64 percent of total billed charges Nuclear medicine study of bone taken at different times 1340238_1 CDM 0341 RC 78315 HCPCS inpatient 4312 2802.8 ENCORE - ALL PLANS ENCORE - ALL PLANS 2975.28 69 999999999 2610.92 4182.64 percent of total billed charges Nuclear medicine study of bone taken at different times 1340238_1 CDM 0341 RC 78315 HCPCS inpatient 4312 2802.8 HUMANA - ALL PLANS HUMANA - ALL PLANS 3363.36 78 999999999 2610.92 4182.64 percent of total billed charges Nuclear medicine study of bone taken at different times 1340238_1 CDM 0341 RC 78315 HCPCS inpatient 4312 2802.8 UMR - ALL PLANS UMR - ALL PLANS 3018.4 70 999999999 2610.92 4182.64 percent of total billed charges Nuclear medicine study of bone taken at different times 1340238_1 CDM 0341 RC 78315 HCPCS inpatient 4312 2802.8 SIHO - ALL PLANS SIHO - ALL PLANS 3880.8 90 999999999 2610.92 4182.64 percent of total billed charges Nuclear medicine study of bone taken at different times 1340238_1 CDM 0341 RC 78315 HCPCS inpatient 4312 2802.8 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 2610.92 4182.64 Nuclear medicine study of bone taken at different times 1340238_1 CDM 0341 RC 78315 HCPCS inpatient 4312 2802.8 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 2610.92 60.55 999999999 2610.92 4182.64 percent of total billed charges Nuclear medicine study of bone taken at different times 1340238_1 CDM 0341 RC 78315 HCPCS inpatient 4312 2802.8 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 2610.92 4182.64 Nuclear medicine study of bone taken at different times 1340238_1 CDM 0341 RC 78315 HCPCS inpatient 4312 2802.8 ANTHEM HMO ANTHEM HMO 999999999 2610.92 4182.64 Nuclear medicine study of bone taken at different times 1340238_1 CDM 0341 RC 78315 HCPCS inpatient 4312 2802.8 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 2610.92 4182.64 Nuclear medicine study of bone taken at different times 1340238_1 CDM 0341 RC 78315 HCPCS inpatient 4312 2802.8 UHC - ALL PLANS UHC - ALL PLANS 999999999 2610.92 4182.64 Nuclear medicine study of bone taken at different times 1340238_1 CDM 0341 RC 78315 HCPCS inpatient 4312 2802.8 CIGNA - ALL PLANS CIGNA - ALL PLANS 2914.91 67.6 999999999 2610.92 4182.64 percent of total billed charges Nuclear medicine study of heart muscle following heart attack 1340250_1 CDM 0340 RC 78466 HCPCS inpatient 2417 1571.05 AETNA AETNA 1909.43 79 999999999 1463.49 2344.49 percent of total billed charges Nuclear medicine study of heart muscle following heart attack 1340250_1 CDM 0340 RC 78466 HCPCS inpatient 2417 1571.05 SELF PAY DISCOUNT SELF PAY DISCOUNT 1571.05 65 999999999 1463.49 2344.49 percent of total billed charges Nuclear medicine study of heart muscle following heart attack 1340250_1 CDM 0340 RC 78466 HCPCS inpatient 2417 1571.05 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 2344.49 97 999999999 1463.49 2344.49 percent of total billed charges Nuclear medicine study of heart muscle following heart attack 1340250_1 CDM 0340 RC 78466 HCPCS inpatient 2417 1571.05 ENCORE - ALL PLANS ENCORE - ALL PLANS 1667.73 69 999999999 1463.49 2344.49 percent of total billed charges Nuclear medicine study of heart muscle following heart attack 1340250_1 CDM 0340 RC 78466 HCPCS inpatient 2417 1571.05 HUMANA - ALL PLANS HUMANA - ALL PLANS 1885.26 78 999999999 1463.49 2344.49 percent of total billed charges Nuclear medicine study of heart muscle following heart attack 1340250_1 CDM 0340 RC 78466 HCPCS inpatient 2417 1571.05 UMR - ALL PLANS UMR - ALL PLANS 1691.9 70 999999999 1463.49 2344.49 percent of total billed charges Nuclear medicine study of heart muscle following heart attack 1340250_1 CDM 0340 RC 78466 HCPCS inpatient 2417 1571.05 SIHO - ALL PLANS SIHO - ALL PLANS 2175.3 90 999999999 1463.49 2344.49 percent of total billed charges Nuclear medicine study of heart muscle following heart attack 1340250_1 CDM 0340 RC 78466 HCPCS inpatient 2417 1571.05 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1463.49 2344.49 Nuclear medicine study of heart muscle following heart attack 1340250_1 CDM 0340 RC 78466 HCPCS inpatient 2417 1571.05 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1463.49 60.55 999999999 1463.49 2344.49 percent of total billed charges Nuclear medicine study of heart muscle following heart attack 1340250_1 CDM 0340 RC 78466 HCPCS inpatient 2417 1571.05 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1463.49 2344.49 Nuclear medicine study of heart muscle following heart attack 1340250_1 CDM 0340 RC 78466 HCPCS inpatient 2417 1571.05 ANTHEM HMO ANTHEM HMO 999999999 1463.49 2344.49 Nuclear medicine study of heart muscle following heart attack 1340250_1 CDM 0340 RC 78466 HCPCS inpatient 2417 1571.05 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1463.49 2344.49 Nuclear medicine study of heart muscle following heart attack 1340250_1 CDM 0340 RC 78466 HCPCS inpatient 2417 1571.05 UHC - ALL PLANS UHC - ALL PLANS 999999999 1463.49 2344.49 Nuclear medicine study of heart muscle following heart attack 1340250_1 CDM 0340 RC 78466 HCPCS inpatient 2417 1571.05 CIGNA - ALL PLANS CIGNA - ALL PLANS 1633.89 67.6 999999999 1463.49 2344.49 percent of total billed charges NM Myocardial Spect Multi Rest/Stress 1340265_1 CDM 0341 RC 78465 HCPCS inpatient 4617 3001.05 AETNA AETNA 3647.43 79 999999999 2795.59 4478.49 percent of total billed charges NM Myocardial Spect Multi Rest/Stress 1340265_1 CDM 0341 RC 78465 HCPCS inpatient 4617 3001.05 SELF PAY DISCOUNT SELF PAY DISCOUNT 3001.05 65 999999999 2795.59 4478.49 percent of total billed charges NM Myocardial Spect Multi Rest/Stress 1340265_1 CDM 0341 RC 78465 HCPCS inpatient 4617 3001.05 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 4478.49 97 999999999 2795.59 4478.49 percent of total billed charges NM Myocardial Spect Multi Rest/Stress 1340265_1 CDM 0341 RC 78465 HCPCS inpatient 4617 3001.05 ENCORE - ALL PLANS ENCORE - ALL PLANS 3185.73 69 999999999 2795.59 4478.49 percent of total billed charges NM Myocardial Spect Multi Rest/Stress 1340265_1 CDM 0341 RC 78465 HCPCS inpatient 4617 3001.05 HUMANA - ALL PLANS HUMANA - ALL PLANS 3601.26 78 999999999 2795.59 4478.49 percent of total billed charges NM Myocardial Spect Multi Rest/Stress 1340265_1 CDM 0341 RC 78465 HCPCS inpatient 4617 3001.05 UMR - ALL PLANS UMR - ALL PLANS 3231.9 70 999999999 2795.59 4478.49 percent of total billed charges NM Myocardial Spect Multi Rest/Stress 1340265_1 CDM 0341 RC 78465 HCPCS inpatient 4617 3001.05 SIHO - ALL PLANS SIHO - ALL PLANS 4155.3 90 999999999 2795.59 4478.49 percent of total billed charges NM Myocardial Spect Multi Rest/Stress 1340265_1 CDM 0341 RC 78465 HCPCS inpatient 4617 3001.05 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 2795.59 4478.49 NM Myocardial Spect Multi Rest/Stress 1340265_1 CDM 0341 RC 78465 HCPCS inpatient 4617 3001.05 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 2795.59 60.55 999999999 2795.59 4478.49 percent of total billed charges NM Myocardial Spect Multi Rest/Stress 1340265_1 CDM 0341 RC 78465 HCPCS inpatient 4617 3001.05 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 2795.59 4478.49 NM Myocardial Spect Multi Rest/Stress 1340265_1 CDM 0341 RC 78465 HCPCS inpatient 4617 3001.05 ANTHEM HMO ANTHEM HMO 999999999 2795.59 4478.49 NM Myocardial Spect Multi Rest/Stress 1340265_1 CDM 0341 RC 78465 HCPCS inpatient 4617 3001.05 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 2795.59 4478.49 NM Myocardial Spect Multi Rest/Stress 1340265_1 CDM 0341 RC 78465 HCPCS inpatient 4617 3001.05 UHC - ALL PLANS UHC - ALL PLANS 999999999 2795.59 4478.49 NM Myocardial Spect Multi Rest/Stress 1340265_1 CDM 0341 RC 78465 HCPCS inpatient 4617 3001.05 CIGNA - ALL PLANS CIGNA - ALL PLANS 3121.09 67.6 999999999 2795.59 4478.49 percent of total billed charges Injection of radioactive material for X-ray identification of lymph node 1340280_1 CDM 0341 RC 38792 HCPCS inpatient 766 497.9 AETNA AETNA 605.14 79 999999999 463.81 743.02 percent of total billed charges Injection of radioactive material for X-ray identification of lymph node 1340280_1 CDM 0341 RC 38792 HCPCS inpatient 766 497.9 SELF PAY DISCOUNT SELF PAY DISCOUNT 497.9 65 999999999 463.81 743.02 percent of total billed charges Injection of radioactive material for X-ray identification of lymph node 1340280_1 CDM 0341 RC 38792 HCPCS inpatient 766 497.9 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 743.02 97 999999999 463.81 743.02 percent of total billed charges Injection of radioactive material for X-ray identification of lymph node 1340280_1 CDM 0341 RC 38792 HCPCS inpatient 766 497.9 ENCORE - ALL PLANS ENCORE - ALL PLANS 528.54 69 999999999 463.81 743.02 percent of total billed charges Injection of radioactive material for X-ray identification of lymph node 1340280_1 CDM 0341 RC 38792 HCPCS inpatient 766 497.9 HUMANA - ALL PLANS HUMANA - ALL PLANS 597.48 78 999999999 463.81 743.02 percent of total billed charges Injection of radioactive material for X-ray identification of lymph node 1340280_1 CDM 0341 RC 38792 HCPCS inpatient 766 497.9 UMR - ALL PLANS UMR - ALL PLANS 536.2 70 999999999 463.81 743.02 percent of total billed charges Injection of radioactive material for X-ray identification of lymph node 1340280_1 CDM 0341 RC 38792 HCPCS inpatient 766 497.9 SIHO - ALL PLANS SIHO - ALL PLANS 689.4 90 999999999 463.81 743.02 percent of total billed charges Injection of radioactive material for X-ray identification of lymph node 1340280_1 CDM 0341 RC 38792 HCPCS inpatient 766 497.9 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 463.81 743.02 Injection of radioactive material for X-ray identification of lymph node 1340280_1 CDM 0341 RC 38792 HCPCS inpatient 766 497.9 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 463.81 60.55 999999999 463.81 743.02 percent of total billed charges Injection of radioactive material for X-ray identification of lymph node 1340280_1 CDM 0341 RC 38792 HCPCS inpatient 766 497.9 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 463.81 743.02 Injection of radioactive material for X-ray identification of lymph node 1340280_1 CDM 0341 RC 38792 HCPCS inpatient 766 497.9 ANTHEM HMO ANTHEM HMO 999999999 463.81 743.02 Injection of radioactive material for X-ray identification of lymph node 1340280_1 CDM 0341 RC 38792 HCPCS inpatient 766 497.9 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 463.81 743.02 Injection of radioactive material for X-ray identification of lymph node 1340280_1 CDM 0341 RC 38792 HCPCS inpatient 766 497.9 UHC - ALL PLANS UHC - ALL PLANS 999999999 463.81 743.02 Injection of radioactive material for X-ray identification of lymph node 1340280_1 CDM 0341 RC 38792 HCPCS inpatient 766 497.9 CIGNA - ALL PLANS CIGNA - ALL PLANS 517.82 67.6 999999999 463.81 743.02 percent of total billed charges Ultrasonic guidance for needle placement 1340290_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 AETNA AETNA 692.83 79 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 1340290_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 SELF PAY DISCOUNT SELF PAY DISCOUNT 570.05 65 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 1340290_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 850.69 97 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 1340290_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 ENCORE - ALL PLANS ENCORE - ALL PLANS 605.13 69 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 1340290_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 HUMANA - ALL PLANS HUMANA - ALL PLANS 684.06 78 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 1340290_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 UMR - ALL PLANS UMR - ALL PLANS 613.9 70 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 1340290_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 SIHO - ALL PLANS SIHO - ALL PLANS 789.3 90 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 1340290_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 531.02 850.69 Ultrasonic guidance for needle placement 1340290_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 531.02 60.55 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 1340290_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 531.02 850.69 Ultrasonic guidance for needle placement 1340290_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 ANTHEM HMO ANTHEM HMO 999999999 531.02 850.69 Ultrasonic guidance for needle placement 1340290_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 531.02 850.69 Ultrasonic guidance for needle placement 1340290_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 UHC - ALL PLANS UHC - ALL PLANS 999999999 531.02 850.69 Ultrasonic guidance for needle placement 1340290_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 CIGNA - ALL PLANS CIGNA - ALL PLANS 592.85 67.6 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 1340292_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 AETNA AETNA 692.83 79 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 1340292_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 SELF PAY DISCOUNT SELF PAY DISCOUNT 570.05 65 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 1340292_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 850.69 97 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 1340292_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 ENCORE - ALL PLANS ENCORE - ALL PLANS 605.13 69 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 1340292_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 HUMANA - ALL PLANS HUMANA - ALL PLANS 684.06 78 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 1340292_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 UMR - ALL PLANS UMR - ALL PLANS 613.9 70 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 1340292_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 SIHO - ALL PLANS SIHO - ALL PLANS 789.3 90 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 1340292_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 531.02 850.69 Ultrasonic guidance for needle placement 1340292_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 531.02 60.55 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 1340292_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 531.02 850.69 Ultrasonic guidance for needle placement 1340292_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 ANTHEM HMO ANTHEM HMO 999999999 531.02 850.69 Ultrasonic guidance for needle placement 1340292_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 531.02 850.69 Ultrasonic guidance for needle placement 1340292_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 UHC - ALL PLANS UHC - ALL PLANS 999999999 531.02 850.69 Ultrasonic guidance for needle placement 1340292_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 CIGNA - ALL PLANS CIGNA - ALL PLANS 592.85 67.6 999999999 531.02 850.69 percent of total billed charges Complete ultrasound scan of 1 breast 1340297_1 CDM 0402 RC 76641 HCPCS inpatient 1484 964.6 AETNA AETNA 1172.36 79 999999999 898.56 1439.48 percent of total billed charges Complete ultrasound scan of 1 breast 1340297_1 CDM 0402 RC 76641 HCPCS inpatient 1484 964.6 SELF PAY DISCOUNT SELF PAY DISCOUNT 964.6 65 999999999 898.56 1439.48 percent of total billed charges Complete ultrasound scan of 1 breast 1340297_1 CDM 0402 RC 76641 HCPCS inpatient 1484 964.6 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 1439.48 97 999999999 898.56 1439.48 percent of total billed charges Complete ultrasound scan of 1 breast 1340297_1 CDM 0402 RC 76641 HCPCS inpatient 1484 964.6 ENCORE - ALL PLANS ENCORE - ALL PLANS 1023.96 69 999999999 898.56 1439.48 percent of total billed charges Complete ultrasound scan of 1 breast 1340297_1 CDM 0402 RC 76641 HCPCS inpatient 1484 964.6 HUMANA - ALL PLANS HUMANA - ALL PLANS 1157.52 78 999999999 898.56 1439.48 percent of total billed charges Complete ultrasound scan of 1 breast 1340297_1 CDM 0402 RC 76641 HCPCS inpatient 1484 964.6 UMR - ALL PLANS UMR - ALL PLANS 1038.8 70 999999999 898.56 1439.48 percent of total billed charges Complete ultrasound scan of 1 breast 1340297_1 CDM 0402 RC 76641 HCPCS inpatient 1484 964.6 SIHO - ALL PLANS SIHO - ALL PLANS 1335.6 90 999999999 898.56 1439.48 percent of total billed charges Complete ultrasound scan of 1 breast 1340297_1 CDM 0402 RC 76641 HCPCS inpatient 1484 964.6 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 898.56 1439.48 Complete ultrasound scan of 1 breast 1340297_1 CDM 0402 RC 76641 HCPCS inpatient 1484 964.6 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 898.56 60.55 999999999 898.56 1439.48 percent of total billed charges Complete ultrasound scan of 1 breast 1340297_1 CDM 0402 RC 76641 HCPCS inpatient 1484 964.6 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 898.56 1439.48 Complete ultrasound scan of 1 breast 1340297_1 CDM 0402 RC 76641 HCPCS inpatient 1484 964.6 ANTHEM HMO ANTHEM HMO 999999999 898.56 1439.48 Complete ultrasound scan of 1 breast 1340297_1 CDM 0402 RC 76641 HCPCS inpatient 1484 964.6 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 898.56 1439.48 Complete ultrasound scan of 1 breast 1340297_1 CDM 0402 RC 76641 HCPCS inpatient 1484 964.6 UHC - ALL PLANS UHC - ALL PLANS 999999999 898.56 1439.48 Complete ultrasound scan of 1 breast 1340297_1 CDM 0402 RC 76641 HCPCS inpatient 1484 964.6 CIGNA - ALL PLANS CIGNA - ALL PLANS 1003.18 67.6 999999999 898.56 1439.48 percent of total billed charges Complete ultrasound scan of 1 breast 1340300_1 CDM 0402 RC 76641 HCPCS inpatient 761 494.65 AETNA AETNA 601.19 79 999999999 460.79 738.17 percent of total billed charges Complete ultrasound scan of 1 breast 1340300_1 CDM 0402 RC 76641 HCPCS inpatient 761 494.65 SELF PAY DISCOUNT SELF PAY DISCOUNT 494.65 65 999999999 460.79 738.17 percent of total billed charges Complete ultrasound scan of 1 breast 1340300_1 CDM 0402 RC 76641 HCPCS inpatient 761 494.65 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 738.17 97 999999999 460.79 738.17 percent of total billed charges Complete ultrasound scan of 1 breast 1340300_1 CDM 0402 RC 76641 HCPCS inpatient 761 494.65 ENCORE - ALL PLANS ENCORE - ALL PLANS 525.09 69 999999999 460.79 738.17 percent of total billed charges Complete ultrasound scan of 1 breast 1340300_1 CDM 0402 RC 76641 HCPCS inpatient 761 494.65 HUMANA - ALL PLANS HUMANA - ALL PLANS 593.58 78 999999999 460.79 738.17 percent of total billed charges Complete ultrasound scan of 1 breast 1340300_1 CDM 0402 RC 76641 HCPCS inpatient 761 494.65 UMR - ALL PLANS UMR - ALL PLANS 532.7 70 999999999 460.79 738.17 percent of total billed charges Complete ultrasound scan of 1 breast 1340300_1 CDM 0402 RC 76641 HCPCS inpatient 761 494.65 SIHO - ALL PLANS SIHO - ALL PLANS 684.9 90 999999999 460.79 738.17 percent of total billed charges Complete ultrasound scan of 1 breast 1340300_1 CDM 0402 RC 76641 HCPCS inpatient 761 494.65 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 460.79 738.17 Complete ultrasound scan of 1 breast 1340300_1 CDM 0402 RC 76641 HCPCS inpatient 761 494.65 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 460.79 60.55 999999999 460.79 738.17 percent of total billed charges Complete ultrasound scan of 1 breast 1340300_1 CDM 0402 RC 76641 HCPCS inpatient 761 494.65 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 460.79 738.17 Complete ultrasound scan of 1 breast 1340300_1 CDM 0402 RC 76641 HCPCS inpatient 761 494.65 ANTHEM HMO ANTHEM HMO 999999999 460.79 738.17 Complete ultrasound scan of 1 breast 1340300_1 CDM 0402 RC 76641 HCPCS inpatient 761 494.65 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 460.79 738.17 Complete ultrasound scan of 1 breast 1340300_1 CDM 0402 RC 76641 HCPCS inpatient 761 494.65 UHC - ALL PLANS UHC - ALL PLANS 999999999 460.79 738.17 Complete ultrasound scan of 1 breast 1340300_1 CDM 0402 RC 76641 HCPCS inpatient 761 494.65 CIGNA - ALL PLANS CIGNA - ALL PLANS 514.44 67.6 999999999 460.79 738.17 percent of total billed charges Complete ultrasound scan of 1 breast 1340309_1 CDM 0402 RC 76641 HCPCS inpatient 761 494.65 AETNA AETNA 601.19 79 999999999 460.79 738.17 percent of total billed charges Complete ultrasound scan of 1 breast 1340309_1 CDM 0402 RC 76641 HCPCS inpatient 761 494.65 SELF PAY DISCOUNT SELF PAY DISCOUNT 494.65 65 999999999 460.79 738.17 percent of total billed charges Complete ultrasound scan of 1 breast 1340309_1 CDM 0402 RC 76641 HCPCS inpatient 761 494.65 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 738.17 97 999999999 460.79 738.17 percent of total billed charges Complete ultrasound scan of 1 breast 1340309_1 CDM 0402 RC 76641 HCPCS inpatient 761 494.65 ENCORE - ALL PLANS ENCORE - ALL PLANS 525.09 69 999999999 460.79 738.17 percent of total billed charges Complete ultrasound scan of 1 breast 1340309_1 CDM 0402 RC 76641 HCPCS inpatient 761 494.65 HUMANA - ALL PLANS HUMANA - ALL PLANS 593.58 78 999999999 460.79 738.17 percent of total billed charges Complete ultrasound scan of 1 breast 1340309_1 CDM 0402 RC 76641 HCPCS inpatient 761 494.65 UMR - ALL PLANS UMR - ALL PLANS 532.7 70 999999999 460.79 738.17 percent of total billed charges Complete ultrasound scan of 1 breast 1340309_1 CDM 0402 RC 76641 HCPCS inpatient 761 494.65 SIHO - ALL PLANS SIHO - ALL PLANS 684.9 90 999999999 460.79 738.17 percent of total billed charges Complete ultrasound scan of 1 breast 1340309_1 CDM 0402 RC 76641 HCPCS inpatient 761 494.65 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 460.79 738.17 Complete ultrasound scan of 1 breast 1340309_1 CDM 0402 RC 76641 HCPCS inpatient 761 494.65 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 460.79 60.55 999999999 460.79 738.17 percent of total billed charges Complete ultrasound scan of 1 breast 1340309_1 CDM 0402 RC 76641 HCPCS inpatient 761 494.65 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 460.79 738.17 Complete ultrasound scan of 1 breast 1340309_1 CDM 0402 RC 76641 HCPCS inpatient 761 494.65 ANTHEM HMO ANTHEM HMO 999999999 460.79 738.17 Complete ultrasound scan of 1 breast 1340309_1 CDM 0402 RC 76641 HCPCS inpatient 761 494.65 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 460.79 738.17 Complete ultrasound scan of 1 breast 1340309_1 CDM 0402 RC 76641 HCPCS inpatient 761 494.65 UHC - ALL PLANS UHC - ALL PLANS 999999999 460.79 738.17 Complete ultrasound scan of 1 breast 1340309_1 CDM 0402 RC 76641 HCPCS inpatient 761 494.65 CIGNA - ALL PLANS CIGNA - ALL PLANS 514.44 67.6 999999999 460.79 738.17 percent of total billed charges Limited ultrasound scan of abdomen 1340339_1 CDM 0402 RC 76705 HCPCS inpatient 1082 703.3 AETNA AETNA 854.78 79 999999999 655.15 1049.54 percent of total billed charges Limited ultrasound scan of abdomen 1340339_1 CDM 0402 RC 76705 HCPCS inpatient 1082 703.3 SELF PAY DISCOUNT SELF PAY DISCOUNT 703.3 65 999999999 655.15 1049.54 percent of total billed charges Limited ultrasound scan of abdomen 1340339_1 CDM 0402 RC 76705 HCPCS inpatient 1082 703.3 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 1049.54 97 999999999 655.15 1049.54 percent of total billed charges Limited ultrasound scan of abdomen 1340339_1 CDM 0402 RC 76705 HCPCS inpatient 1082 703.3 ENCORE - ALL PLANS ENCORE - ALL PLANS 746.58 69 999999999 655.15 1049.54 percent of total billed charges Limited ultrasound scan of abdomen 1340339_1 CDM 0402 RC 76705 HCPCS inpatient 1082 703.3 HUMANA - ALL PLANS HUMANA - ALL PLANS 843.96 78 999999999 655.15 1049.54 percent of total billed charges Limited ultrasound scan of abdomen 1340339_1 CDM 0402 RC 76705 HCPCS inpatient 1082 703.3 UMR - ALL PLANS UMR - ALL PLANS 757.4 70 999999999 655.15 1049.54 percent of total billed charges Limited ultrasound scan of abdomen 1340339_1 CDM 0402 RC 76705 HCPCS inpatient 1082 703.3 SIHO - ALL PLANS SIHO - ALL PLANS 973.8 90 999999999 655.15 1049.54 percent of total billed charges Limited ultrasound scan of abdomen 1340339_1 CDM 0402 RC 76705 HCPCS inpatient 1082 703.3 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 655.15 1049.54 Limited ultrasound scan of abdomen 1340339_1 CDM 0402 RC 76705 HCPCS inpatient 1082 703.3 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 655.15 60.55 999999999 655.15 1049.54 percent of total billed charges Limited ultrasound scan of abdomen 1340339_1 CDM 0402 RC 76705 HCPCS inpatient 1082 703.3 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 655.15 1049.54 Limited ultrasound scan of abdomen 1340339_1 CDM 0402 RC 76705 HCPCS inpatient 1082 703.3 ANTHEM HMO ANTHEM HMO 999999999 655.15 1049.54 Limited ultrasound scan of abdomen 1340339_1 CDM 0402 RC 76705 HCPCS inpatient 1082 703.3 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 655.15 1049.54 Limited ultrasound scan of abdomen 1340339_1 CDM 0402 RC 76705 HCPCS inpatient 1082 703.3 UHC - ALL PLANS UHC - ALL PLANS 999999999 655.15 1049.54 Limited ultrasound scan of abdomen 1340339_1 CDM 0402 RC 76705 HCPCS inpatient 1082 703.3 CIGNA - ALL PLANS CIGNA - ALL PLANS 731.43 67.6 999999999 655.15 1049.54 percent of total billed charges "X-ray of abdomen, minimum of 3 views" 1340348_1 CDM 0320 RC 74021 HCPCS inpatient 544 353.6 AETNA AETNA 429.76 79 999999999 329.39 527.68 percent of total billed charges "X-ray of abdomen, minimum of 3 views" 1340348_1 CDM 0320 RC 74021 HCPCS inpatient 544 353.6 SELF PAY DISCOUNT SELF PAY DISCOUNT 353.6 65 999999999 329.39 527.68 percent of total billed charges "X-ray of abdomen, minimum of 3 views" 1340348_1 CDM 0320 RC 74021 HCPCS inpatient 544 353.6 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 527.68 97 999999999 329.39 527.68 percent of total billed charges "X-ray of abdomen, minimum of 3 views" 1340348_1 CDM 0320 RC 74021 HCPCS inpatient 544 353.6 ENCORE - ALL PLANS ENCORE - ALL PLANS 375.36 69 999999999 329.39 527.68 percent of total billed charges "X-ray of abdomen, minimum of 3 views" 1340348_1 CDM 0320 RC 74021 HCPCS inpatient 544 353.6 HUMANA - ALL PLANS HUMANA - ALL PLANS 424.32 78 999999999 329.39 527.68 percent of total billed charges "X-ray of abdomen, minimum of 3 views" 1340348_1 CDM 0320 RC 74021 HCPCS inpatient 544 353.6 UMR - ALL PLANS UMR - ALL PLANS 380.8 70 999999999 329.39 527.68 percent of total billed charges "X-ray of abdomen, minimum of 3 views" 1340348_1 CDM 0320 RC 74021 HCPCS inpatient 544 353.6 SIHO - ALL PLANS SIHO - ALL PLANS 489.6 90 999999999 329.39 527.68 percent of total billed charges "X-ray of abdomen, minimum of 3 views" 1340348_1 CDM 0320 RC 74021 HCPCS inpatient 544 353.6 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 329.39 527.68 "X-ray of abdomen, minimum of 3 views" 1340348_1 CDM 0320 RC 74021 HCPCS inpatient 544 353.6 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 329.39 60.55 999999999 329.39 527.68 percent of total billed charges "X-ray of abdomen, minimum of 3 views" 1340348_1 CDM 0320 RC 74021 HCPCS inpatient 544 353.6 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 329.39 527.68 "X-ray of abdomen, minimum of 3 views" 1340348_1 CDM 0320 RC 74021 HCPCS inpatient 544 353.6 ANTHEM HMO ANTHEM HMO 999999999 329.39 527.68 "X-ray of abdomen, minimum of 3 views" 1340348_1 CDM 0320 RC 74021 HCPCS inpatient 544 353.6 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 329.39 527.68 "X-ray of abdomen, minimum of 3 views" 1340348_1 CDM 0320 RC 74021 HCPCS inpatient 544 353.6 UHC - ALL PLANS UHC - ALL PLANS 999999999 329.39 527.68 "X-ray of abdomen, minimum of 3 views" 1340348_1 CDM 0320 RC 74021 HCPCS inpatient 544 353.6 CIGNA - ALL PLANS CIGNA - ALL PLANS 367.74 67.6 999999999 329.39 527.68 percent of total billed charges "X-ray of abdomen, minimum of 3 views" 1340351_1 CDM 0320 RC 74021 HCPCS inpatient 544 353.6 AETNA AETNA 429.76 79 999999999 329.39 527.68 percent of total billed charges "X-ray of abdomen, minimum of 3 views" 1340351_1 CDM 0320 RC 74021 HCPCS inpatient 544 353.6 SELF PAY DISCOUNT SELF PAY DISCOUNT 353.6 65 999999999 329.39 527.68 percent of total billed charges "X-ray of abdomen, minimum of 3 views" 1340351_1 CDM 0320 RC 74021 HCPCS inpatient 544 353.6 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 527.68 97 999999999 329.39 527.68 percent of total billed charges "X-ray of abdomen, minimum of 3 views" 1340351_1 CDM 0320 RC 74021 HCPCS inpatient 544 353.6 ENCORE - ALL PLANS ENCORE - ALL PLANS 375.36 69 999999999 329.39 527.68 percent of total billed charges "X-ray of abdomen, minimum of 3 views" 1340351_1 CDM 0320 RC 74021 HCPCS inpatient 544 353.6 HUMANA - ALL PLANS HUMANA - ALL PLANS 424.32 78 999999999 329.39 527.68 percent of total billed charges "X-ray of abdomen, minimum of 3 views" 1340351_1 CDM 0320 RC 74021 HCPCS inpatient 544 353.6 UMR - ALL PLANS UMR - ALL PLANS 380.8 70 999999999 329.39 527.68 percent of total billed charges "X-ray of abdomen, minimum of 3 views" 1340351_1 CDM 0320 RC 74021 HCPCS inpatient 544 353.6 SIHO - ALL PLANS SIHO - ALL PLANS 489.6 90 999999999 329.39 527.68 percent of total billed charges "X-ray of abdomen, minimum of 3 views" 1340351_1 CDM 0320 RC 74021 HCPCS inpatient 544 353.6 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 329.39 527.68 "X-ray of abdomen, minimum of 3 views" 1340351_1 CDM 0320 RC 74021 HCPCS inpatient 544 353.6 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 329.39 60.55 999999999 329.39 527.68 percent of total billed charges "X-ray of abdomen, minimum of 3 views" 1340351_1 CDM 0320 RC 74021 HCPCS inpatient 544 353.6 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 329.39 527.68 "X-ray of abdomen, minimum of 3 views" 1340351_1 CDM 0320 RC 74021 HCPCS inpatient 544 353.6 ANTHEM HMO ANTHEM HMO 999999999 329.39 527.68 "X-ray of abdomen, minimum of 3 views" 1340351_1 CDM 0320 RC 74021 HCPCS inpatient 544 353.6 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 329.39 527.68 "X-ray of abdomen, minimum of 3 views" 1340351_1 CDM 0320 RC 74021 HCPCS inpatient 544 353.6 UHC - ALL PLANS UHC - ALL PLANS 999999999 329.39 527.68 "X-ray of abdomen, minimum of 3 views" 1340351_1 CDM 0320 RC 74021 HCPCS inpatient 544 353.6 CIGNA - ALL PLANS CIGNA - ALL PLANS 367.74 67.6 999999999 329.39 527.68 percent of total billed charges Single contrast X-ray of esophagus 1340354_1 CDM 0320 RC 74220 HCPCS inpatient 872 566.8 AETNA AETNA 688.88 79 999999999 528 845.84 percent of total billed charges Single contrast X-ray of esophagus 1340354_1 CDM 0320 RC 74220 HCPCS inpatient 872 566.8 SELF PAY DISCOUNT SELF PAY DISCOUNT 566.8 65 999999999 528 845.84 percent of total billed charges Single contrast X-ray of esophagus 1340354_1 CDM 0320 RC 74220 HCPCS inpatient 872 566.8 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 845.84 97 999999999 528 845.84 percent of total billed charges Single contrast X-ray of esophagus 1340354_1 CDM 0320 RC 74220 HCPCS inpatient 872 566.8 ENCORE - ALL PLANS ENCORE - ALL PLANS 601.68 69 999999999 528 845.84 percent of total billed charges Single contrast X-ray of esophagus 1340354_1 CDM 0320 RC 74220 HCPCS inpatient 872 566.8 HUMANA - ALL PLANS HUMANA - ALL PLANS 680.16 78 999999999 528 845.84 percent of total billed charges Single contrast X-ray of esophagus 1340354_1 CDM 0320 RC 74220 HCPCS inpatient 872 566.8 UMR - ALL PLANS UMR - ALL PLANS 610.4 70 999999999 528 845.84 percent of total billed charges Single contrast X-ray of esophagus 1340354_1 CDM 0320 RC 74220 HCPCS inpatient 872 566.8 SIHO - ALL PLANS SIHO - ALL PLANS 784.8 90 999999999 528 845.84 percent of total billed charges Single contrast X-ray of esophagus 1340354_1 CDM 0320 RC 74220 HCPCS inpatient 872 566.8 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 528 845.84 Single contrast X-ray of esophagus 1340354_1 CDM 0320 RC 74220 HCPCS inpatient 872 566.8 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 528 60.55 999999999 528 845.84 percent of total billed charges Single contrast X-ray of esophagus 1340354_1 CDM 0320 RC 74220 HCPCS inpatient 872 566.8 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 528 845.84 Single contrast X-ray of esophagus 1340354_1 CDM 0320 RC 74220 HCPCS inpatient 872 566.8 ANTHEM HMO ANTHEM HMO 999999999 528 845.84 Single contrast X-ray of esophagus 1340354_1 CDM 0320 RC 74220 HCPCS inpatient 872 566.8 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 528 845.84 Single contrast X-ray of esophagus 1340354_1 CDM 0320 RC 74220 HCPCS inpatient 872 566.8 UHC - ALL PLANS UHC - ALL PLANS 999999999 528 845.84 Single contrast X-ray of esophagus 1340354_1 CDM 0320 RC 74220 HCPCS inpatient 872 566.8 CIGNA - ALL PLANS CIGNA - ALL PLANS 589.47 67.6 999999999 528 845.84 percent of total billed charges Review by radiologist of previous placed shunt image 1340411_1 CDM 0320 RC 75809 HCPCS inpatient 529 343.85 AETNA AETNA 417.91 79 999999999 320.31 513.13 percent of total billed charges Review by radiologist of previous placed shunt image 1340411_1 CDM 0320 RC 75809 HCPCS inpatient 529 343.85 SELF PAY DISCOUNT SELF PAY DISCOUNT 343.85 65 999999999 320.31 513.13 percent of total billed charges Review by radiologist of previous placed shunt image 1340411_1 CDM 0320 RC 75809 HCPCS inpatient 529 343.85 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 513.13 97 999999999 320.31 513.13 percent of total billed charges Review by radiologist of previous placed shunt image 1340411_1 CDM 0320 RC 75809 HCPCS inpatient 529 343.85 ENCORE - ALL PLANS ENCORE - ALL PLANS 365.01 69 999999999 320.31 513.13 percent of total billed charges Review by radiologist of previous placed shunt image 1340411_1 CDM 0320 RC 75809 HCPCS inpatient 529 343.85 HUMANA - ALL PLANS HUMANA - ALL PLANS 412.62 78 999999999 320.31 513.13 percent of total billed charges Review by radiologist of previous placed shunt image 1340411_1 CDM 0320 RC 75809 HCPCS inpatient 529 343.85 UMR - ALL PLANS UMR - ALL PLANS 370.3 70 999999999 320.31 513.13 percent of total billed charges Review by radiologist of previous placed shunt image 1340411_1 CDM 0320 RC 75809 HCPCS inpatient 529 343.85 SIHO - ALL PLANS SIHO - ALL PLANS 476.1 90 999999999 320.31 513.13 percent of total billed charges Review by radiologist of previous placed shunt image 1340411_1 CDM 0320 RC 75809 HCPCS inpatient 529 343.85 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 320.31 513.13 Review by radiologist of previous placed shunt image 1340411_1 CDM 0320 RC 75809 HCPCS inpatient 529 343.85 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 320.31 60.55 999999999 320.31 513.13 percent of total billed charges Review by radiologist of previous placed shunt image 1340411_1 CDM 0320 RC 75809 HCPCS inpatient 529 343.85 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 320.31 513.13 Review by radiologist of previous placed shunt image 1340411_1 CDM 0320 RC 75809 HCPCS inpatient 529 343.85 ANTHEM HMO ANTHEM HMO 999999999 320.31 513.13 Review by radiologist of previous placed shunt image 1340411_1 CDM 0320 RC 75809 HCPCS inpatient 529 343.85 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 320.31 513.13 Review by radiologist of previous placed shunt image 1340411_1 CDM 0320 RC 75809 HCPCS inpatient 529 343.85 UHC - ALL PLANS UHC - ALL PLANS 999999999 320.31 513.13 Review by radiologist of previous placed shunt image 1340411_1 CDM 0320 RC 75809 HCPCS inpatient 529 343.85 CIGNA - ALL PLANS CIGNA - ALL PLANS 357.6 67.6 999999999 320.31 513.13 percent of total billed charges Injection into tendon or ligament 1353686_1 CDM 0360 RC 20550 HCPCS inpatient 675 438.75 AETNA AETNA 533.25 79 999999999 408.71 654.75 percent of total billed charges Injection into tendon or ligament 1353686_1 CDM 0360 RC 20550 HCPCS inpatient 675 438.75 SELF PAY DISCOUNT SELF PAY DISCOUNT 438.75 65 999999999 408.71 654.75 percent of total billed charges Injection into tendon or ligament 1353686_1 CDM 0360 RC 20550 HCPCS inpatient 675 438.75 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 654.75 97 999999999 408.71 654.75 percent of total billed charges Injection into tendon or ligament 1353686_1 CDM 0360 RC 20550 HCPCS inpatient 675 438.75 ENCORE - ALL PLANS ENCORE - ALL PLANS 465.75 69 999999999 408.71 654.75 percent of total billed charges Injection into tendon or ligament 1353686_1 CDM 0360 RC 20550 HCPCS inpatient 675 438.75 HUMANA - ALL PLANS HUMANA - ALL PLANS 526.5 78 999999999 408.71 654.75 percent of total billed charges Injection into tendon or ligament 1353686_1 CDM 0360 RC 20550 HCPCS inpatient 675 438.75 UMR - ALL PLANS UMR - ALL PLANS 472.5 70 999999999 408.71 654.75 percent of total billed charges Injection into tendon or ligament 1353686_1 CDM 0360 RC 20550 HCPCS inpatient 675 438.75 SIHO - ALL PLANS SIHO - ALL PLANS 607.5 90 999999999 408.71 654.75 percent of total billed charges Injection into tendon or ligament 1353686_1 CDM 0360 RC 20550 HCPCS inpatient 675 438.75 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 408.71 654.75 Injection into tendon or ligament 1353686_1 CDM 0360 RC 20550 HCPCS inpatient 675 438.75 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 408.71 60.55 999999999 408.71 654.75 percent of total billed charges Injection into tendon or ligament 1353686_1 CDM 0360 RC 20550 HCPCS inpatient 675 438.75 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 408.71 654.75 Injection into tendon or ligament 1353686_1 CDM 0360 RC 20550 HCPCS inpatient 675 438.75 ANTHEM HMO ANTHEM HMO 999999999 408.71 654.75 Injection into tendon or ligament 1353686_1 CDM 0360 RC 20550 HCPCS inpatient 675 438.75 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 408.71 654.75 Injection into tendon or ligament 1353686_1 CDM 0360 RC 20550 HCPCS inpatient 675 438.75 UHC - ALL PLANS UHC - ALL PLANS 999999999 408.71 654.75 Injection into tendon or ligament 1353686_1 CDM 0360 RC 20550 HCPCS inpatient 675 438.75 CIGNA - ALL PLANS CIGNA - ALL PLANS 456.3 67.6 999999999 408.71 654.75 percent of total billed charges "Injection of trigger points, 1-2 muscles" 1359598_1 CDM 0360 RC 20552 HCPCS inpatient 732 475.8 AETNA AETNA 578.28 79 999999999 443.23 710.04 percent of total billed charges "Injection of trigger points, 1-2 muscles" 1359598_1 CDM 0360 RC 20552 HCPCS inpatient 732 475.8 SELF PAY DISCOUNT SELF PAY DISCOUNT 475.8 65 999999999 443.23 710.04 percent of total billed charges "Injection of trigger points, 1-2 muscles" 1359598_1 CDM 0360 RC 20552 HCPCS inpatient 732 475.8 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 710.04 97 999999999 443.23 710.04 percent of total billed charges "Injection of trigger points, 1-2 muscles" 1359598_1 CDM 0360 RC 20552 HCPCS inpatient 732 475.8 ENCORE - ALL PLANS ENCORE - ALL PLANS 505.08 69 999999999 443.23 710.04 percent of total billed charges "Injection of trigger points, 1-2 muscles" 1359598_1 CDM 0360 RC 20552 HCPCS inpatient 732 475.8 HUMANA - ALL PLANS HUMANA - ALL PLANS 570.96 78 999999999 443.23 710.04 percent of total billed charges "Injection of trigger points, 1-2 muscles" 1359598_1 CDM 0360 RC 20552 HCPCS inpatient 732 475.8 UMR - ALL PLANS UMR - ALL PLANS 512.4 70 999999999 443.23 710.04 percent of total billed charges "Injection of trigger points, 1-2 muscles" 1359598_1 CDM 0360 RC 20552 HCPCS inpatient 732 475.8 SIHO - ALL PLANS SIHO - ALL PLANS 658.8 90 999999999 443.23 710.04 percent of total billed charges "Injection of trigger points, 1-2 muscles" 1359598_1 CDM 0360 RC 20552 HCPCS inpatient 732 475.8 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 443.23 710.04 "Injection of trigger points, 1-2 muscles" 1359598_1 CDM 0360 RC 20552 HCPCS inpatient 732 475.8 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 443.23 60.55 999999999 443.23 710.04 percent of total billed charges "Injection of trigger points, 1-2 muscles" 1359598_1 CDM 0360 RC 20552 HCPCS inpatient 732 475.8 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 443.23 710.04 "Injection of trigger points, 1-2 muscles" 1359598_1 CDM 0360 RC 20552 HCPCS inpatient 732 475.8 ANTHEM HMO ANTHEM HMO 999999999 443.23 710.04 "Injection of trigger points, 1-2 muscles" 1359598_1 CDM 0360 RC 20552 HCPCS inpatient 732 475.8 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 443.23 710.04 "Injection of trigger points, 1-2 muscles" 1359598_1 CDM 0360 RC 20552 HCPCS inpatient 732 475.8 CIGNA - ALL PLANS CIGNA - ALL PLANS 494.83 67.6 999999999 443.23 710.04 percent of total billed charges "Injection of trigger points, 1-2 muscles" 1359598_1 CDM 0360 RC 20552 HCPCS inpatient 732 475.8 UHC - ALL PLANS UHC - ALL PLANS 999999999 443.23 710.04 MRI scan of blood vessels of abdomen 1403599_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 AETNA AETNA 2370.79 79 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of abdomen 1403599_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 SELF PAY DISCOUNT SELF PAY DISCOUNT 1950.65 65 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of abdomen 1403599_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 2910.97 97 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of abdomen 1403599_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 ENCORE - ALL PLANS ENCORE - ALL PLANS 2070.69 69 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of abdomen 1403599_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 HUMANA - ALL PLANS HUMANA - ALL PLANS 2340.78 78 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of abdomen 1403599_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 UMR - ALL PLANS UMR - ALL PLANS 2100.7 70 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of abdomen 1403599_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 SIHO - ALL PLANS SIHO - ALL PLANS 2700.9 90 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of abdomen 1403599_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1817.11 2910.97 MRI scan of blood vessels of abdomen 1403599_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1817.11 60.55 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of abdomen 1403599_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1817.11 2910.97 MRI scan of blood vessels of abdomen 1403599_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 ANTHEM HMO ANTHEM HMO 999999999 1817.11 2910.97 MRI scan of blood vessels of abdomen 1403599_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1817.11 2910.97 MRI scan of blood vessels of abdomen 1403599_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 CIGNA - ALL PLANS CIGNA - ALL PLANS 2028.68 67.6 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of abdomen 1403599_1 CDM 0618 RC 74185 HCPCS inpatient 3001 1950.65 UHC - ALL PLANS UHC - ALL PLANS 999999999 1817.11 2910.97 "DXA bone density measurement of forearm, finger, hand, or foot" 1405655_1 CDM 0320 RC 77081 HCPCS inpatient 203 131.95 AETNA AETNA 160.37 79 999999999 122.92 196.91 percent of total billed charges "DXA bone density measurement of forearm, finger, hand, or foot" 1405655_1 CDM 0320 RC 77081 HCPCS inpatient 203 131.95 SELF PAY DISCOUNT SELF PAY DISCOUNT 131.95 65 999999999 122.92 196.91 percent of total billed charges "DXA bone density measurement of forearm, finger, hand, or foot" 1405655_1 CDM 0320 RC 77081 HCPCS inpatient 203 131.95 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 196.91 97 999999999 122.92 196.91 percent of total billed charges "DXA bone density measurement of forearm, finger, hand, or foot" 1405655_1 CDM 0320 RC 77081 HCPCS inpatient 203 131.95 ENCORE - ALL PLANS ENCORE - ALL PLANS 140.07 69 999999999 122.92 196.91 percent of total billed charges "DXA bone density measurement of forearm, finger, hand, or foot" 1405655_1 CDM 0320 RC 77081 HCPCS inpatient 203 131.95 HUMANA - ALL PLANS HUMANA - ALL PLANS 158.34 78 999999999 122.92 196.91 percent of total billed charges "DXA bone density measurement of forearm, finger, hand, or foot" 1405655_1 CDM 0320 RC 77081 HCPCS inpatient 203 131.95 UMR - ALL PLANS UMR - ALL PLANS 142.1 70 999999999 122.92 196.91 percent of total billed charges "DXA bone density measurement of forearm, finger, hand, or foot" 1405655_1 CDM 0320 RC 77081 HCPCS inpatient 203 131.95 SIHO - ALL PLANS SIHO - ALL PLANS 182.7 90 999999999 122.92 196.91 percent of total billed charges "DXA bone density measurement of forearm, finger, hand, or foot" 1405655_1 CDM 0320 RC 77081 HCPCS inpatient 203 131.95 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 122.92 196.91 "DXA bone density measurement of forearm, finger, hand, or foot" 1405655_1 CDM 0320 RC 77081 HCPCS inpatient 203 131.95 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 122.92 60.55 999999999 122.92 196.91 percent of total billed charges "DXA bone density measurement of forearm, finger, hand, or foot" 1405655_1 CDM 0320 RC 77081 HCPCS inpatient 203 131.95 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 122.92 196.91 "DXA bone density measurement of forearm, finger, hand, or foot" 1405655_1 CDM 0320 RC 77081 HCPCS inpatient 203 131.95 ANTHEM HMO ANTHEM HMO 999999999 122.92 196.91 "DXA bone density measurement of forearm, finger, hand, or foot" 1405655_1 CDM 0320 RC 77081 HCPCS inpatient 203 131.95 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 122.92 196.91 "DXA bone density measurement of forearm, finger, hand, or foot" 1405655_1 CDM 0320 RC 77081 HCPCS inpatient 203 131.95 CIGNA - ALL PLANS CIGNA - ALL PLANS 137.23 67.6 999999999 122.92 196.91 percent of total billed charges "DXA bone density measurement of forearm, finger, hand, or foot" 1405655_1 CDM 0320 RC 77081 HCPCS inpatient 203 131.95 UHC - ALL PLANS UHC - ALL PLANS 999999999 122.92 196.91 Review by radiologist of CT guidance for needle placement 1405670_1 CDM 0350 RC 77012 HCPCS inpatient 1688 1097.2 AETNA AETNA 1333.52 79 999999999 1022.08 1637.36 percent of total billed charges Review by radiologist of CT guidance for needle placement 1405670_1 CDM 0350 RC 77012 HCPCS inpatient 1688 1097.2 SELF PAY DISCOUNT SELF PAY DISCOUNT 1097.2 65 999999999 1022.08 1637.36 percent of total billed charges Review by radiologist of CT guidance for needle placement 1405670_1 CDM 0350 RC 77012 HCPCS inpatient 1688 1097.2 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 1637.36 97 999999999 1022.08 1637.36 percent of total billed charges Review by radiologist of CT guidance for needle placement 1405670_1 CDM 0350 RC 77012 HCPCS inpatient 1688 1097.2 ENCORE - ALL PLANS ENCORE - ALL PLANS 1164.72 69 999999999 1022.08 1637.36 percent of total billed charges Review by radiologist of CT guidance for needle placement 1405670_1 CDM 0350 RC 77012 HCPCS inpatient 1688 1097.2 HUMANA - ALL PLANS HUMANA - ALL PLANS 1316.64 78 999999999 1022.08 1637.36 percent of total billed charges Review by radiologist of CT guidance for needle placement 1405670_1 CDM 0350 RC 77012 HCPCS inpatient 1688 1097.2 UMR - ALL PLANS UMR - ALL PLANS 1181.6 70 999999999 1022.08 1637.36 percent of total billed charges Review by radiologist of CT guidance for needle placement 1405670_1 CDM 0350 RC 77012 HCPCS inpatient 1688 1097.2 SIHO - ALL PLANS SIHO - ALL PLANS 1519.2 90 999999999 1022.08 1637.36 percent of total billed charges Review by radiologist of CT guidance for needle placement 1405670_1 CDM 0350 RC 77012 HCPCS inpatient 1688 1097.2 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1022.08 1637.36 Review by radiologist of CT guidance for needle placement 1405670_1 CDM 0350 RC 77012 HCPCS inpatient 1688 1097.2 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1022.08 60.55 999999999 1022.08 1637.36 percent of total billed charges Review by radiologist of CT guidance for needle placement 1405670_1 CDM 0350 RC 77012 HCPCS inpatient 1688 1097.2 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1022.08 1637.36 Review by radiologist of CT guidance for needle placement 1405670_1 CDM 0350 RC 77012 HCPCS inpatient 1688 1097.2 ANTHEM HMO ANTHEM HMO 999999999 1022.08 1637.36 Review by radiologist of CT guidance for needle placement 1405670_1 CDM 0350 RC 77012 HCPCS inpatient 1688 1097.2 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1022.08 1637.36 Review by radiologist of CT guidance for needle placement 1405670_1 CDM 0350 RC 77012 HCPCS inpatient 1688 1097.2 CIGNA - ALL PLANS CIGNA - ALL PLANS 1141.09 67.6 999999999 1022.08 1637.36 percent of total billed charges Review by radiologist of CT guidance for needle placement 1405670_1 CDM 0350 RC 77012 HCPCS inpatient 1688 1097.2 UHC - ALL PLANS UHC - ALL PLANS 999999999 1022.08 1637.36 Review by radiologist of CT guidance for needle placement 1405715_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 AETNA AETNA 1334.31 79 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1405715_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 SELF PAY DISCOUNT SELF PAY DISCOUNT 1097.85 65 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1405715_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 1638.33 97 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1405715_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ENCORE - ALL PLANS ENCORE - ALL PLANS 1165.41 69 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1405715_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 HUMANA - ALL PLANS HUMANA - ALL PLANS 1317.42 78 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1405715_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 UMR - ALL PLANS UMR - ALL PLANS 1182.3 70 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1405715_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 SIHO - ALL PLANS SIHO - ALL PLANS 1520.1 90 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1405715_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1405715_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1022.69 60.55 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1405715_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1405715_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM HMO ANTHEM HMO 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1405715_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1022.69 1638.33 Review by radiologist of CT guidance for needle placement 1405715_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 CIGNA - ALL PLANS CIGNA - ALL PLANS 1141.76 67.6 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of CT guidance for needle placement 1405715_1 CDM 0320 RC 77012 HCPCS inpatient 1689 1097.85 UHC - ALL PLANS UHC - ALL PLANS 999999999 1022.69 1638.33 MRI scan of blood vessels of chest 1405751_1 CDM 0618 RC 71555 HCPCS inpatient 3001 1950.65 AETNA AETNA 2370.79 79 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of chest 1405751_1 CDM 0618 RC 71555 HCPCS inpatient 3001 1950.65 SELF PAY DISCOUNT SELF PAY DISCOUNT 1950.65 65 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of chest 1405751_1 CDM 0618 RC 71555 HCPCS inpatient 3001 1950.65 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 2910.97 97 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of chest 1405751_1 CDM 0618 RC 71555 HCPCS inpatient 3001 1950.65 ENCORE - ALL PLANS ENCORE - ALL PLANS 2070.69 69 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of chest 1405751_1 CDM 0618 RC 71555 HCPCS inpatient 3001 1950.65 HUMANA - ALL PLANS HUMANA - ALL PLANS 2340.78 78 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of chest 1405751_1 CDM 0618 RC 71555 HCPCS inpatient 3001 1950.65 UMR - ALL PLANS UMR - ALL PLANS 2100.7 70 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of chest 1405751_1 CDM 0618 RC 71555 HCPCS inpatient 3001 1950.65 SIHO - ALL PLANS SIHO - ALL PLANS 2700.9 90 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of chest 1405751_1 CDM 0618 RC 71555 HCPCS inpatient 3001 1950.65 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1817.11 2910.97 MRI scan of blood vessels of chest 1405751_1 CDM 0618 RC 71555 HCPCS inpatient 3001 1950.65 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1817.11 60.55 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of chest 1405751_1 CDM 0618 RC 71555 HCPCS inpatient 3001 1950.65 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1817.11 2910.97 MRI scan of blood vessels of chest 1405751_1 CDM 0618 RC 71555 HCPCS inpatient 3001 1950.65 ANTHEM HMO ANTHEM HMO 999999999 1817.11 2910.97 MRI scan of blood vessels of chest 1405751_1 CDM 0618 RC 71555 HCPCS inpatient 3001 1950.65 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1817.11 2910.97 MRI scan of blood vessels of chest 1405751_1 CDM 0618 RC 71555 HCPCS inpatient 3001 1950.65 CIGNA - ALL PLANS CIGNA - ALL PLANS 2028.68 67.6 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of chest 1405751_1 CDM 0618 RC 71555 HCPCS inpatient 3001 1950.65 UHC - ALL PLANS UHC - ALL PLANS 999999999 1817.11 2910.97 MRI scan of blood vessels of pelvis 1405766_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 AETNA AETNA 2370.79 79 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of pelvis 1405766_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 SELF PAY DISCOUNT SELF PAY DISCOUNT 1950.65 65 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of pelvis 1405766_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 2910.97 97 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of pelvis 1405766_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 ENCORE - ALL PLANS ENCORE - ALL PLANS 2070.69 69 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of pelvis 1405766_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 HUMANA - ALL PLANS HUMANA - ALL PLANS 2340.78 78 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of pelvis 1405766_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 UMR - ALL PLANS UMR - ALL PLANS 2100.7 70 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of pelvis 1405766_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 SIHO - ALL PLANS SIHO - ALL PLANS 2700.9 90 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of pelvis 1405766_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1817.11 2910.97 MRI scan of blood vessels of pelvis 1405766_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1817.11 60.55 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of pelvis 1405766_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1817.11 2910.97 MRI scan of blood vessels of pelvis 1405766_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 ANTHEM HMO ANTHEM HMO 999999999 1817.11 2910.97 MRI scan of blood vessels of pelvis 1405766_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1817.11 2910.97 MRI scan of blood vessels of pelvis 1405766_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 CIGNA - ALL PLANS CIGNA - ALL PLANS 2028.68 67.6 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of pelvis 1405766_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 UHC - ALL PLANS UHC - ALL PLANS 999999999 1817.11 2910.97 MRI scan of blood vessels of pelvis 1405769_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 AETNA AETNA 2370.79 79 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of pelvis 1405769_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 SELF PAY DISCOUNT SELF PAY DISCOUNT 1950.65 65 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of pelvis 1405769_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 2910.97 97 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of pelvis 1405769_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 ENCORE - ALL PLANS ENCORE - ALL PLANS 2070.69 69 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of pelvis 1405769_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 HUMANA - ALL PLANS HUMANA - ALL PLANS 2340.78 78 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of pelvis 1405769_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 UMR - ALL PLANS UMR - ALL PLANS 2100.7 70 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of pelvis 1405769_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 SIHO - ALL PLANS SIHO - ALL PLANS 2700.9 90 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of pelvis 1405769_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1817.11 2910.97 MRI scan of blood vessels of pelvis 1405769_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1817.11 60.55 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of pelvis 1405769_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1817.11 2910.97 MRI scan of blood vessels of pelvis 1405769_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 ANTHEM HMO ANTHEM HMO 999999999 1817.11 2910.97 MRI scan of blood vessels of pelvis 1405769_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1817.11 2910.97 MRI scan of blood vessels of pelvis 1405769_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 CIGNA - ALL PLANS CIGNA - ALL PLANS 2028.68 67.6 999999999 1817.11 2910.97 percent of total billed charges MRI scan of blood vessels of pelvis 1405769_1 CDM 0618 RC 72198 HCPCS inpatient 3001 1950.65 UHC - ALL PLANS UHC - ALL PLANS 999999999 1817.11 2910.97 MRI scan of blood vessels of arm 1405772_1 CDM 0618 RC 73225 HCPCS inpatient 5972 3881.8 AETNA AETNA 4717.88 79 999999999 3616.05 5792.84 percent of total billed charges MRI scan of blood vessels of arm 1405772_1 CDM 0618 RC 73225 HCPCS inpatient 5972 3881.8 SELF PAY DISCOUNT SELF PAY DISCOUNT 3881.8 65 999999999 3616.05 5792.84 percent of total billed charges MRI scan of blood vessels of arm 1405772_1 CDM 0618 RC 73225 HCPCS inpatient 5972 3881.8 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 5792.84 97 999999999 3616.05 5792.84 percent of total billed charges MRI scan of blood vessels of arm 1405772_1 CDM 0618 RC 73225 HCPCS inpatient 5972 3881.8 ENCORE - ALL PLANS ENCORE - ALL PLANS 4120.68 69 999999999 3616.05 5792.84 percent of total billed charges MRI scan of blood vessels of arm 1405772_1 CDM 0618 RC 73225 HCPCS inpatient 5972 3881.8 HUMANA - ALL PLANS HUMANA - ALL PLANS 4658.16 78 999999999 3616.05 5792.84 percent of total billed charges MRI scan of blood vessels of arm 1405772_1 CDM 0618 RC 73225 HCPCS inpatient 5972 3881.8 UMR - ALL PLANS UMR - ALL PLANS 4180.4 70 999999999 3616.05 5792.84 percent of total billed charges MRI scan of blood vessels of arm 1405772_1 CDM 0618 RC 73225 HCPCS inpatient 5972 3881.8 SIHO - ALL PLANS SIHO - ALL PLANS 5374.8 90 999999999 3616.05 5792.84 percent of total billed charges MRI scan of blood vessels of arm 1405772_1 CDM 0618 RC 73225 HCPCS inpatient 5972 3881.8 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 3616.05 5792.84 MRI scan of blood vessels of arm 1405772_1 CDM 0618 RC 73225 HCPCS inpatient 5972 3881.8 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 3616.05 60.55 999999999 3616.05 5792.84 percent of total billed charges MRI scan of blood vessels of arm 1405772_1 CDM 0618 RC 73225 HCPCS inpatient 5972 3881.8 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 3616.05 5792.84 MRI scan of blood vessels of arm 1405772_1 CDM 0618 RC 73225 HCPCS inpatient 5972 3881.8 ANTHEM HMO ANTHEM HMO 999999999 3616.05 5792.84 MRI scan of blood vessels of arm 1405772_1 CDM 0618 RC 73225 HCPCS inpatient 5972 3881.8 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 3616.05 5792.84 MRI scan of blood vessels of arm 1405772_1 CDM 0618 RC 73225 HCPCS inpatient 5972 3881.8 CIGNA - ALL PLANS CIGNA - ALL PLANS 4037.07 67.6 999999999 3616.05 5792.84 percent of total billed charges MRI scan of blood vessels of arm 1405772_1 CDM 0618 RC 73225 HCPCS inpatient 5972 3881.8 UHC - ALL PLANS UHC - ALL PLANS 999999999 3616.05 5792.84 X-ray for bone length assessment 1405792_1 CDM 0320 RC 77073 HCPCS inpatient 548 356.2 AETNA AETNA 432.92 79 999999999 331.81 531.56 percent of total billed charges X-ray for bone length assessment 1405792_1 CDM 0320 RC 77073 HCPCS inpatient 548 356.2 SELF PAY DISCOUNT SELF PAY DISCOUNT 356.2 65 999999999 331.81 531.56 percent of total billed charges X-ray for bone length assessment 1405792_1 CDM 0320 RC 77073 HCPCS inpatient 548 356.2 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 531.56 97 999999999 331.81 531.56 percent of total billed charges X-ray for bone length assessment 1405792_1 CDM 0320 RC 77073 HCPCS inpatient 548 356.2 ENCORE - ALL PLANS ENCORE - ALL PLANS 378.12 69 999999999 331.81 531.56 percent of total billed charges X-ray for bone length assessment 1405792_1 CDM 0320 RC 77073 HCPCS inpatient 548 356.2 HUMANA - ALL PLANS HUMANA - ALL PLANS 427.44 78 999999999 331.81 531.56 percent of total billed charges X-ray for bone length assessment 1405792_1 CDM 0320 RC 77073 HCPCS inpatient 548 356.2 UMR - ALL PLANS UMR - ALL PLANS 383.6 70 999999999 331.81 531.56 percent of total billed charges X-ray for bone length assessment 1405792_1 CDM 0320 RC 77073 HCPCS inpatient 548 356.2 SIHO - ALL PLANS SIHO - ALL PLANS 493.2 90 999999999 331.81 531.56 percent of total billed charges X-ray for bone length assessment 1405792_1 CDM 0320 RC 77073 HCPCS inpatient 548 356.2 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 331.81 531.56 X-ray for bone length assessment 1405792_1 CDM 0320 RC 77073 HCPCS inpatient 548 356.2 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 331.81 60.55 999999999 331.81 531.56 percent of total billed charges X-ray for bone length assessment 1405792_1 CDM 0320 RC 77073 HCPCS inpatient 548 356.2 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 331.81 531.56 X-ray for bone length assessment 1405792_1 CDM 0320 RC 77073 HCPCS inpatient 548 356.2 ANTHEM HMO ANTHEM HMO 999999999 331.81 531.56 X-ray for bone length assessment 1405792_1 CDM 0320 RC 77073 HCPCS inpatient 548 356.2 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 331.81 531.56 X-ray for bone length assessment 1405792_1 CDM 0320 RC 77073 HCPCS inpatient 548 356.2 CIGNA - ALL PLANS CIGNA - ALL PLANS 370.45 67.6 999999999 331.81 531.56 percent of total billed charges X-ray for bone length assessment 1405792_1 CDM 0320 RC 77073 HCPCS inpatient 548 356.2 UHC - ALL PLANS UHC - ALL PLANS 999999999 331.81 531.56 "X-ray of chest, 2 views" 1405795_1 CDM 0324 RC 71046 HCPCS inpatient 696 452.4 AETNA AETNA 549.84 79 999999999 421.43 675.12 percent of total billed charges "X-ray of chest, 2 views" 1405795_1 CDM 0324 RC 71046 HCPCS inpatient 696 452.4 SELF PAY DISCOUNT SELF PAY DISCOUNT 452.4 65 999999999 421.43 675.12 percent of total billed charges "X-ray of chest, 2 views" 1405795_1 CDM 0324 RC 71046 HCPCS inpatient 696 452.4 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 675.12 97 999999999 421.43 675.12 percent of total billed charges "X-ray of chest, 2 views" 1405795_1 CDM 0324 RC 71046 HCPCS inpatient 696 452.4 ENCORE - ALL PLANS ENCORE - ALL PLANS 480.24 69 999999999 421.43 675.12 percent of total billed charges "X-ray of chest, 2 views" 1405795_1 CDM 0324 RC 71046 HCPCS inpatient 696 452.4 HUMANA - ALL PLANS HUMANA - ALL PLANS 542.88 78 999999999 421.43 675.12 percent of total billed charges "X-ray of chest, 2 views" 1405795_1 CDM 0324 RC 71046 HCPCS inpatient 696 452.4 UMR - ALL PLANS UMR - ALL PLANS 487.2 70 999999999 421.43 675.12 percent of total billed charges "X-ray of chest, 2 views" 1405795_1 CDM 0324 RC 71046 HCPCS inpatient 696 452.4 SIHO - ALL PLANS SIHO - ALL PLANS 626.4 90 999999999 421.43 675.12 percent of total billed charges "X-ray of chest, 2 views" 1405795_1 CDM 0324 RC 71046 HCPCS inpatient 696 452.4 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 421.43 675.12 "X-ray of chest, 2 views" 1405795_1 CDM 0324 RC 71046 HCPCS inpatient 696 452.4 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 421.43 60.55 999999999 421.43 675.12 percent of total billed charges "X-ray of chest, 2 views" 1405795_1 CDM 0324 RC 71046 HCPCS inpatient 696 452.4 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 421.43 675.12 "X-ray of chest, 2 views" 1405795_1 CDM 0324 RC 71046 HCPCS inpatient 696 452.4 ANTHEM HMO ANTHEM HMO 999999999 421.43 675.12 "X-ray of chest, 2 views" 1405795_1 CDM 0324 RC 71046 HCPCS inpatient 696 452.4 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 421.43 675.12 "X-ray of chest, 2 views" 1405795_1 CDM 0324 RC 71046 HCPCS inpatient 696 452.4 CIGNA - ALL PLANS CIGNA - ALL PLANS 470.5 67.6 999999999 421.43 675.12 percent of total billed charges "X-ray of chest, 2 views" 1405795_1 CDM 0324 RC 71046 HCPCS inpatient 696 452.4 UHC - ALL PLANS UHC - ALL PLANS 999999999 421.43 675.12 "X-ray of joints, multiple" 1405801_1 CDM 0320 RC 77077 HCPCS inpatient 527 342.55 AETNA AETNA 416.33 79 999999999 319.1 511.19 percent of total billed charges "X-ray of joints, multiple" 1405801_1 CDM 0320 RC 77077 HCPCS inpatient 527 342.55 SELF PAY DISCOUNT SELF PAY DISCOUNT 342.55 65 999999999 319.1 511.19 percent of total billed charges "X-ray of joints, multiple" 1405801_1 CDM 0320 RC 77077 HCPCS inpatient 527 342.55 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 511.19 97 999999999 319.1 511.19 percent of total billed charges "X-ray of joints, multiple" 1405801_1 CDM 0320 RC 77077 HCPCS inpatient 527 342.55 ENCORE - ALL PLANS ENCORE - ALL PLANS 363.63 69 999999999 319.1 511.19 percent of total billed charges "X-ray of joints, multiple" 1405801_1 CDM 0320 RC 77077 HCPCS inpatient 527 342.55 HUMANA - ALL PLANS HUMANA - ALL PLANS 411.06 78 999999999 319.1 511.19 percent of total billed charges "X-ray of joints, multiple" 1405801_1 CDM 0320 RC 77077 HCPCS inpatient 527 342.55 UMR - ALL PLANS UMR - ALL PLANS 368.9 70 999999999 319.1 511.19 percent of total billed charges "X-ray of joints, multiple" 1405801_1 CDM 0320 RC 77077 HCPCS inpatient 527 342.55 SIHO - ALL PLANS SIHO - ALL PLANS 474.3 90 999999999 319.1 511.19 percent of total billed charges "X-ray of joints, multiple" 1405801_1 CDM 0320 RC 77077 HCPCS inpatient 527 342.55 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 319.1 511.19 "X-ray of joints, multiple" 1405801_1 CDM 0320 RC 77077 HCPCS inpatient 527 342.55 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 319.1 60.55 999999999 319.1 511.19 percent of total billed charges "X-ray of joints, multiple" 1405801_1 CDM 0320 RC 77077 HCPCS inpatient 527 342.55 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 319.1 511.19 "X-ray of joints, multiple" 1405801_1 CDM 0320 RC 77077 HCPCS inpatient 527 342.55 ANTHEM HMO ANTHEM HMO 999999999 319.1 511.19 "X-ray of joints, multiple" 1405801_1 CDM 0320 RC 77077 HCPCS inpatient 527 342.55 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 319.1 511.19 "X-ray of joints, multiple" 1405801_1 CDM 0320 RC 77077 HCPCS inpatient 527 342.55 CIGNA - ALL PLANS CIGNA - ALL PLANS 356.25 67.6 999999999 319.1 511.19 percent of total billed charges "X-ray of joints, multiple" 1405801_1 CDM 0320 RC 77077 HCPCS inpatient 527 342.55 UHC - ALL PLANS UHC - ALL PLANS 999999999 319.1 511.19 "X-ray of ribs on both sides of body, 3 views" 1405804_1 CDM 0320 RC 71110 HCPCS inpatient 609 395.85 AETNA AETNA 481.11 79 999999999 368.75 590.73 percent of total billed charges "X-ray of ribs on both sides of body, 3 views" 1405804_1 CDM 0320 RC 71110 HCPCS inpatient 609 395.85 SELF PAY DISCOUNT SELF PAY DISCOUNT 395.85 65 999999999 368.75 590.73 percent of total billed charges "X-ray of ribs on both sides of body, 3 views" 1405804_1 CDM 0320 RC 71110 HCPCS inpatient 609 395.85 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 590.73 97 999999999 368.75 590.73 percent of total billed charges "X-ray of ribs on both sides of body, 3 views" 1405804_1 CDM 0320 RC 71110 HCPCS inpatient 609 395.85 ENCORE - ALL PLANS ENCORE - ALL PLANS 420.21 69 999999999 368.75 590.73 percent of total billed charges "X-ray of ribs on both sides of body, 3 views" 1405804_1 CDM 0320 RC 71110 HCPCS inpatient 609 395.85 HUMANA - ALL PLANS HUMANA - ALL PLANS 475.02 78 999999999 368.75 590.73 percent of total billed charges "X-ray of ribs on both sides of body, 3 views" 1405804_1 CDM 0320 RC 71110 HCPCS inpatient 609 395.85 UMR - ALL PLANS UMR - ALL PLANS 426.3 70 999999999 368.75 590.73 percent of total billed charges "X-ray of ribs on both sides of body, 3 views" 1405804_1 CDM 0320 RC 71110 HCPCS inpatient 609 395.85 SIHO - ALL PLANS SIHO - ALL PLANS 548.1 90 999999999 368.75 590.73 percent of total billed charges "X-ray of ribs on both sides of body, 3 views" 1405804_1 CDM 0320 RC 71110 HCPCS inpatient 609 395.85 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 368.75 590.73 "X-ray of ribs on both sides of body, 3 views" 1405804_1 CDM 0320 RC 71110 HCPCS inpatient 609 395.85 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 368.75 60.55 999999999 368.75 590.73 percent of total billed charges "X-ray of ribs on both sides of body, 3 views" 1405804_1 CDM 0320 RC 71110 HCPCS inpatient 609 395.85 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 368.75 590.73 "X-ray of ribs on both sides of body, 3 views" 1405804_1 CDM 0320 RC 71110 HCPCS inpatient 609 395.85 ANTHEM HMO ANTHEM HMO 999999999 368.75 590.73 "X-ray of ribs on both sides of body, 3 views" 1405804_1 CDM 0320 RC 71110 HCPCS inpatient 609 395.85 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 368.75 590.73 "X-ray of ribs on both sides of body, 3 views" 1405804_1 CDM 0320 RC 71110 HCPCS inpatient 609 395.85 CIGNA - ALL PLANS CIGNA - ALL PLANS 411.68 67.6 999999999 368.75 590.73 percent of total billed charges "X-ray of ribs on both sides of body, 3 views" 1405804_1 CDM 0320 RC 71110 HCPCS inpatient 609 395.85 UHC - ALL PLANS UHC - ALL PLANS 999999999 368.75 590.73 "X-ray of skull, 1-3 views" 1405806_1 CDM 0320 RC 70250 HCPCS inpatient 586 380.9 AETNA AETNA 462.94 79 999999999 354.82 568.42 percent of total billed charges "X-ray of skull, 1-3 views" 1405806_1 CDM 0320 RC 70250 HCPCS inpatient 586 380.9 SELF PAY DISCOUNT SELF PAY DISCOUNT 380.9 65 999999999 354.82 568.42 percent of total billed charges "X-ray of skull, 1-3 views" 1405806_1 CDM 0320 RC 70250 HCPCS inpatient 586 380.9 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 568.42 97 999999999 354.82 568.42 percent of total billed charges "X-ray of skull, 1-3 views" 1405806_1 CDM 0320 RC 70250 HCPCS inpatient 586 380.9 ENCORE - ALL PLANS ENCORE - ALL PLANS 404.34 69 999999999 354.82 568.42 percent of total billed charges "X-ray of skull, 1-3 views" 1405806_1 CDM 0320 RC 70250 HCPCS inpatient 586 380.9 HUMANA - ALL PLANS HUMANA - ALL PLANS 457.08 78 999999999 354.82 568.42 percent of total billed charges "X-ray of skull, 1-3 views" 1405806_1 CDM 0320 RC 70250 HCPCS inpatient 586 380.9 UMR - ALL PLANS UMR - ALL PLANS 410.2 70 999999999 354.82 568.42 percent of total billed charges "X-ray of skull, 1-3 views" 1405806_1 CDM 0320 RC 70250 HCPCS inpatient 586 380.9 SIHO - ALL PLANS SIHO - ALL PLANS 527.4 90 999999999 354.82 568.42 percent of total billed charges "X-ray of skull, 1-3 views" 1405806_1 CDM 0320 RC 70250 HCPCS inpatient 586 380.9 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 354.82 568.42 "X-ray of skull, 1-3 views" 1405806_1 CDM 0320 RC 70250 HCPCS inpatient 586 380.9 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 354.82 60.55 999999999 354.82 568.42 percent of total billed charges "X-ray of skull, 1-3 views" 1405806_1 CDM 0320 RC 70250 HCPCS inpatient 586 380.9 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 354.82 568.42 "X-ray of skull, 1-3 views" 1405806_1 CDM 0320 RC 70250 HCPCS inpatient 586 380.9 ANTHEM HMO ANTHEM HMO 999999999 354.82 568.42 "X-ray of skull, 1-3 views" 1405806_1 CDM 0320 RC 70250 HCPCS inpatient 586 380.9 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 354.82 568.42 "X-ray of skull, 1-3 views" 1405806_1 CDM 0320 RC 70250 HCPCS inpatient 586 380.9 CIGNA - ALL PLANS CIGNA - ALL PLANS 396.14 67.6 999999999 354.82 568.42 percent of total billed charges "X-ray of skull, 1-3 views" 1405806_1 CDM 0320 RC 70250 HCPCS inpatient 586 380.9 UHC - ALL PLANS UHC - ALL PLANS 999999999 354.82 568.42 "X-ray of middle and lower spine, 2 views" 1405815_1 CDM 0320 RC 72080 HCPCS inpatient 270 175.5 AETNA AETNA 213.3 79 999999999 163.49 261.9 percent of total billed charges "X-ray of middle and lower spine, 2 views" 1405815_1 CDM 0320 RC 72080 HCPCS inpatient 270 175.5 SELF PAY DISCOUNT SELF PAY DISCOUNT 175.5 65 999999999 163.49 261.9 percent of total billed charges "X-ray of middle and lower spine, 2 views" 1405815_1 CDM 0320 RC 72080 HCPCS inpatient 270 175.5 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 261.9 97 999999999 163.49 261.9 percent of total billed charges "X-ray of middle and lower spine, 2 views" 1405815_1 CDM 0320 RC 72080 HCPCS inpatient 270 175.5 ENCORE - ALL PLANS ENCORE - ALL PLANS 186.3 69 999999999 163.49 261.9 percent of total billed charges "X-ray of middle and lower spine, 2 views" 1405815_1 CDM 0320 RC 72080 HCPCS inpatient 270 175.5 HUMANA - ALL PLANS HUMANA - ALL PLANS 210.6 78 999999999 163.49 261.9 percent of total billed charges "X-ray of middle and lower spine, 2 views" 1405815_1 CDM 0320 RC 72080 HCPCS inpatient 270 175.5 UMR - ALL PLANS UMR - ALL PLANS 189 70 999999999 163.49 261.9 percent of total billed charges "X-ray of middle and lower spine, 2 views" 1405815_1 CDM 0320 RC 72080 HCPCS inpatient 270 175.5 SIHO - ALL PLANS SIHO - ALL PLANS 243 90 999999999 163.49 261.9 percent of total billed charges "X-ray of middle and lower spine, 2 views" 1405815_1 CDM 0320 RC 72080 HCPCS inpatient 270 175.5 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 163.49 261.9 "X-ray of middle and lower spine, 2 views" 1405815_1 CDM 0320 RC 72080 HCPCS inpatient 270 175.5 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 163.49 60.55 999999999 163.49 261.9 percent of total billed charges "X-ray of middle and lower spine, 2 views" 1405815_1 CDM 0320 RC 72080 HCPCS inpatient 270 175.5 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 163.49 261.9 "X-ray of middle and lower spine, 2 views" 1405815_1 CDM 0320 RC 72080 HCPCS inpatient 270 175.5 ANTHEM HMO ANTHEM HMO 999999999 163.49 261.9 "X-ray of middle and lower spine, 2 views" 1405815_1 CDM 0320 RC 72080 HCPCS inpatient 270 175.5 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 163.49 261.9 "X-ray of middle and lower spine, 2 views" 1405815_1 CDM 0320 RC 72080 HCPCS inpatient 270 175.5 CIGNA - ALL PLANS CIGNA - ALL PLANS 182.52 67.6 999999999 163.49 261.9 percent of total billed charges "X-ray of middle and lower spine, 2 views" 1405815_1 CDM 0320 RC 72080 HCPCS inpatient 270 175.5 UHC - ALL PLANS UHC - ALL PLANS 999999999 163.49 261.9 Single contrast X-ray of upper digestive tract 1405821_1 CDM 0320 RC 74240 HCPCS inpatient 869 564.85 AETNA AETNA 686.51 79 999999999 526.18 842.93 percent of total billed charges Single contrast X-ray of upper digestive tract 1405821_1 CDM 0320 RC 74240 HCPCS inpatient 869 564.85 SELF PAY DISCOUNT SELF PAY DISCOUNT 564.85 65 999999999 526.18 842.93 percent of total billed charges Single contrast X-ray of upper digestive tract 1405821_1 CDM 0320 RC 74240 HCPCS inpatient 869 564.85 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 842.93 97 999999999 526.18 842.93 percent of total billed charges Single contrast X-ray of upper digestive tract 1405821_1 CDM 0320 RC 74240 HCPCS inpatient 869 564.85 ENCORE - ALL PLANS ENCORE - ALL PLANS 599.61 69 999999999 526.18 842.93 percent of total billed charges Single contrast X-ray of upper digestive tract 1405821_1 CDM 0320 RC 74240 HCPCS inpatient 869 564.85 HUMANA - ALL PLANS HUMANA - ALL PLANS 677.82 78 999999999 526.18 842.93 percent of total billed charges Single contrast X-ray of upper digestive tract 1405821_1 CDM 0320 RC 74240 HCPCS inpatient 869 564.85 UMR - ALL PLANS UMR - ALL PLANS 608.3 70 999999999 526.18 842.93 percent of total billed charges Single contrast X-ray of upper digestive tract 1405821_1 CDM 0320 RC 74240 HCPCS inpatient 869 564.85 SIHO - ALL PLANS SIHO - ALL PLANS 782.1 90 999999999 526.18 842.93 percent of total billed charges Single contrast X-ray of upper digestive tract 1405821_1 CDM 0320 RC 74240 HCPCS inpatient 869 564.85 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 526.18 842.93 Single contrast X-ray of upper digestive tract 1405821_1 CDM 0320 RC 74240 HCPCS inpatient 869 564.85 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 526.18 60.55 999999999 526.18 842.93 percent of total billed charges Single contrast X-ray of upper digestive tract 1405821_1 CDM 0320 RC 74240 HCPCS inpatient 869 564.85 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 526.18 842.93 Single contrast X-ray of upper digestive tract 1405821_1 CDM 0320 RC 74240 HCPCS inpatient 869 564.85 ANTHEM HMO ANTHEM HMO 999999999 526.18 842.93 Single contrast X-ray of upper digestive tract 1405821_1 CDM 0320 RC 74240 HCPCS inpatient 869 564.85 CIGNA - ALL PLANS CIGNA - ALL PLANS 587.44 67.6 999999999 526.18 842.93 percent of total billed charges Single contrast X-ray of upper digestive tract 1405821_1 CDM 0320 RC 74240 HCPCS inpatient 869 564.85 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 526.18 842.93 Single contrast X-ray of upper digestive tract 1405821_1 CDM 0320 RC 74240 HCPCS inpatient 869 564.85 UHC - ALL PLANS UHC - ALL PLANS 999999999 526.18 842.93 "PSA (prostate specific antigen) measurement, free" 1413617_1 CDM 0301 RC 84154 HCPCS inpatient 267 173.55 AETNA AETNA 210.93 79 999999999 161.67 258.99 percent of total billed charges "PSA (prostate specific antigen) measurement, free" 1413617_1 CDM 0301 RC 84154 HCPCS inpatient 267 173.55 SELF PAY DISCOUNT SELF PAY DISCOUNT 173.55 65 999999999 161.67 258.99 percent of total billed charges "PSA (prostate specific antigen) measurement, free" 1413617_1 CDM 0301 RC 84154 HCPCS inpatient 267 173.55 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 258.99 97 999999999 161.67 258.99 percent of total billed charges "PSA (prostate specific antigen) measurement, free" 1413617_1 CDM 0301 RC 84154 HCPCS inpatient 267 173.55 ENCORE - ALL PLANS ENCORE - ALL PLANS 184.23 69 999999999 161.67 258.99 percent of total billed charges "PSA (prostate specific antigen) measurement, free" 1413617_1 CDM 0301 RC 84154 HCPCS inpatient 267 173.55 HUMANA - ALL PLANS HUMANA - ALL PLANS 208.26 78 999999999 161.67 258.99 percent of total billed charges "PSA (prostate specific antigen) measurement, free" 1413617_1 CDM 0301 RC 84154 HCPCS inpatient 267 173.55 UMR - ALL PLANS UMR - ALL PLANS 186.9 70 999999999 161.67 258.99 percent of total billed charges "PSA (prostate specific antigen) measurement, free" 1413617_1 CDM 0301 RC 84154 HCPCS inpatient 267 173.55 SIHO - ALL PLANS SIHO - ALL PLANS 240.3 90 999999999 161.67 258.99 percent of total billed charges "PSA (prostate specific antigen) measurement, free" 1413617_1 CDM 0301 RC 84154 HCPCS inpatient 267 173.55 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 161.67 258.99 "PSA (prostate specific antigen) measurement, free" 1413617_1 CDM 0301 RC 84154 HCPCS inpatient 267 173.55 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 161.67 60.55 999999999 161.67 258.99 percent of total billed charges "PSA (prostate specific antigen) measurement, free" 1413617_1 CDM 0301 RC 84154 HCPCS inpatient 267 173.55 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 161.67 258.99 "PSA (prostate specific antigen) measurement, free" 1413617_1 CDM 0301 RC 84154 HCPCS inpatient 267 173.55 ANTHEM HMO ANTHEM HMO 999999999 161.67 258.99 "PSA (prostate specific antigen) measurement, free" 1413617_1 CDM 0301 RC 84154 HCPCS inpatient 267 173.55 CIGNA - ALL PLANS CIGNA - ALL PLANS 180.49 67.6 999999999 161.67 258.99 percent of total billed charges "PSA (prostate specific antigen) measurement, free" 1413617_1 CDM 0301 RC 84154 HCPCS inpatient 267 173.55 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 161.67 258.99 "PSA (prostate specific antigen) measurement, free" 1413617_1 CDM 0301 RC 84154 HCPCS inpatient 267 173.55 UHC - ALL PLANS UHC - ALL PLANS 999999999 161.67 258.99 Hemoglobin A1C level 1413627_1 CDM 0301 RC 83036 HCPCS inpatient 196 127.4 AETNA AETNA 154.84 79 999999999 118.68 190.12 percent of total billed charges Hemoglobin A1C level 1413627_1 CDM 0301 RC 83036 HCPCS inpatient 196 127.4 SELF PAY DISCOUNT SELF PAY DISCOUNT 127.4 65 999999999 118.68 190.12 percent of total billed charges Hemoglobin A1C level 1413627_1 CDM 0301 RC 83036 HCPCS inpatient 196 127.4 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 190.12 97 999999999 118.68 190.12 percent of total billed charges Hemoglobin A1C level 1413627_1 CDM 0301 RC 83036 HCPCS inpatient 196 127.4 ENCORE - ALL PLANS ENCORE - ALL PLANS 135.24 69 999999999 118.68 190.12 percent of total billed charges Hemoglobin A1C level 1413627_1 CDM 0301 RC 83036 HCPCS inpatient 196 127.4 HUMANA - ALL PLANS HUMANA - ALL PLANS 152.88 78 999999999 118.68 190.12 percent of total billed charges Hemoglobin A1C level 1413627_1 CDM 0301 RC 83036 HCPCS inpatient 196 127.4 UMR - ALL PLANS UMR - ALL PLANS 137.2 70 999999999 118.68 190.12 percent of total billed charges Hemoglobin A1C level 1413627_1 CDM 0301 RC 83036 HCPCS inpatient 196 127.4 SIHO - ALL PLANS SIHO - ALL PLANS 176.4 90 999999999 118.68 190.12 percent of total billed charges Hemoglobin A1C level 1413627_1 CDM 0301 RC 83036 HCPCS inpatient 196 127.4 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 118.68 190.12 Hemoglobin A1C level 1413627_1 CDM 0301 RC 83036 HCPCS inpatient 196 127.4 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 118.68 60.55 999999999 118.68 190.12 percent of total billed charges Hemoglobin A1C level 1413627_1 CDM 0301 RC 83036 HCPCS inpatient 196 127.4 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 118.68 190.12 Hemoglobin A1C level 1413627_1 CDM 0301 RC 83036 HCPCS inpatient 196 127.4 ANTHEM HMO ANTHEM HMO 999999999 118.68 190.12 Hemoglobin A1C level 1413627_1 CDM 0301 RC 83036 HCPCS inpatient 196 127.4 CIGNA - ALL PLANS CIGNA - ALL PLANS 132.5 67.6 999999999 118.68 190.12 percent of total billed charges Hemoglobin A1C level 1413627_1 CDM 0301 RC 83036 HCPCS inpatient 196 127.4 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 118.68 190.12 Hemoglobin A1C level 1413627_1 CDM 0301 RC 83036 HCPCS inpatient 196 127.4 UHC - ALL PLANS UHC - ALL PLANS 999999999 118.68 190.12 "Creatine kinase (cardiac enzyme) level, MB fraction only" 1417603_1 CDM 0301 RC 82553 HCPCS inpatient 244 158.6 AETNA AETNA 192.76 79 999999999 147.74 236.68 percent of total billed charges "Creatine kinase (cardiac enzyme) level, MB fraction only" 1417603_1 CDM 0301 RC 82553 HCPCS inpatient 244 158.6 SELF PAY DISCOUNT SELF PAY DISCOUNT 158.6 65 999999999 147.74 236.68 percent of total billed charges "Creatine kinase (cardiac enzyme) level, MB fraction only" 1417603_1 CDM 0301 RC 82553 HCPCS inpatient 244 158.6 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 236.68 97 999999999 147.74 236.68 percent of total billed charges "Creatine kinase (cardiac enzyme) level, MB fraction only" 1417603_1 CDM 0301 RC 82553 HCPCS inpatient 244 158.6 ENCORE - ALL PLANS ENCORE - ALL PLANS 168.36 69 999999999 147.74 236.68 percent of total billed charges "Creatine kinase (cardiac enzyme) level, MB fraction only" 1417603_1 CDM 0301 RC 82553 HCPCS inpatient 244 158.6 HUMANA - ALL PLANS HUMANA - ALL PLANS 190.32 78 999999999 147.74 236.68 percent of total billed charges "Creatine kinase (cardiac enzyme) level, MB fraction only" 1417603_1 CDM 0301 RC 82553 HCPCS inpatient 244 158.6 UMR - ALL PLANS UMR - ALL PLANS 170.8 70 999999999 147.74 236.68 percent of total billed charges "Creatine kinase (cardiac enzyme) level, MB fraction only" 1417603_1 CDM 0301 RC 82553 HCPCS inpatient 244 158.6 SIHO - ALL PLANS SIHO - ALL PLANS 219.6 90 999999999 147.74 236.68 percent of total billed charges "Creatine kinase (cardiac enzyme) level, MB fraction only" 1417603_1 CDM 0301 RC 82553 HCPCS inpatient 244 158.6 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 147.74 236.68 "Creatine kinase (cardiac enzyme) level, MB fraction only" 1417603_1 CDM 0301 RC 82553 HCPCS inpatient 244 158.6 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 147.74 60.55 999999999 147.74 236.68 percent of total billed charges "Creatine kinase (cardiac enzyme) level, MB fraction only" 1417603_1 CDM 0301 RC 82553 HCPCS inpatient 244 158.6 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 147.74 236.68 "Creatine kinase (cardiac enzyme) level, MB fraction only" 1417603_1 CDM 0301 RC 82553 HCPCS inpatient 244 158.6 ANTHEM HMO ANTHEM HMO 999999999 147.74 236.68 "Creatine kinase (cardiac enzyme) level, MB fraction only" 1417603_1 CDM 0301 RC 82553 HCPCS inpatient 244 158.6 CIGNA - ALL PLANS CIGNA - ALL PLANS 164.94 67.6 999999999 147.74 236.68 percent of total billed charges "Creatine kinase (cardiac enzyme) level, MB fraction only" 1417603_1 CDM 0301 RC 82553 HCPCS inpatient 244 158.6 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 147.74 236.68 "Creatine kinase (cardiac enzyme) level, MB fraction only" 1417603_1 CDM 0301 RC 82553 HCPCS inpatient 244 158.6 UHC - ALL PLANS UHC - ALL PLANS 999999999 147.74 236.68 Nuclear medicine study of bone and/or joint whole body 1428649_1 CDM 0341 RC 78306 HCPCS inpatient 1978 1285.7 AETNA AETNA 1562.62 79 999999999 1197.68 1918.66 percent of total billed charges Nuclear medicine study of bone and/or joint whole body 1428649_1 CDM 0341 RC 78306 HCPCS inpatient 1978 1285.7 SELF PAY DISCOUNT SELF PAY DISCOUNT 1285.7 65 999999999 1197.68 1918.66 percent of total billed charges Nuclear medicine study of bone and/or joint whole body 1428649_1 CDM 0341 RC 78306 HCPCS inpatient 1978 1285.7 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 1918.66 97 999999999 1197.68 1918.66 percent of total billed charges Nuclear medicine study of bone and/or joint whole body 1428649_1 CDM 0341 RC 78306 HCPCS inpatient 1978 1285.7 ENCORE - ALL PLANS ENCORE - ALL PLANS 1364.82 69 999999999 1197.68 1918.66 percent of total billed charges Nuclear medicine study of bone and/or joint whole body 1428649_1 CDM 0341 RC 78306 HCPCS inpatient 1978 1285.7 HUMANA - ALL PLANS HUMANA - ALL PLANS 1542.84 78 999999999 1197.68 1918.66 percent of total billed charges Nuclear medicine study of bone and/or joint whole body 1428649_1 CDM 0341 RC 78306 HCPCS inpatient 1978 1285.7 UMR - ALL PLANS UMR - ALL PLANS 1384.6 70 999999999 1197.68 1918.66 percent of total billed charges Nuclear medicine study of bone and/or joint whole body 1428649_1 CDM 0341 RC 78306 HCPCS inpatient 1978 1285.7 SIHO - ALL PLANS SIHO - ALL PLANS 1780.2 90 999999999 1197.68 1918.66 percent of total billed charges Nuclear medicine study of bone and/or joint whole body 1428649_1 CDM 0341 RC 78306 HCPCS inpatient 1978 1285.7 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1197.68 1918.66 Nuclear medicine study of bone and/or joint whole body 1428649_1 CDM 0341 RC 78306 HCPCS inpatient 1978 1285.7 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1197.68 60.55 999999999 1197.68 1918.66 percent of total billed charges Nuclear medicine study of bone and/or joint whole body 1428649_1 CDM 0341 RC 78306 HCPCS inpatient 1978 1285.7 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1197.68 1918.66 Nuclear medicine study of bone and/or joint whole body 1428649_1 CDM 0341 RC 78306 HCPCS inpatient 1978 1285.7 ANTHEM HMO ANTHEM HMO 999999999 1197.68 1918.66 Nuclear medicine study of bone and/or joint whole body 1428649_1 CDM 0341 RC 78306 HCPCS inpatient 1978 1285.7 CIGNA - ALL PLANS CIGNA - ALL PLANS 1337.13 67.6 999999999 1197.68 1918.66 percent of total billed charges Nuclear medicine study of bone and/or joint whole body 1428649_1 CDM 0341 RC 78306 HCPCS inpatient 1978 1285.7 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1197.68 1918.66 Nuclear medicine study of bone and/or joint whole body 1428649_1 CDM 0341 RC 78306 HCPCS inpatient 1978 1285.7 UHC - ALL PLANS UHC - ALL PLANS 999999999 1197.68 1918.66 "Nuclear medicine study, whole body" 1428661_1 CDM 0341 RC 78802 HCPCS inpatient 2004 1302.6 AETNA AETNA 1583.16 79 999999999 1213.42 1943.88 percent of total billed charges "Nuclear medicine study, whole body" 1428661_1 CDM 0341 RC 78802 HCPCS inpatient 2004 1302.6 SELF PAY DISCOUNT SELF PAY DISCOUNT 1302.6 65 999999999 1213.42 1943.88 percent of total billed charges "Nuclear medicine study, whole body" 1428661_1 CDM 0341 RC 78802 HCPCS inpatient 2004 1302.6 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 1943.88 97 999999999 1213.42 1943.88 percent of total billed charges "Nuclear medicine study, whole body" 1428661_1 CDM 0341 RC 78802 HCPCS inpatient 2004 1302.6 ENCORE - ALL PLANS ENCORE - ALL PLANS 1382.76 69 999999999 1213.42 1943.88 percent of total billed charges "Nuclear medicine study, whole body" 1428661_1 CDM 0341 RC 78802 HCPCS inpatient 2004 1302.6 HUMANA - ALL PLANS HUMANA - ALL PLANS 1563.12 78 999999999 1213.42 1943.88 percent of total billed charges "Nuclear medicine study, whole body" 1428661_1 CDM 0341 RC 78802 HCPCS inpatient 2004 1302.6 UMR - ALL PLANS UMR - ALL PLANS 1402.8 70 999999999 1213.42 1943.88 percent of total billed charges "Nuclear medicine study, whole body" 1428661_1 CDM 0341 RC 78802 HCPCS inpatient 2004 1302.6 SIHO - ALL PLANS SIHO - ALL PLANS 1803.6 90 999999999 1213.42 1943.88 percent of total billed charges "Nuclear medicine study, whole body" 1428661_1 CDM 0341 RC 78802 HCPCS inpatient 2004 1302.6 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1213.42 1943.88 "Nuclear medicine study, whole body" 1428661_1 CDM 0341 RC 78802 HCPCS inpatient 2004 1302.6 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1213.42 60.55 999999999 1213.42 1943.88 percent of total billed charges "Nuclear medicine study, whole body" 1428661_1 CDM 0341 RC 78802 HCPCS inpatient 2004 1302.6 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1213.42 1943.88 "Nuclear medicine study, whole body" 1428661_1 CDM 0341 RC 78802 HCPCS inpatient 2004 1302.6 ANTHEM HMO ANTHEM HMO 999999999 1213.42 1943.88 "Nuclear medicine study, whole body" 1428661_1 CDM 0341 RC 78802 HCPCS inpatient 2004 1302.6 CIGNA - ALL PLANS CIGNA - ALL PLANS 1354.7 67.6 999999999 1213.42 1943.88 percent of total billed charges "Nuclear medicine study, whole body" 1428661_1 CDM 0341 RC 78802 HCPCS inpatient 2004 1302.6 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1213.42 1943.88 "Nuclear medicine study, whole body" 1428661_1 CDM 0341 RC 78802 HCPCS inpatient 2004 1302.6 UHC - ALL PLANS UHC - ALL PLANS 999999999 1213.42 1943.88 Blood group typing (ABO) 1433598_1 CDM 0302 RC 86900 HCPCS inpatient 171 111.15 AETNA AETNA 135.09 79 999999999 103.54 165.87 percent of total billed charges Blood group typing (ABO) 1433598_1 CDM 0302 RC 86900 HCPCS inpatient 171 111.15 SELF PAY DISCOUNT SELF PAY DISCOUNT 111.15 65 999999999 103.54 165.87 percent of total billed charges Blood group typing (ABO) 1433598_1 CDM 0302 RC 86900 HCPCS inpatient 171 111.15 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 165.87 97 999999999 103.54 165.87 percent of total billed charges Blood group typing (ABO) 1433598_1 CDM 0302 RC 86900 HCPCS inpatient 171 111.15 ENCORE - ALL PLANS ENCORE - ALL PLANS 117.99 69 999999999 103.54 165.87 percent of total billed charges Blood group typing (ABO) 1433598_1 CDM 0302 RC 86900 HCPCS inpatient 171 111.15 HUMANA - ALL PLANS HUMANA - ALL PLANS 133.38 78 999999999 103.54 165.87 percent of total billed charges Blood group typing (ABO) 1433598_1 CDM 0302 RC 86900 HCPCS inpatient 171 111.15 UMR - ALL PLANS UMR - ALL PLANS 119.7 70 999999999 103.54 165.87 percent of total billed charges Blood group typing (ABO) 1433598_1 CDM 0302 RC 86900 HCPCS inpatient 171 111.15 SIHO - ALL PLANS SIHO - ALL PLANS 153.9 90 999999999 103.54 165.87 percent of total billed charges Blood group typing (ABO) 1433598_1 CDM 0302 RC 86900 HCPCS inpatient 171 111.15 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 103.54 165.87 Blood group typing (ABO) 1433598_1 CDM 0302 RC 86900 HCPCS inpatient 171 111.15 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 103.54 60.55 999999999 103.54 165.87 percent of total billed charges Blood group typing (ABO) 1433598_1 CDM 0302 RC 86900 HCPCS inpatient 171 111.15 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 103.54 165.87 Blood group typing (ABO) 1433598_1 CDM 0302 RC 86900 HCPCS inpatient 171 111.15 ANTHEM HMO ANTHEM HMO 999999999 103.54 165.87 Blood group typing (ABO) 1433598_1 CDM 0302 RC 86900 HCPCS inpatient 171 111.15 CIGNA - ALL PLANS CIGNA - ALL PLANS 115.6 67.6 999999999 103.54 165.87 percent of total billed charges Blood group typing (ABO) 1433598_1 CDM 0302 RC 86900 HCPCS inpatient 171 111.15 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 103.54 165.87 Blood group typing (ABO) 1433598_1 CDM 0302 RC 86900 HCPCS inpatient 171 111.15 UHC - ALL PLANS UHC - ALL PLANS 999999999 103.54 165.87 Screening test for red blood cell antibodies 1433599_1 CDM 0302 RC 86850 HCPCS inpatient 135 87.75 AETNA AETNA 106.65 79 999999999 81.74 130.95 percent of total billed charges Screening test for red blood cell antibodies 1433599_1 CDM 0302 RC 86850 HCPCS inpatient 135 87.75 SELF PAY DISCOUNT SELF PAY DISCOUNT 87.75 65 999999999 81.74 130.95 percent of total billed charges Screening test for red blood cell antibodies 1433599_1 CDM 0302 RC 86850 HCPCS inpatient 135 87.75 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 130.95 97 999999999 81.74 130.95 percent of total billed charges Screening test for red blood cell antibodies 1433599_1 CDM 0302 RC 86850 HCPCS inpatient 135 87.75 ENCORE - ALL PLANS ENCORE - ALL PLANS 93.15 69 999999999 81.74 130.95 percent of total billed charges Screening test for red blood cell antibodies 1433599_1 CDM 0302 RC 86850 HCPCS inpatient 135 87.75 HUMANA - ALL PLANS HUMANA - ALL PLANS 105.3 78 999999999 81.74 130.95 percent of total billed charges Screening test for red blood cell antibodies 1433599_1 CDM 0302 RC 86850 HCPCS inpatient 135 87.75 UMR - ALL PLANS UMR - ALL PLANS 94.5 70 999999999 81.74 130.95 percent of total billed charges Screening test for red blood cell antibodies 1433599_1 CDM 0302 RC 86850 HCPCS inpatient 135 87.75 SIHO - ALL PLANS SIHO - ALL PLANS 121.5 90 999999999 81.74 130.95 percent of total billed charges Screening test for red blood cell antibodies 1433599_1 CDM 0302 RC 86850 HCPCS inpatient 135 87.75 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 81.74 130.95 Screening test for red blood cell antibodies 1433599_1 CDM 0302 RC 86850 HCPCS inpatient 135 87.75 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 81.74 60.55 999999999 81.74 130.95 percent of total billed charges Screening test for red blood cell antibodies 1433599_1 CDM 0302 RC 86850 HCPCS inpatient 135 87.75 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 81.74 130.95 Screening test for red blood cell antibodies 1433599_1 CDM 0302 RC 86850 HCPCS inpatient 135 87.75 ANTHEM HMO ANTHEM HMO 999999999 81.74 130.95 Screening test for red blood cell antibodies 1433599_1 CDM 0302 RC 86850 HCPCS inpatient 135 87.75 CIGNA - ALL PLANS CIGNA - ALL PLANS 91.26 67.6 999999999 81.74 130.95 percent of total billed charges Screening test for red blood cell antibodies 1433599_1 CDM 0302 RC 86850 HCPCS inpatient 135 87.75 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 81.74 130.95 Screening test for red blood cell antibodies 1433599_1 CDM 0302 RC 86850 HCPCS inpatient 135 87.75 UHC - ALL PLANS UHC - ALL PLANS 999999999 81.74 130.95 "Red blood cell antibody detection test, direct" 1433620_1 CDM 0300 RC 86880 HCPCS inpatient 77 50.05 AETNA AETNA 60.83 79 999999999 46.62 74.69 percent of total billed charges "Red blood cell antibody detection test, direct" 1433620_1 CDM 0300 RC 86880 HCPCS inpatient 77 50.05 SELF PAY DISCOUNT SELF PAY DISCOUNT 50.05 65 999999999 46.62 74.69 percent of total billed charges "Red blood cell antibody detection test, direct" 1433620_1 CDM 0300 RC 86880 HCPCS inpatient 77 50.05 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 74.69 97 999999999 46.62 74.69 percent of total billed charges "Red blood cell antibody detection test, direct" 1433620_1 CDM 0300 RC 86880 HCPCS inpatient 77 50.05 ENCORE - ALL PLANS ENCORE - ALL PLANS 53.13 69 999999999 46.62 74.69 percent of total billed charges "Red blood cell antibody detection test, direct" 1433620_1 CDM 0300 RC 86880 HCPCS inpatient 77 50.05 HUMANA - ALL PLANS HUMANA - ALL PLANS 60.06 78 999999999 46.62 74.69 percent of total billed charges "Red blood cell antibody detection test, direct" 1433620_1 CDM 0300 RC 86880 HCPCS inpatient 77 50.05 UMR - ALL PLANS UMR - ALL PLANS 53.9 70 999999999 46.62 74.69 percent of total billed charges "Red blood cell antibody detection test, direct" 1433620_1 CDM 0300 RC 86880 HCPCS inpatient 77 50.05 SIHO - ALL PLANS SIHO - ALL PLANS 69.3 90 999999999 46.62 74.69 percent of total billed charges "Red blood cell antibody detection test, direct" 1433620_1 CDM 0300 RC 86880 HCPCS inpatient 77 50.05 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 46.62 74.69 "Red blood cell antibody detection test, direct" 1433620_1 CDM 0300 RC 86880 HCPCS inpatient 77 50.05 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 46.62 60.55 999999999 46.62 74.69 percent of total billed charges "Red blood cell antibody detection test, direct" 1433620_1 CDM 0300 RC 86880 HCPCS inpatient 77 50.05 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 46.62 74.69 "Red blood cell antibody detection test, direct" 1433620_1 CDM 0300 RC 86880 HCPCS inpatient 77 50.05 ANTHEM HMO ANTHEM HMO 999999999 46.62 74.69 "Red blood cell antibody detection test, direct" 1433620_1 CDM 0300 RC 86880 HCPCS inpatient 77 50.05 CIGNA - ALL PLANS CIGNA - ALL PLANS 52.05 67.6 999999999 46.62 74.69 percent of total billed charges "Red blood cell antibody detection test, direct" 1433620_1 CDM 0300 RC 86880 HCPCS inpatient 77 50.05 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 46.62 74.69 "Red blood cell antibody detection test, direct" 1433620_1 CDM 0300 RC 86880 HCPCS inpatient 77 50.05 UHC - ALL PLANS UHC - ALL PLANS 999999999 46.62 74.69 Removal of antibodies from surface of red blood cell 1433624_1 CDM 0302 RC 86860 HCPCS inpatient 499 324.35 AETNA AETNA 394.21 79 999999999 302.14 484.03 percent of total billed charges Removal of antibodies from surface of red blood cell 1433624_1 CDM 0302 RC 86860 HCPCS inpatient 499 324.35 SELF PAY DISCOUNT SELF PAY DISCOUNT 324.35 65 999999999 302.14 484.03 percent of total billed charges Removal of antibodies from surface of red blood cell 1433624_1 CDM 0302 RC 86860 HCPCS inpatient 499 324.35 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 484.03 97 999999999 302.14 484.03 percent of total billed charges Removal of antibodies from surface of red blood cell 1433624_1 CDM 0302 RC 86860 HCPCS inpatient 499 324.35 ENCORE - ALL PLANS ENCORE - ALL PLANS 344.31 69 999999999 302.14 484.03 percent of total billed charges Removal of antibodies from surface of red blood cell 1433624_1 CDM 0302 RC 86860 HCPCS inpatient 499 324.35 HUMANA - ALL PLANS HUMANA - ALL PLANS 389.22 78 999999999 302.14 484.03 percent of total billed charges Removal of antibodies from surface of red blood cell 1433624_1 CDM 0302 RC 86860 HCPCS inpatient 499 324.35 UMR - ALL PLANS UMR - ALL PLANS 349.3 70 999999999 302.14 484.03 percent of total billed charges Removal of antibodies from surface of red blood cell 1433624_1 CDM 0302 RC 86860 HCPCS inpatient 499 324.35 SIHO - ALL PLANS SIHO - ALL PLANS 449.1 90 999999999 302.14 484.03 percent of total billed charges Removal of antibodies from surface of red blood cell 1433624_1 CDM 0302 RC 86860 HCPCS inpatient 499 324.35 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 302.14 484.03 Removal of antibodies from surface of red blood cell 1433624_1 CDM 0302 RC 86860 HCPCS inpatient 499 324.35 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 302.14 60.55 999999999 302.14 484.03 percent of total billed charges Removal of antibodies from surface of red blood cell 1433624_1 CDM 0302 RC 86860 HCPCS inpatient 499 324.35 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 302.14 484.03 Removal of antibodies from surface of red blood cell 1433624_1 CDM 0302 RC 86860 HCPCS inpatient 499 324.35 ANTHEM HMO ANTHEM HMO 999999999 302.14 484.03 Removal of antibodies from surface of red blood cell 1433624_1 CDM 0302 RC 86860 HCPCS inpatient 499 324.35 CIGNA - ALL PLANS CIGNA - ALL PLANS 337.32 67.6 999999999 302.14 484.03 percent of total billed charges Removal of antibodies from surface of red blood cell 1433624_1 CDM 0302 RC 86860 HCPCS inpatient 499 324.35 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 302.14 484.03 Removal of antibodies from surface of red blood cell 1433624_1 CDM 0302 RC 86860 HCPCS inpatient 499 324.35 UHC - ALL PLANS UHC - ALL PLANS 999999999 302.14 484.03 Microscopic examination for white blood cells 1452105_1 CDM 0305 RC 85008 HCPCS inpatient 348 226.2 AETNA AETNA 274.92 79 999999999 210.71 337.56 percent of total billed charges Microscopic examination for white blood cells 1452105_1 CDM 0305 RC 85008 HCPCS inpatient 348 226.2 SELF PAY DISCOUNT SELF PAY DISCOUNT 226.2 65 999999999 210.71 337.56 percent of total billed charges Microscopic examination for white blood cells 1452105_1 CDM 0305 RC 85008 HCPCS inpatient 348 226.2 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 337.56 97 999999999 210.71 337.56 percent of total billed charges Microscopic examination for white blood cells 1452105_1 CDM 0305 RC 85008 HCPCS inpatient 348 226.2 ENCORE - ALL PLANS ENCORE - ALL PLANS 240.12 69 999999999 210.71 337.56 percent of total billed charges Microscopic examination for white blood cells 1452105_1 CDM 0305 RC 85008 HCPCS inpatient 348 226.2 HUMANA - ALL PLANS HUMANA - ALL PLANS 271.44 78 999999999 210.71 337.56 percent of total billed charges Microscopic examination for white blood cells 1452105_1 CDM 0305 RC 85008 HCPCS inpatient 348 226.2 UMR - ALL PLANS UMR - ALL PLANS 243.6 70 999999999 210.71 337.56 percent of total billed charges Microscopic examination for white blood cells 1452105_1 CDM 0305 RC 85008 HCPCS inpatient 348 226.2 SIHO - ALL PLANS SIHO - ALL PLANS 313.2 90 999999999 210.71 337.56 percent of total billed charges Microscopic examination for white blood cells 1452105_1 CDM 0305 RC 85008 HCPCS inpatient 348 226.2 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 210.71 337.56 Microscopic examination for white blood cells 1452105_1 CDM 0305 RC 85008 HCPCS inpatient 348 226.2 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 210.71 60.55 999999999 210.71 337.56 percent of total billed charges Microscopic examination for white blood cells 1452105_1 CDM 0305 RC 85008 HCPCS inpatient 348 226.2 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 210.71 337.56 Microscopic examination for white blood cells 1452105_1 CDM 0305 RC 85008 HCPCS inpatient 348 226.2 ANTHEM HMO ANTHEM HMO 999999999 210.71 337.56 Microscopic examination for white blood cells 1452105_1 CDM 0305 RC 85008 HCPCS inpatient 348 226.2 CIGNA - ALL PLANS CIGNA - ALL PLANS 235.25 67.6 999999999 210.71 337.56 percent of total billed charges Microscopic examination for white blood cells 1452105_1 CDM 0305 RC 85008 HCPCS inpatient 348 226.2 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 210.71 337.56 Microscopic examination for white blood cells 1452105_1 CDM 0305 RC 85008 HCPCS inpatient 348 226.2 UHC - ALL PLANS UHC - ALL PLANS 999999999 210.71 337.56 Ultrasonic guidance during surgery 1457744_1 CDM 0402 RC 76998 HCPCS inpatient 280 182 AETNA AETNA 221.2 79 999999999 169.54 271.6 percent of total billed charges Ultrasonic guidance during surgery 1457744_1 CDM 0402 RC 76998 HCPCS inpatient 280 182 SELF PAY DISCOUNT SELF PAY DISCOUNT 182 65 999999999 169.54 271.6 percent of total billed charges Ultrasonic guidance during surgery 1457744_1 CDM 0402 RC 76998 HCPCS inpatient 280 182 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 271.6 97 999999999 169.54 271.6 percent of total billed charges Ultrasonic guidance during surgery 1457744_1 CDM 0402 RC 76998 HCPCS inpatient 280 182 ENCORE - ALL PLANS ENCORE - ALL PLANS 193.2 69 999999999 169.54 271.6 percent of total billed charges Ultrasonic guidance during surgery 1457744_1 CDM 0402 RC 76998 HCPCS inpatient 280 182 HUMANA - ALL PLANS HUMANA - ALL PLANS 218.4 78 999999999 169.54 271.6 percent of total billed charges Ultrasonic guidance during surgery 1457744_1 CDM 0402 RC 76998 HCPCS inpatient 280 182 UMR - ALL PLANS UMR - ALL PLANS 196 70 999999999 169.54 271.6 percent of total billed charges Ultrasonic guidance during surgery 1457744_1 CDM 0402 RC 76998 HCPCS inpatient 280 182 SIHO - ALL PLANS SIHO - ALL PLANS 252 90 999999999 169.54 271.6 percent of total billed charges Ultrasonic guidance during surgery 1457744_1 CDM 0402 RC 76998 HCPCS inpatient 280 182 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 169.54 271.6 Ultrasonic guidance during surgery 1457744_1 CDM 0402 RC 76998 HCPCS inpatient 280 182 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 169.54 60.55 999999999 169.54 271.6 percent of total billed charges Ultrasonic guidance during surgery 1457744_1 CDM 0402 RC 76998 HCPCS inpatient 280 182 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 169.54 271.6 Ultrasonic guidance during surgery 1457744_1 CDM 0402 RC 76998 HCPCS inpatient 280 182 ANTHEM HMO ANTHEM HMO 999999999 169.54 271.6 Ultrasonic guidance during surgery 1457744_1 CDM 0402 RC 76998 HCPCS inpatient 280 182 CIGNA - ALL PLANS CIGNA - ALL PLANS 189.28 67.6 999999999 169.54 271.6 percent of total billed charges Ultrasonic guidance during surgery 1457744_1 CDM 0402 RC 76998 HCPCS inpatient 280 182 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 169.54 271.6 Ultrasonic guidance during surgery 1457744_1 CDM 0402 RC 76998 HCPCS inpatient 280 182 UHC - ALL PLANS UHC - ALL PLANS 999999999 169.54 271.6 "X-ray of chest, 2 views" 1457758_1 CDM 0324 RC 71046 HCPCS inpatient 666 432.9 AETNA AETNA 526.14 79 999999999 403.26 646.02 percent of total billed charges "X-ray of chest, 2 views" 1457758_1 CDM 0324 RC 71046 HCPCS inpatient 666 432.9 SELF PAY DISCOUNT SELF PAY DISCOUNT 432.9 65 999999999 403.26 646.02 percent of total billed charges "X-ray of chest, 2 views" 1457758_1 CDM 0324 RC 71046 HCPCS inpatient 666 432.9 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 646.02 97 999999999 403.26 646.02 percent of total billed charges "X-ray of chest, 2 views" 1457758_1 CDM 0324 RC 71046 HCPCS inpatient 666 432.9 ENCORE - ALL PLANS ENCORE - ALL PLANS 459.54 69 999999999 403.26 646.02 percent of total billed charges "X-ray of chest, 2 views" 1457758_1 CDM 0324 RC 71046 HCPCS inpatient 666 432.9 HUMANA - ALL PLANS HUMANA - ALL PLANS 519.48 78 999999999 403.26 646.02 percent of total billed charges "X-ray of chest, 2 views" 1457758_1 CDM 0324 RC 71046 HCPCS inpatient 666 432.9 UMR - ALL PLANS UMR - ALL PLANS 466.2 70 999999999 403.26 646.02 percent of total billed charges "X-ray of chest, 2 views" 1457758_1 CDM 0324 RC 71046 HCPCS inpatient 666 432.9 SIHO - ALL PLANS SIHO - ALL PLANS 599.4 90 999999999 403.26 646.02 percent of total billed charges "X-ray of chest, 2 views" 1457758_1 CDM 0324 RC 71046 HCPCS inpatient 666 432.9 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 403.26 646.02 "X-ray of chest, 2 views" 1457758_1 CDM 0324 RC 71046 HCPCS inpatient 666 432.9 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 403.26 60.55 999999999 403.26 646.02 percent of total billed charges "X-ray of chest, 2 views" 1457758_1 CDM 0324 RC 71046 HCPCS inpatient 666 432.9 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 403.26 646.02 "X-ray of chest, 2 views" 1457758_1 CDM 0324 RC 71046 HCPCS inpatient 666 432.9 ANTHEM HMO ANTHEM HMO 999999999 403.26 646.02 "X-ray of chest, 2 views" 1457758_1 CDM 0324 RC 71046 HCPCS inpatient 666 432.9 CIGNA - ALL PLANS CIGNA - ALL PLANS 450.22 67.6 999999999 403.26 646.02 percent of total billed charges "X-ray of chest, 2 views" 1457758_1 CDM 0324 RC 71046 HCPCS inpatient 666 432.9 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 403.26 646.02 "X-ray of chest, 2 views" 1457758_1 CDM 0324 RC 71046 HCPCS inpatient 666 432.9 UHC - ALL PLANS UHC - ALL PLANS 999999999 403.26 646.02 Review by radiologist of image for drainage of fluid 1457762_1 CDM 0320 RC 75989 HCPCS inpatient 1689 1097.85 AETNA AETNA 1334.31 79 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of image for drainage of fluid 1457762_1 CDM 0320 RC 75989 HCPCS inpatient 1689 1097.85 SELF PAY DISCOUNT SELF PAY DISCOUNT 1097.85 65 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of image for drainage of fluid 1457762_1 CDM 0320 RC 75989 HCPCS inpatient 1689 1097.85 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 1638.33 97 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of image for drainage of fluid 1457762_1 CDM 0320 RC 75989 HCPCS inpatient 1689 1097.85 ENCORE - ALL PLANS ENCORE - ALL PLANS 1165.41 69 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of image for drainage of fluid 1457762_1 CDM 0320 RC 75989 HCPCS inpatient 1689 1097.85 HUMANA - ALL PLANS HUMANA - ALL PLANS 1317.42 78 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of image for drainage of fluid 1457762_1 CDM 0320 RC 75989 HCPCS inpatient 1689 1097.85 UMR - ALL PLANS UMR - ALL PLANS 1182.3 70 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of image for drainage of fluid 1457762_1 CDM 0320 RC 75989 HCPCS inpatient 1689 1097.85 SIHO - ALL PLANS SIHO - ALL PLANS 1520.1 90 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of image for drainage of fluid 1457762_1 CDM 0320 RC 75989 HCPCS inpatient 1689 1097.85 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1022.69 1638.33 Review by radiologist of image for drainage of fluid 1457762_1 CDM 0320 RC 75989 HCPCS inpatient 1689 1097.85 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1022.69 60.55 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of image for drainage of fluid 1457762_1 CDM 0320 RC 75989 HCPCS inpatient 1689 1097.85 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1022.69 1638.33 Review by radiologist of image for drainage of fluid 1457762_1 CDM 0320 RC 75989 HCPCS inpatient 1689 1097.85 ANTHEM HMO ANTHEM HMO 999999999 1022.69 1638.33 Review by radiologist of image for drainage of fluid 1457762_1 CDM 0320 RC 75989 HCPCS inpatient 1689 1097.85 CIGNA - ALL PLANS CIGNA - ALL PLANS 1141.76 67.6 999999999 1022.69 1638.33 percent of total billed charges Review by radiologist of image for drainage of fluid 1457762_1 CDM 0320 RC 75989 HCPCS inpatient 1689 1097.85 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1022.69 1638.33 Review by radiologist of image for drainage of fluid 1457762_1 CDM 0320 RC 75989 HCPCS inpatient 1689 1097.85 UHC - ALL PLANS UHC - ALL PLANS 999999999 1022.69 1638.33 Review by radiologist of abscess or sinus cavity study 1457764_1 CDM 0320 RC 76080 HCPCS inpatient 612 397.8 AETNA AETNA 483.48 79 999999999 370.57 593.64 percent of total billed charges Review by radiologist of abscess or sinus cavity study 1457764_1 CDM 0320 RC 76080 HCPCS inpatient 612 397.8 SELF PAY DISCOUNT SELF PAY DISCOUNT 397.8 65 999999999 370.57 593.64 percent of total billed charges Review by radiologist of abscess or sinus cavity study 1457764_1 CDM 0320 RC 76080 HCPCS inpatient 612 397.8 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 593.64 97 999999999 370.57 593.64 percent of total billed charges Review by radiologist of abscess or sinus cavity study 1457764_1 CDM 0320 RC 76080 HCPCS inpatient 612 397.8 ENCORE - ALL PLANS ENCORE - ALL PLANS 422.28 69 999999999 370.57 593.64 percent of total billed charges Review by radiologist of abscess or sinus cavity study 1457764_1 CDM 0320 RC 76080 HCPCS inpatient 612 397.8 HUMANA - ALL PLANS HUMANA - ALL PLANS 477.36 78 999999999 370.57 593.64 percent of total billed charges Review by radiologist of abscess or sinus cavity study 1457764_1 CDM 0320 RC 76080 HCPCS inpatient 612 397.8 UMR - ALL PLANS UMR - ALL PLANS 428.4 70 999999999 370.57 593.64 percent of total billed charges Review by radiologist of abscess or sinus cavity study 1457764_1 CDM 0320 RC 76080 HCPCS inpatient 612 397.8 SIHO - ALL PLANS SIHO - ALL PLANS 550.8 90 999999999 370.57 593.64 percent of total billed charges Review by radiologist of abscess or sinus cavity study 1457764_1 CDM 0320 RC 76080 HCPCS inpatient 612 397.8 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 370.57 593.64 Review by radiologist of abscess or sinus cavity study 1457764_1 CDM 0320 RC 76080 HCPCS inpatient 612 397.8 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 370.57 60.55 999999999 370.57 593.64 percent of total billed charges Review by radiologist of abscess or sinus cavity study 1457764_1 CDM 0320 RC 76080 HCPCS inpatient 612 397.8 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 370.57 593.64 Review by radiologist of abscess or sinus cavity study 1457764_1 CDM 0320 RC 76080 HCPCS inpatient 612 397.8 ANTHEM HMO ANTHEM HMO 999999999 370.57 593.64 Review by radiologist of abscess or sinus cavity study 1457764_1 CDM 0320 RC 76080 HCPCS inpatient 612 397.8 CIGNA - ALL PLANS CIGNA - ALL PLANS 413.71 67.6 999999999 370.57 593.64 percent of total billed charges Review by radiologist of abscess or sinus cavity study 1457764_1 CDM 0320 RC 76080 HCPCS inpatient 612 397.8 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 370.57 593.64 Review by radiologist of abscess or sinus cavity study 1457764_1 CDM 0320 RC 76080 HCPCS inpatient 612 397.8 UHC - ALL PLANS UHC - ALL PLANS 999999999 370.57 593.64 "X-ray of ribs on side of body, 2 views" 1457770_1 CDM 0320 RC 71100 HCPCS inpatient 479 311.35 AETNA AETNA 378.41 79 999999999 290.03 464.63 percent of total billed charges "X-ray of ribs on side of body, 2 views" 1457770_1 CDM 0320 RC 71100 HCPCS inpatient 479 311.35 SELF PAY DISCOUNT SELF PAY DISCOUNT 311.35 65 999999999 290.03 464.63 percent of total billed charges "X-ray of ribs on side of body, 2 views" 1457770_1 CDM 0320 RC 71100 HCPCS inpatient 479 311.35 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 464.63 97 999999999 290.03 464.63 percent of total billed charges "X-ray of ribs on side of body, 2 views" 1457770_1 CDM 0320 RC 71100 HCPCS inpatient 479 311.35 ENCORE - ALL PLANS ENCORE - ALL PLANS 330.51 69 999999999 290.03 464.63 percent of total billed charges "X-ray of ribs on side of body, 2 views" 1457770_1 CDM 0320 RC 71100 HCPCS inpatient 479 311.35 HUMANA - ALL PLANS HUMANA - ALL PLANS 373.62 78 999999999 290.03 464.63 percent of total billed charges "X-ray of ribs on side of body, 2 views" 1457770_1 CDM 0320 RC 71100 HCPCS inpatient 479 311.35 UMR - ALL PLANS UMR - ALL PLANS 335.3 70 999999999 290.03 464.63 percent of total billed charges "X-ray of ribs on side of body, 2 views" 1457770_1 CDM 0320 RC 71100 HCPCS inpatient 479 311.35 SIHO - ALL PLANS SIHO - ALL PLANS 431.1 90 999999999 290.03 464.63 percent of total billed charges "X-ray of ribs on side of body, 2 views" 1457770_1 CDM 0320 RC 71100 HCPCS inpatient 479 311.35 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 290.03 464.63 "X-ray of ribs on side of body, 2 views" 1457770_1 CDM 0320 RC 71100 HCPCS inpatient 479 311.35 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 290.03 60.55 999999999 290.03 464.63 percent of total billed charges "X-ray of ribs on side of body, 2 views" 1457770_1 CDM 0320 RC 71100 HCPCS inpatient 479 311.35 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 290.03 464.63 "X-ray of ribs on side of body, 2 views" 1457770_1 CDM 0320 RC 71100 HCPCS inpatient 479 311.35 ANTHEM HMO ANTHEM HMO 999999999 290.03 464.63 "X-ray of ribs on side of body, 2 views" 1457770_1 CDM 0320 RC 71100 HCPCS inpatient 479 311.35 CIGNA - ALL PLANS CIGNA - ALL PLANS 323.8 67.6 999999999 290.03 464.63 percent of total billed charges "X-ray of ribs on side of body, 2 views" 1457770_1 CDM 0320 RC 71100 HCPCS inpatient 479 311.35 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 290.03 464.63 "X-ray of ribs on side of body, 2 views" 1457770_1 CDM 0320 RC 71100 HCPCS inpatient 479 311.35 UHC - ALL PLANS UHC - ALL PLANS 999999999 290.03 464.63 "X-ray of ribs on side of body, 2 views" 1457773_1 CDM 0320 RC 71100 HCPCS inpatient 479 311.35 AETNA AETNA 378.41 79 999999999 290.03 464.63 percent of total billed charges "X-ray of ribs on side of body, 2 views" 1457773_1 CDM 0320 RC 71100 HCPCS inpatient 479 311.35 SELF PAY DISCOUNT SELF PAY DISCOUNT 311.35 65 999999999 290.03 464.63 percent of total billed charges "X-ray of ribs on side of body, 2 views" 1457773_1 CDM 0320 RC 71100 HCPCS inpatient 479 311.35 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 464.63 97 999999999 290.03 464.63 percent of total billed charges "X-ray of ribs on side of body, 2 views" 1457773_1 CDM 0320 RC 71100 HCPCS inpatient 479 311.35 ENCORE - ALL PLANS ENCORE - ALL PLANS 330.51 69 999999999 290.03 464.63 percent of total billed charges "X-ray of ribs on side of body, 2 views" 1457773_1 CDM 0320 RC 71100 HCPCS inpatient 479 311.35 HUMANA - ALL PLANS HUMANA - ALL PLANS 373.62 78 999999999 290.03 464.63 percent of total billed charges "X-ray of ribs on side of body, 2 views" 1457773_1 CDM 0320 RC 71100 HCPCS inpatient 479 311.35 UMR - ALL PLANS UMR - ALL PLANS 335.3 70 999999999 290.03 464.63 percent of total billed charges "X-ray of ribs on side of body, 2 views" 1457773_1 CDM 0320 RC 71100 HCPCS inpatient 479 311.35 SIHO - ALL PLANS SIHO - ALL PLANS 431.1 90 999999999 290.03 464.63 percent of total billed charges "X-ray of ribs on side of body, 2 views" 1457773_1 CDM 0320 RC 71100 HCPCS inpatient 479 311.35 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 290.03 464.63 "X-ray of ribs on side of body, 2 views" 1457773_1 CDM 0320 RC 71100 HCPCS inpatient 479 311.35 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 290.03 60.55 999999999 290.03 464.63 percent of total billed charges "X-ray of ribs on side of body, 2 views" 1457773_1 CDM 0320 RC 71100 HCPCS inpatient 479 311.35 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 290.03 464.63 "X-ray of ribs on side of body, 2 views" 1457773_1 CDM 0320 RC 71100 HCPCS inpatient 479 311.35 ANTHEM HMO ANTHEM HMO 999999999 290.03 464.63 "X-ray of ribs on side of body, 2 views" 1457773_1 CDM 0320 RC 71100 HCPCS inpatient 479 311.35 CIGNA - ALL PLANS CIGNA - ALL PLANS 323.8 67.6 999999999 290.03 464.63 percent of total billed charges "X-ray of ribs on side of body, 2 views" 1457773_1 CDM 0320 RC 71100 HCPCS inpatient 479 311.35 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 290.03 464.63 "X-ray of ribs on side of body, 2 views" 1457773_1 CDM 0320 RC 71100 HCPCS inpatient 479 311.35 UHC - ALL PLANS UHC - ALL PLANS 999999999 290.03 464.63 Injection of drug or substance under skin or into muscle 1489779_1 CDM 0510 RC 96372 HCPCS inpatient 52.5 34.13 AETNA AETNA 41.48 79 999999999 31.79 50.93 percent of total billed charges Injection of drug or substance under skin or into muscle 1489779_1 CDM 0510 RC 96372 HCPCS inpatient 52.5 34.13 SELF PAY DISCOUNT SELF PAY DISCOUNT 34.13 65 999999999 31.79 50.93 percent of total billed charges Injection of drug or substance under skin or into muscle 1489779_1 CDM 0510 RC 96372 HCPCS inpatient 52.5 34.13 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 50.93 97 999999999 31.79 50.93 percent of total billed charges Injection of drug or substance under skin or into muscle 1489779_1 CDM 0510 RC 96372 HCPCS inpatient 52.5 34.13 ENCORE - ALL PLANS ENCORE - ALL PLANS 36.23 69 999999999 31.79 50.93 percent of total billed charges Injection of drug or substance under skin or into muscle 1489779_1 CDM 0510 RC 96372 HCPCS inpatient 52.5 34.13 SIHO - ALL PLANS SIHO - ALL PLANS 47.25 90 999999999 31.79 50.93 percent of total billed charges Injection of drug or substance under skin or into muscle 1489779_1 CDM 0510 RC 96372 HCPCS inpatient 52.5 34.13 HUMANA - ALL PLANS HUMANA - ALL PLANS 40.95 78 999999999 31.79 50.93 percent of total billed charges Injection of drug or substance under skin or into muscle 1489779_1 CDM 0510 RC 96372 HCPCS inpatient 52.5 34.13 UMR - ALL PLANS UMR - ALL PLANS 36.75 70 999999999 31.79 50.93 percent of total billed charges Injection of drug or substance under skin or into muscle 1489779_1 CDM 0510 RC 96372 HCPCS inpatient 52.5 34.13 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 31.79 60.55 999999999 31.79 50.93 percent of total billed charges Injection of drug or substance under skin or into muscle 1489779_1 CDM 0510 RC 96372 HCPCS inpatient 52.5 34.13 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 31.79 50.93 Injection of drug or substance under skin or into muscle 1489779_1 CDM 0510 RC 96372 HCPCS inpatient 52.5 34.13 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 31.79 50.93 Injection of drug or substance under skin or into muscle 1489779_1 CDM 0510 RC 96372 HCPCS inpatient 52.5 34.13 ANTHEM HMO ANTHEM HMO 999999999 31.79 50.93 Injection of drug or substance under skin or into muscle 1489779_1 CDM 0510 RC 96372 HCPCS inpatient 52.5 34.13 CIGNA - ALL PLANS CIGNA - ALL PLANS 35.49 67.6 999999999 31.79 50.93 percent of total billed charges Injection of drug or substance under skin or into muscle 1489779_1 CDM 0510 RC 96372 HCPCS inpatient 52.5 34.13 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 31.79 50.93 Injection of drug or substance under skin or into muscle 1489779_1 CDM 0510 RC 96372 HCPCS inpatient 52.5 34.13 UHC - ALL PLANS UHC - ALL PLANS 999999999 31.79 50.93 "Bilirubin level, total" 15340860_1 CDM 0301 RC 82247 HCPCS inpatient 72 46.8 SELF PAY DISCOUNT SELF PAY DISCOUNT 46.8 65 999999999 43.6 69.84 percent of total billed charges "Bilirubin level, total" 15340860_1 CDM 0301 RC 82247 HCPCS inpatient 72 46.8 AETNA AETNA 56.88 79 999999999 43.6 69.84 percent of total billed charges "Bilirubin level, total" 15340860_1 CDM 0301 RC 82247 HCPCS inpatient 72 46.8 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 69.84 97 999999999 43.6 69.84 percent of total billed charges "Bilirubin level, total" 15340860_1 CDM 0301 RC 82247 HCPCS inpatient 72 46.8 ENCORE - ALL PLANS ENCORE - ALL PLANS 49.68 69 999999999 43.6 69.84 percent of total billed charges "Bilirubin level, total" 15340860_1 CDM 0301 RC 82247 HCPCS inpatient 72 46.8 HUMANA - ALL PLANS HUMANA - ALL PLANS 56.16 78 999999999 43.6 69.84 percent of total billed charges "Bilirubin level, total" 15340860_1 CDM 0301 RC 82247 HCPCS inpatient 72 46.8 UMR - ALL PLANS UMR - ALL PLANS 50.4 70 999999999 43.6 69.84 percent of total billed charges "Bilirubin level, total" 15340860_1 CDM 0301 RC 82247 HCPCS inpatient 72 46.8 SIHO - ALL PLANS SIHO - ALL PLANS 64.8 90 999999999 43.6 69.84 percent of total billed charges "Bilirubin level, total" 15340860_1 CDM 0301 RC 82247 HCPCS inpatient 72 46.8 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 43.6 60.55 999999999 43.6 69.84 percent of total billed charges "Bilirubin level, total" 15340860_1 CDM 0301 RC 82247 HCPCS inpatient 72 46.8 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 43.6 69.84 "Bilirubin level, total" 15340860_1 CDM 0301 RC 82247 HCPCS inpatient 72 46.8 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 43.6 69.84 "Bilirubin level, total" 15340860_1 CDM 0301 RC 82247 HCPCS inpatient 72 46.8 ANTHEM HMO ANTHEM HMO 999999999 43.6 69.84 "Bilirubin level, total" 15340860_1 CDM 0301 RC 82247 HCPCS inpatient 72 46.8 CIGNA - ALL PLANS CIGNA - ALL PLANS 48.67 67.6 999999999 43.6 69.84 percent of total billed charges "Bilirubin level, total" 15340860_1 CDM 0301 RC 82247 HCPCS inpatient 72 46.8 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 43.6 69.84 "Bilirubin level, total" 15340860_1 CDM 0301 RC 82247 HCPCS inpatient 72 46.8 UHC - ALL PLANS UHC - ALL PLANS 999999999 43.6 69.84 "Bilirubin level, direct" 15340861_1 CDM 0301 RC 82248 HCPCS inpatient 81 52.65 SELF PAY DISCOUNT SELF PAY DISCOUNT 52.65 65 999999999 49.05 78.57 percent of total billed charges "Bilirubin level, direct" 15340861_1 CDM 0301 RC 82248 HCPCS inpatient 81 52.65 AETNA AETNA 63.99 79 999999999 49.05 78.57 percent of total billed charges "Bilirubin level, direct" 15340861_1 CDM 0301 RC 82248 HCPCS inpatient 81 52.65 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 78.57 97 999999999 49.05 78.57 percent of total billed charges "Bilirubin level, direct" 15340861_1 CDM 0301 RC 82248 HCPCS inpatient 81 52.65 ENCORE - ALL PLANS ENCORE - ALL PLANS 55.89 69 999999999 49.05 78.57 percent of total billed charges "Bilirubin level, direct" 15340861_1 CDM 0301 RC 82248 HCPCS inpatient 81 52.65 HUMANA - ALL PLANS HUMANA - ALL PLANS 63.18 78 999999999 49.05 78.57 percent of total billed charges "Bilirubin level, direct" 15340861_1 CDM 0301 RC 82248 HCPCS inpatient 81 52.65 UMR - ALL PLANS UMR - ALL PLANS 56.7 70 999999999 49.05 78.57 percent of total billed charges "Bilirubin level, direct" 15340861_1 CDM 0301 RC 82248 HCPCS inpatient 81 52.65 SIHO - ALL PLANS SIHO - ALL PLANS 72.9 90 999999999 49.05 78.57 percent of total billed charges "Bilirubin level, direct" 15340861_1 CDM 0301 RC 82248 HCPCS inpatient 81 52.65 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 49.05 60.55 999999999 49.05 78.57 percent of total billed charges "Bilirubin level, direct" 15340861_1 CDM 0301 RC 82248 HCPCS inpatient 81 52.65 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 49.05 78.57 "Bilirubin level, direct" 15340861_1 CDM 0301 RC 82248 HCPCS inpatient 81 52.65 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 49.05 78.57 "Bilirubin level, direct" 15340861_1 CDM 0301 RC 82248 HCPCS inpatient 81 52.65 ANTHEM HMO ANTHEM HMO 999999999 49.05 78.57 "Bilirubin level, direct" 15340861_1 CDM 0301 RC 82248 HCPCS inpatient 81 52.65 CIGNA - ALL PLANS CIGNA - ALL PLANS 54.76 67.6 999999999 49.05 78.57 percent of total billed charges "Bilirubin level, direct" 15340861_1 CDM 0301 RC 82248 HCPCS inpatient 81 52.65 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 49.05 78.57 "Bilirubin level, direct" 15340861_1 CDM 0301 RC 82248 HCPCS inpatient 81 52.65 UHC - ALL PLANS UHC - ALL PLANS 999999999 49.05 78.57 "PSA (prostate specific antigen) measurement, total" 15768857_1 CDM 0300 RC 84153 HCPCS inpatient 307 199.55 SELF PAY DISCOUNT SELF PAY DISCOUNT 199.55 65 999999999 185.89 297.79 percent of total billed charges "PSA (prostate specific antigen) measurement, total" 15768857_1 CDM 0300 RC 84153 HCPCS inpatient 307 199.55 AETNA AETNA 242.53 79 999999999 185.89 297.79 percent of total billed charges "PSA (prostate specific antigen) measurement, total" 15768857_1 CDM 0300 RC 84153 HCPCS inpatient 307 199.55 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 297.79 97 999999999 185.89 297.79 percent of total billed charges "PSA (prostate specific antigen) measurement, total" 15768857_1 CDM 0300 RC 84153 HCPCS inpatient 307 199.55 ENCORE - ALL PLANS ENCORE - ALL PLANS 211.83 69 999999999 185.89 297.79 percent of total billed charges "PSA (prostate specific antigen) measurement, total" 15768857_1 CDM 0300 RC 84153 HCPCS inpatient 307 199.55 HUMANA - ALL PLANS HUMANA - ALL PLANS 239.46 78 999999999 185.89 297.79 percent of total billed charges "PSA (prostate specific antigen) measurement, total" 15768857_1 CDM 0300 RC 84153 HCPCS inpatient 307 199.55 UMR - ALL PLANS UMR - ALL PLANS 214.9 70 999999999 185.89 297.79 percent of total billed charges "PSA (prostate specific antigen) measurement, total" 15768857_1 CDM 0300 RC 84153 HCPCS inpatient 307 199.55 SIHO - ALL PLANS SIHO - ALL PLANS 276.3 90 999999999 185.89 297.79 percent of total billed charges "PSA (prostate specific antigen) measurement, total" 15768857_1 CDM 0300 RC 84153 HCPCS inpatient 307 199.55 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 185.89 60.55 999999999 185.89 297.79 percent of total billed charges "PSA (prostate specific antigen) measurement, total" 15768857_1 CDM 0300 RC 84153 HCPCS inpatient 307 199.55 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 185.89 297.79 "PSA (prostate specific antigen) measurement, total" 15768857_1 CDM 0300 RC 84153 HCPCS inpatient 307 199.55 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 185.89 297.79 "PSA (prostate specific antigen) measurement, total" 15768857_1 CDM 0300 RC 84153 HCPCS inpatient 307 199.55 ANTHEM HMO ANTHEM HMO 999999999 185.89 297.79 "PSA (prostate specific antigen) measurement, total" 15768857_1 CDM 0300 RC 84153 HCPCS inpatient 307 199.55 CIGNA - ALL PLANS CIGNA - ALL PLANS 207.53 67.6 999999999 185.89 297.79 percent of total billed charges "PSA (prostate specific antigen) measurement, total" 15768857_1 CDM 0300 RC 84153 HCPCS inpatient 307 199.55 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 185.89 297.79 "PSA (prostate specific antigen) measurement, total" 15768857_1 CDM 0300 RC 84153 HCPCS inpatient 307 199.55 UHC - ALL PLANS UHC - ALL PLANS 999999999 185.89 297.79 Iron binding capacity 16598872_1 CDM 0301 RC 83550 HCPCS inpatient 71 46.15 SELF PAY DISCOUNT SELF PAY DISCOUNT 46.15 65 999999999 42.99 68.87 percent of total billed charges Iron binding capacity 16598872_1 CDM 0301 RC 83550 HCPCS inpatient 71 46.15 AETNA AETNA 56.09 79 999999999 42.99 68.87 percent of total billed charges Iron binding capacity 16598872_1 CDM 0301 RC 83550 HCPCS inpatient 71 46.15 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 68.87 97 999999999 42.99 68.87 percent of total billed charges Iron binding capacity 16598872_1 CDM 0301 RC 83550 HCPCS inpatient 71 46.15 ENCORE - ALL PLANS ENCORE - ALL PLANS 48.99 69 999999999 42.99 68.87 percent of total billed charges Iron binding capacity 16598872_1 CDM 0301 RC 83550 HCPCS inpatient 71 46.15 HUMANA - ALL PLANS HUMANA - ALL PLANS 55.38 78 999999999 42.99 68.87 percent of total billed charges Iron binding capacity 16598872_1 CDM 0301 RC 83550 HCPCS inpatient 71 46.15 UMR - ALL PLANS UMR - ALL PLANS 49.7 70 999999999 42.99 68.87 percent of total billed charges Iron binding capacity 16598872_1 CDM 0301 RC 83550 HCPCS inpatient 71 46.15 SIHO - ALL PLANS SIHO - ALL PLANS 63.9 90 999999999 42.99 68.87 percent of total billed charges Iron binding capacity 16598872_1 CDM 0301 RC 83550 HCPCS inpatient 71 46.15 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 42.99 60.55 999999999 42.99 68.87 percent of total billed charges Iron binding capacity 16598872_1 CDM 0301 RC 83550 HCPCS inpatient 71 46.15 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 42.99 68.87 Iron binding capacity 16598872_1 CDM 0301 RC 83550 HCPCS inpatient 71 46.15 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 42.99 68.87 Iron binding capacity 16598872_1 CDM 0301 RC 83550 HCPCS inpatient 71 46.15 ANTHEM HMO ANTHEM HMO 999999999 42.99 68.87 Iron binding capacity 16598872_1 CDM 0301 RC 83550 HCPCS inpatient 71 46.15 CIGNA - ALL PLANS CIGNA - ALL PLANS 48 67.6 999999999 42.99 68.87 percent of total billed charges Iron binding capacity 16598872_1 CDM 0301 RC 83550 HCPCS inpatient 71 46.15 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 42.99 68.87 Iron binding capacity 16598872_1 CDM 0301 RC 83550 HCPCS inpatient 71 46.15 UHC - ALL PLANS UHC - ALL PLANS 999999999 42.99 68.87 Urine phosphate level 16598874_1 CDM 0301 RC 84105 HCPCS inpatient 146 94.9 SELF PAY DISCOUNT SELF PAY DISCOUNT 94.9 65 999999999 88.4 141.62 percent of total billed charges Urine phosphate level 16598874_1 CDM 0301 RC 84105 HCPCS inpatient 146 94.9 AETNA AETNA 115.34 79 999999999 88.4 141.62 percent of total billed charges Urine phosphate level 16598874_1 CDM 0301 RC 84105 HCPCS inpatient 146 94.9 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 141.62 97 999999999 88.4 141.62 percent of total billed charges Urine phosphate level 16598874_1 CDM 0301 RC 84105 HCPCS inpatient 146 94.9 ENCORE - ALL PLANS ENCORE - ALL PLANS 100.74 69 999999999 88.4 141.62 percent of total billed charges Urine phosphate level 16598874_1 CDM 0301 RC 84105 HCPCS inpatient 146 94.9 HUMANA - ALL PLANS HUMANA - ALL PLANS 113.88 78 999999999 88.4 141.62 percent of total billed charges Urine phosphate level 16598874_1 CDM 0301 RC 84105 HCPCS inpatient 146 94.9 UMR - ALL PLANS UMR - ALL PLANS 102.2 70 999999999 88.4 141.62 percent of total billed charges Urine phosphate level 16598874_1 CDM 0301 RC 84105 HCPCS inpatient 146 94.9 SIHO - ALL PLANS SIHO - ALL PLANS 131.4 90 999999999 88.4 141.62 percent of total billed charges Urine phosphate level 16598874_1 CDM 0301 RC 84105 HCPCS inpatient 146 94.9 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 88.4 60.55 999999999 88.4 141.62 percent of total billed charges Urine phosphate level 16598874_1 CDM 0301 RC 84105 HCPCS inpatient 146 94.9 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 88.4 141.62 Urine phosphate level 16598874_1 CDM 0301 RC 84105 HCPCS inpatient 146 94.9 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 88.4 141.62 Urine phosphate level 16598874_1 CDM 0301 RC 84105 HCPCS inpatient 146 94.9 ANTHEM HMO ANTHEM HMO 999999999 88.4 141.62 Urine phosphate level 16598874_1 CDM 0301 RC 84105 HCPCS inpatient 146 94.9 CIGNA - ALL PLANS CIGNA - ALL PLANS 98.7 67.6 999999999 88.4 141.62 percent of total billed charges Urine phosphate level 16598874_1 CDM 0301 RC 84105 HCPCS inpatient 146 94.9 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 88.4 141.62 Urine phosphate level 16598874_1 CDM 0301 RC 84105 HCPCS inpatient 146 94.9 UHC - ALL PLANS UHC - ALL PLANS 999999999 88.4 141.62 Uric acid level 16600878_1 CDM 0301 RC 84560 HCPCS inpatient 137 89.05 SELF PAY DISCOUNT SELF PAY DISCOUNT 89.05 65 999999999 82.95 132.89 percent of total billed charges Uric acid level 16600878_1 CDM 0301 RC 84560 HCPCS inpatient 137 89.05 AETNA AETNA 108.23 79 999999999 82.95 132.89 percent of total billed charges Uric acid level 16600878_1 CDM 0301 RC 84560 HCPCS inpatient 137 89.05 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 132.89 97 999999999 82.95 132.89 percent of total billed charges Uric acid level 16600878_1 CDM 0301 RC 84560 HCPCS inpatient 137 89.05 ENCORE - ALL PLANS ENCORE - ALL PLANS 94.53 69 999999999 82.95 132.89 percent of total billed charges Uric acid level 16600878_1 CDM 0301 RC 84560 HCPCS inpatient 137 89.05 HUMANA - ALL PLANS HUMANA - ALL PLANS 106.86 78 999999999 82.95 132.89 percent of total billed charges Uric acid level 16600878_1 CDM 0301 RC 84560 HCPCS inpatient 137 89.05 UMR - ALL PLANS UMR - ALL PLANS 95.9 70 999999999 82.95 132.89 percent of total billed charges Uric acid level 16600878_1 CDM 0301 RC 84560 HCPCS inpatient 137 89.05 SIHO - ALL PLANS SIHO - ALL PLANS 123.3 90 999999999 82.95 132.89 percent of total billed charges Uric acid level 16600878_1 CDM 0301 RC 84560 HCPCS inpatient 137 89.05 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 82.95 60.55 999999999 82.95 132.89 percent of total billed charges Uric acid level 16600878_1 CDM 0301 RC 84560 HCPCS inpatient 137 89.05 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 82.95 132.89 Uric acid level 16600878_1 CDM 0301 RC 84560 HCPCS inpatient 137 89.05 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 82.95 132.89 Uric acid level 16600878_1 CDM 0301 RC 84560 HCPCS inpatient 137 89.05 ANTHEM HMO ANTHEM HMO 999999999 82.95 132.89 Uric acid level 16600878_1 CDM 0301 RC 84560 HCPCS inpatient 137 89.05 CIGNA - ALL PLANS CIGNA - ALL PLANS 92.61 67.6 999999999 82.95 132.89 percent of total billed charges Uric acid level 16600878_1 CDM 0301 RC 84560 HCPCS inpatient 137 89.05 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 82.95 132.89 Uric acid level 16600878_1 CDM 0301 RC 84560 HCPCS inpatient 137 89.05 UHC - ALL PLANS UHC - ALL PLANS 999999999 82.95 132.89 "Blood unit compatibility test, immediate spin technique" 16802881_1 CDM 0300 RC 86920 HCPCS inpatient 432 280.8 SELF PAY DISCOUNT SELF PAY DISCOUNT 280.8 65 999999999 261.58 419.04 percent of total billed charges "Blood unit compatibility test, immediate spin technique" 16802881_1 CDM 0300 RC 86920 HCPCS inpatient 432 280.8 AETNA AETNA 341.28 79 999999999 261.58 419.04 percent of total billed charges "Blood unit compatibility test, immediate spin technique" 16802881_1 CDM 0300 RC 86920 HCPCS inpatient 432 280.8 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 419.04 97 999999999 261.58 419.04 percent of total billed charges "Blood unit compatibility test, immediate spin technique" 16802881_1 CDM 0300 RC 86920 HCPCS inpatient 432 280.8 ENCORE - ALL PLANS ENCORE - ALL PLANS 298.08 69 999999999 261.58 419.04 percent of total billed charges "Blood unit compatibility test, immediate spin technique" 16802881_1 CDM 0300 RC 86920 HCPCS inpatient 432 280.8 HUMANA - ALL PLANS HUMANA - ALL PLANS 336.96 78 999999999 261.58 419.04 percent of total billed charges "Blood unit compatibility test, immediate spin technique" 16802881_1 CDM 0300 RC 86920 HCPCS inpatient 432 280.8 UMR - ALL PLANS UMR - ALL PLANS 302.4 70 999999999 261.58 419.04 percent of total billed charges "Blood unit compatibility test, immediate spin technique" 16802881_1 CDM 0300 RC 86920 HCPCS inpatient 432 280.8 SIHO - ALL PLANS SIHO - ALL PLANS 388.8 90 999999999 261.58 419.04 percent of total billed charges "Blood unit compatibility test, immediate spin technique" 16802881_1 CDM 0300 RC 86920 HCPCS inpatient 432 280.8 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 261.58 60.55 999999999 261.58 419.04 percent of total billed charges "Blood unit compatibility test, immediate spin technique" 16802881_1 CDM 0300 RC 86920 HCPCS inpatient 432 280.8 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 261.58 419.04 "Blood unit compatibility test, immediate spin technique" 16802881_1 CDM 0300 RC 86920 HCPCS inpatient 432 280.8 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 261.58 419.04 "Blood unit compatibility test, immediate spin technique" 16802881_1 CDM 0300 RC 86920 HCPCS inpatient 432 280.8 ANTHEM HMO ANTHEM HMO 999999999 261.58 419.04 "Blood unit compatibility test, immediate spin technique" 16802881_1 CDM 0300 RC 86920 HCPCS inpatient 432 280.8 CIGNA - ALL PLANS CIGNA - ALL PLANS 292.03 67.6 999999999 261.58 419.04 percent of total billed charges "Blood unit compatibility test, immediate spin technique" 16802881_1 CDM 0300 RC 86920 HCPCS inpatient 432 280.8 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 261.58 419.04 "Blood unit compatibility test, immediate spin technique" 16802881_1 CDM 0300 RC 86920 HCPCS inpatient 432 280.8 UHC - ALL PLANS UHC - ALL PLANS 999999999 261.58 419.04 Imaging of urinary tract using infusion technique with kidney section filming 1712827_1 CDM 0320 RC 74415 HCPCS inpatient 1248 811.2 SELF PAY DISCOUNT SELF PAY DISCOUNT 811.2 65 999999999 755.66 1210.56 percent of total billed charges Imaging of urinary tract using infusion technique with kidney section filming 1712827_1 CDM 0320 RC 74415 HCPCS inpatient 1248 811.2 AETNA AETNA 985.92 79 999999999 755.66 1210.56 percent of total billed charges Imaging of urinary tract using infusion technique with kidney section filming 1712827_1 CDM 0320 RC 74415 HCPCS inpatient 1248 811.2 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 1210.56 97 999999999 755.66 1210.56 percent of total billed charges Imaging of urinary tract using infusion technique with kidney section filming 1712827_1 CDM 0320 RC 74415 HCPCS inpatient 1248 811.2 ENCORE - ALL PLANS ENCORE - ALL PLANS 861.12 69 999999999 755.66 1210.56 percent of total billed charges Imaging of urinary tract using infusion technique with kidney section filming 1712827_1 CDM 0320 RC 74415 HCPCS inpatient 1248 811.2 HUMANA - ALL PLANS HUMANA - ALL PLANS 973.44 78 999999999 755.66 1210.56 percent of total billed charges Imaging of urinary tract using infusion technique with kidney section filming 1712827_1 CDM 0320 RC 74415 HCPCS inpatient 1248 811.2 UMR - ALL PLANS UMR - ALL PLANS 873.6 70 999999999 755.66 1210.56 percent of total billed charges Imaging of urinary tract using infusion technique with kidney section filming 1712827_1 CDM 0320 RC 74415 HCPCS inpatient 1248 811.2 SIHO - ALL PLANS SIHO - ALL PLANS 1123.2 90 999999999 755.66 1210.56 percent of total billed charges Imaging of urinary tract using infusion technique with kidney section filming 1712827_1 CDM 0320 RC 74415 HCPCS inpatient 1248 811.2 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 755.66 60.55 999999999 755.66 1210.56 percent of total billed charges Imaging of urinary tract using infusion technique with kidney section filming 1712827_1 CDM 0320 RC 74415 HCPCS inpatient 1248 811.2 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 755.66 1210.56 Imaging of urinary tract using infusion technique with kidney section filming 1712827_1 CDM 0320 RC 74415 HCPCS inpatient 1248 811.2 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 755.66 1210.56 Imaging of urinary tract using infusion technique with kidney section filming 1712827_1 CDM 0320 RC 74415 HCPCS inpatient 1248 811.2 ANTHEM HMO ANTHEM HMO 999999999 755.66 1210.56 Imaging of urinary tract using infusion technique with kidney section filming 1712827_1 CDM 0320 RC 74415 HCPCS inpatient 1248 811.2 CIGNA - ALL PLANS CIGNA - ALL PLANS 843.65 67.6 999999999 755.66 1210.56 percent of total billed charges Imaging of urinary tract using infusion technique with kidney section filming 1712827_1 CDM 0320 RC 74415 HCPCS inpatient 1248 811.2 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 755.66 1210.56 Imaging of urinary tract using infusion technique with kidney section filming 1712827_1 CDM 0320 RC 74415 HCPCS inpatient 1248 811.2 UHC - ALL PLANS UHC - ALL PLANS 999999999 755.66 1210.56 CT scan of chest before and after contrast 1712896_1 CDM 0350 RC 71270 HCPCS inpatient 4113 2673.45 SELF PAY DISCOUNT SELF PAY DISCOUNT 2673.45 65 999999999 2490.42 3989.61 percent of total billed charges CT scan of chest before and after contrast 1712896_1 CDM 0350 RC 71270 HCPCS inpatient 4113 2673.45 AETNA AETNA 3249.27 79 999999999 2490.42 3989.61 percent of total billed charges CT scan of chest before and after contrast 1712896_1 CDM 0350 RC 71270 HCPCS inpatient 4113 2673.45 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 3989.61 97 999999999 2490.42 3989.61 percent of total billed charges CT scan of chest before and after contrast 1712896_1 CDM 0350 RC 71270 HCPCS inpatient 4113 2673.45 ENCORE - ALL PLANS ENCORE - ALL PLANS 2837.97 69 999999999 2490.42 3989.61 percent of total billed charges CT scan of chest before and after contrast 1712896_1 CDM 0350 RC 71270 HCPCS inpatient 4113 2673.45 HUMANA - ALL PLANS HUMANA - ALL PLANS 3208.14 78 999999999 2490.42 3989.61 percent of total billed charges CT scan of chest before and after contrast 1712896_1 CDM 0350 RC 71270 HCPCS inpatient 4113 2673.45 UMR - ALL PLANS UMR - ALL PLANS 2879.1 70 999999999 2490.42 3989.61 percent of total billed charges CT scan of chest before and after contrast 1712896_1 CDM 0350 RC 71270 HCPCS inpatient 4113 2673.45 SIHO - ALL PLANS SIHO - ALL PLANS 3701.7 90 999999999 2490.42 3989.61 percent of total billed charges CT scan of chest before and after contrast 1712896_1 CDM 0350 RC 71270 HCPCS inpatient 4113 2673.45 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 2490.42 60.55 999999999 2490.42 3989.61 percent of total billed charges CT scan of chest before and after contrast 1712896_1 CDM 0350 RC 71270 HCPCS inpatient 4113 2673.45 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 2490.42 3989.61 CT scan of chest before and after contrast 1712896_1 CDM 0350 RC 71270 HCPCS inpatient 4113 2673.45 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 2490.42 3989.61 CT scan of chest before and after contrast 1712896_1 CDM 0350 RC 71270 HCPCS inpatient 4113 2673.45 ANTHEM HMO ANTHEM HMO 999999999 2490.42 3989.61 CT scan of chest before and after contrast 1712896_1 CDM 0350 RC 71270 HCPCS inpatient 4113 2673.45 CIGNA - ALL PLANS CIGNA - ALL PLANS 2780.39 67.6 999999999 2490.42 3989.61 percent of total billed charges CT scan of chest before and after contrast 1712896_1 CDM 0350 RC 71270 HCPCS inpatient 4113 2673.45 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 2490.42 3989.61 CT scan of chest before and after contrast 1712896_1 CDM 0350 RC 71270 HCPCS inpatient 4113 2673.45 UHC - ALL PLANS UHC - ALL PLANS 999999999 2490.42 3989.61 Ultrasonic guidance for needle placement 1712920_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 SELF PAY DISCOUNT SELF PAY DISCOUNT 570.05 65 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 1712920_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 AETNA AETNA 692.83 79 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 1712920_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 850.69 97 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 1712920_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 ENCORE - ALL PLANS ENCORE - ALL PLANS 605.13 69 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 1712920_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 HUMANA - ALL PLANS HUMANA - ALL PLANS 684.06 78 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 1712920_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 UMR - ALL PLANS UMR - ALL PLANS 613.9 70 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 1712920_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 SIHO - ALL PLANS SIHO - ALL PLANS 789.3 90 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 1712920_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 531.02 60.55 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 1712920_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 531.02 850.69 Ultrasonic guidance for needle placement 1712920_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 531.02 850.69 Ultrasonic guidance for needle placement 1712920_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 ANTHEM HMO ANTHEM HMO 999999999 531.02 850.69 Ultrasonic guidance for needle placement 1712920_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 CIGNA - ALL PLANS CIGNA - ALL PLANS 592.85 67.6 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 1712920_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 531.02 850.69 Ultrasonic guidance for needle placement 1712920_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 UHC - ALL PLANS UHC - ALL PLANS 999999999 531.02 850.69 Ultrasonic guidance for needle placement 1712926_1 CDM 0402 RC 76942 HCPCS inpatient 965 627.25 SELF PAY DISCOUNT SELF PAY DISCOUNT 627.25 65 999999999 584.31 936.05 percent of total billed charges Ultrasonic guidance for needle placement 1712926_1 CDM 0402 RC 76942 HCPCS inpatient 965 627.25 AETNA AETNA 762.35 79 999999999 584.31 936.05 percent of total billed charges Ultrasonic guidance for needle placement 1712926_1 CDM 0402 RC 76942 HCPCS inpatient 965 627.25 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 936.05 97 999999999 584.31 936.05 percent of total billed charges Ultrasonic guidance for needle placement 1712926_1 CDM 0402 RC 76942 HCPCS inpatient 965 627.25 ENCORE - ALL PLANS ENCORE - ALL PLANS 665.85 69 999999999 584.31 936.05 percent of total billed charges Ultrasonic guidance for needle placement 1712926_1 CDM 0402 RC 76942 HCPCS inpatient 965 627.25 HUMANA - ALL PLANS HUMANA - ALL PLANS 752.7 78 999999999 584.31 936.05 percent of total billed charges Ultrasonic guidance for needle placement 1712926_1 CDM 0402 RC 76942 HCPCS inpatient 965 627.25 UMR - ALL PLANS UMR - ALL PLANS 675.5 70 999999999 584.31 936.05 percent of total billed charges Ultrasonic guidance for needle placement 1712926_1 CDM 0402 RC 76942 HCPCS inpatient 965 627.25 SIHO - ALL PLANS SIHO - ALL PLANS 868.5 90 999999999 584.31 936.05 percent of total billed charges Ultrasonic guidance for needle placement 1712926_1 CDM 0402 RC 76942 HCPCS inpatient 965 627.25 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 584.31 60.55 999999999 584.31 936.05 percent of total billed charges Ultrasonic guidance for needle placement 1712926_1 CDM 0402 RC 76942 HCPCS inpatient 965 627.25 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 584.31 936.05 Ultrasonic guidance for needle placement 1712926_1 CDM 0402 RC 76942 HCPCS inpatient 965 627.25 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 584.31 936.05 Ultrasonic guidance for needle placement 1712926_1 CDM 0402 RC 76942 HCPCS inpatient 965 627.25 ANTHEM HMO ANTHEM HMO 999999999 584.31 936.05 Ultrasonic guidance for needle placement 1712926_1 CDM 0402 RC 76942 HCPCS inpatient 965 627.25 CIGNA - ALL PLANS CIGNA - ALL PLANS 652.34 67.6 999999999 584.31 936.05 percent of total billed charges Ultrasonic guidance for needle placement 1712926_1 CDM 0402 RC 76942 HCPCS inpatient 965 627.25 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 584.31 936.05 Ultrasonic guidance for needle placement 1712926_1 CDM 0402 RC 76942 HCPCS inpatient 965 627.25 UHC - ALL PLANS UHC - ALL PLANS 999999999 584.31 936.05 "X-ray of finger, minimum of 2 views" 1712953_1 CDM 0320 RC 73140 HCPCS inpatient 378 245.7 SELF PAY DISCOUNT SELF PAY DISCOUNT 245.7 65 999999999 228.88 366.66 percent of total billed charges "X-ray of finger, minimum of 2 views" 1712953_1 CDM 0320 RC 73140 HCPCS inpatient 378 245.7 AETNA AETNA 298.62 79 999999999 228.88 366.66 percent of total billed charges "X-ray of finger, minimum of 2 views" 1712953_1 CDM 0320 RC 73140 HCPCS inpatient 378 245.7 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 366.66 97 999999999 228.88 366.66 percent of total billed charges "X-ray of finger, minimum of 2 views" 1712953_1 CDM 0320 RC 73140 HCPCS inpatient 378 245.7 ENCORE - ALL PLANS ENCORE - ALL PLANS 260.82 69 999999999 228.88 366.66 percent of total billed charges "X-ray of finger, minimum of 2 views" 1712953_1 CDM 0320 RC 73140 HCPCS inpatient 378 245.7 HUMANA - ALL PLANS HUMANA - ALL PLANS 294.84 78 999999999 228.88 366.66 percent of total billed charges "X-ray of finger, minimum of 2 views" 1712953_1 CDM 0320 RC 73140 HCPCS inpatient 378 245.7 UMR - ALL PLANS UMR - ALL PLANS 264.6 70 999999999 228.88 366.66 percent of total billed charges "X-ray of finger, minimum of 2 views" 1712953_1 CDM 0320 RC 73140 HCPCS inpatient 378 245.7 SIHO - ALL PLANS SIHO - ALL PLANS 340.2 90 999999999 228.88 366.66 percent of total billed charges "X-ray of finger, minimum of 2 views" 1712953_1 CDM 0320 RC 73140 HCPCS inpatient 378 245.7 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 228.88 60.55 999999999 228.88 366.66 percent of total billed charges "X-ray of finger, minimum of 2 views" 1712953_1 CDM 0320 RC 73140 HCPCS inpatient 378 245.7 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 228.88 366.66 "X-ray of finger, minimum of 2 views" 1712953_1 CDM 0320 RC 73140 HCPCS inpatient 378 245.7 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 228.88 366.66 "X-ray of finger, minimum of 2 views" 1712953_1 CDM 0320 RC 73140 HCPCS inpatient 378 245.7 ANTHEM HMO ANTHEM HMO 999999999 228.88 366.66 "X-ray of finger, minimum of 2 views" 1712953_1 CDM 0320 RC 73140 HCPCS inpatient 378 245.7 CIGNA - ALL PLANS CIGNA - ALL PLANS 255.53 67.6 999999999 228.88 366.66 percent of total billed charges "X-ray of finger, minimum of 2 views" 1712953_1 CDM 0320 RC 73140 HCPCS inpatient 378 245.7 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 228.88 366.66 "X-ray of finger, minimum of 2 views" 1712953_1 CDM 0320 RC 73140 HCPCS inpatient 378 245.7 UHC - ALL PLANS UHC - ALL PLANS 999999999 228.88 366.66 "X-ray of finger, minimum of 2 views" 1712956_1 CDM 0320 RC 73140 HCPCS inpatient 378 245.7 SELF PAY DISCOUNT SELF PAY DISCOUNT 245.7 65 999999999 228.88 366.66 percent of total billed charges "X-ray of finger, minimum of 2 views" 1712956_1 CDM 0320 RC 73140 HCPCS inpatient 378 245.7 AETNA AETNA 298.62 79 999999999 228.88 366.66 percent of total billed charges "X-ray of finger, minimum of 2 views" 1712956_1 CDM 0320 RC 73140 HCPCS inpatient 378 245.7 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 366.66 97 999999999 228.88 366.66 percent of total billed charges "X-ray of finger, minimum of 2 views" 1712956_1 CDM 0320 RC 73140 HCPCS inpatient 378 245.7 ENCORE - ALL PLANS ENCORE - ALL PLANS 260.82 69 999999999 228.88 366.66 percent of total billed charges "X-ray of finger, minimum of 2 views" 1712956_1 CDM 0320 RC 73140 HCPCS inpatient 378 245.7 HUMANA - ALL PLANS HUMANA - ALL PLANS 294.84 78 999999999 228.88 366.66 percent of total billed charges "X-ray of finger, minimum of 2 views" 1712956_1 CDM 0320 RC 73140 HCPCS inpatient 378 245.7 UMR - ALL PLANS UMR - ALL PLANS 264.6 70 999999999 228.88 366.66 percent of total billed charges "X-ray of finger, minimum of 2 views" 1712956_1 CDM 0320 RC 73140 HCPCS inpatient 378 245.7 SIHO - ALL PLANS SIHO - ALL PLANS 340.2 90 999999999 228.88 366.66 percent of total billed charges "X-ray of finger, minimum of 2 views" 1712956_1 CDM 0320 RC 73140 HCPCS inpatient 378 245.7 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 228.88 60.55 999999999 228.88 366.66 percent of total billed charges "X-ray of finger, minimum of 2 views" 1712956_1 CDM 0320 RC 73140 HCPCS inpatient 378 245.7 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 228.88 366.66 "X-ray of finger, minimum of 2 views" 1712956_1 CDM 0320 RC 73140 HCPCS inpatient 378 245.7 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 228.88 366.66 "X-ray of finger, minimum of 2 views" 1712956_1 CDM 0320 RC 73140 HCPCS inpatient 378 245.7 ANTHEM HMO ANTHEM HMO 999999999 228.88 366.66 "X-ray of finger, minimum of 2 views" 1712956_1 CDM 0320 RC 73140 HCPCS inpatient 378 245.7 CIGNA - ALL PLANS CIGNA - ALL PLANS 255.53 67.6 999999999 228.88 366.66 percent of total billed charges "X-ray of finger, minimum of 2 views" 1712956_1 CDM 0320 RC 73140 HCPCS inpatient 378 245.7 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 228.88 366.66 "X-ray of finger, minimum of 2 views" 1712956_1 CDM 0320 RC 73140 HCPCS inpatient 378 245.7 UHC - ALL PLANS UHC - ALL PLANS 999999999 228.88 366.66 "X-ray of upper spine, 4-5 views" 1713008_1 CDM 0320 RC 72050 HCPCS inpatient 573 372.45 SELF PAY DISCOUNT SELF PAY DISCOUNT 372.45 65 999999999 346.95 555.81 percent of total billed charges "X-ray of upper spine, 4-5 views" 1713008_1 CDM 0320 RC 72050 HCPCS inpatient 573 372.45 AETNA AETNA 452.67 79 999999999 346.95 555.81 percent of total billed charges "X-ray of upper spine, 4-5 views" 1713008_1 CDM 0320 RC 72050 HCPCS inpatient 573 372.45 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 555.81 97 999999999 346.95 555.81 percent of total billed charges "X-ray of upper spine, 4-5 views" 1713008_1 CDM 0320 RC 72050 HCPCS inpatient 573 372.45 ENCORE - ALL PLANS ENCORE - ALL PLANS 395.37 69 999999999 346.95 555.81 percent of total billed charges "X-ray of upper spine, 4-5 views" 1713008_1 CDM 0320 RC 72050 HCPCS inpatient 573 372.45 HUMANA - ALL PLANS HUMANA - ALL PLANS 446.94 78 999999999 346.95 555.81 percent of total billed charges "X-ray of upper spine, 4-5 views" 1713008_1 CDM 0320 RC 72050 HCPCS inpatient 573 372.45 UMR - ALL PLANS UMR - ALL PLANS 401.1 70 999999999 346.95 555.81 percent of total billed charges "X-ray of upper spine, 4-5 views" 1713008_1 CDM 0320 RC 72050 HCPCS inpatient 573 372.45 SIHO - ALL PLANS SIHO - ALL PLANS 515.7 90 999999999 346.95 555.81 percent of total billed charges "X-ray of upper spine, 4-5 views" 1713008_1 CDM 0320 RC 72050 HCPCS inpatient 573 372.45 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 346.95 60.55 999999999 346.95 555.81 percent of total billed charges "X-ray of upper spine, 4-5 views" 1713008_1 CDM 0320 RC 72050 HCPCS inpatient 573 372.45 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 346.95 555.81 "X-ray of upper spine, 4-5 views" 1713008_1 CDM 0320 RC 72050 HCPCS inpatient 573 372.45 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 346.95 555.81 "X-ray of upper spine, 4-5 views" 1713008_1 CDM 0320 RC 72050 HCPCS inpatient 573 372.45 ANTHEM HMO ANTHEM HMO 999999999 346.95 555.81 "X-ray of upper spine, 4-5 views" 1713008_1 CDM 0320 RC 72050 HCPCS inpatient 573 372.45 CIGNA - ALL PLANS CIGNA - ALL PLANS 387.35 67.6 999999999 346.95 555.81 percent of total billed charges "X-ray of upper spine, 4-5 views" 1713008_1 CDM 0320 RC 72050 HCPCS inpatient 573 372.45 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 346.95 555.81 "X-ray of upper spine, 4-5 views" 1713008_1 CDM 0320 RC 72050 HCPCS inpatient 573 372.45 UHC - ALL PLANS UHC - ALL PLANS 999999999 346.95 555.81 "X-ray of middle spine, 3 views" 1713017_1 CDM 0320 RC 72072 HCPCS inpatient 583 378.95 SELF PAY DISCOUNT SELF PAY DISCOUNT 378.95 65 999999999 353.01 565.51 percent of total billed charges "X-ray of middle spine, 3 views" 1713017_1 CDM 0320 RC 72072 HCPCS inpatient 583 378.95 AETNA AETNA 460.57 79 999999999 353.01 565.51 percent of total billed charges "X-ray of middle spine, 3 views" 1713017_1 CDM 0320 RC 72072 HCPCS inpatient 583 378.95 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 565.51 97 999999999 353.01 565.51 percent of total billed charges "X-ray of middle spine, 3 views" 1713017_1 CDM 0320 RC 72072 HCPCS inpatient 583 378.95 ENCORE - ALL PLANS ENCORE - ALL PLANS 402.27 69 999999999 353.01 565.51 percent of total billed charges "X-ray of middle spine, 3 views" 1713017_1 CDM 0320 RC 72072 HCPCS inpatient 583 378.95 HUMANA - ALL PLANS HUMANA - ALL PLANS 454.74 78 999999999 353.01 565.51 percent of total billed charges "X-ray of middle spine, 3 views" 1713017_1 CDM 0320 RC 72072 HCPCS inpatient 583 378.95 UMR - ALL PLANS UMR - ALL PLANS 408.1 70 999999999 353.01 565.51 percent of total billed charges "X-ray of middle spine, 3 views" 1713017_1 CDM 0320 RC 72072 HCPCS inpatient 583 378.95 SIHO - ALL PLANS SIHO - ALL PLANS 524.7 90 999999999 353.01 565.51 percent of total billed charges "X-ray of middle spine, 3 views" 1713017_1 CDM 0320 RC 72072 HCPCS inpatient 583 378.95 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 353.01 60.55 999999999 353.01 565.51 percent of total billed charges "X-ray of middle spine, 3 views" 1713017_1 CDM 0320 RC 72072 HCPCS inpatient 583 378.95 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 353.01 565.51 "X-ray of middle spine, 3 views" 1713017_1 CDM 0320 RC 72072 HCPCS inpatient 583 378.95 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 353.01 565.51 "X-ray of middle spine, 3 views" 1713017_1 CDM 0320 RC 72072 HCPCS inpatient 583 378.95 ANTHEM HMO ANTHEM HMO 999999999 353.01 565.51 "X-ray of middle spine, 3 views" 1713017_1 CDM 0320 RC 72072 HCPCS inpatient 583 378.95 CIGNA - ALL PLANS CIGNA - ALL PLANS 394.11 67.6 999999999 353.01 565.51 percent of total billed charges "X-ray of middle spine, 3 views" 1713017_1 CDM 0320 RC 72072 HCPCS inpatient 583 378.95 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 353.01 565.51 "X-ray of middle spine, 3 views" 1713017_1 CDM 0320 RC 72072 HCPCS inpatient 583 378.95 UHC - ALL PLANS UHC - ALL PLANS 999999999 353.01 565.51 "X-ray of toe, minimum of 2 views" 1713020_1 CDM 0320 RC 73660 HCPCS inpatient 340 221 SELF PAY DISCOUNT SELF PAY DISCOUNT 221 65 999999999 205.87 329.8 percent of total billed charges "X-ray of toe, minimum of 2 views" 1713020_1 CDM 0320 RC 73660 HCPCS inpatient 340 221 AETNA AETNA 268.6 79 999999999 205.87 329.8 percent of total billed charges "X-ray of toe, minimum of 2 views" 1713020_1 CDM 0320 RC 73660 HCPCS inpatient 340 221 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 329.8 97 999999999 205.87 329.8 percent of total billed charges "X-ray of toe, minimum of 2 views" 1713020_1 CDM 0320 RC 73660 HCPCS inpatient 340 221 ENCORE - ALL PLANS ENCORE - ALL PLANS 234.6 69 999999999 205.87 329.8 percent of total billed charges "X-ray of toe, minimum of 2 views" 1713020_1 CDM 0320 RC 73660 HCPCS inpatient 340 221 HUMANA - ALL PLANS HUMANA - ALL PLANS 265.2 78 999999999 205.87 329.8 percent of total billed charges "X-ray of toe, minimum of 2 views" 1713020_1 CDM 0320 RC 73660 HCPCS inpatient 340 221 UMR - ALL PLANS UMR - ALL PLANS 238 70 999999999 205.87 329.8 percent of total billed charges "X-ray of toe, minimum of 2 views" 1713020_1 CDM 0320 RC 73660 HCPCS inpatient 340 221 SIHO - ALL PLANS SIHO - ALL PLANS 306 90 999999999 205.87 329.8 percent of total billed charges "X-ray of toe, minimum of 2 views" 1713020_1 CDM 0320 RC 73660 HCPCS inpatient 340 221 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 205.87 60.55 999999999 205.87 329.8 percent of total billed charges "X-ray of toe, minimum of 2 views" 1713020_1 CDM 0320 RC 73660 HCPCS inpatient 340 221 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 205.87 329.8 "X-ray of toe, minimum of 2 views" 1713020_1 CDM 0320 RC 73660 HCPCS inpatient 340 221 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 205.87 329.8 "X-ray of toe, minimum of 2 views" 1713020_1 CDM 0320 RC 73660 HCPCS inpatient 340 221 ANTHEM HMO ANTHEM HMO 999999999 205.87 329.8 "X-ray of toe, minimum of 2 views" 1713020_1 CDM 0320 RC 73660 HCPCS inpatient 340 221 CIGNA - ALL PLANS CIGNA - ALL PLANS 229.84 67.6 999999999 205.87 329.8 percent of total billed charges "X-ray of toe, minimum of 2 views" 1713020_1 CDM 0320 RC 73660 HCPCS inpatient 340 221 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 205.87 329.8 "X-ray of toe, minimum of 2 views" 1713020_1 CDM 0320 RC 73660 HCPCS inpatient 340 221 UHC - ALL PLANS UHC - ALL PLANS 999999999 205.87 329.8 "X-ray of toe, minimum of 2 views" 1713023_1 CDM 0320 RC 73660 HCPCS inpatient 340 221 SELF PAY DISCOUNT SELF PAY DISCOUNT 221 65 999999999 205.87 329.8 percent of total billed charges "X-ray of toe, minimum of 2 views" 1713023_1 CDM 0320 RC 73660 HCPCS inpatient 340 221 AETNA AETNA 268.6 79 999999999 205.87 329.8 percent of total billed charges "X-ray of toe, minimum of 2 views" 1713023_1 CDM 0320 RC 73660 HCPCS inpatient 340 221 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 329.8 97 999999999 205.87 329.8 percent of total billed charges "X-ray of toe, minimum of 2 views" 1713023_1 CDM 0320 RC 73660 HCPCS inpatient 340 221 ENCORE - ALL PLANS ENCORE - ALL PLANS 234.6 69 999999999 205.87 329.8 percent of total billed charges "X-ray of toe, minimum of 2 views" 1713023_1 CDM 0320 RC 73660 HCPCS inpatient 340 221 HUMANA - ALL PLANS HUMANA - ALL PLANS 265.2 78 999999999 205.87 329.8 percent of total billed charges "X-ray of toe, minimum of 2 views" 1713023_1 CDM 0320 RC 73660 HCPCS inpatient 340 221 UMR - ALL PLANS UMR - ALL PLANS 238 70 999999999 205.87 329.8 percent of total billed charges "X-ray of toe, minimum of 2 views" 1713023_1 CDM 0320 RC 73660 HCPCS inpatient 340 221 SIHO - ALL PLANS SIHO - ALL PLANS 306 90 999999999 205.87 329.8 percent of total billed charges "X-ray of toe, minimum of 2 views" 1713023_1 CDM 0320 RC 73660 HCPCS inpatient 340 221 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 205.87 60.55 999999999 205.87 329.8 percent of total billed charges "X-ray of toe, minimum of 2 views" 1713023_1 CDM 0320 RC 73660 HCPCS inpatient 340 221 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 205.87 329.8 "X-ray of toe, minimum of 2 views" 1713023_1 CDM 0320 RC 73660 HCPCS inpatient 340 221 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 205.87 329.8 "X-ray of toe, minimum of 2 views" 1713023_1 CDM 0320 RC 73660 HCPCS inpatient 340 221 ANTHEM HMO ANTHEM HMO 999999999 205.87 329.8 "X-ray of toe, minimum of 2 views" 1713023_1 CDM 0320 RC 73660 HCPCS inpatient 340 221 CIGNA - ALL PLANS CIGNA - ALL PLANS 229.84 67.6 999999999 205.87 329.8 percent of total billed charges "X-ray of toe, minimum of 2 views" 1713023_1 CDM 0320 RC 73660 HCPCS inpatient 340 221 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 205.87 329.8 "X-ray of toe, minimum of 2 views" 1713023_1 CDM 0320 RC 73660 HCPCS inpatient 340 221 UHC - ALL PLANS UHC - ALL PLANS 999999999 205.87 329.8 Insertion of tube into airway for aspiration of secretions 17680938_1 CDM 0410 RC 31720 HCPCS inpatient 258 167.7 SELF PAY DISCOUNT SELF PAY DISCOUNT 167.7 65 999999999 156.22 250.26 percent of total billed charges Insertion of tube into airway for aspiration of secretions 17680938_1 CDM 0410 RC 31720 HCPCS inpatient 258 167.7 AETNA AETNA 203.82 79 999999999 156.22 250.26 percent of total billed charges Insertion of tube into airway for aspiration of secretions 17680938_1 CDM 0410 RC 31720 HCPCS inpatient 258 167.7 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 250.26 97 999999999 156.22 250.26 percent of total billed charges Insertion of tube into airway for aspiration of secretions 17680938_1 CDM 0410 RC 31720 HCPCS inpatient 258 167.7 ENCORE - ALL PLANS ENCORE - ALL PLANS 178.02 69 999999999 156.22 250.26 percent of total billed charges Insertion of tube into airway for aspiration of secretions 17680938_1 CDM 0410 RC 31720 HCPCS inpatient 258 167.7 HUMANA - ALL PLANS HUMANA - ALL PLANS 201.24 78 999999999 156.22 250.26 percent of total billed charges Insertion of tube into airway for aspiration of secretions 17680938_1 CDM 0410 RC 31720 HCPCS inpatient 258 167.7 UMR - ALL PLANS UMR - ALL PLANS 180.6 70 999999999 156.22 250.26 percent of total billed charges Insertion of tube into airway for aspiration of secretions 17680938_1 CDM 0410 RC 31720 HCPCS inpatient 258 167.7 SIHO - ALL PLANS SIHO - ALL PLANS 232.2 90 999999999 156.22 250.26 percent of total billed charges Insertion of tube into airway for aspiration of secretions 17680938_1 CDM 0410 RC 31720 HCPCS inpatient 258 167.7 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 156.22 60.55 999999999 156.22 250.26 percent of total billed charges Insertion of tube into airway for aspiration of secretions 17680938_1 CDM 0410 RC 31720 HCPCS inpatient 258 167.7 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 156.22 250.26 Insertion of tube into airway for aspiration of secretions 17680938_1 CDM 0410 RC 31720 HCPCS inpatient 258 167.7 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 156.22 250.26 Insertion of tube into airway for aspiration of secretions 17680938_1 CDM 0410 RC 31720 HCPCS inpatient 258 167.7 ANTHEM HMO ANTHEM HMO 999999999 156.22 250.26 Insertion of tube into airway for aspiration of secretions 17680938_1 CDM 0410 RC 31720 HCPCS inpatient 258 167.7 CIGNA - ALL PLANS CIGNA - ALL PLANS 174.41 67.6 999999999 156.22 250.26 percent of total billed charges Insertion of tube into airway for aspiration of secretions 17680938_1 CDM 0410 RC 31720 HCPCS inpatient 258 167.7 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 156.22 250.26 Insertion of tube into airway for aspiration of secretions 17680938_1 CDM 0410 RC 31720 HCPCS inpatient 258 167.7 UHC - ALL PLANS UHC - ALL PLANS 999999999 156.22 250.26 Fluoroscopic guidance for spine or back muscle injection 18692284_1 CDM 0320 RC 77003 HCPCS inpatient 1167 758.55 SELF PAY DISCOUNT SELF PAY DISCOUNT 758.55 65 999999999 706.62 1131.99 percent of total billed charges Fluoroscopic guidance for spine or back muscle injection 18692284_1 CDM 0320 RC 77003 HCPCS inpatient 1167 758.55 AETNA AETNA 921.93 79 999999999 706.62 1131.99 percent of total billed charges Fluoroscopic guidance for spine or back muscle injection 18692284_1 CDM 0320 RC 77003 HCPCS inpatient 1167 758.55 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 1131.99 97 999999999 706.62 1131.99 percent of total billed charges Fluoroscopic guidance for spine or back muscle injection 18692284_1 CDM 0320 RC 77003 HCPCS inpatient 1167 758.55 ENCORE - ALL PLANS ENCORE - ALL PLANS 805.23 69 999999999 706.62 1131.99 percent of total billed charges Fluoroscopic guidance for spine or back muscle injection 18692284_1 CDM 0320 RC 77003 HCPCS inpatient 1167 758.55 HUMANA - ALL PLANS HUMANA - ALL PLANS 910.26 78 999999999 706.62 1131.99 percent of total billed charges Fluoroscopic guidance for spine or back muscle injection 18692284_1 CDM 0320 RC 77003 HCPCS inpatient 1167 758.55 UMR - ALL PLANS UMR - ALL PLANS 816.9 70 999999999 706.62 1131.99 percent of total billed charges Fluoroscopic guidance for spine or back muscle injection 18692284_1 CDM 0320 RC 77003 HCPCS inpatient 1167 758.55 SIHO - ALL PLANS SIHO - ALL PLANS 1050.3 90 999999999 706.62 1131.99 percent of total billed charges Fluoroscopic guidance for spine or back muscle injection 18692284_1 CDM 0320 RC 77003 HCPCS inpatient 1167 758.55 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 706.62 60.55 999999999 706.62 1131.99 percent of total billed charges Fluoroscopic guidance for spine or back muscle injection 18692284_1 CDM 0320 RC 77003 HCPCS inpatient 1167 758.55 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 706.62 1131.99 Fluoroscopic guidance for spine or back muscle injection 18692284_1 CDM 0320 RC 77003 HCPCS inpatient 1167 758.55 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 706.62 1131.99 Fluoroscopic guidance for spine or back muscle injection 18692284_1 CDM 0320 RC 77003 HCPCS inpatient 1167 758.55 ANTHEM HMO ANTHEM HMO 999999999 706.62 1131.99 Fluoroscopic guidance for spine or back muscle injection 18692284_1 CDM 0320 RC 77003 HCPCS inpatient 1167 758.55 CIGNA - ALL PLANS CIGNA - ALL PLANS 788.89 67.6 999999999 706.62 1131.99 percent of total billed charges Fluoroscopic guidance for spine or back muscle injection 18692284_1 CDM 0320 RC 77003 HCPCS inpatient 1167 758.55 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 706.62 1131.99 Fluoroscopic guidance for spine or back muscle injection 18692284_1 CDM 0320 RC 77003 HCPCS inpatient 1167 758.55 UHC - ALL PLANS UHC - ALL PLANS 999999999 706.62 1131.99 HDL cholesterol level 1881473_1 CDM 0301 RC 83718 HCPCS inpatient 176 114.4 SELF PAY DISCOUNT SELF PAY DISCOUNT 114.4 65 999999999 106.57 170.72 percent of total billed charges HDL cholesterol level 1881473_1 CDM 0301 RC 83718 HCPCS inpatient 176 114.4 AETNA AETNA 139.04 79 999999999 106.57 170.72 percent of total billed charges HDL cholesterol level 1881473_1 CDM 0301 RC 83718 HCPCS inpatient 176 114.4 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 170.72 97 999999999 106.57 170.72 percent of total billed charges HDL cholesterol level 1881473_1 CDM 0301 RC 83718 HCPCS inpatient 176 114.4 ENCORE - ALL PLANS ENCORE - ALL PLANS 121.44 69 999999999 106.57 170.72 percent of total billed charges HDL cholesterol level 1881473_1 CDM 0301 RC 83718 HCPCS inpatient 176 114.4 HUMANA - ALL PLANS HUMANA - ALL PLANS 137.28 78 999999999 106.57 170.72 percent of total billed charges HDL cholesterol level 1881473_1 CDM 0301 RC 83718 HCPCS inpatient 176 114.4 UMR - ALL PLANS UMR - ALL PLANS 123.2 70 999999999 106.57 170.72 percent of total billed charges HDL cholesterol level 1881473_1 CDM 0301 RC 83718 HCPCS inpatient 176 114.4 SIHO - ALL PLANS SIHO - ALL PLANS 158.4 90 999999999 106.57 170.72 percent of total billed charges HDL cholesterol level 1881473_1 CDM 0301 RC 83718 HCPCS inpatient 176 114.4 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 106.57 60.55 999999999 106.57 170.72 percent of total billed charges HDL cholesterol level 1881473_1 CDM 0301 RC 83718 HCPCS inpatient 176 114.4 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 106.57 170.72 HDL cholesterol level 1881473_1 CDM 0301 RC 83718 HCPCS inpatient 176 114.4 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 106.57 170.72 HDL cholesterol level 1881473_1 CDM 0301 RC 83718 HCPCS inpatient 176 114.4 ANTHEM HMO ANTHEM HMO 999999999 106.57 170.72 HDL cholesterol level 1881473_1 CDM 0301 RC 83718 HCPCS inpatient 176 114.4 CIGNA - ALL PLANS CIGNA - ALL PLANS 118.98 67.6 999999999 106.57 170.72 percent of total billed charges HDL cholesterol level 1881473_1 CDM 0301 RC 83718 HCPCS inpatient 176 114.4 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 106.57 170.72 HDL cholesterol level 1881473_1 CDM 0301 RC 83718 HCPCS inpatient 176 114.4 UHC - ALL PLANS UHC - ALL PLANS 999999999 106.57 170.72 "Red blood cell count, automated test" 1881511_1 CDM 0305 RC 85041 HCPCS inpatient 87 56.55 SELF PAY DISCOUNT SELF PAY DISCOUNT 56.55 65 999999999 52.68 84.39 percent of total billed charges "Red blood cell count, automated test" 1881511_1 CDM 0305 RC 85041 HCPCS inpatient 87 56.55 AETNA AETNA 68.73 79 999999999 52.68 84.39 percent of total billed charges "Red blood cell count, automated test" 1881511_1 CDM 0305 RC 85041 HCPCS inpatient 87 56.55 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 84.39 97 999999999 52.68 84.39 percent of total billed charges "Red blood cell count, automated test" 1881511_1 CDM 0305 RC 85041 HCPCS inpatient 87 56.55 ENCORE - ALL PLANS ENCORE - ALL PLANS 60.03 69 999999999 52.68 84.39 percent of total billed charges "Red blood cell count, automated test" 1881511_1 CDM 0305 RC 85041 HCPCS inpatient 87 56.55 HUMANA - ALL PLANS HUMANA - ALL PLANS 67.86 78 999999999 52.68 84.39 percent of total billed charges "Red blood cell count, automated test" 1881511_1 CDM 0305 RC 85041 HCPCS inpatient 87 56.55 UMR - ALL PLANS UMR - ALL PLANS 60.9 70 999999999 52.68 84.39 percent of total billed charges "Red blood cell count, automated test" 1881511_1 CDM 0305 RC 85041 HCPCS inpatient 87 56.55 SIHO - ALL PLANS SIHO - ALL PLANS 78.3 90 999999999 52.68 84.39 percent of total billed charges "Red blood cell count, automated test" 1881511_1 CDM 0305 RC 85041 HCPCS inpatient 87 56.55 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 52.68 60.55 999999999 52.68 84.39 percent of total billed charges "Red blood cell count, automated test" 1881511_1 CDM 0305 RC 85041 HCPCS inpatient 87 56.55 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 52.68 84.39 "Red blood cell count, automated test" 1881511_1 CDM 0305 RC 85041 HCPCS inpatient 87 56.55 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 52.68 84.39 "Red blood cell count, automated test" 1881511_1 CDM 0305 RC 85041 HCPCS inpatient 87 56.55 ANTHEM HMO ANTHEM HMO 999999999 52.68 84.39 "Red blood cell count, automated test" 1881511_1 CDM 0305 RC 85041 HCPCS inpatient 87 56.55 CIGNA - ALL PLANS CIGNA - ALL PLANS 58.81 67.6 999999999 52.68 84.39 percent of total billed charges "Red blood cell count, automated test" 1881511_1 CDM 0305 RC 85041 HCPCS inpatient 87 56.55 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 52.68 84.39 "Red blood cell count, automated test" 1881511_1 CDM 0305 RC 85041 HCPCS inpatient 87 56.55 UHC - ALL PLANS UHC - ALL PLANS 999999999 52.68 84.39 CT scan of chest with contrast 1881678_1 CDM 0352 RC 71260 HCPCS inpatient 2772 1801.8 SELF PAY DISCOUNT SELF PAY DISCOUNT 1801.8 65 999999999 1678.45 2688.84 percent of total billed charges CT scan of chest with contrast 1881678_1 CDM 0352 RC 71260 HCPCS inpatient 2772 1801.8 AETNA AETNA 2189.88 79 999999999 1678.45 2688.84 percent of total billed charges CT scan of chest with contrast 1881678_1 CDM 0352 RC 71260 HCPCS inpatient 2772 1801.8 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 2688.84 97 999999999 1678.45 2688.84 percent of total billed charges CT scan of chest with contrast 1881678_1 CDM 0352 RC 71260 HCPCS inpatient 2772 1801.8 ENCORE - ALL PLANS ENCORE - ALL PLANS 1912.68 69 999999999 1678.45 2688.84 percent of total billed charges CT scan of chest with contrast 1881678_1 CDM 0352 RC 71260 HCPCS inpatient 2772 1801.8 HUMANA - ALL PLANS HUMANA - ALL PLANS 2162.16 78 999999999 1678.45 2688.84 percent of total billed charges CT scan of chest with contrast 1881678_1 CDM 0352 RC 71260 HCPCS inpatient 2772 1801.8 UMR - ALL PLANS UMR - ALL PLANS 1940.4 70 999999999 1678.45 2688.84 percent of total billed charges CT scan of chest with contrast 1881678_1 CDM 0352 RC 71260 HCPCS inpatient 2772 1801.8 SIHO - ALL PLANS SIHO - ALL PLANS 2494.8 90 999999999 1678.45 2688.84 percent of total billed charges CT scan of chest with contrast 1881678_1 CDM 0352 RC 71260 HCPCS inpatient 2772 1801.8 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1678.45 60.55 999999999 1678.45 2688.84 percent of total billed charges CT scan of chest with contrast 1881678_1 CDM 0352 RC 71260 HCPCS inpatient 2772 1801.8 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1678.45 2688.84 CT scan of chest with contrast 1881678_1 CDM 0352 RC 71260 HCPCS inpatient 2772 1801.8 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1678.45 2688.84 CT scan of chest with contrast 1881678_1 CDM 0352 RC 71260 HCPCS inpatient 2772 1801.8 ANTHEM HMO ANTHEM HMO 999999999 1678.45 2688.84 CT scan of chest with contrast 1881678_1 CDM 0352 RC 71260 HCPCS inpatient 2772 1801.8 CIGNA - ALL PLANS CIGNA - ALL PLANS 1873.87 67.6 999999999 1678.45 2688.84 percent of total billed charges CT scan of chest with contrast 1881678_1 CDM 0352 RC 71260 HCPCS inpatient 2772 1801.8 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1678.45 2688.84 CT scan of chest with contrast 1881678_1 CDM 0352 RC 71260 HCPCS inpatient 2772 1801.8 UHC - ALL PLANS UHC - ALL PLANS 999999999 1678.45 2688.84 Blood typing Rh phenotyping 1932605_1 CDM 0300 RC 86906 HCPCS inpatient 284 184.6 SELF PAY DISCOUNT SELF PAY DISCOUNT 184.6 65 999999999 171.96 275.48 percent of total billed charges Blood typing Rh phenotyping 1932605_1 CDM 0300 RC 86906 HCPCS inpatient 284 184.6 AETNA AETNA 224.36 79 999999999 171.96 275.48 percent of total billed charges Blood typing Rh phenotyping 1932605_1 CDM 0300 RC 86906 HCPCS inpatient 284 184.6 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 275.48 97 999999999 171.96 275.48 percent of total billed charges Blood typing Rh phenotyping 1932605_1 CDM 0300 RC 86906 HCPCS inpatient 284 184.6 ENCORE - ALL PLANS ENCORE - ALL PLANS 195.96 69 999999999 171.96 275.48 percent of total billed charges Blood typing Rh phenotyping 1932605_1 CDM 0300 RC 86906 HCPCS inpatient 284 184.6 HUMANA - ALL PLANS HUMANA - ALL PLANS 221.52 78 999999999 171.96 275.48 percent of total billed charges Blood typing Rh phenotyping 1932605_1 CDM 0300 RC 86906 HCPCS inpatient 284 184.6 UMR - ALL PLANS UMR - ALL PLANS 198.8 70 999999999 171.96 275.48 percent of total billed charges Blood typing Rh phenotyping 1932605_1 CDM 0300 RC 86906 HCPCS inpatient 284 184.6 SIHO - ALL PLANS SIHO - ALL PLANS 255.6 90 999999999 171.96 275.48 percent of total billed charges Blood typing Rh phenotyping 1932605_1 CDM 0300 RC 86906 HCPCS inpatient 284 184.6 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 171.96 60.55 999999999 171.96 275.48 percent of total billed charges Blood typing Rh phenotyping 1932605_1 CDM 0300 RC 86906 HCPCS inpatient 284 184.6 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 171.96 275.48 Blood typing Rh phenotyping 1932605_1 CDM 0300 RC 86906 HCPCS inpatient 284 184.6 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 171.96 275.48 Blood typing Rh phenotyping 1932605_1 CDM 0300 RC 86906 HCPCS inpatient 284 184.6 ANTHEM HMO ANTHEM HMO 999999999 171.96 275.48 Blood typing Rh phenotyping 1932605_1 CDM 0300 RC 86906 HCPCS inpatient 284 184.6 CIGNA - ALL PLANS CIGNA - ALL PLANS 191.98 67.6 999999999 171.96 275.48 percent of total billed charges Blood typing Rh phenotyping 1932605_1 CDM 0300 RC 86906 HCPCS inpatient 284 184.6 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 171.96 275.48 Blood typing Rh phenotyping 1932605_1 CDM 0300 RC 86906 HCPCS inpatient 284 184.6 UHC - ALL PLANS UHC - ALL PLANS 999999999 171.96 275.48 Test to measure oxygen level in blood using ear or finger device 19952406_1 CDM 0410 RC 94760 HCPCS inpatient 209 135.85 SELF PAY DISCOUNT SELF PAY DISCOUNT 135.85 65 999999999 126.55 202.73 percent of total billed charges Test to measure oxygen level in blood using ear or finger device 19952406_1 CDM 0410 RC 94760 HCPCS inpatient 209 135.85 AETNA AETNA 165.11 79 999999999 126.55 202.73 percent of total billed charges Test to measure oxygen level in blood using ear or finger device 19952406_1 CDM 0410 RC 94760 HCPCS inpatient 209 135.85 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 202.73 97 999999999 126.55 202.73 percent of total billed charges Test to measure oxygen level in blood using ear or finger device 19952406_1 CDM 0410 RC 94760 HCPCS inpatient 209 135.85 ENCORE - ALL PLANS ENCORE - ALL PLANS 144.21 69 999999999 126.55 202.73 percent of total billed charges Test to measure oxygen level in blood using ear or finger device 19952406_1 CDM 0410 RC 94760 HCPCS inpatient 209 135.85 HUMANA - ALL PLANS HUMANA - ALL PLANS 163.02 78 999999999 126.55 202.73 percent of total billed charges Test to measure oxygen level in blood using ear or finger device 19952406_1 CDM 0410 RC 94760 HCPCS inpatient 209 135.85 UMR - ALL PLANS UMR - ALL PLANS 146.3 70 999999999 126.55 202.73 percent of total billed charges Test to measure oxygen level in blood using ear or finger device 19952406_1 CDM 0410 RC 94760 HCPCS inpatient 209 135.85 SIHO - ALL PLANS SIHO - ALL PLANS 188.1 90 999999999 126.55 202.73 percent of total billed charges Test to measure oxygen level in blood using ear or finger device 19952406_1 CDM 0410 RC 94760 HCPCS inpatient 209 135.85 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 126.55 60.55 999999999 126.55 202.73 percent of total billed charges Test to measure oxygen level in blood using ear or finger device 19952406_1 CDM 0410 RC 94760 HCPCS inpatient 209 135.85 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 126.55 202.73 Test to measure oxygen level in blood using ear or finger device 19952406_1 CDM 0410 RC 94760 HCPCS inpatient 209 135.85 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 126.55 202.73 Test to measure oxygen level in blood using ear or finger device 19952406_1 CDM 0410 RC 94760 HCPCS inpatient 209 135.85 ANTHEM HMO ANTHEM HMO 999999999 126.55 202.73 Test to measure oxygen level in blood using ear or finger device 19952406_1 CDM 0410 RC 94760 HCPCS inpatient 209 135.85 CIGNA - ALL PLANS CIGNA - ALL PLANS 141.28 67.6 999999999 126.55 202.73 percent of total billed charges Test to measure oxygen level in blood using ear or finger device 19952406_1 CDM 0410 RC 94760 HCPCS inpatient 209 135.85 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 126.55 202.73 Test to measure oxygen level in blood using ear or finger device 19952406_1 CDM 0410 RC 94760 HCPCS inpatient 209 135.85 UHC - ALL PLANS UHC - ALL PLANS 999999999 126.55 202.73 Vitamin D-3 level 20572257_1 CDM 0301 RC 82306 HCPCS inpatient 90 58.5 SELF PAY DISCOUNT SELF PAY DISCOUNT 58.5 65 999999999 54.5 87.3 percent of total billed charges Vitamin D-3 level 20572257_1 CDM 0301 RC 82306 HCPCS inpatient 90 58.5 AETNA AETNA 71.1 79 999999999 54.5 87.3 percent of total billed charges Vitamin D-3 level 20572257_1 CDM 0301 RC 82306 HCPCS inpatient 90 58.5 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 87.3 97 999999999 54.5 87.3 percent of total billed charges Vitamin D-3 level 20572257_1 CDM 0301 RC 82306 HCPCS inpatient 90 58.5 ENCORE - ALL PLANS ENCORE - ALL PLANS 62.1 69 999999999 54.5 87.3 percent of total billed charges Vitamin D-3 level 20572257_1 CDM 0301 RC 82306 HCPCS inpatient 90 58.5 HUMANA - ALL PLANS HUMANA - ALL PLANS 70.2 78 999999999 54.5 87.3 percent of total billed charges Vitamin D-3 level 20572257_1 CDM 0301 RC 82306 HCPCS inpatient 90 58.5 UMR - ALL PLANS UMR - ALL PLANS 63 70 999999999 54.5 87.3 percent of total billed charges Vitamin D-3 level 20572257_1 CDM 0301 RC 82306 HCPCS inpatient 90 58.5 SIHO - ALL PLANS SIHO - ALL PLANS 81 90 999999999 54.5 87.3 percent of total billed charges Vitamin D-3 level 20572257_1 CDM 0301 RC 82306 HCPCS inpatient 90 58.5 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 54.5 60.55 999999999 54.5 87.3 percent of total billed charges Vitamin D-3 level 20572257_1 CDM 0301 RC 82306 HCPCS inpatient 90 58.5 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 54.5 87.3 Vitamin D-3 level 20572257_1 CDM 0301 RC 82306 HCPCS inpatient 90 58.5 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 54.5 87.3 Vitamin D-3 level 20572257_1 CDM 0301 RC 82306 HCPCS inpatient 90 58.5 ANTHEM HMO ANTHEM HMO 999999999 54.5 87.3 Vitamin D-3 level 20572257_1 CDM 0301 RC 82306 HCPCS inpatient 90 58.5 CIGNA - ALL PLANS CIGNA - ALL PLANS 60.84 67.6 999999999 54.5 87.3 percent of total billed charges Vitamin D-3 level 20572257_1 CDM 0301 RC 82306 HCPCS inpatient 90 58.5 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 54.5 87.3 Vitamin D-3 level 20572257_1 CDM 0301 RC 82306 HCPCS inpatient 90 58.5 UHC - ALL PLANS UHC - ALL PLANS 999999999 54.5 87.3 Blood group typing (ABO) 2200615_1 CDM 0302 RC 86900 HCPCS inpatient 171 111.15 SELF PAY DISCOUNT SELF PAY DISCOUNT 111.15 65 999999999 103.54 165.87 percent of total billed charges Blood group typing (ABO) 2200615_1 CDM 0302 RC 86900 HCPCS inpatient 171 111.15 AETNA AETNA 135.09 79 999999999 103.54 165.87 percent of total billed charges Blood group typing (ABO) 2200615_1 CDM 0302 RC 86900 HCPCS inpatient 171 111.15 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 165.87 97 999999999 103.54 165.87 percent of total billed charges Blood group typing (ABO) 2200615_1 CDM 0302 RC 86900 HCPCS inpatient 171 111.15 ENCORE - ALL PLANS ENCORE - ALL PLANS 117.99 69 999999999 103.54 165.87 percent of total billed charges Blood group typing (ABO) 2200615_1 CDM 0302 RC 86900 HCPCS inpatient 171 111.15 HUMANA - ALL PLANS HUMANA - ALL PLANS 133.38 78 999999999 103.54 165.87 percent of total billed charges Blood group typing (ABO) 2200615_1 CDM 0302 RC 86900 HCPCS inpatient 171 111.15 UMR - ALL PLANS UMR - ALL PLANS 119.7 70 999999999 103.54 165.87 percent of total billed charges Blood group typing (ABO) 2200615_1 CDM 0302 RC 86900 HCPCS inpatient 171 111.15 SIHO - ALL PLANS SIHO - ALL PLANS 153.9 90 999999999 103.54 165.87 percent of total billed charges Blood group typing (ABO) 2200615_1 CDM 0302 RC 86900 HCPCS inpatient 171 111.15 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 103.54 60.55 999999999 103.54 165.87 percent of total billed charges Blood group typing (ABO) 2200615_1 CDM 0302 RC 86900 HCPCS inpatient 171 111.15 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 103.54 165.87 Blood group typing (ABO) 2200615_1 CDM 0302 RC 86900 HCPCS inpatient 171 111.15 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 103.54 165.87 Blood group typing (ABO) 2200615_1 CDM 0302 RC 86900 HCPCS inpatient 171 111.15 ANTHEM HMO ANTHEM HMO 999999999 103.54 165.87 Blood group typing (ABO) 2200615_1 CDM 0302 RC 86900 HCPCS inpatient 171 111.15 CIGNA - ALL PLANS CIGNA - ALL PLANS 115.6 67.6 999999999 103.54 165.87 percent of total billed charges Blood group typing (ABO) 2200615_1 CDM 0302 RC 86900 HCPCS inpatient 171 111.15 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 103.54 165.87 Blood group typing (ABO) 2200615_1 CDM 0302 RC 86900 HCPCS inpatient 171 111.15 UHC - ALL PLANS UHC - ALL PLANS 999999999 103.54 165.87 Screening test for red blood cell antibodies 2200617_1 CDM 0302 RC 86850 HCPCS inpatient 124 80.6 SELF PAY DISCOUNT SELF PAY DISCOUNT 80.6 65 999999999 75.08 120.28 percent of total billed charges Screening test for red blood cell antibodies 2200617_1 CDM 0302 RC 86850 HCPCS inpatient 124 80.6 AETNA AETNA 97.96 79 999999999 75.08 120.28 percent of total billed charges Screening test for red blood cell antibodies 2200617_1 CDM 0302 RC 86850 HCPCS inpatient 124 80.6 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 120.28 97 999999999 75.08 120.28 percent of total billed charges Screening test for red blood cell antibodies 2200617_1 CDM 0302 RC 86850 HCPCS inpatient 124 80.6 ENCORE - ALL PLANS ENCORE - ALL PLANS 85.56 69 999999999 75.08 120.28 percent of total billed charges Screening test for red blood cell antibodies 2200617_1 CDM 0302 RC 86850 HCPCS inpatient 124 80.6 HUMANA - ALL PLANS HUMANA - ALL PLANS 96.72 78 999999999 75.08 120.28 percent of total billed charges Screening test for red blood cell antibodies 2200617_1 CDM 0302 RC 86850 HCPCS inpatient 124 80.6 UMR - ALL PLANS UMR - ALL PLANS 86.8 70 999999999 75.08 120.28 percent of total billed charges Screening test for red blood cell antibodies 2200617_1 CDM 0302 RC 86850 HCPCS inpatient 124 80.6 SIHO - ALL PLANS SIHO - ALL PLANS 111.6 90 999999999 75.08 120.28 percent of total billed charges Screening test for red blood cell antibodies 2200617_1 CDM 0302 RC 86850 HCPCS inpatient 124 80.6 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 75.08 60.55 999999999 75.08 120.28 percent of total billed charges Screening test for red blood cell antibodies 2200617_1 CDM 0302 RC 86850 HCPCS inpatient 124 80.6 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 75.08 120.28 Screening test for red blood cell antibodies 2200617_1 CDM 0302 RC 86850 HCPCS inpatient 124 80.6 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 75.08 120.28 Screening test for red blood cell antibodies 2200617_1 CDM 0302 RC 86850 HCPCS inpatient 124 80.6 ANTHEM HMO ANTHEM HMO 999999999 75.08 120.28 Screening test for red blood cell antibodies 2200617_1 CDM 0302 RC 86850 HCPCS inpatient 124 80.6 CIGNA - ALL PLANS CIGNA - ALL PLANS 83.82 67.6 999999999 75.08 120.28 percent of total billed charges Screening test for red blood cell antibodies 2200617_1 CDM 0302 RC 86850 HCPCS inpatient 124 80.6 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 75.08 120.28 Screening test for red blood cell antibodies 2200617_1 CDM 0302 RC 86850 HCPCS inpatient 124 80.6 UHC - ALL PLANS UHC - ALL PLANS 999999999 75.08 120.28 Blood group typing (ABO) 2200619_1 CDM 0302 RC 86900 HCPCS inpatient 83 53.95 SELF PAY DISCOUNT SELF PAY DISCOUNT 53.95 65 999999999 50.26 80.51 percent of total billed charges Blood group typing (ABO) 2200619_1 CDM 0302 RC 86900 HCPCS inpatient 83 53.95 AETNA AETNA 65.57 79 999999999 50.26 80.51 percent of total billed charges Blood group typing (ABO) 2200619_1 CDM 0302 RC 86900 HCPCS inpatient 83 53.95 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 80.51 97 999999999 50.26 80.51 percent of total billed charges Blood group typing (ABO) 2200619_1 CDM 0302 RC 86900 HCPCS inpatient 83 53.95 ENCORE - ALL PLANS ENCORE - ALL PLANS 57.27 69 999999999 50.26 80.51 percent of total billed charges Blood group typing (ABO) 2200619_1 CDM 0302 RC 86900 HCPCS inpatient 83 53.95 HUMANA - ALL PLANS HUMANA - ALL PLANS 64.74 78 999999999 50.26 80.51 percent of total billed charges Blood group typing (ABO) 2200619_1 CDM 0302 RC 86900 HCPCS inpatient 83 53.95 UMR - ALL PLANS UMR - ALL PLANS 58.1 70 999999999 50.26 80.51 percent of total billed charges Blood group typing (ABO) 2200619_1 CDM 0302 RC 86900 HCPCS inpatient 83 53.95 SIHO - ALL PLANS SIHO - ALL PLANS 74.7 90 999999999 50.26 80.51 percent of total billed charges Blood group typing (ABO) 2200619_1 CDM 0302 RC 86900 HCPCS inpatient 83 53.95 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 50.26 60.55 999999999 50.26 80.51 percent of total billed charges Blood group typing (ABO) 2200619_1 CDM 0302 RC 86900 HCPCS inpatient 83 53.95 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 50.26 80.51 Blood group typing (ABO) 2200619_1 CDM 0302 RC 86900 HCPCS inpatient 83 53.95 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 50.26 80.51 Blood group typing (ABO) 2200619_1 CDM 0302 RC 86900 HCPCS inpatient 83 53.95 ANTHEM HMO ANTHEM HMO 999999999 50.26 80.51 Blood group typing (ABO) 2200619_1 CDM 0302 RC 86900 HCPCS inpatient 83 53.95 CIGNA - ALL PLANS CIGNA - ALL PLANS 56.11 67.6 999999999 50.26 80.51 percent of total billed charges Blood group typing (ABO) 2200619_1 CDM 0302 RC 86900 HCPCS inpatient 83 53.95 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 50.26 80.51 Blood group typing (ABO) 2200619_1 CDM 0302 RC 86900 HCPCS inpatient 83 53.95 UHC - ALL PLANS UHC - ALL PLANS 999999999 50.26 80.51 "Blood unit compatibility test, immediate spin technique" 2216608_1 CDM 0300 RC 86920 HCPCS inpatient 432 280.8 SELF PAY DISCOUNT SELF PAY DISCOUNT 280.8 65 999999999 261.58 419.04 percent of total billed charges "Blood unit compatibility test, immediate spin technique" 2216608_1 CDM 0300 RC 86920 HCPCS inpatient 432 280.8 AETNA AETNA 341.28 79 999999999 261.58 419.04 percent of total billed charges "Blood unit compatibility test, immediate spin technique" 2216608_1 CDM 0300 RC 86920 HCPCS inpatient 432 280.8 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 419.04 97 999999999 261.58 419.04 percent of total billed charges "Blood unit compatibility test, immediate spin technique" 2216608_1 CDM 0300 RC 86920 HCPCS inpatient 432 280.8 ENCORE - ALL PLANS ENCORE - ALL PLANS 298.08 69 999999999 261.58 419.04 percent of total billed charges "Blood unit compatibility test, immediate spin technique" 2216608_1 CDM 0300 RC 86920 HCPCS inpatient 432 280.8 HUMANA - ALL PLANS HUMANA - ALL PLANS 336.96 78 999999999 261.58 419.04 percent of total billed charges "Blood unit compatibility test, immediate spin technique" 2216608_1 CDM 0300 RC 86920 HCPCS inpatient 432 280.8 UMR - ALL PLANS UMR - ALL PLANS 302.4 70 999999999 261.58 419.04 percent of total billed charges "Blood unit compatibility test, immediate spin technique" 2216608_1 CDM 0300 RC 86920 HCPCS inpatient 432 280.8 SIHO - ALL PLANS SIHO - ALL PLANS 388.8 90 999999999 261.58 419.04 percent of total billed charges "Blood unit compatibility test, immediate spin technique" 2216608_1 CDM 0300 RC 86920 HCPCS inpatient 432 280.8 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 261.58 60.55 999999999 261.58 419.04 percent of total billed charges "Blood unit compatibility test, immediate spin technique" 2216608_1 CDM 0300 RC 86920 HCPCS inpatient 432 280.8 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 261.58 419.04 "Blood unit compatibility test, immediate spin technique" 2216608_1 CDM 0300 RC 86920 HCPCS inpatient 432 280.8 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 261.58 419.04 "Blood unit compatibility test, immediate spin technique" 2216608_1 CDM 0300 RC 86920 HCPCS inpatient 432 280.8 ANTHEM HMO ANTHEM HMO 999999999 261.58 419.04 "Blood unit compatibility test, immediate spin technique" 2216608_1 CDM 0300 RC 86920 HCPCS inpatient 432 280.8 CIGNA - ALL PLANS CIGNA - ALL PLANS 292.03 67.6 999999999 261.58 419.04 percent of total billed charges "Blood unit compatibility test, immediate spin technique" 2216608_1 CDM 0300 RC 86920 HCPCS inpatient 432 280.8 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 261.58 419.04 "Blood unit compatibility test, immediate spin technique" 2216608_1 CDM 0300 RC 86920 HCPCS inpatient 432 280.8 UHC - ALL PLANS UHC - ALL PLANS 999999999 261.58 419.04 "Application of hot and cold baths, each 15 minutes" 22736256_1 CDM 0420 RC 97034 HCPCS inpatient 206 133.9 SELF PAY DISCOUNT SELF PAY DISCOUNT 133.9 65 999999999 124.73 199.82 percent of total billed charges "Application of hot and cold baths, each 15 minutes" 22736256_1 CDM 0420 RC 97034 HCPCS inpatient 206 133.9 AETNA AETNA 162.74 79 999999999 124.73 199.82 percent of total billed charges "Application of hot and cold baths, each 15 minutes" 22736256_1 CDM 0420 RC 97034 HCPCS inpatient 206 133.9 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 199.82 97 999999999 124.73 199.82 percent of total billed charges "Application of hot and cold baths, each 15 minutes" 22736256_1 CDM 0420 RC 97034 HCPCS inpatient 206 133.9 ENCORE - ALL PLANS ENCORE - ALL PLANS 142.14 69 999999999 124.73 199.82 percent of total billed charges "Application of hot and cold baths, each 15 minutes" 22736256_1 CDM 0420 RC 97034 HCPCS inpatient 206 133.9 HUMANA - ALL PLANS HUMANA - ALL PLANS 160.68 78 999999999 124.73 199.82 percent of total billed charges "Application of hot and cold baths, each 15 minutes" 22736256_1 CDM 0420 RC 97034 HCPCS inpatient 206 133.9 UMR - ALL PLANS UMR - ALL PLANS 144.2 70 999999999 124.73 199.82 percent of total billed charges "Application of hot and cold baths, each 15 minutes" 22736256_1 CDM 0420 RC 97034 HCPCS inpatient 206 133.9 SIHO - ALL PLANS SIHO - ALL PLANS 185.4 90 999999999 124.73 199.82 percent of total billed charges "Application of hot and cold baths, each 15 minutes" 22736256_1 CDM 0420 RC 97034 HCPCS inpatient 206 133.9 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 124.73 60.55 999999999 124.73 199.82 percent of total billed charges "Application of hot and cold baths, each 15 minutes" 22736256_1 CDM 0420 RC 97034 HCPCS inpatient 206 133.9 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 124.73 199.82 "Application of hot and cold baths, each 15 minutes" 22736256_1 CDM 0420 RC 97034 HCPCS inpatient 206 133.9 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 124.73 199.82 "Application of hot and cold baths, each 15 minutes" 22736256_1 CDM 0420 RC 97034 HCPCS inpatient 206 133.9 ANTHEM HMO ANTHEM HMO 999999999 124.73 199.82 "Application of hot and cold baths, each 15 minutes" 22736256_1 CDM 0420 RC 97034 HCPCS inpatient 206 133.9 CIGNA - ALL PLANS CIGNA - ALL PLANS 139.26 67.6 999999999 124.73 199.82 percent of total billed charges "Application of hot and cold baths, each 15 minutes" 22736256_1 CDM 0420 RC 97034 HCPCS inpatient 206 133.9 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 124.73 199.82 "Application of hot and cold baths, each 15 minutes" 22736256_1 CDM 0420 RC 97034 HCPCS inpatient 206 133.9 UHC - ALL PLANS UHC - ALL PLANS 999999999 124.73 199.82 "Training for self-care or home management, each 15 minutes" 22736257_1 CDM 0420 RC 97535 HCPCS inpatient 199 129.35 SELF PAY DISCOUNT SELF PAY DISCOUNT 129.35 65 999999999 120.49 193.03 percent of total billed charges "Training for self-care or home management, each 15 minutes" 22736257_1 CDM 0420 RC 97535 HCPCS inpatient 199 129.35 AETNA AETNA 157.21 79 999999999 120.49 193.03 percent of total billed charges "Training for self-care or home management, each 15 minutes" 22736257_1 CDM 0420 RC 97535 HCPCS inpatient 199 129.35 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 193.03 97 999999999 120.49 193.03 percent of total billed charges "Training for self-care or home management, each 15 minutes" 22736257_1 CDM 0420 RC 97535 HCPCS inpatient 199 129.35 ENCORE - ALL PLANS ENCORE - ALL PLANS 137.31 69 999999999 120.49 193.03 percent of total billed charges "Training for self-care or home management, each 15 minutes" 22736257_1 CDM 0420 RC 97535 HCPCS inpatient 199 129.35 HUMANA - ALL PLANS HUMANA - ALL PLANS 155.22 78 999999999 120.49 193.03 percent of total billed charges "Training for self-care or home management, each 15 minutes" 22736257_1 CDM 0420 RC 97535 HCPCS inpatient 199 129.35 UMR - ALL PLANS UMR - ALL PLANS 139.3 70 999999999 120.49 193.03 percent of total billed charges "Training for self-care or home management, each 15 minutes" 22736257_1 CDM 0420 RC 97535 HCPCS inpatient 199 129.35 SIHO - ALL PLANS SIHO - ALL PLANS 179.1 90 999999999 120.49 193.03 percent of total billed charges "Training for self-care or home management, each 15 minutes" 22736257_1 CDM 0420 RC 97535 HCPCS inpatient 199 129.35 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 120.49 60.55 999999999 120.49 193.03 percent of total billed charges "Training for self-care or home management, each 15 minutes" 22736257_1 CDM 0420 RC 97535 HCPCS inpatient 199 129.35 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 120.49 193.03 "Training for self-care or home management, each 15 minutes" 22736257_1 CDM 0420 RC 97535 HCPCS inpatient 199 129.35 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 120.49 193.03 "Training for self-care or home management, each 15 minutes" 22736257_1 CDM 0420 RC 97535 HCPCS inpatient 199 129.35 ANTHEM HMO ANTHEM HMO 999999999 120.49 193.03 "Training for self-care or home management, each 15 minutes" 22736257_1 CDM 0420 RC 97535 HCPCS inpatient 199 129.35 CIGNA - ALL PLANS CIGNA - ALL PLANS 134.52 67.6 999999999 120.49 193.03 percent of total billed charges "Training for self-care or home management, each 15 minutes" 22736257_1 CDM 0420 RC 97535 HCPCS inpatient 199 129.35 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 120.49 193.03 "Training for self-care or home management, each 15 minutes" 22736257_1 CDM 0420 RC 97535 HCPCS inpatient 199 129.35 UHC - ALL PLANS UHC - ALL PLANS 999999999 120.49 193.03 "Test or measurement for functional capacity, each 15 minutes" 22736352_1 CDM 0420 RC 97750 HCPCS inpatient 1008 655.2 SELF PAY DISCOUNT SELF PAY DISCOUNT 655.2 65 999999999 610.34 977.76 percent of total billed charges "Test or measurement for functional capacity, each 15 minutes" 22736352_1 CDM 0420 RC 97750 HCPCS inpatient 1008 655.2 AETNA AETNA 796.32 79 999999999 610.34 977.76 percent of total billed charges "Test or measurement for functional capacity, each 15 minutes" 22736352_1 CDM 0420 RC 97750 HCPCS inpatient 1008 655.2 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 977.76 97 999999999 610.34 977.76 percent of total billed charges "Test or measurement for functional capacity, each 15 minutes" 22736352_1 CDM 0420 RC 97750 HCPCS inpatient 1008 655.2 ENCORE - ALL PLANS ENCORE - ALL PLANS 695.52 69 999999999 610.34 977.76 percent of total billed charges "Test or measurement for functional capacity, each 15 minutes" 22736352_1 CDM 0420 RC 97750 HCPCS inpatient 1008 655.2 HUMANA - ALL PLANS HUMANA - ALL PLANS 786.24 78 999999999 610.34 977.76 percent of total billed charges "Test or measurement for functional capacity, each 15 minutes" 22736352_1 CDM 0420 RC 97750 HCPCS inpatient 1008 655.2 UMR - ALL PLANS UMR - ALL PLANS 705.6 70 999999999 610.34 977.76 percent of total billed charges "Test or measurement for functional capacity, each 15 minutes" 22736352_1 CDM 0420 RC 97750 HCPCS inpatient 1008 655.2 SIHO - ALL PLANS SIHO - ALL PLANS 907.2 90 999999999 610.34 977.76 percent of total billed charges "Test or measurement for functional capacity, each 15 minutes" 22736352_1 CDM 0420 RC 97750 HCPCS inpatient 1008 655.2 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 610.34 60.55 999999999 610.34 977.76 percent of total billed charges "Test or measurement for functional capacity, each 15 minutes" 22736352_1 CDM 0420 RC 97750 HCPCS inpatient 1008 655.2 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 610.34 977.76 "Test or measurement for functional capacity, each 15 minutes" 22736352_1 CDM 0420 RC 97750 HCPCS inpatient 1008 655.2 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 610.34 977.76 "Test or measurement for functional capacity, each 15 minutes" 22736352_1 CDM 0420 RC 97750 HCPCS inpatient 1008 655.2 ANTHEM HMO ANTHEM HMO 999999999 610.34 977.76 "Test or measurement for functional capacity, each 15 minutes" 22736352_1 CDM 0420 RC 97750 HCPCS inpatient 1008 655.2 CIGNA - ALL PLANS CIGNA - ALL PLANS 681.41 67.6 999999999 610.34 977.76 percent of total billed charges "Test or measurement for functional capacity, each 15 minutes" 22736352_1 CDM 0420 RC 97750 HCPCS inpatient 1008 655.2 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 610.34 977.76 "Test or measurement for functional capacity, each 15 minutes" 22736352_1 CDM 0420 RC 97750 HCPCS inpatient 1008 655.2 UHC - ALL PLANS UHC - ALL PLANS 999999999 610.34 977.76 "Application of hot and cold baths, each 15 minutes" 22780435_1 CDM 0430 RC 97034 HCPCS inpatient 206 133.9 SELF PAY DISCOUNT SELF PAY DISCOUNT 133.9 65 999999999 124.73 199.82 percent of total billed charges "Application of hot and cold baths, each 15 minutes" 22780435_1 CDM 0430 RC 97034 HCPCS inpatient 206 133.9 AETNA AETNA 162.74 79 999999999 124.73 199.82 percent of total billed charges "Application of hot and cold baths, each 15 minutes" 22780435_1 CDM 0430 RC 97034 HCPCS inpatient 206 133.9 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 199.82 97 999999999 124.73 199.82 percent of total billed charges "Application of hot and cold baths, each 15 minutes" 22780435_1 CDM 0430 RC 97034 HCPCS inpatient 206 133.9 ENCORE - ALL PLANS ENCORE - ALL PLANS 142.14 69 999999999 124.73 199.82 percent of total billed charges "Application of hot and cold baths, each 15 minutes" 22780435_1 CDM 0430 RC 97034 HCPCS inpatient 206 133.9 HUMANA - ALL PLANS HUMANA - ALL PLANS 160.68 78 999999999 124.73 199.82 percent of total billed charges "Application of hot and cold baths, each 15 minutes" 22780435_1 CDM 0430 RC 97034 HCPCS inpatient 206 133.9 UMR - ALL PLANS UMR - ALL PLANS 144.2 70 999999999 124.73 199.82 percent of total billed charges "Application of hot and cold baths, each 15 minutes" 22780435_1 CDM 0430 RC 97034 HCPCS inpatient 206 133.9 SIHO - ALL PLANS SIHO - ALL PLANS 185.4 90 999999999 124.73 199.82 percent of total billed charges "Application of hot and cold baths, each 15 minutes" 22780435_1 CDM 0430 RC 97034 HCPCS inpatient 206 133.9 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 124.73 60.55 999999999 124.73 199.82 percent of total billed charges "Application of hot and cold baths, each 15 minutes" 22780435_1 CDM 0430 RC 97034 HCPCS inpatient 206 133.9 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 124.73 199.82 "Application of hot and cold baths, each 15 minutes" 22780435_1 CDM 0430 RC 97034 HCPCS inpatient 206 133.9 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 124.73 199.82 "Application of hot and cold baths, each 15 minutes" 22780435_1 CDM 0430 RC 97034 HCPCS inpatient 206 133.9 ANTHEM HMO ANTHEM HMO 999999999 124.73 199.82 "Application of hot and cold baths, each 15 minutes" 22780435_1 CDM 0430 RC 97034 HCPCS inpatient 206 133.9 CIGNA - ALL PLANS CIGNA - ALL PLANS 139.26 67.6 999999999 124.73 199.82 percent of total billed charges "Application of hot and cold baths, each 15 minutes" 22780435_1 CDM 0430 RC 97034 HCPCS inpatient 206 133.9 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 124.73 199.82 "Application of hot and cold baths, each 15 minutes" 22780435_1 CDM 0430 RC 97034 HCPCS inpatient 206 133.9 UHC - ALL PLANS UHC - ALL PLANS 999999999 124.73 199.82 "Test or measurement for functional capacity, each 15 minutes" 22780438_1 CDM 0430 RC 97750 HCPCS inpatient 164 106.6 SELF PAY DISCOUNT SELF PAY DISCOUNT 106.6 65 999999999 99.3 159.08 percent of total billed charges "Test or measurement for functional capacity, each 15 minutes" 22780438_1 CDM 0430 RC 97750 HCPCS inpatient 164 106.6 AETNA AETNA 129.56 79 999999999 99.3 159.08 percent of total billed charges "Test or measurement for functional capacity, each 15 minutes" 22780438_1 CDM 0430 RC 97750 HCPCS inpatient 164 106.6 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 159.08 97 999999999 99.3 159.08 percent of total billed charges "Test or measurement for functional capacity, each 15 minutes" 22780438_1 CDM 0430 RC 97750 HCPCS inpatient 164 106.6 ENCORE - ALL PLANS ENCORE - ALL PLANS 113.16 69 999999999 99.3 159.08 percent of total billed charges "Test or measurement for functional capacity, each 15 minutes" 22780438_1 CDM 0430 RC 97750 HCPCS inpatient 164 106.6 HUMANA - ALL PLANS HUMANA - ALL PLANS 127.92 78 999999999 99.3 159.08 percent of total billed charges "Test or measurement for functional capacity, each 15 minutes" 22780438_1 CDM 0430 RC 97750 HCPCS inpatient 164 106.6 UMR - ALL PLANS UMR - ALL PLANS 114.8 70 999999999 99.3 159.08 percent of total billed charges "Test or measurement for functional capacity, each 15 minutes" 22780438_1 CDM 0430 RC 97750 HCPCS inpatient 164 106.6 SIHO - ALL PLANS SIHO - ALL PLANS 147.6 90 999999999 99.3 159.08 percent of total billed charges "Test or measurement for functional capacity, each 15 minutes" 22780438_1 CDM 0430 RC 97750 HCPCS inpatient 164 106.6 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 99.3 60.55 999999999 99.3 159.08 percent of total billed charges "Test or measurement for functional capacity, each 15 minutes" 22780438_1 CDM 0430 RC 97750 HCPCS inpatient 164 106.6 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 99.3 159.08 "Test or measurement for functional capacity, each 15 minutes" 22780438_1 CDM 0430 RC 97750 HCPCS inpatient 164 106.6 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 99.3 159.08 "Test or measurement for functional capacity, each 15 minutes" 22780438_1 CDM 0430 RC 97750 HCPCS inpatient 164 106.6 ANTHEM HMO ANTHEM HMO 999999999 99.3 159.08 "Test or measurement for functional capacity, each 15 minutes" 22780438_1 CDM 0430 RC 97750 HCPCS inpatient 164 106.6 CIGNA - ALL PLANS CIGNA - ALL PLANS 110.86 67.6 999999999 99.3 159.08 percent of total billed charges "Test or measurement for functional capacity, each 15 minutes" 22780438_1 CDM 0430 RC 97750 HCPCS inpatient 164 106.6 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 99.3 159.08 "Test or measurement for functional capacity, each 15 minutes" 22780438_1 CDM 0430 RC 97750 HCPCS inpatient 164 106.6 UHC - ALL PLANS UHC - ALL PLANS 999999999 99.3 159.08 CT scan of chest with contrast 2342693_1 CDM 0352 RC 71260 HCPCS inpatient 2772 1801.8 SELF PAY DISCOUNT SELF PAY DISCOUNT 1801.8 65 999999999 1678.45 2688.84 percent of total billed charges CT scan of chest with contrast 2342693_1 CDM 0352 RC 71260 HCPCS inpatient 2772 1801.8 AETNA AETNA 2189.88 79 999999999 1678.45 2688.84 percent of total billed charges CT scan of chest with contrast 2342693_1 CDM 0352 RC 71260 HCPCS inpatient 2772 1801.8 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 2688.84 97 999999999 1678.45 2688.84 percent of total billed charges CT scan of chest with contrast 2342693_1 CDM 0352 RC 71260 HCPCS inpatient 2772 1801.8 ENCORE - ALL PLANS ENCORE - ALL PLANS 1912.68 69 999999999 1678.45 2688.84 percent of total billed charges CT scan of chest with contrast 2342693_1 CDM 0352 RC 71260 HCPCS inpatient 2772 1801.8 HUMANA - ALL PLANS HUMANA - ALL PLANS 2162.16 78 999999999 1678.45 2688.84 percent of total billed charges CT scan of chest with contrast 2342693_1 CDM 0352 RC 71260 HCPCS inpatient 2772 1801.8 UMR - ALL PLANS UMR - ALL PLANS 1940.4 70 999999999 1678.45 2688.84 percent of total billed charges CT scan of chest with contrast 2342693_1 CDM 0352 RC 71260 HCPCS inpatient 2772 1801.8 SIHO - ALL PLANS SIHO - ALL PLANS 2494.8 90 999999999 1678.45 2688.84 percent of total billed charges CT scan of chest with contrast 2342693_1 CDM 0352 RC 71260 HCPCS inpatient 2772 1801.8 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1678.45 60.55 999999999 1678.45 2688.84 percent of total billed charges CT scan of chest with contrast 2342693_1 CDM 0352 RC 71260 HCPCS inpatient 2772 1801.8 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1678.45 2688.84 CT scan of chest with contrast 2342693_1 CDM 0352 RC 71260 HCPCS inpatient 2772 1801.8 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1678.45 2688.84 CT scan of chest with contrast 2342693_1 CDM 0352 RC 71260 HCPCS inpatient 2772 1801.8 ANTHEM HMO ANTHEM HMO 999999999 1678.45 2688.84 CT scan of chest with contrast 2342693_1 CDM 0352 RC 71260 HCPCS inpatient 2772 1801.8 CIGNA - ALL PLANS CIGNA - ALL PLANS 1873.87 67.6 999999999 1678.45 2688.84 percent of total billed charges CT scan of chest with contrast 2342693_1 CDM 0352 RC 71260 HCPCS inpatient 2772 1801.8 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1678.45 2688.84 CT scan of chest with contrast 2342693_1 CDM 0352 RC 71260 HCPCS inpatient 2772 1801.8 UHC - ALL PLANS UHC - ALL PLANS 999999999 1678.45 2688.84 CT scan of abdomen without contrast 2342699_1 CDM 0352 RC 74150 HCPCS inpatient 2684 1744.6 SELF PAY DISCOUNT SELF PAY DISCOUNT 1744.6 65 999999999 1625.16 2603.48 percent of total billed charges CT scan of abdomen without contrast 2342699_1 CDM 0352 RC 74150 HCPCS inpatient 2684 1744.6 AETNA AETNA 2120.36 79 999999999 1625.16 2603.48 percent of total billed charges CT scan of abdomen without contrast 2342699_1 CDM 0352 RC 74150 HCPCS inpatient 2684 1744.6 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 2603.48 97 999999999 1625.16 2603.48 percent of total billed charges CT scan of abdomen without contrast 2342699_1 CDM 0352 RC 74150 HCPCS inpatient 2684 1744.6 ENCORE - ALL PLANS ENCORE - ALL PLANS 1851.96 69 999999999 1625.16 2603.48 percent of total billed charges CT scan of abdomen without contrast 2342699_1 CDM 0352 RC 74150 HCPCS inpatient 2684 1744.6 HUMANA - ALL PLANS HUMANA - ALL PLANS 2093.52 78 999999999 1625.16 2603.48 percent of total billed charges CT scan of abdomen without contrast 2342699_1 CDM 0352 RC 74150 HCPCS inpatient 2684 1744.6 UMR - ALL PLANS UMR - ALL PLANS 1878.8 70 999999999 1625.16 2603.48 percent of total billed charges CT scan of abdomen without contrast 2342699_1 CDM 0352 RC 74150 HCPCS inpatient 2684 1744.6 SIHO - ALL PLANS SIHO - ALL PLANS 2415.6 90 999999999 1625.16 2603.48 percent of total billed charges CT scan of abdomen without contrast 2342699_1 CDM 0352 RC 74150 HCPCS inpatient 2684 1744.6 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1625.16 60.55 999999999 1625.16 2603.48 percent of total billed charges CT scan of abdomen without contrast 2342699_1 CDM 0352 RC 74150 HCPCS inpatient 2684 1744.6 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1625.16 2603.48 CT scan of abdomen without contrast 2342699_1 CDM 0352 RC 74150 HCPCS inpatient 2684 1744.6 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1625.16 2603.48 CT scan of abdomen without contrast 2342699_1 CDM 0352 RC 74150 HCPCS inpatient 2684 1744.6 ANTHEM HMO ANTHEM HMO 999999999 1625.16 2603.48 CT scan of abdomen without contrast 2342699_1 CDM 0352 RC 74150 HCPCS inpatient 2684 1744.6 CIGNA - ALL PLANS CIGNA - ALL PLANS 1814.38 67.6 999999999 1625.16 2603.48 percent of total billed charges CT scan of abdomen without contrast 2342699_1 CDM 0352 RC 74150 HCPCS inpatient 2684 1744.6 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1625.16 2603.48 CT scan of abdomen without contrast 2342699_1 CDM 0352 RC 74150 HCPCS inpatient 2684 1744.6 UHC - ALL PLANS UHC - ALL PLANS 999999999 1625.16 2603.48 "Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast" 2342735_1 CDM 0352 RC 0042T HCPCS inpatient 2096 1362.4 SELF PAY DISCOUNT SELF PAY DISCOUNT 1362.4 65 999999999 1269.13 2033.12 percent of total billed charges "Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast" 2342735_1 CDM 0352 RC 0042T HCPCS inpatient 2096 1362.4 AETNA AETNA 1655.84 79 999999999 1269.13 2033.12 percent of total billed charges "Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast" 2342735_1 CDM 0352 RC 0042T HCPCS inpatient 2096 1362.4 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 2033.12 97 999999999 1269.13 2033.12 percent of total billed charges "Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast" 2342735_1 CDM 0352 RC 0042T HCPCS inpatient 2096 1362.4 ENCORE - ALL PLANS ENCORE - ALL PLANS 1446.24 69 999999999 1269.13 2033.12 percent of total billed charges "Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast" 2342735_1 CDM 0352 RC 0042T HCPCS inpatient 2096 1362.4 HUMANA - ALL PLANS HUMANA - ALL PLANS 1634.88 78 999999999 1269.13 2033.12 percent of total billed charges "Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast" 2342735_1 CDM 0352 RC 0042T HCPCS inpatient 2096 1362.4 UMR - ALL PLANS UMR - ALL PLANS 1467.2 70 999999999 1269.13 2033.12 percent of total billed charges "Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast" 2342735_1 CDM 0352 RC 0042T HCPCS inpatient 2096 1362.4 SIHO - ALL PLANS SIHO - ALL PLANS 1886.4 90 999999999 1269.13 2033.12 percent of total billed charges "Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast" 2342735_1 CDM 0352 RC 0042T HCPCS inpatient 2096 1362.4 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1269.13 60.55 999999999 1269.13 2033.12 percent of total billed charges "Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast" 2342735_1 CDM 0352 RC 0042T HCPCS inpatient 2096 1362.4 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1269.13 2033.12 "Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast" 2342735_1 CDM 0352 RC 0042T HCPCS inpatient 2096 1362.4 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1269.13 2033.12 "Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast" 2342735_1 CDM 0352 RC 0042T HCPCS inpatient 2096 1362.4 ANTHEM HMO ANTHEM HMO 999999999 1269.13 2033.12 "Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast" 2342735_1 CDM 0352 RC 0042T HCPCS inpatient 2096 1362.4 CIGNA - ALL PLANS CIGNA - ALL PLANS 1416.9 67.6 999999999 1269.13 2033.12 percent of total billed charges "Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast" 2342735_1 CDM 0352 RC 0042T HCPCS inpatient 2096 1362.4 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1269.13 2033.12 "Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast" 2342735_1 CDM 0352 RC 0042T HCPCS inpatient 2096 1362.4 UHC - ALL PLANS UHC - ALL PLANS 999999999 1269.13 2033.12 CT scan of blood vessels and grafts of heart with contrast 2342780_1 CDM 0350 RC 75574 HCPCS inpatient 2592 1684.8 SELF PAY DISCOUNT SELF PAY DISCOUNT 1684.8 65 999999999 1569.46 2514.24 percent of total billed charges CT scan of blood vessels and grafts of heart with contrast 2342780_1 CDM 0350 RC 75574 HCPCS inpatient 2592 1684.8 AETNA AETNA 2047.68 79 999999999 1569.46 2514.24 percent of total billed charges CT scan of blood vessels and grafts of heart with contrast 2342780_1 CDM 0350 RC 75574 HCPCS inpatient 2592 1684.8 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 2514.24 97 999999999 1569.46 2514.24 percent of total billed charges CT scan of blood vessels and grafts of heart with contrast 2342780_1 CDM 0350 RC 75574 HCPCS inpatient 2592 1684.8 ENCORE - ALL PLANS ENCORE - ALL PLANS 1788.48 69 999999999 1569.46 2514.24 percent of total billed charges CT scan of blood vessels and grafts of heart with contrast 2342780_1 CDM 0350 RC 75574 HCPCS inpatient 2592 1684.8 HUMANA - ALL PLANS HUMANA - ALL PLANS 2021.76 78 999999999 1569.46 2514.24 percent of total billed charges CT scan of blood vessels and grafts of heart with contrast 2342780_1 CDM 0350 RC 75574 HCPCS inpatient 2592 1684.8 UMR - ALL PLANS UMR - ALL PLANS 1814.4 70 999999999 1569.46 2514.24 percent of total billed charges CT scan of blood vessels and grafts of heart with contrast 2342780_1 CDM 0350 RC 75574 HCPCS inpatient 2592 1684.8 SIHO - ALL PLANS SIHO - ALL PLANS 2332.8 90 999999999 1569.46 2514.24 percent of total billed charges CT scan of blood vessels and grafts of heart with contrast 2342780_1 CDM 0350 RC 75574 HCPCS inpatient 2592 1684.8 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 1569.46 60.55 999999999 1569.46 2514.24 percent of total billed charges CT scan of blood vessels and grafts of heart with contrast 2342780_1 CDM 0350 RC 75574 HCPCS inpatient 2592 1684.8 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 1569.46 2514.24 CT scan of blood vessels and grafts of heart with contrast 2342780_1 CDM 0350 RC 75574 HCPCS inpatient 2592 1684.8 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 1569.46 2514.24 CT scan of blood vessels and grafts of heart with contrast 2342780_1 CDM 0350 RC 75574 HCPCS inpatient 2592 1684.8 ANTHEM HMO ANTHEM HMO 999999999 1569.46 2514.24 CT scan of blood vessels and grafts of heart with contrast 2342780_1 CDM 0350 RC 75574 HCPCS inpatient 2592 1684.8 CIGNA - ALL PLANS CIGNA - ALL PLANS 1752.19 67.6 999999999 1569.46 2514.24 percent of total billed charges CT scan of blood vessels and grafts of heart with contrast 2342780_1 CDM 0350 RC 75574 HCPCS inpatient 2592 1684.8 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 1569.46 2514.24 CT scan of blood vessels and grafts of heart with contrast 2342780_1 CDM 0350 RC 75574 HCPCS inpatient 2592 1684.8 UHC - ALL PLANS UHC - ALL PLANS 999999999 1569.46 2514.24 Ultrasound measurement of bladder capacity after voiding 2342828_1 CDM 0402 RC 51798 HCPCS inpatient 132 85.8 SELF PAY DISCOUNT SELF PAY DISCOUNT 85.8 65 999999999 79.93 128.04 percent of total billed charges Ultrasound measurement of bladder capacity after voiding 2342828_1 CDM 0402 RC 51798 HCPCS inpatient 132 85.8 AETNA AETNA 104.28 79 999999999 79.93 128.04 percent of total billed charges Ultrasound measurement of bladder capacity after voiding 2342828_1 CDM 0402 RC 51798 HCPCS inpatient 132 85.8 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 128.04 97 999999999 79.93 128.04 percent of total billed charges Ultrasound measurement of bladder capacity after voiding 2342828_1 CDM 0402 RC 51798 HCPCS inpatient 132 85.8 ENCORE - ALL PLANS ENCORE - ALL PLANS 91.08 69 999999999 79.93 128.04 percent of total billed charges Ultrasound measurement of bladder capacity after voiding 2342828_1 CDM 0402 RC 51798 HCPCS inpatient 132 85.8 HUMANA - ALL PLANS HUMANA - ALL PLANS 102.96 78 999999999 79.93 128.04 percent of total billed charges Ultrasound measurement of bladder capacity after voiding 2342828_1 CDM 0402 RC 51798 HCPCS inpatient 132 85.8 UMR - ALL PLANS UMR - ALL PLANS 92.4 70 999999999 79.93 128.04 percent of total billed charges Ultrasound measurement of bladder capacity after voiding 2342828_1 CDM 0402 RC 51798 HCPCS inpatient 132 85.8 SIHO - ALL PLANS SIHO - ALL PLANS 118.8 90 999999999 79.93 128.04 percent of total billed charges Ultrasound measurement of bladder capacity after voiding 2342828_1 CDM 0402 RC 51798 HCPCS inpatient 132 85.8 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 79.93 60.55 999999999 79.93 128.04 percent of total billed charges Ultrasound measurement of bladder capacity after voiding 2342828_1 CDM 0402 RC 51798 HCPCS inpatient 132 85.8 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 79.93 128.04 Ultrasound measurement of bladder capacity after voiding 2342828_1 CDM 0402 RC 51798 HCPCS inpatient 132 85.8 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 79.93 128.04 Ultrasound measurement of bladder capacity after voiding 2342828_1 CDM 0402 RC 51798 HCPCS inpatient 132 85.8 ANTHEM HMO ANTHEM HMO 999999999 79.93 128.04 Ultrasound measurement of bladder capacity after voiding 2342828_1 CDM 0402 RC 51798 HCPCS inpatient 132 85.8 CIGNA - ALL PLANS CIGNA - ALL PLANS 89.23 67.6 999999999 79.93 128.04 percent of total billed charges Ultrasound measurement of bladder capacity after voiding 2342828_1 CDM 0402 RC 51798 HCPCS inpatient 132 85.8 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 79.93 128.04 Ultrasound measurement of bladder capacity after voiding 2342828_1 CDM 0402 RC 51798 HCPCS inpatient 132 85.8 UHC - ALL PLANS UHC - ALL PLANS 999999999 79.93 128.04 Ultrasonic guidance for needle placement 2342834_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 SELF PAY DISCOUNT SELF PAY DISCOUNT 570.05 65 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 2342834_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 AETNA AETNA 692.83 79 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 2342834_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 850.69 97 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 2342834_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 ENCORE - ALL PLANS ENCORE - ALL PLANS 605.13 69 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 2342834_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 HUMANA - ALL PLANS HUMANA - ALL PLANS 684.06 78 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 2342834_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 UMR - ALL PLANS UMR - ALL PLANS 613.9 70 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 2342834_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 SIHO - ALL PLANS SIHO - ALL PLANS 789.3 90 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 2342834_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 531.02 60.55 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 2342834_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 531.02 850.69 Ultrasonic guidance for needle placement 2342834_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 531.02 850.69 Ultrasonic guidance for needle placement 2342834_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 ANTHEM HMO ANTHEM HMO 999999999 531.02 850.69 Ultrasonic guidance for needle placement 2342834_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 CIGNA - ALL PLANS CIGNA - ALL PLANS 592.85 67.6 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 2342834_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 531.02 850.69 Ultrasonic guidance for needle placement 2342834_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 UHC - ALL PLANS UHC - ALL PLANS 999999999 531.02 850.69 Ultrasonic guidance for needle placement 2342837_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 SELF PAY DISCOUNT SELF PAY DISCOUNT 570.05 65 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 2342837_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 AETNA AETNA 692.83 79 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 2342837_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 850.69 97 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 2342837_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 ENCORE - ALL PLANS ENCORE - ALL PLANS 605.13 69 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 2342837_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 HUMANA - ALL PLANS HUMANA - ALL PLANS 684.06 78 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 2342837_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 UMR - ALL PLANS UMR - ALL PLANS 613.9 70 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 2342837_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 SIHO - ALL PLANS SIHO - ALL PLANS 789.3 90 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 2342837_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 531.02 60.55 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 2342837_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 531.02 850.69 Ultrasonic guidance for needle placement 2342837_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 531.02 850.69 Ultrasonic guidance for needle placement 2342837_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 ANTHEM HMO ANTHEM HMO 999999999 531.02 850.69 Ultrasonic guidance for needle placement 2342837_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 CIGNA - ALL PLANS CIGNA - ALL PLANS 592.85 67.6 999999999 531.02 850.69 percent of total billed charges Ultrasonic guidance for needle placement 2342837_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 531.02 850.69 Ultrasonic guidance for needle placement 2342837_1 CDM 0402 RC 76942 HCPCS inpatient 877 570.05 UHC - ALL PLANS UHC - ALL PLANS 999999999 531.02 850.69 Ultrasonic guidance for needle placement 2342840_1 CDM 0402 RC 76942 HCPCS inpatient 965 627.25 SELF PAY DISCOUNT SELF PAY DISCOUNT 627.25 65 999999999 584.31 936.05 percent of total billed charges Ultrasonic guidance for needle placement 2342840_1 CDM 0402 RC 76942 HCPCS inpatient 965 627.25 AETNA AETNA 762.35 79 999999999 584.31 936.05 percent of total billed charges Ultrasonic guidance for needle placement 2342840_1 CDM 0402 RC 76942 HCPCS inpatient 965 627.25 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 936.05 97 999999999 584.31 936.05 percent of total billed charges Ultrasonic guidance for needle placement 2342840_1 CDM 0402 RC 76942 HCPCS inpatient 965 627.25 ENCORE - ALL PLANS ENCORE - ALL PLANS 665.85 69 999999999 584.31 936.05 percent of total billed charges Ultrasonic guidance for needle placement 2342840_1 CDM 0402 RC 76942 HCPCS inpatient 965 627.25 HUMANA - ALL PLANS HUMANA - ALL PLANS 752.7 78 999999999 584.31 936.05 percent of total billed charges Ultrasonic guidance for needle placement 2342840_1 CDM 0402 RC 76942 HCPCS inpatient 965 627.25 UMR - ALL PLANS UMR - ALL PLANS 675.5 70 999999999 584.31 936.05 percent of total billed charges Ultrasonic guidance for needle placement 2342840_1 CDM 0402 RC 76942 HCPCS inpatient 965 627.25 SIHO - ALL PLANS SIHO - ALL PLANS 868.5 90 999999999 584.31 936.05 percent of total billed charges Ultrasonic guidance for needle placement 2342840_1 CDM 0402 RC 76942 HCPCS inpatient 965 627.25 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 584.31 60.55 999999999 584.31 936.05 percent of total billed charges Ultrasonic guidance for needle placement 2342840_1 CDM 0402 RC 76942 HCPCS inpatient 965 627.25 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 584.31 936.05 Ultrasonic guidance for needle placement 2342840_1 CDM 0402 RC 76942 HCPCS inpatient 965 627.25 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 584.31 936.05 Ultrasonic guidance for needle placement 2342840_1 CDM 0402 RC 76942 HCPCS inpatient 965 627.25 ANTHEM HMO ANTHEM HMO 999999999 584.31 936.05 Ultrasonic guidance for needle placement 2342840_1 CDM 0402 RC 76942 HCPCS inpatient 965 627.25 CIGNA - ALL PLANS CIGNA - ALL PLANS 652.34 67.6 999999999 584.31 936.05 percent of total billed charges Ultrasonic guidance for needle placement 2342840_1 CDM 0402 RC 76942 HCPCS inpatient 965 627.25 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 584.31 936.05 Ultrasonic guidance for needle placement 2342840_1 CDM 0402 RC 76942 HCPCS inpatient 965 627.25 UHC - ALL PLANS UHC - ALL PLANS 999999999 584.31 936.05 "Ultrasound scan of pregnant uterus (14 weeks or more), each additional fetus" 2342885_1 CDM 0402 RC 76810 HCPCS inpatient 1179 766.35 SELF PAY DISCOUNT SELF PAY DISCOUNT 766.35 65 999999999 713.88 1143.63 percent of total billed charges "Ultrasound scan of pregnant uterus (14 weeks or more), each additional fetus" 2342885_1 CDM 0402 RC 76810 HCPCS inpatient 1179 766.35 AETNA AETNA 931.41 79 999999999 713.88 1143.63 percent of total billed charges "Ultrasound scan of pregnant uterus (14 weeks or more), each additional fetus" 2342885_1 CDM 0402 RC 76810 HCPCS inpatient 1179 766.35 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 1143.63 97 999999999 713.88 1143.63 percent of total billed charges "Ultrasound scan of pregnant uterus (14 weeks or more), each additional fetus" 2342885_1 CDM 0402 RC 76810 HCPCS inpatient 1179 766.35 ENCORE - ALL PLANS ENCORE - ALL PLANS 813.51 69 999999999 713.88 1143.63 percent of total billed charges "Ultrasound scan of pregnant uterus (14 weeks or more), each additional fetus" 2342885_1 CDM 0402 RC 76810 HCPCS inpatient 1179 766.35 HUMANA - ALL PLANS HUMANA - ALL PLANS 919.62 78 999999999 713.88 1143.63 percent of total billed charges "Ultrasound scan of pregnant uterus (14 weeks or more), each additional fetus" 2342885_1 CDM 0402 RC 76810 HCPCS inpatient 1179 766.35 UMR - ALL PLANS UMR - ALL PLANS 825.3 70 999999999 713.88 1143.63 percent of total billed charges "Ultrasound scan of pregnant uterus (14 weeks or more), each additional fetus" 2342885_1 CDM 0402 RC 76810 HCPCS inpatient 1179 766.35 SIHO - ALL PLANS SIHO - ALL PLANS 1061.1 90 999999999 713.88 1143.63 percent of total billed charges "Ultrasound scan of pregnant uterus (14 weeks or more), each additional fetus" 2342885_1 CDM 0402 RC 76810 HCPCS inpatient 1179 766.35 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 713.88 60.55 999999999 713.88 1143.63 percent of total billed charges "Ultrasound scan of pregnant uterus (14 weeks or more), each additional fetus" 2342885_1 CDM 0402 RC 76810 HCPCS inpatient 1179 766.35 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 713.88 1143.63 "Ultrasound scan of pregnant uterus (14 weeks or more), each additional fetus" 2342885_1 CDM 0402 RC 76810 HCPCS inpatient 1179 766.35 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 713.88 1143.63 "Ultrasound scan of pregnant uterus (14 weeks or more), each additional fetus" 2342885_1 CDM 0402 RC 76810 HCPCS inpatient 1179 766.35 ANTHEM HMO ANTHEM HMO 999999999 713.88 1143.63 "Ultrasound scan of pregnant uterus (14 weeks or more), each additional fetus" 2342885_1 CDM 0402 RC 76810 HCPCS inpatient 1179 766.35 CIGNA - ALL PLANS CIGNA - ALL PLANS 797 67.6 999999999 713.88 1143.63 percent of total billed charges "Ultrasound scan of pregnant uterus (14 weeks or more), each additional fetus" 2342885_1 CDM 0402 RC 76810 HCPCS inpatient 1179 766.35 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 713.88 1143.63 "Ultrasound scan of pregnant uterus (14 weeks or more), each additional fetus" 2342885_1 CDM 0402 RC 76810 HCPCS inpatient 1179 766.35 UHC - ALL PLANS UHC - ALL PLANS 999999999 713.88 1143.63 "Ultrasound scan of pregnant uterus (less than 14 weeks), single or first fetus" 2396609_1 CDM 0402 RC 76801 HCPCS inpatient 811 527.15 SELF PAY DISCOUNT SELF PAY DISCOUNT 527.15 65 999999999 491.06 786.67 percent of total billed charges "Ultrasound scan of pregnant uterus (less than 14 weeks), single or first fetus" 2396609_1 CDM 0402 RC 76801 HCPCS inpatient 811 527.15 AETNA AETNA 640.69 79 999999999 491.06 786.67 percent of total billed charges "Ultrasound scan of pregnant uterus (less than 14 weeks), single or first fetus" 2396609_1 CDM 0402 RC 76801 HCPCS inpatient 811 527.15 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 786.67 97 999999999 491.06 786.67 percent of total billed charges "Ultrasound scan of pregnant uterus (less than 14 weeks), single or first fetus" 2396609_1 CDM 0402 RC 76801 HCPCS inpatient 811 527.15 ENCORE - ALL PLANS ENCORE - ALL PLANS 559.59 69 999999999 491.06 786.67 percent of total billed charges "Ultrasound scan of pregnant uterus (less than 14 weeks), single or first fetus" 2396609_1 CDM 0402 RC 76801 HCPCS inpatient 811 527.15 HUMANA - ALL PLANS HUMANA - ALL PLANS 632.58 78 999999999 491.06 786.67 percent of total billed charges "Ultrasound scan of pregnant uterus (less than 14 weeks), single or first fetus" 2396609_1 CDM 0402 RC 76801 HCPCS inpatient 811 527.15 UMR - ALL PLANS UMR - ALL PLANS 567.7 70 999999999 491.06 786.67 percent of total billed charges "Ultrasound scan of pregnant uterus (less than 14 weeks), single or first fetus" 2396609_1 CDM 0402 RC 76801 HCPCS inpatient 811 527.15 SIHO - ALL PLANS SIHO - ALL PLANS 729.9 90 999999999 491.06 786.67 percent of total billed charges "Ultrasound scan of pregnant uterus (less than 14 weeks), single or first fetus" 2396609_1 CDM 0402 RC 76801 HCPCS inpatient 811 527.15 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 491.06 60.55 999999999 491.06 786.67 percent of total billed charges "Ultrasound scan of pregnant uterus (less than 14 weeks), single or first fetus" 2396609_1 CDM 0402 RC 76801 HCPCS inpatient 811 527.15 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 491.06 786.67 "Ultrasound scan of pregnant uterus (less than 14 weeks), single or first fetus" 2396609_1 CDM 0402 RC 76801 HCPCS inpatient 811 527.15 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 491.06 786.67 "Ultrasound scan of pregnant uterus (less than 14 weeks), single or first fetus" 2396609_1 CDM 0402 RC 76801 HCPCS inpatient 811 527.15 ANTHEM HMO ANTHEM HMO 999999999 491.06 786.67 "Ultrasound scan of pregnant uterus (less than 14 weeks), single or first fetus" 2396609_1 CDM 0402 RC 76801 HCPCS inpatient 811 527.15 CIGNA - ALL PLANS CIGNA - ALL PLANS 548.24 67.6 999999999 491.06 786.67 percent of total billed charges "Ultrasound scan of pregnant uterus (less than 14 weeks), single or first fetus" 2396609_1 CDM 0402 RC 76801 HCPCS inpatient 811 527.15 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 491.06 786.67 "Ultrasound scan of pregnant uterus (less than 14 weeks), single or first fetus" 2396609_1 CDM 0402 RC 76801 HCPCS inpatient 811 527.15 UHC - ALL PLANS UHC - ALL PLANS 999999999 491.06 786.67 "Training for self-care or home management, each 15 minutes" 2573543_1 CDM 0430 RC 97535 HCPCS inpatient 186 120.9 SELF PAY DISCOUNT SELF PAY DISCOUNT 120.9 65 999999999 112.62 180.42 percent of total billed charges "Training for self-care or home management, each 15 minutes" 2573543_1 CDM 0430 RC 97535 HCPCS inpatient 186 120.9 AETNA AETNA 146.94 79 999999999 112.62 180.42 percent of total billed charges "Training for self-care or home management, each 15 minutes" 2573543_1 CDM 0430 RC 97535 HCPCS inpatient 186 120.9 ENCORE - ALL PLANS ENCORE - ALL PLANS 128.34 69 999999999 112.62 180.42 percent of total billed charges "Training for self-care or home management, each 15 minutes" 2573543_1 CDM 0430 RC 97535 HCPCS inpatient 186 120.9 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 180.42 97 999999999 112.62 180.42 percent of total billed charges "Training for self-care or home management, each 15 minutes" 2573543_1 CDM 0430 RC 97535 HCPCS inpatient 186 120.9 HUMANA - ALL PLANS HUMANA - ALL PLANS 145.08 78 999999999 112.62 180.42 percent of total billed charges "Training for self-care or home management, each 15 minutes" 2573543_1 CDM 0430 RC 97535 HCPCS inpatient 186 120.9 UMR - ALL PLANS UMR - ALL PLANS 130.2 70 999999999 112.62 180.42 percent of total billed charges "Training for self-care or home management, each 15 minutes" 2573543_1 CDM 0430 RC 97535 HCPCS inpatient 186 120.9 SIHO - ALL PLANS SIHO - ALL PLANS 167.4 90 999999999 112.62 180.42 percent of total billed charges "Training for self-care or home management, each 15 minutes" 2573543_1 CDM 0430 RC 97535 HCPCS inpatient 186 120.9 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 112.62 60.55 999999999 112.62 180.42 percent of total billed charges "Training for self-care or home management, each 15 minutes" 2573543_1 CDM 0430 RC 97535 HCPCS inpatient 186 120.9 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 112.62 180.42 "Training for self-care or home management, each 15 minutes" 2573543_1 CDM 0430 RC 97535 HCPCS inpatient 186 120.9 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 112.62 180.42 "Training for self-care or home management, each 15 minutes" 2573543_1 CDM 0430 RC 97535 HCPCS inpatient 186 120.9 ANTHEM HMO ANTHEM HMO 999999999 112.62 180.42 "Training for self-care or home management, each 15 minutes" 2573543_1 CDM 0430 RC 97535 HCPCS inpatient 186 120.9 CIGNA - ALL PLANS CIGNA - ALL PLANS 125.74 67.6 999999999 112.62 180.42 percent of total billed charges "Training for self-care or home management, each 15 minutes" 2573543_1 CDM 0430 RC 97535 HCPCS inpatient 186 120.9 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 112.62 180.42 "Training for self-care or home management, each 15 minutes" 2573543_1 CDM 0430 RC 97535 HCPCS inpatient 186 120.9 UHC - ALL PLANS UHC - ALL PLANS 999999999 112.62 180.42 "Application of electrical stimulation with therapist present, each 15 minutes" 2573545_1 CDM 0430 RC 97032 HCPCS inpatient 188 122.2 SELF PAY DISCOUNT SELF PAY DISCOUNT 122.2 65 999999999 113.83 182.36 percent of total billed charges "Application of electrical stimulation with therapist present, each 15 minutes" 2573545_1 CDM 0430 RC 97032 HCPCS inpatient 188 122.2 AETNA AETNA 148.52 79 999999999 113.83 182.36 percent of total billed charges "Application of electrical stimulation with therapist present, each 15 minutes" 2573545_1 CDM 0430 RC 97032 HCPCS inpatient 188 122.2 ENCORE - ALL PLANS ENCORE - ALL PLANS 129.72 69 999999999 113.83 182.36 percent of total billed charges "Application of electrical stimulation with therapist present, each 15 minutes" 2573545_1 CDM 0430 RC 97032 HCPCS inpatient 188 122.2 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 182.36 97 999999999 113.83 182.36 percent of total billed charges "Application of electrical stimulation with therapist present, each 15 minutes" 2573545_1 CDM 0430 RC 97032 HCPCS inpatient 188 122.2 HUMANA - ALL PLANS HUMANA - ALL PLANS 146.64 78 999999999 113.83 182.36 percent of total billed charges "Application of electrical stimulation with therapist present, each 15 minutes" 2573545_1 CDM 0430 RC 97032 HCPCS inpatient 188 122.2 UMR - ALL PLANS UMR - ALL PLANS 131.6 70 999999999 113.83 182.36 percent of total billed charges "Application of electrical stimulation with therapist present, each 15 minutes" 2573545_1 CDM 0430 RC 97032 HCPCS inpatient 188 122.2 SIHO - ALL PLANS SIHO - ALL PLANS 169.2 90 999999999 113.83 182.36 percent of total billed charges "Application of electrical stimulation with therapist present, each 15 minutes" 2573545_1 CDM 0430 RC 97032 HCPCS inpatient 188 122.2 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 113.83 60.55 999999999 113.83 182.36 percent of total billed charges "Application of electrical stimulation with therapist present, each 15 minutes" 2573545_1 CDM 0430 RC 97032 HCPCS inpatient 188 122.2 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 113.83 182.36 "Application of electrical stimulation with therapist present, each 15 minutes" 2573545_1 CDM 0430 RC 97032 HCPCS inpatient 188 122.2 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 113.83 182.36 "Application of electrical stimulation with therapist present, each 15 minutes" 2573545_1 CDM 0430 RC 97032 HCPCS inpatient 188 122.2 ANTHEM HMO ANTHEM HMO 999999999 113.83 182.36 "Application of electrical stimulation with therapist present, each 15 minutes" 2573545_1 CDM 0430 RC 97032 HCPCS inpatient 188 122.2 CIGNA - ALL PLANS CIGNA - ALL PLANS 127.09 67.6 999999999 113.83 182.36 percent of total billed charges "Application of electrical stimulation with therapist present, each 15 minutes" 2573545_1 CDM 0430 RC 97032 HCPCS inpatient 188 122.2 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 113.83 182.36 "Application of electrical stimulation with therapist present, each 15 minutes" 2573545_1 CDM 0430 RC 97032 HCPCS inpatient 188 122.2 UHC - ALL PLANS UHC - ALL PLANS 999999999 113.83 182.36 "Application of medication using electrical current, each 15 minutes" 2573546_1 CDM 0430 RC 97033 HCPCS inpatient 216 140.4 SELF PAY DISCOUNT SELF PAY DISCOUNT 140.4 65 999999999 130.79 209.52 percent of total billed charges "Application of medication using electrical current, each 15 minutes" 2573546_1 CDM 0430 RC 97033 HCPCS inpatient 216 140.4 AETNA AETNA 170.64 79 999999999 130.79 209.52 percent of total billed charges "Application of medication using electrical current, each 15 minutes" 2573546_1 CDM 0430 RC 97033 HCPCS inpatient 216 140.4 ENCORE - ALL PLANS ENCORE - ALL PLANS 149.04 69 999999999 130.79 209.52 percent of total billed charges "Application of medication using electrical current, each 15 minutes" 2573546_1 CDM 0430 RC 97033 HCPCS inpatient 216 140.4 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 209.52 97 999999999 130.79 209.52 percent of total billed charges "Application of medication using electrical current, each 15 minutes" 2573546_1 CDM 0430 RC 97033 HCPCS inpatient 216 140.4 HUMANA - ALL PLANS HUMANA - ALL PLANS 168.48 78 999999999 130.79 209.52 percent of total billed charges "Application of medication using electrical current, each 15 minutes" 2573546_1 CDM 0430 RC 97033 HCPCS inpatient 216 140.4 UMR - ALL PLANS UMR - ALL PLANS 151.2 70 999999999 130.79 209.52 percent of total billed charges "Application of medication using electrical current, each 15 minutes" 2573546_1 CDM 0430 RC 97033 HCPCS inpatient 216 140.4 SIHO - ALL PLANS SIHO - ALL PLANS 194.4 90 999999999 130.79 209.52 percent of total billed charges "Application of medication using electrical current, each 15 minutes" 2573546_1 CDM 0430 RC 97033 HCPCS inpatient 216 140.4 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 130.79 60.55 999999999 130.79 209.52 percent of total billed charges "Application of medication using electrical current, each 15 minutes" 2573546_1 CDM 0430 RC 97033 HCPCS inpatient 216 140.4 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 130.79 209.52 "Application of medication using electrical current, each 15 minutes" 2573546_1 CDM 0430 RC 97033 HCPCS inpatient 216 140.4 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 130.79 209.52 "Application of medication using electrical current, each 15 minutes" 2573546_1 CDM 0430 RC 97033 HCPCS inpatient 216 140.4 ANTHEM HMO ANTHEM HMO 999999999 130.79 209.52 "Application of medication using electrical current, each 15 minutes" 2573546_1 CDM 0430 RC 97033 HCPCS inpatient 216 140.4 CIGNA - ALL PLANS CIGNA - ALL PLANS 146.02 67.6 999999999 130.79 209.52 percent of total billed charges "Application of medication using electrical current, each 15 minutes" 2573546_1 CDM 0430 RC 97033 HCPCS inpatient 216 140.4 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 130.79 209.52 "Application of medication using electrical current, each 15 minutes" 2573546_1 CDM 0430 RC 97033 HCPCS inpatient 216 140.4 UHC - ALL PLANS UHC - ALL PLANS 999999999 130.79 209.52 "Therapy procedure using massage, each 15 minutes" 2573548_1 CDM 0430 RC 97124 HCPCS inpatient 196 127.4 SELF PAY DISCOUNT SELF PAY DISCOUNT 127.4 65 999999999 118.68 190.12 percent of total billed charges "Therapy procedure using massage, each 15 minutes" 2573548_1 CDM 0430 RC 97124 HCPCS inpatient 196 127.4 AETNA AETNA 154.84 79 999999999 118.68 190.12 percent of total billed charges "Therapy procedure using massage, each 15 minutes" 2573548_1 CDM 0430 RC 97124 HCPCS inpatient 196 127.4 ENCORE - ALL PLANS ENCORE - ALL PLANS 135.24 69 999999999 118.68 190.12 percent of total billed charges "Therapy procedure using massage, each 15 minutes" 2573548_1 CDM 0430 RC 97124 HCPCS inpatient 196 127.4 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 190.12 97 999999999 118.68 190.12 percent of total billed charges "Therapy procedure using massage, each 15 minutes" 2573548_1 CDM 0430 RC 97124 HCPCS inpatient 196 127.4 HUMANA - ALL PLANS HUMANA - ALL PLANS 152.88 78 999999999 118.68 190.12 percent of total billed charges "Therapy procedure using massage, each 15 minutes" 2573548_1 CDM 0430 RC 97124 HCPCS inpatient 196 127.4 UMR - ALL PLANS UMR - ALL PLANS 137.2 70 999999999 118.68 190.12 percent of total billed charges "Therapy procedure using massage, each 15 minutes" 2573548_1 CDM 0430 RC 97124 HCPCS inpatient 196 127.4 SIHO - ALL PLANS SIHO - ALL PLANS 176.4 90 999999999 118.68 190.12 percent of total billed charges "Therapy procedure using massage, each 15 minutes" 2573548_1 CDM 0430 RC 97124 HCPCS inpatient 196 127.4 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 118.68 60.55 999999999 118.68 190.12 percent of total billed charges "Therapy procedure using massage, each 15 minutes" 2573548_1 CDM 0430 RC 97124 HCPCS inpatient 196 127.4 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 118.68 190.12 "Therapy procedure using massage, each 15 minutes" 2573548_1 CDM 0430 RC 97124 HCPCS inpatient 196 127.4 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 118.68 190.12 "Therapy procedure using massage, each 15 minutes" 2573548_1 CDM 0430 RC 97124 HCPCS inpatient 196 127.4 ANTHEM HMO ANTHEM HMO 999999999 118.68 190.12 "Therapy procedure using massage, each 15 minutes" 2573548_1 CDM 0430 RC 97124 HCPCS inpatient 196 127.4 CIGNA - ALL PLANS CIGNA - ALL PLANS 132.5 67.6 999999999 118.68 190.12 percent of total billed charges "Therapy procedure using massage, each 15 minutes" 2573548_1 CDM 0430 RC 97124 HCPCS inpatient 196 127.4 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 118.68 190.12 "Therapy procedure using massage, each 15 minutes" 2573548_1 CDM 0430 RC 97124 HCPCS inpatient 196 127.4 UHC - ALL PLANS UHC - ALL PLANS 999999999 118.68 190.12 Application of hot wax bath 2573551_1 CDM 0430 RC 97018 HCPCS inpatient 201 130.65 SELF PAY DISCOUNT SELF PAY DISCOUNT 130.65 65 999999999 121.71 194.97 percent of total billed charges Application of hot wax bath 2573551_1 CDM 0430 RC 97018 HCPCS inpatient 201 130.65 AETNA AETNA 158.79 79 999999999 121.71 194.97 percent of total billed charges Application of hot wax bath 2573551_1 CDM 0430 RC 97018 HCPCS inpatient 201 130.65 ENCORE - ALL PLANS ENCORE - ALL PLANS 138.69 69 999999999 121.71 194.97 percent of total billed charges Application of hot wax bath 2573551_1 CDM 0430 RC 97018 HCPCS inpatient 201 130.65 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 194.97 97 999999999 121.71 194.97 percent of total billed charges Application of hot wax bath 2573551_1 CDM 0430 RC 97018 HCPCS inpatient 201 130.65 HUMANA - ALL PLANS HUMANA - ALL PLANS 156.78 78 999999999 121.71 194.97 percent of total billed charges Application of hot wax bath 2573551_1 CDM 0430 RC 97018 HCPCS inpatient 201 130.65 UMR - ALL PLANS UMR - ALL PLANS 140.7 70 999999999 121.71 194.97 percent of total billed charges Application of hot wax bath 2573551_1 CDM 0430 RC 97018 HCPCS inpatient 201 130.65 SIHO - ALL PLANS SIHO - ALL PLANS 180.9 90 999999999 121.71 194.97 percent of total billed charges Application of hot wax bath 2573551_1 CDM 0430 RC 97018 HCPCS inpatient 201 130.65 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 121.71 60.55 999999999 121.71 194.97 percent of total billed charges Application of hot wax bath 2573551_1 CDM 0430 RC 97018 HCPCS inpatient 201 130.65 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 121.71 194.97 Application of hot wax bath 2573551_1 CDM 0430 RC 97018 HCPCS inpatient 201 130.65 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 121.71 194.97 Application of hot wax bath 2573551_1 CDM 0430 RC 97018 HCPCS inpatient 201 130.65 ANTHEM HMO ANTHEM HMO 999999999 121.71 194.97 Application of hot wax bath 2573551_1 CDM 0430 RC 97018 HCPCS inpatient 201 130.65 CIGNA - ALL PLANS CIGNA - ALL PLANS 135.88 67.6 999999999 121.71 194.97 percent of total billed charges Application of hot wax bath 2573551_1 CDM 0430 RC 97018 HCPCS inpatient 201 130.65 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 121.71 194.97 Application of hot wax bath 2573551_1 CDM 0430 RC 97018 HCPCS inpatient 201 130.65 UHC - ALL PLANS UHC - ALL PLANS 999999999 121.71 194.97 "Application of ultrasound, each 15 minutes" 2573552_1 CDM 0430 RC 97035 HCPCS inpatient 196 127.4 SELF PAY DISCOUNT SELF PAY DISCOUNT 127.4 65 999999999 118.68 190.12 percent of total billed charges "Application of ultrasound, each 15 minutes" 2573552_1 CDM 0430 RC 97035 HCPCS inpatient 196 127.4 AETNA AETNA 154.84 79 999999999 118.68 190.12 percent of total billed charges "Application of ultrasound, each 15 minutes" 2573552_1 CDM 0430 RC 97035 HCPCS inpatient 196 127.4 ENCORE - ALL PLANS ENCORE - ALL PLANS 135.24 69 999999999 118.68 190.12 percent of total billed charges "Application of ultrasound, each 15 minutes" 2573552_1 CDM 0430 RC 97035 HCPCS inpatient 196 127.4 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 190.12 97 999999999 118.68 190.12 percent of total billed charges "Application of ultrasound, each 15 minutes" 2573552_1 CDM 0430 RC 97035 HCPCS inpatient 196 127.4 HUMANA - ALL PLANS HUMANA - ALL PLANS 152.88 78 999999999 118.68 190.12 percent of total billed charges "Application of ultrasound, each 15 minutes" 2573552_1 CDM 0430 RC 97035 HCPCS inpatient 196 127.4 UMR - ALL PLANS UMR - ALL PLANS 137.2 70 999999999 118.68 190.12 percent of total billed charges "Application of ultrasound, each 15 minutes" 2573552_1 CDM 0430 RC 97035 HCPCS inpatient 196 127.4 SIHO - ALL PLANS SIHO - ALL PLANS 176.4 90 999999999 118.68 190.12 percent of total billed charges "Application of ultrasound, each 15 minutes" 2573552_1 CDM 0430 RC 97035 HCPCS inpatient 196 127.4 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 118.68 60.55 999999999 118.68 190.12 percent of total billed charges "Application of ultrasound, each 15 minutes" 2573552_1 CDM 0430 RC 97035 HCPCS inpatient 196 127.4 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 118.68 190.12 "Application of ultrasound, each 15 minutes" 2573552_1 CDM 0430 RC 97035 HCPCS inpatient 196 127.4 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 118.68 190.12 "Application of ultrasound, each 15 minutes" 2573552_1 CDM 0430 RC 97035 HCPCS inpatient 196 127.4 ANTHEM HMO ANTHEM HMO 999999999 118.68 190.12 "Application of ultrasound, each 15 minutes" 2573552_1 CDM 0430 RC 97035 HCPCS inpatient 196 127.4 CIGNA - ALL PLANS CIGNA - ALL PLANS 132.5 67.6 999999999 118.68 190.12 percent of total billed charges "Application of ultrasound, each 15 minutes" 2573552_1 CDM 0430 RC 97035 HCPCS inpatient 196 127.4 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 118.68 190.12 "Application of ultrasound, each 15 minutes" 2573552_1 CDM 0430 RC 97035 HCPCS inpatient 196 127.4 UHC - ALL PLANS UHC - ALL PLANS 999999999 118.68 190.12 "Strapping, Unna boot" 2573952_1 CDM 0420 RC 29580 HCPCS inpatient 350 227.5 SELF PAY DISCOUNT SELF PAY DISCOUNT 227.5 65 999999999 211.93 339.5 percent of total billed charges "Strapping, Unna boot" 2573952_1 CDM 0420 RC 29580 HCPCS inpatient 350 227.5 AETNA AETNA 276.5 79 999999999 211.93 339.5 percent of total billed charges "Strapping, Unna boot" 2573952_1 CDM 0420 RC 29580 HCPCS inpatient 350 227.5 ENCORE - ALL PLANS ENCORE - ALL PLANS 241.5 69 999999999 211.93 339.5 percent of total billed charges "Strapping, Unna boot" 2573952_1 CDM 0420 RC 29580 HCPCS inpatient 350 227.5 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 339.5 97 999999999 211.93 339.5 percent of total billed charges "Strapping, Unna boot" 2573952_1 CDM 0420 RC 29580 HCPCS inpatient 350 227.5 HUMANA - ALL PLANS HUMANA - ALL PLANS 273 78 999999999 211.93 339.5 percent of total billed charges "Strapping, Unna boot" 2573952_1 CDM 0420 RC 29580 HCPCS inpatient 350 227.5 UMR - ALL PLANS UMR - ALL PLANS 245 70 999999999 211.93 339.5 percent of total billed charges "Strapping, Unna boot" 2573952_1 CDM 0420 RC 29580 HCPCS inpatient 350 227.5 SIHO - ALL PLANS SIHO - ALL PLANS 315 90 999999999 211.93 339.5 percent of total billed charges "Strapping, Unna boot" 2573952_1 CDM 0420 RC 29580 HCPCS inpatient 350 227.5 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 211.93 60.55 999999999 211.93 339.5 percent of total billed charges "Strapping, Unna boot" 2573952_1 CDM 0420 RC 29580 HCPCS inpatient 350 227.5 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 211.93 339.5 "Strapping, Unna boot" 2573952_1 CDM 0420 RC 29580 HCPCS inpatient 350 227.5 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 211.93 339.5 "Strapping, Unna boot" 2573952_1 CDM 0420 RC 29580 HCPCS inpatient 350 227.5 ANTHEM HMO ANTHEM HMO 999999999 211.93 339.5 "Strapping, Unna boot" 2573952_1 CDM 0420 RC 29580 HCPCS inpatient 350 227.5 CIGNA - ALL PLANS CIGNA - ALL PLANS 236.6 67.6 999999999 211.93 339.5 percent of total billed charges "Strapping, Unna boot" 2573952_1 CDM 0420 RC 29580 HCPCS inpatient 350 227.5 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 211.93 339.5 "Strapping, Unna boot" 2573952_1 CDM 0420 RC 29580 HCPCS inpatient 350 227.5 UHC - ALL PLANS UHC - ALL PLANS 999999999 211.93 339.5 Application of whirlpool therapy 2573954_1 CDM 0420 RC 97022 HCPCS inpatient 143 92.95 SELF PAY DISCOUNT SELF PAY DISCOUNT 92.95 65 999999999 86.59 138.71 percent of total billed charges Application of whirlpool therapy 2573954_1 CDM 0420 RC 97022 HCPCS inpatient 143 92.95 AETNA AETNA 112.97 79 999999999 86.59 138.71 percent of total billed charges Application of whirlpool therapy 2573954_1 CDM 0420 RC 97022 HCPCS inpatient 143 92.95 ENCORE - ALL PLANS ENCORE - ALL PLANS 98.67 69 999999999 86.59 138.71 percent of total billed charges Application of whirlpool therapy 2573954_1 CDM 0420 RC 97022 HCPCS inpatient 143 92.95 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 138.71 97 999999999 86.59 138.71 percent of total billed charges Application of whirlpool therapy 2573954_1 CDM 0420 RC 97022 HCPCS inpatient 143 92.95 HUMANA - ALL PLANS HUMANA - ALL PLANS 111.54 78 999999999 86.59 138.71 percent of total billed charges Application of whirlpool therapy 2573954_1 CDM 0420 RC 97022 HCPCS inpatient 143 92.95 UMR - ALL PLANS UMR - ALL PLANS 100.1 70 999999999 86.59 138.71 percent of total billed charges Application of whirlpool therapy 2573954_1 CDM 0420 RC 97022 HCPCS inpatient 143 92.95 SIHO - ALL PLANS SIHO - ALL PLANS 128.7 90 999999999 86.59 138.71 percent of total billed charges Application of whirlpool therapy 2573954_1 CDM 0420 RC 97022 HCPCS inpatient 143 92.95 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 86.59 60.55 999999999 86.59 138.71 percent of total billed charges Application of whirlpool therapy 2573954_1 CDM 0420 RC 97022 HCPCS inpatient 143 92.95 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 86.59 138.71 Application of whirlpool therapy 2573954_1 CDM 0420 RC 97022 HCPCS inpatient 143 92.95 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 86.59 138.71 Application of whirlpool therapy 2573954_1 CDM 0420 RC 97022 HCPCS inpatient 143 92.95 ANTHEM HMO ANTHEM HMO 999999999 86.59 138.71 Application of whirlpool therapy 2573954_1 CDM 0420 RC 97022 HCPCS inpatient 143 92.95 CIGNA - ALL PLANS CIGNA - ALL PLANS 96.67 67.6 999999999 86.59 138.71 percent of total billed charges Application of whirlpool therapy 2573954_1 CDM 0420 RC 97022 HCPCS inpatient 143 92.95 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 86.59 138.71 Application of whirlpool therapy 2573954_1 CDM 0420 RC 97022 HCPCS inpatient 143 92.95 UHC - ALL PLANS UHC - ALL PLANS 999999999 86.59 138.71 "Training in the use of orthopedic device for arm, leg and/or trunk, each 15 minutes" 2574031_1 CDM 0420 RC 97760 HCPCS inpatient 142 92.3 SELF PAY DISCOUNT SELF PAY DISCOUNT 92.3 65 999999999 85.98 137.74 percent of total billed charges "Training in the use of orthopedic device for arm, leg and/or trunk, each 15 minutes" 2574031_1 CDM 0420 RC 97760 HCPCS inpatient 142 92.3 AETNA AETNA 112.18 79 999999999 85.98 137.74 percent of total billed charges "Training in the use of orthopedic device for arm, leg and/or trunk, each 15 minutes" 2574031_1 CDM 0420 RC 97760 HCPCS inpatient 142 92.3 ENCORE - ALL PLANS ENCORE - ALL PLANS 97.98 69 999999999 85.98 137.74 percent of total billed charges "Training in the use of orthopedic device for arm, leg and/or trunk, each 15 minutes" 2574031_1 CDM 0420 RC 97760 HCPCS inpatient 142 92.3 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 137.74 97 999999999 85.98 137.74 percent of total billed charges "Training in the use of orthopedic device for arm, leg and/or trunk, each 15 minutes" 2574031_1 CDM 0420 RC 97760 HCPCS inpatient 142 92.3 HUMANA - ALL PLANS HUMANA - ALL PLANS 110.76 78 999999999 85.98 137.74 percent of total billed charges "Training in the use of orthopedic device for arm, leg and/or trunk, each 15 minutes" 2574031_1 CDM 0420 RC 97760 HCPCS inpatient 142 92.3 UMR - ALL PLANS UMR - ALL PLANS 99.4 70 999999999 85.98 137.74 percent of total billed charges "Training in the use of orthopedic device for arm, leg and/or trunk, each 15 minutes" 2574031_1 CDM 0420 RC 97760 HCPCS inpatient 142 92.3 SIHO - ALL PLANS SIHO - ALL PLANS 127.8 90 999999999 85.98 137.74 percent of total billed charges "Training in the use of orthopedic device for arm, leg and/or trunk, each 15 minutes" 2574031_1 CDM 0420 RC 97760 HCPCS inpatient 142 92.3 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 85.98 60.55 999999999 85.98 137.74 percent of total billed charges "Training in the use of orthopedic device for arm, leg and/or trunk, each 15 minutes" 2574031_1 CDM 0420 RC 97760 HCPCS inpatient 142 92.3 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 85.98 137.74 "Training in the use of orthopedic device for arm, leg and/or trunk, each 15 minutes" 2574031_1 CDM 0420 RC 97760 HCPCS inpatient 142 92.3 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 85.98 137.74 "Training in the use of orthopedic device for arm, leg and/or trunk, each 15 minutes" 2574031_1 CDM 0420 RC 97760 HCPCS inpatient 142 92.3 ANTHEM HMO ANTHEM HMO 999999999 85.98 137.74 "Training in the use of orthopedic device for arm, leg and/or trunk, each 15 minutes" 2574031_1 CDM 0420 RC 97760 HCPCS inpatient 142 92.3 CIGNA - ALL PLANS CIGNA - ALL PLANS 95.99 67.6 999999999 85.98 137.74 percent of total billed charges "Training in the use of orthopedic device for arm, leg and/or trunk, each 15 minutes" 2574031_1 CDM 0420 RC 97760 HCPCS inpatient 142 92.3 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 85.98 137.74 "Training in the use of orthopedic device for arm, leg and/or trunk, each 15 minutes" 2574031_1 CDM 0420 RC 97760 HCPCS inpatient 142 92.3 UHC - ALL PLANS UHC - ALL PLANS 999999999 85.98 137.74 "Training in the use of orthopedic device for arm, leg and/or trunk, each 15 minutes" 2574033_1 CDM 0430 RC 97760 HCPCS inpatient 133 86.45 SELF PAY DISCOUNT SELF PAY DISCOUNT 86.45 65 999999999 80.53 129.01 percent of total billed charges "Training in the use of orthopedic device for arm, leg and/or trunk, each 15 minutes" 2574033_1 CDM 0430 RC 97760 HCPCS inpatient 133 86.45 AETNA AETNA 105.07 79 999999999 80.53 129.01 percent of total billed charges "Training in the use of orthopedic device for arm, leg and/or trunk, each 15 minutes" 2574033_1 CDM 0430 RC 97760 HCPCS inpatient 133 86.45 ENCORE - ALL PLANS ENCORE - ALL PLANS 91.77 69 999999999 80.53 129.01 percent of total billed charges "Training in the use of orthopedic device for arm, leg and/or trunk, each 15 minutes" 2574033_1 CDM 0430 RC 97760 HCPCS inpatient 133 86.45 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 129.01 97 999999999 80.53 129.01 percent of total billed charges "Training in the use of orthopedic device for arm, leg and/or trunk, each 15 minutes" 2574033_1 CDM 0430 RC 97760 HCPCS inpatient 133 86.45 HUMANA - ALL PLANS HUMANA - ALL PLANS 103.74 78 999999999 80.53 129.01 percent of total billed charges "Training in the use of orthopedic device for arm, leg and/or trunk, each 15 minutes" 2574033_1 CDM 0430 RC 97760 HCPCS inpatient 133 86.45 UMR - ALL PLANS UMR - ALL PLANS 93.1 70 999999999 80.53 129.01 percent of total billed charges "Training in the use of orthopedic device for arm, leg and/or trunk, each 15 minutes" 2574033_1 CDM 0430 RC 97760 HCPCS inpatient 133 86.45 SIHO - ALL PLANS SIHO - ALL PLANS 119.7 90 999999999 80.53 129.01 percent of total billed charges "Training in the use of orthopedic device for arm, leg and/or trunk, each 15 minutes" 2574033_1 CDM 0430 RC 97760 HCPCS inpatient 133 86.45 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 80.53 60.55 999999999 80.53 129.01 percent of total billed charges "Training in the use of orthopedic device for arm, leg and/or trunk, each 15 minutes" 2574033_1 CDM 0430 RC 97760 HCPCS inpatient 133 86.45 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 80.53 129.01 "Training in the use of orthopedic device for arm, leg and/or trunk, each 15 minutes" 2574033_1 CDM 0430 RC 97760 HCPCS inpatient 133 86.45 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 80.53 129.01 "Training in the use of orthopedic device for arm, leg and/or trunk, each 15 minutes" 2574033_1 CDM 0430 RC 97760 HCPCS inpatient 133 86.45 ANTHEM HMO ANTHEM HMO 999999999 80.53 129.01 "Training in the use of orthopedic device for arm, leg and/or trunk, each 15 minutes" 2574033_1 CDM 0430 RC 97760 HCPCS inpatient 133 86.45 CIGNA - ALL PLANS CIGNA - ALL PLANS 89.91 67.6 999999999 80.53 129.01 percent of total billed charges "Training in the use of orthopedic device for arm, leg and/or trunk, each 15 minutes" 2574033_1 CDM 0430 RC 97760 HCPCS inpatient 133 86.45 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 80.53 129.01 "Training in the use of orthopedic device for arm, leg and/or trunk, each 15 minutes" 2574033_1 CDM 0430 RC 97760 HCPCS inpatient 133 86.45 UHC - ALL PLANS UHC - ALL PLANS 999999999 80.53 129.01 "Therapy procedure using massage, each 15 minutes" 2574137_1 CDM 0420 RC 97124 HCPCS inpatient 178 115.7 SELF PAY DISCOUNT SELF PAY DISCOUNT 115.7 65 999999999 107.78 172.66 percent of total billed charges "Therapy procedure using massage, each 15 minutes" 2574137_1 CDM 0420 RC 97124 HCPCS inpatient 178 115.7 AETNA AETNA 140.62 79 999999999 107.78 172.66 percent of total billed charges "Therapy procedure using massage, each 15 minutes" 2574137_1 CDM 0420 RC 97124 HCPCS inpatient 178 115.7 ENCORE - ALL PLANS ENCORE - ALL PLANS 122.82 69 999999999 107.78 172.66 percent of total billed charges "Therapy procedure using massage, each 15 minutes" 2574137_1 CDM 0420 RC 97124 HCPCS inpatient 178 115.7 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 172.66 97 999999999 107.78 172.66 percent of total billed charges "Therapy procedure using massage, each 15 minutes" 2574137_1 CDM 0420 RC 97124 HCPCS inpatient 178 115.7 HUMANA - ALL PLANS HUMANA - ALL PLANS 138.84 78 999999999 107.78 172.66 percent of total billed charges "Therapy procedure using massage, each 15 minutes" 2574137_1 CDM 0420 RC 97124 HCPCS inpatient 178 115.7 UMR - ALL PLANS UMR - ALL PLANS 124.6 70 999999999 107.78 172.66 percent of total billed charges "Therapy procedure using massage, each 15 minutes" 2574137_1 CDM 0420 RC 97124 HCPCS inpatient 178 115.7 SIHO - ALL PLANS SIHO - ALL PLANS 160.2 90 999999999 107.78 172.66 percent of total billed charges "Therapy procedure using massage, each 15 minutes" 2574137_1 CDM 0420 RC 97124 HCPCS inpatient 178 115.7 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 107.78 60.55 999999999 107.78 172.66 percent of total billed charges "Therapy procedure using massage, each 15 minutes" 2574137_1 CDM 0420 RC 97124 HCPCS inpatient 178 115.7 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 107.78 172.66 "Therapy procedure using massage, each 15 minutes" 2574137_1 CDM 0420 RC 97124 HCPCS inpatient 178 115.7 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 107.78 172.66 "Therapy procedure using massage, each 15 minutes" 2574137_1 CDM 0420 RC 97124 HCPCS inpatient 178 115.7 ANTHEM HMO ANTHEM HMO 999999999 107.78 172.66 "Therapy procedure using massage, each 15 minutes" 2574137_1 CDM 0420 RC 97124 HCPCS inpatient 178 115.7 CIGNA - ALL PLANS CIGNA - ALL PLANS 120.33 67.6 999999999 107.78 172.66 percent of total billed charges "Therapy procedure using massage, each 15 minutes" 2574137_1 CDM 0420 RC 97124 HCPCS inpatient 178 115.7 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 107.78 172.66 "Therapy procedure using massage, each 15 minutes" 2574137_1 CDM 0420 RC 97124 HCPCS inpatient 178 115.7 UHC - ALL PLANS UHC - ALL PLANS 999999999 107.78 172.66 Application of hot wax bath 2574141_1 CDM 0420 RC 97018 HCPCS inpatient 183 118.95 SELF PAY DISCOUNT SELF PAY DISCOUNT 118.95 65 999999999 110.81 177.51 percent of total billed charges Application of hot wax bath 2574141_1 CDM 0420 RC 97018 HCPCS inpatient 183 118.95 AETNA AETNA 144.57 79 999999999 110.81 177.51 percent of total billed charges Application of hot wax bath 2574141_1 CDM 0420 RC 97018 HCPCS inpatient 183 118.95 ENCORE - ALL PLANS ENCORE - ALL PLANS 126.27 69 999999999 110.81 177.51 percent of total billed charges Application of hot wax bath 2574141_1 CDM 0420 RC 97018 HCPCS inpatient 183 118.95 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 177.51 97 999999999 110.81 177.51 percent of total billed charges Application of hot wax bath 2574141_1 CDM 0420 RC 97018 HCPCS inpatient 183 118.95 HUMANA - ALL PLANS HUMANA - ALL PLANS 142.74 78 999999999 110.81 177.51 percent of total billed charges Application of hot wax bath 2574141_1 CDM 0420 RC 97018 HCPCS inpatient 183 118.95 UMR - ALL PLANS UMR - ALL PLANS 128.1 70 999999999 110.81 177.51 percent of total billed charges Application of hot wax bath 2574141_1 CDM 0420 RC 97018 HCPCS inpatient 183 118.95 SIHO - ALL PLANS SIHO - ALL PLANS 164.7 90 999999999 110.81 177.51 percent of total billed charges Application of hot wax bath 2574141_1 CDM 0420 RC 97018 HCPCS inpatient 183 118.95 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 110.81 60.55 999999999 110.81 177.51 percent of total billed charges Application of hot wax bath 2574141_1 CDM 0420 RC 97018 HCPCS inpatient 183 118.95 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 110.81 177.51 Application of hot wax bath 2574141_1 CDM 0420 RC 97018 HCPCS inpatient 183 118.95 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 110.81 177.51 Application of hot wax bath 2574141_1 CDM 0420 RC 97018 HCPCS inpatient 183 118.95 ANTHEM HMO ANTHEM HMO 999999999 110.81 177.51 Application of hot wax bath 2574141_1 CDM 0420 RC 97018 HCPCS inpatient 183 118.95 CIGNA - ALL PLANS CIGNA - ALL PLANS 123.71 67.6 999999999 110.81 177.51 percent of total billed charges Application of hot wax bath 2574141_1 CDM 0420 RC 97018 HCPCS inpatient 183 118.95 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 110.81 177.51 Application of hot wax bath 2574141_1 CDM 0420 RC 97018 HCPCS inpatient 183 118.95 UHC - ALL PLANS UHC - ALL PLANS 999999999 110.81 177.51 Application of mechanical traction 2574174_1 CDM 0420 RC 97012 HCPCS inpatient 199 129.35 SELF PAY DISCOUNT SELF PAY DISCOUNT 129.35 65 999999999 120.49 193.03 percent of total billed charges Application of mechanical traction 2574174_1 CDM 0420 RC 97012 HCPCS inpatient 199 129.35 AETNA AETNA 157.21 79 999999999 120.49 193.03 percent of total billed charges Application of mechanical traction 2574174_1 CDM 0420 RC 97012 HCPCS inpatient 199 129.35 ENCORE - ALL PLANS ENCORE - ALL PLANS 137.31 69 999999999 120.49 193.03 percent of total billed charges Application of mechanical traction 2574174_1 CDM 0420 RC 97012 HCPCS inpatient 199 129.35 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 193.03 97 999999999 120.49 193.03 percent of total billed charges Application of mechanical traction 2574174_1 CDM 0420 RC 97012 HCPCS inpatient 199 129.35 HUMANA - ALL PLANS HUMANA - ALL PLANS 155.22 78 999999999 120.49 193.03 percent of total billed charges Application of mechanical traction 2574174_1 CDM 0420 RC 97012 HCPCS inpatient 199 129.35 UMR - ALL PLANS UMR - ALL PLANS 139.3 70 999999999 120.49 193.03 percent of total billed charges Application of mechanical traction 2574174_1 CDM 0420 RC 97012 HCPCS inpatient 199 129.35 SIHO - ALL PLANS SIHO - ALL PLANS 179.1 90 999999999 120.49 193.03 percent of total billed charges Application of mechanical traction 2574174_1 CDM 0420 RC 97012 HCPCS inpatient 199 129.35 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 120.49 60.55 999999999 120.49 193.03 percent of total billed charges Application of mechanical traction 2574174_1 CDM 0420 RC 97012 HCPCS inpatient 199 129.35 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 120.49 193.03 Application of mechanical traction 2574174_1 CDM 0420 RC 97012 HCPCS inpatient 199 129.35 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 120.49 193.03 Application of mechanical traction 2574174_1 CDM 0420 RC 97012 HCPCS inpatient 199 129.35 ANTHEM HMO ANTHEM HMO 999999999 120.49 193.03 Application of mechanical traction 2574174_1 CDM 0420 RC 97012 HCPCS inpatient 199 129.35 CIGNA - ALL PLANS CIGNA - ALL PLANS 134.52 67.6 999999999 120.49 193.03 percent of total billed charges Application of mechanical traction 2574174_1 CDM 0420 RC 97012 HCPCS inpatient 199 129.35 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 120.49 193.03 Application of mechanical traction 2574174_1 CDM 0420 RC 97012 HCPCS inpatient 199 129.35 UHC - ALL PLANS UHC - ALL PLANS 999999999 120.49 193.03 "Therapy procedure for walking training, each 15 minutes" 2574888_1 CDM 0420 RC 97116 HCPCS inpatient 168 109.2 SELF PAY DISCOUNT SELF PAY DISCOUNT 109.2 65 999999999 101.72 162.96 percent of total billed charges "Therapy procedure for walking training, each 15 minutes" 2574888_1 CDM 0420 RC 97116 HCPCS inpatient 168 109.2 AETNA AETNA 132.72 79 999999999 101.72 162.96 percent of total billed charges "Therapy procedure for walking training, each 15 minutes" 2574888_1 CDM 0420 RC 97116 HCPCS inpatient 168 109.2 ENCORE - ALL PLANS ENCORE - ALL PLANS 115.92 69 999999999 101.72 162.96 percent of total billed charges "Therapy procedure for walking training, each 15 minutes" 2574888_1 CDM 0420 RC 97116 HCPCS inpatient 168 109.2 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 162.96 97 999999999 101.72 162.96 percent of total billed charges "Therapy procedure for walking training, each 15 minutes" 2574888_1 CDM 0420 RC 97116 HCPCS inpatient 168 109.2 HUMANA - ALL PLANS HUMANA - ALL PLANS 131.04 78 999999999 101.72 162.96 percent of total billed charges "Therapy procedure for walking training, each 15 minutes" 2574888_1 CDM 0420 RC 97116 HCPCS inpatient 168 109.2 UMR - ALL PLANS UMR - ALL PLANS 117.6 70 999999999 101.72 162.96 percent of total billed charges "Therapy procedure for walking training, each 15 minutes" 2574888_1 CDM 0420 RC 97116 HCPCS inpatient 168 109.2 SIHO - ALL PLANS SIHO - ALL PLANS 151.2 90 999999999 101.72 162.96 percent of total billed charges "Therapy procedure for walking training, each 15 minutes" 2574888_1 CDM 0420 RC 97116 HCPCS inpatient 168 109.2 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 101.72 60.55 999999999 101.72 162.96 percent of total billed charges "Therapy procedure for walking training, each 15 minutes" 2574888_1 CDM 0420 RC 97116 HCPCS inpatient 168 109.2 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 101.72 162.96 "Therapy procedure for walking training, each 15 minutes" 2574888_1 CDM 0420 RC 97116 HCPCS inpatient 168 109.2 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 101.72 162.96 "Therapy procedure for walking training, each 15 minutes" 2574888_1 CDM 0420 RC 97116 HCPCS inpatient 168 109.2 ANTHEM HMO ANTHEM HMO 999999999 101.72 162.96 "Therapy procedure for walking training, each 15 minutes" 2574888_1 CDM 0420 RC 97116 HCPCS inpatient 168 109.2 CIGNA - ALL PLANS CIGNA - ALL PLANS 113.57 67.6 999999999 101.72 162.96 percent of total billed charges "Therapy procedure for walking training, each 15 minutes" 2574888_1 CDM 0420 RC 97116 HCPCS inpatient 168 109.2 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 101.72 162.96 "Therapy procedure for walking training, each 15 minutes" 2574888_1 CDM 0420 RC 97116 HCPCS inpatient 168 109.2 UHC - ALL PLANS UHC - ALL PLANS 999999999 101.72 162.96 Therapy procedure using functional activities 2574922_1 CDM 0430 RC 97530 HCPCS inpatient 169 109.85 SELF PAY DISCOUNT SELF PAY DISCOUNT 109.85 65 999999999 102.33 163.93 percent of total billed charges Therapy procedure using functional activities 2574922_1 CDM 0430 RC 97530 HCPCS inpatient 169 109.85 AETNA AETNA 133.51 79 999999999 102.33 163.93 percent of total billed charges Therapy procedure using functional activities 2574922_1 CDM 0430 RC 97530 HCPCS inpatient 169 109.85 ENCORE - ALL PLANS ENCORE - ALL PLANS 116.61 69 999999999 102.33 163.93 percent of total billed charges Therapy procedure using functional activities 2574922_1 CDM 0430 RC 97530 HCPCS inpatient 169 109.85 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 163.93 97 999999999 102.33 163.93 percent of total billed charges Therapy procedure using functional activities 2574922_1 CDM 0430 RC 97530 HCPCS inpatient 169 109.85 HUMANA - ALL PLANS HUMANA - ALL PLANS 131.82 78 999999999 102.33 163.93 percent of total billed charges Therapy procedure using functional activities 2574922_1 CDM 0430 RC 97530 HCPCS inpatient 169 109.85 UMR - ALL PLANS UMR - ALL PLANS 118.3 70 999999999 102.33 163.93 percent of total billed charges Therapy procedure using functional activities 2574922_1 CDM 0430 RC 97530 HCPCS inpatient 169 109.85 SIHO - ALL PLANS SIHO - ALL PLANS 152.1 90 999999999 102.33 163.93 percent of total billed charges Therapy procedure using functional activities 2574922_1 CDM 0430 RC 97530 HCPCS inpatient 169 109.85 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 102.33 60.55 999999999 102.33 163.93 percent of total billed charges Therapy procedure using functional activities 2574922_1 CDM 0430 RC 97530 HCPCS inpatient 169 109.85 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 102.33 163.93 Therapy procedure using functional activities 2574922_1 CDM 0430 RC 97530 HCPCS inpatient 169 109.85 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 102.33 163.93 Therapy procedure using functional activities 2574922_1 CDM 0430 RC 97530 HCPCS inpatient 169 109.85 ANTHEM HMO ANTHEM HMO 999999999 102.33 163.93 Therapy procedure using functional activities 2574922_1 CDM 0430 RC 97530 HCPCS inpatient 169 109.85 CIGNA - ALL PLANS CIGNA - ALL PLANS 114.24 67.6 999999999 102.33 163.93 percent of total billed charges Therapy procedure using functional activities 2574922_1 CDM 0430 RC 97530 HCPCS inpatient 169 109.85 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 102.33 163.93 Therapy procedure using functional activities 2574922_1 CDM 0430 RC 97530 HCPCS inpatient 169 109.85 UHC - ALL PLANS UHC - ALL PLANS 999999999 102.33 163.93 Application of blood vessel compression device 2575085_1 CDM 0420 RC 97016 HCPCS inpatient 206 133.9 SELF PAY DISCOUNT SELF PAY DISCOUNT 133.9 65 999999999 124.73 199.82 percent of total billed charges Application of blood vessel compression device 2575085_1 CDM 0420 RC 97016 HCPCS inpatient 206 133.9 AETNA AETNA 162.74 79 999999999 124.73 199.82 percent of total billed charges Application of blood vessel compression device 2575085_1 CDM 0420 RC 97016 HCPCS inpatient 206 133.9 ENCORE - ALL PLANS ENCORE - ALL PLANS 142.14 69 999999999 124.73 199.82 percent of total billed charges Application of blood vessel compression device 2575085_1 CDM 0420 RC 97016 HCPCS inpatient 206 133.9 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 199.82 97 999999999 124.73 199.82 percent of total billed charges Application of blood vessel compression device 2575085_1 CDM 0420 RC 97016 HCPCS inpatient 206 133.9 HUMANA - ALL PLANS HUMANA - ALL PLANS 160.68 78 999999999 124.73 199.82 percent of total billed charges Application of blood vessel compression device 2575085_1 CDM 0420 RC 97016 HCPCS inpatient 206 133.9 UMR - ALL PLANS UMR - ALL PLANS 144.2 70 999999999 124.73 199.82 percent of total billed charges Application of blood vessel compression device 2575085_1 CDM 0420 RC 97016 HCPCS inpatient 206 133.9 SIHO - ALL PLANS SIHO - ALL PLANS 185.4 90 999999999 124.73 199.82 percent of total billed charges Application of blood vessel compression device 2575085_1 CDM 0420 RC 97016 HCPCS inpatient 206 133.9 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 124.73 60.55 999999999 124.73 199.82 percent of total billed charges Application of blood vessel compression device 2575085_1 CDM 0420 RC 97016 HCPCS inpatient 206 133.9 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 124.73 199.82 Application of blood vessel compression device 2575085_1 CDM 0420 RC 97016 HCPCS inpatient 206 133.9 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 124.73 199.82 Application of blood vessel compression device 2575085_1 CDM 0420 RC 97016 HCPCS inpatient 206 133.9 ANTHEM HMO ANTHEM HMO 999999999 124.73 199.82 Application of blood vessel compression device 2575085_1 CDM 0420 RC 97016 HCPCS inpatient 206 133.9 CIGNA - ALL PLANS CIGNA - ALL PLANS 139.26 67.6 999999999 124.73 199.82 percent of total billed charges Application of blood vessel compression device 2575085_1 CDM 0420 RC 97016 HCPCS inpatient 206 133.9 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 124.73 199.82 Application of blood vessel compression device 2575085_1 CDM 0420 RC 97016 HCPCS inpatient 206 133.9 UHC - ALL PLANS UHC - ALL PLANS 999999999 124.73 199.82 "Test to assess the loss of the ability to speak, write, and understand language" 2575143_1 CDM 0440 RC 96105 HCPCS inpatient 387 251.55 SELF PAY DISCOUNT SELF PAY DISCOUNT 251.55 65 999999999 234.33 375.39 percent of total billed charges "Test to assess the loss of the ability to speak, write, and understand language" 2575143_1 CDM 0440 RC 96105 HCPCS inpatient 387 251.55 AETNA AETNA 305.73 79 999999999 234.33 375.39 percent of total billed charges "Test to assess the loss of the ability to speak, write, and understand language" 2575143_1 CDM 0440 RC 96105 HCPCS inpatient 387 251.55 ENCORE - ALL PLANS ENCORE - ALL PLANS 267.03 69 999999999 234.33 375.39 percent of total billed charges "Test to assess the loss of the ability to speak, write, and understand language" 2575143_1 CDM 0440 RC 96105 HCPCS inpatient 387 251.55 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 375.39 97 999999999 234.33 375.39 percent of total billed charges "Test to assess the loss of the ability to speak, write, and understand language" 2575143_1 CDM 0440 RC 96105 HCPCS inpatient 387 251.55 HUMANA - ALL PLANS HUMANA - ALL PLANS 301.86 78 999999999 234.33 375.39 percent of total billed charges "Test to assess the loss of the ability to speak, write, and understand language" 2575143_1 CDM 0440 RC 96105 HCPCS inpatient 387 251.55 UMR - ALL PLANS UMR - ALL PLANS 270.9 70 999999999 234.33 375.39 percent of total billed charges "Test to assess the loss of the ability to speak, write, and understand language" 2575143_1 CDM 0440 RC 96105 HCPCS inpatient 387 251.55 SIHO - ALL PLANS SIHO - ALL PLANS 348.3 90 999999999 234.33 375.39 percent of total billed charges "Test to assess the loss of the ability to speak, write, and understand language" 2575143_1 CDM 0440 RC 96105 HCPCS inpatient 387 251.55 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 234.33 60.55 999999999 234.33 375.39 percent of total billed charges "Test to assess the loss of the ability to speak, write, and understand language" 2575143_1 CDM 0440 RC 96105 HCPCS inpatient 387 251.55 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 234.33 375.39 "Test to assess the loss of the ability to speak, write, and understand language" 2575143_1 CDM 0440 RC 96105 HCPCS inpatient 387 251.55 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 234.33 375.39 "Test to assess the loss of the ability to speak, write, and understand language" 2575143_1 CDM 0440 RC 96105 HCPCS inpatient 387 251.55 ANTHEM HMO ANTHEM HMO 999999999 234.33 375.39 "Test to assess the loss of the ability to speak, write, and understand language" 2575143_1 CDM 0440 RC 96105 HCPCS inpatient 387 251.55 CIGNA - ALL PLANS CIGNA - ALL PLANS 261.61 67.6 999999999 234.33 375.39 percent of total billed charges "Test to assess the loss of the ability to speak, write, and understand language" 2575143_1 CDM 0440 RC 96105 HCPCS inpatient 387 251.55 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 234.33 375.39 "Test to assess the loss of the ability to speak, write, and understand language" 2575143_1 CDM 0440 RC 96105 HCPCS inpatient 387 251.55 UHC - ALL PLANS UHC - ALL PLANS 999999999 234.33 375.39 "Evaluation for wheelchair, each 15 minutes" 2575559_1 CDM 0430 RC 97542 HCPCS inpatient 168 109.2 SELF PAY DISCOUNT SELF PAY DISCOUNT 109.2 65 999999999 101.72 162.96 percent of total billed charges "Evaluation for wheelchair, each 15 minutes" 2575559_1 CDM 0430 RC 97542 HCPCS inpatient 168 109.2 AETNA AETNA 132.72 79 999999999 101.72 162.96 percent of total billed charges "Evaluation for wheelchair, each 15 minutes" 2575559_1 CDM 0430 RC 97542 HCPCS inpatient 168 109.2 ENCORE - ALL PLANS ENCORE - ALL PLANS 115.92 69 999999999 101.72 162.96 percent of total billed charges "Evaluation for wheelchair, each 15 minutes" 2575559_1 CDM 0430 RC 97542 HCPCS inpatient 168 109.2 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 162.96 97 999999999 101.72 162.96 percent of total billed charges "Evaluation for wheelchair, each 15 minutes" 2575559_1 CDM 0430 RC 97542 HCPCS inpatient 168 109.2 HUMANA - ALL PLANS HUMANA - ALL PLANS 131.04 78 999999999 101.72 162.96 percent of total billed charges "Evaluation for wheelchair, each 15 minutes" 2575559_1 CDM 0430 RC 97542 HCPCS inpatient 168 109.2 UMR - ALL PLANS UMR - ALL PLANS 117.6 70 999999999 101.72 162.96 percent of total billed charges "Evaluation for wheelchair, each 15 minutes" 2575559_1 CDM 0430 RC 97542 HCPCS inpatient 168 109.2 SIHO - ALL PLANS SIHO - ALL PLANS 151.2 90 999999999 101.72 162.96 percent of total billed charges "Evaluation for wheelchair, each 15 minutes" 2575559_1 CDM 0430 RC 97542 HCPCS inpatient 168 109.2 UNIFIED GROUP - ALL PLANS UNIFIED GROUP - ALL PLANS 101.72 60.55 999999999 101.72 162.96 percent of total billed charges "Evaluation for wheelchair, each 15 minutes" 2575559_1 CDM 0430 RC 97542 HCPCS inpatient 168 109.2 ANTHEM PPO/OFF EXCHANGE ANTHEM PPO/OFF EXCHANGE 999999999 101.72 162.96 "Evaluation for wheelchair, each 15 minutes" 2575559_1 CDM 0430 RC 97542 HCPCS inpatient 168 109.2 ANTHEM TRADITIONAL - ALL OTHER PLANS ANTHEM TRADITIONAL - ALL OTHER PLANS 999999999 101.72 162.96 "Evaluation for wheelchair, each 15 minutes" 2575559_1 CDM 0430 RC 97542 HCPCS inpatient 168 109.2 ANTHEM HMO ANTHEM HMO 999999999 101.72 162.96 "Evaluation for wheelchair, each 15 minutes" 2575559_1 CDM 0430 RC 97542 HCPCS inpatient 168 109.2 CIGNA - ALL PLANS CIGNA - ALL PLANS 113.57 67.6 999999999 101.72 162.96 percent of total billed charges "Evaluation for wheelchair, each 15 minutes" 2575559_1 CDM 0430 RC 97542 HCPCS inpatient 168 109.2 ANTHEM ON EXCHANGE ANTHEM ON EXCHANGE 999999999 101.72 162.96 "Evaluation for wheelchair, each 15 minutes" 2575559_1 CDM 0430 RC 97542 HCPCS inpatient 168 109.2 UHC - ALL PLANS UHC - ALL PLANS 999999999 101.72 162.96 "Removal of tissue from wound, 20.0 sq cm or less" 2575658_1 CDM 0420 RC 97597 HCPCS inpatient 456 296.4 SELF PAY DISCOUNT SELF PAY DISCOUNT 296.4 65 999999999 276.11 442.32 percent of total billed charges "Removal of tissue from wound, 20.0 sq cm or less" 2575658_1 CDM 0420 RC 97597 HCPCS inpatient 456 296.4 AETNA AETNA 360.24 79 999999999 276.11 442.32 percent of total billed charges "Removal of tissue from wound, 20.0 sq cm or less" 2575658_1 CDM 0420 RC 97597 HCPCS inpatient 456 296.4 ENCORE - ALL PLANS ENCORE - ALL PLANS 314.64 69 999999999 276.11 442.32 percent of total billed charges "Removal of tissue from wound, 20.0 sq cm or less" 2575658_1 CDM 0420 RC 97597 HCPCS inpatient 456 296.4 MULTIPLAN - ALL PLANS MULTIPLAN - ALL PLANS 442.32 97 999999999 276.11 442.32 percent of total billed charges "Removal of tissue from wound, 20.0 sq cm or less" 2575658_1 CDM 0420 RC 97597 HCPCS inpatient 456 296.4 HUMANA - ALL PLANS HUMANA - ALL PLANS 355.68 78 999999999 276.11 442.32 percent of total billed charges "Removal of tissue from wound, 20.0 sq cm or less" 2575658_1 CDM 0420 RC 97597 HCPCS inpatient 456 296.4 UMR - ALL PLANS UMR - ALL PLANS 319.2 70 999999999 276.11 442.32 percent of total billed